Abstract
The relationship between fructose and cardiovascular disease (CVD) remains controversial. In this study, we aimed to assess possible association of dietary intakes of fructose with the risk of CVD events in a prospective population-based study. Participants without CVD (n = 2369) were recruited from the Tehran Lipid and Glucose Study and followed a mean of 6.7 years. Dietary data were collected using a validated 168 item semi-quantitative food frequency questionnaire. Dietary total fructose (TF) intake was calculated by sum of natural fructose (NF) in fruits and vegetables and added fructose (AF) in commercial foods. Multivariate Cox proportional hazard regression models, adjusted for potential confounders, were used to estimate the risk of CVD across tertiles of dietary fructose. Linear regression models were used to indicate association of fructose intakes with changes of CVD risk factors over the study period. The mean age of participants (43.5% men) was 38.1 ± 13.3 years at baseline. During an average of 6.7 ± 1.4 years of follow-up, 79 participants experienced CVD outcomes. The mean daily intake of TF was 6.4 ± 3.7% of total energy (3.6 ± 2.0 from AF and 2.7 ± 1.8 from NF). Higher consumption of TF (≥7.4% vs. <4.5% of total energy) was accompanied with an increased risk of CVD (HR = 1.81, 95% CI = 1.04–3.15); higher energy intake from AF was also related to incidence of CVD (HR = 1.80, 95% CI = 1.04–3.12), whereas NF was not associated with the risk of CVD outcomes. Both AF and TF were also related to changes of systolic and diastolic blood pressures, waist circumference, serum insulin and creatinine levels, as well as HDL-C. Our data provides further evidence regarding undesirable effects of fructose intake in relation to risk of CVD events.
Highlights
Fructose, a simple carbohydrate, occurs as free hexoses in fruits and honey, and in the form of free glucose-fructose mixtures in high-fructose corn syrup (HFCS), or bound together as sucrose [1].There is an increasing concern regarding the potential role of fructose-containing sweeteners and the Nutrients 2017, 9, 872; doi:10.3390/nu9080872 www.mdpi.com/journal/nutrientsNutrients 2017, 9, 872 development of metabolic and cardiovascular diseases (CVD) [2,3]
Compared to the lowest tertile, participants who were in the highest tertile category of total fructose (TF) had higher body mass index, waist circumference, both systolic and diastolic blood pressures, and lower High-density lipoprotein cholesterol (HDL-C) levels at baseline (p for all
Age-adjusted linear regression models were used. In this prospective cohort study, conducted on a representative Iranian population, a mean 6.7-year follow-up showed that higher intake of energy from dietary fructose contributed to development of CVD-related events and CVD risk factors; mean energy intake from fructose ≥9.7% increased risk of CVD outcomes by 83%
Summary
A simple carbohydrate, occurs as free hexoses in fruits and honey, and in the form of free glucose-fructose mixtures in high-fructose corn syrup (HFCS), or bound together as sucrose [1].There is an increasing concern regarding the potential role of fructose-containing sweeteners and the Nutrients 2017, 9, 872; doi:10.3390/nu9080872 www.mdpi.com/journal/nutrientsNutrients 2017, 9, 872 development of metabolic and cardiovascular diseases (CVD) [2,3]. Epidemiological studies revealed that higher consumption of sweetened beverages and fructose may increase the risk of heart disease [7], hypertension and metabolic syndrome [8]. The vast majority of experimental studies hint towards adverse cardiometabolic outcomes following excessive consumption of fructose, the results from some clinical trials do not support a significant detrimental effect of fructose on metabolic health [11,12]. Most epidemiological reports pointed out that intake of fructose-containing sweeteners and beverages are associated with increased body weight and obesity, and interpretation of these results is complicated because a high-fructose diet is shown to be accompanied with a high-calorie and an unhealthy pattern diet [13]. Public health policies to eliminate or limit fructose in the diet seems to be premature, and it has been suggested that more epidemiological studies are crucial to clarify current concerns regarding fructose toxicity [13]
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