Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.
PLoS One. 2023 Aug 15;18(8):e0264802. doi: 10.1371/journal.pone.0264802. eCollection 2023.
Whether food source or energy mediates the effect of fructose-containing sugars on blood pressure (BP) is unclear. We conducted a systematic review and meta-analysis of the effect of different food sources of fructose-containing sugars at different levels of energy control on BP. We searched MEDLINE, Embase and the Cochrane Library through June 2021 for controlled trials ≥7-days. We prespecified 4 trial designs: substitution (energy matched substitution of sugars); addition (excess energy from sugars added); subtraction (excess energy from sugars subtracted); and ad libitum (energy from sugars freely replaced). Outcomes were systolic and diastolic BP. Independent reviewers extracted data. GRADE assessed the certainty of evidence. We included 93 reports (147 trial comparisons, N = 5,213) assessing 12 different food sources across 4 energy control levels in adults with and without hypertension or at risk for hypertension. Total fructose-containing sugars had no effect in substitution, subtraction, or ad libitum trials but decreased systolic and diastolic BP in addition trials (P<0.05). There was evidence of interaction/influence by food source: fruit and 100% fruit juice decreased and mixed sources (with sugar-sweetened beverages [SSBs]) increased BP in addition trials and the removal of SSBs (linear dose response gradient) and mixed sources (with SSBs) decreased BP in subtraction trials. The certainty of evidence was generally moderate. Food source and energy control appear to mediate the effect of fructose-containing sugars on BP. The evidence provides a good indication that fruit and 100% fruit juice at low doses (up to or less than the public health threshold of ~10% E) lead to small, but important reductions in BP, while the addition of excess energy of mixed sources (with SSBs) at high doses (up to 23%) leads to moderate increases and their removal or the removal of SSBs alone (up to ~20% E) leads to small, but important decreases in BP in adults with and without hypertension or at risk for hypertension. Trial registration: Clinicaltrials.gov: NCT02716870.
食物来源或能量是否调节果糖含量糖对血压（BP）的影响尚不清楚。我们系统地回顾和荟萃分析了不同能量控制水平下不同果糖含量糖的食物来源对 BP 的影响。我们通过 MEDLINE、Embase 和 Cochrane Library 检索了 2021 年 6 月前的对照试验，时间至少为 7 天。我们预先指定了 4 种试验设计：替代（糖的能量匹配替代）；添加（糖额外增加的能量）；减去（糖减去的多余能量）；和随意（糖自由替代的能量）。结果为收缩压和舒张压。独立审查员提取数据。GRADE 评估证据的确定性。我们纳入了 93 项报告（147 项试验比较，N = 5213），评估了成人高血压或高血压高危人群中 12 种不同食物来源的 4 种能量控制水平，这些食物来源包括果糖含量糖。总果糖含量糖在替代、减去或随意试验中没有影响，但在添加试验中降低了收缩压和舒张压（P<0.05）。有证据表明食物来源存在相互作用/影响：水果和 100%纯果汁减少，混合来源（含含糖饮料[SSB]）增加，添加 SSB 和混合来源（含 SSB）减少的 BP 在减去试验中。证据的确定性通常为中度。食物来源和能量控制似乎调节了果糖含量糖对 BP 的影响。证据表明，低剂量的水果和 100%纯果汁（高达或低于公共卫生阈值的10% E）可导致血压适度降低，但重要的是，高剂量的混合来源（含 SSB）添加过多的能量会导致血压适度升高，而单独去除 SSB 或去除 SSB 和混合来源（高达20% E）可导致高血压或高血压高危成人的血压适度降低。试验注册：Clinicaltrials.gov：NCT02716870。
