Abstract
Background: The association between high fructose consumption and elevated blood pressure continues to be controversial, especially in adolescence. The aim of this study was to assess the association between fructose consumption and elevated blood pressure in an European adolescent population. Methods: A total of 1733 adolescents (mean ± SD age: 14.7 ± 1.2; percentage of girls: 52.8%) were analysed from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study in eight European countries. Blood pressure was measured using validated devices and methods for measuring systolic blood pressure (SBP) and diastolic blood pressure (DBP). Dietary data were recorded via repeated 24 h recalls (using specifically developed HELENA–DIAT software) and converted into pure fructose (monosaccharide form) and total fructose exposure (pure fructose + fructose from sucrose) intake using a specific fructose composition database. Food categories were separated at posteriori in natural vs. were non-natural foods. Elevated BP was defined according to the 90th percentile cut-off values and was compared according to tertiles of fructose intake using univariable and multivariable mixed logistic regression models taking into account confounding factors: centre, sex, age and z-score–BMI, MVPA (Moderate to Vigorous Physical Activity) duration, tobacco consumption, salt intake and energy intake. Results: Pure fructose from non-natural foods was only associated with elevated DBP (DBP above the 10th percentile in the highest consuming girls (OR = 2.27 (1.17–4.40); p = 0.015) after adjustment for cofounding factors. Conclusions: Consuming high quantities of non-natural foods was associated with elevated DBP in adolescent girls, which was in part due to high fructose levels in these foods categories. The consumption of natural foods containing fructose, such as whole fruits, does not impact blood pressure and should continue to remain a healthy dietary habit.
Highlights
The introduction of industrial foods and new manufacturing food process at the beginning of 20th century has modified sources of fructose in humans
Among the highest tertiles of fructose consumption from non-natural foods, we found an association with elevated diastolic blood pressure in girls (OR = 2.27 (1.17–4.40); p = 0.015) that persisted after adjustment for cofounding factors compared to the lowest tertiles of “pure” fructose
Fructose intake has quadrupled in the US since the beginning of the 20th century [61,62] and is probably rising across Europe [42], a trend which is predominately driven by the consumption of processed and non-natural food products such as sugar-sweetened beverages (SSB) [13]
Summary
The introduction of industrial foods and new manufacturing food process at the beginning of 20th century has modified sources of fructose in humans. The overconsumption of pure fructose is associated with risk of chronic metabolic noncommunicable diseases such as hypertension [6], cardiovascular diseases [3,7], type 2 diabetes [8], metabolic syndrome [9], steatohepatitis [10] and inflammatory conditions [11]. Results: Pure fructose from non-natural foods was only associated with elevated DBP (DBP above the 10th percentile in the highest consuming girls (OR = 2.27 (1.17–4.40); p = 0.015) after adjustment for cofounding factors. Conclusions: Consuming high quantities of non-natural foods was associated with elevated DBP in adolescent girls, which was in part due to high fructose levels in these foods categories. The consumption of natural foods containing fructose, such as whole fruits, does not impact blood pressure and should continue to remain a healthy dietary habit
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