Background
In the absence of consistent clinical evidence, concerns have been raised that fructose raises postprandial triglycerides.
Purpose
A systematic review and meta-analysis was conducted to assess the effect of fructose on postprandial triglycerides.
Data sources
Relevant studies were identified from MEDLINE, EMBASE, and Cochrane databases (through September 3, 2013).
Data selection
Relevant clinical trials of 鈮?-days were included in the analysis.
Data extraction
Two independent reviewers extracted relevant data with disagreements reconciled by consensus. The Heyland Methodological Quality Score (MQS) assessed study quality. Data were pooled by the generic inverse variance method using random effects models and expressed as standardized mean differences (SMD) with 95% confidence intervals (CI). Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic).
Data synthesis
Eligibility criteria were met by 14 isocaloric trials (n聽=聽290), in which fructose was exchanged isocalorically for other carbohydrate in the diet, and two hypercaloric trials (n聽=聽33), in which fructose supplemented the background diet with excess energy from high-dose fructose compared with the background diet聽alone (without the excess energy). There was no significant effect in the isocaloric trials (SMD: 0.14 [95% CI:聽鈭?.02, 0.30]) with evidence of considerable heterogeneity explained by a single trial. Hypercaloric trials, however, showed a significant postprandial triglyceride raising-effect of fructose (SMD: 0.65 [95% CI: 0.30, 1.01]).
Limitations
Most of the available trials were small, short, and of poor quality. Interpretation of the isocaloric trials is complicated by the large influence of a single trial.
Conclusions
Pooled analyses show that fructose in isocaloric exchange for other carbohydrate does not increase postprandial triglycerides, although an effect cannot be excluded under all conditions. Fructose providing excess energy does increase postprandial triglycerides. Larger, longer, and higher-quality trials are needed.
Protocol registration
ClinicalTrials.gov identifier, .
