Abstract
BackgroundEpidemiological studies investigating the association between dietary fructose intake and the metabolic syndrome (MetS) are scarce and have produced controversial findings. This study aimed at (1) assessing total dietary fructose intake in a sample of Lebanese healthy adults, and determining the intake levels of natural vs. added fructose; (2) investigating the association of dietary fructose with MetS; and (3) identifying the socioeconomic and lifestyle factors associated with high fructose intake.MethodsA cross-sectional survey was conducted on a representative sample of adults living in Beirut, Lebanon (n = 283). Anthropometric and biochemical data were collected, and dietary intake was assessed using a food frequency questionnaire. Intakes of naturally-occurring fructose from fructose-containing food sources, such as fruits, vegetables, honey, were considered as “natural fructose”. Acknowledging that the most common form of added sugar in commodities is sucrose or High Fructose Corn Syrup (HFCS), 50% of added sugar in food products was considered as added fructose. Total dietary fructose intake was calculated by summing up natural and added fructose intakes. Logistic regression analyses were conducted to investigate the association of total, added and natural fructose intakes with the MetS and to identify the socioeconomic predictors of high fructose intake.ResultsMean intake of total fructose was estimated at 51.42 ± 35.54 g/day, representing 6.58 ± 3.71% of energy intakes (EI). Natural and added fructose intakes were estimated at 12.29 ± 8.57 and 39.12 ± 34.10 g/day (1.78 ± 1.41% EI and 4.80 ± 3.56% EI), respectively. Participants in the highest quartile of total and added fructose intakes had higher odds of MetS (OR = 2.84, 95%CI: 1.01, 7.94 and OR = 3.18, 95%CI: 1.06, 9.49, respectively). In contrast, natural fructose intake was not associated with MetS. Age, gender and crowding index were identified as factors that may modulate dietary fructose intakes.ConclusionsThe observed association between high added fructose intake and the MetS highlights the need for public health strategies aimed at limiting sugar intake from industrialized foods and promoting healthier dietary patterns in Lebanon.
Highlights
Epidemiological studies investigating the association between dietary fructose intake and the metabolic syndrome (MetS) are scarce and have produced controversial findings
Over the past 40 years, the intake of processed foods and beverages that are sweetened with High Fructose Corn Syrup (HFCS) or sucrose has escalated dramatically, resulting in significant increases in dietary fructose intake, to levels reaching as high as 85–100 g/day [1]
It was postulated that the metabolism of dietary fructose increases the risk of the metabolic syndrome (MetS) [2, 6], a constellation of cardiometabolic risk factors including insulin resistance, elevated blood pressure (BP), impaired glucose tolerance, hyperglycemia, atherogenic dyslipidemia (hypertriglyceridemia coupled with low high-density lipoprotein cholesterol (HDL-C) levels) and central adiposity [7, 8]
Summary
Epidemiological studies investigating the association between dietary fructose intake and the metabolic syndrome (MetS) are scarce and have produced controversial findings. The sweetest tasting carbohydrate (CHO), is consumed in significant amounts in the human diet. It occurs naturally in fresh fruits, vegetables and honey, with its traditional consumption ranging between 16 and 20 g/day. The MetS increases the risk for developing type 2 diabetes, cardiovascular diseases and all-cause mortality [9, 10]. A longitudinal study of 2902 adults followed for 11 years, showed that participants with the MetS had an adjusted relative risk for type 2 diabetes of 10.3 (5.44– 19.5) and for cardiovascular diseases of 2.13 (1.43–3.18) [11]
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