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The Effect Of ‘Catalytic’ Doses Of Fructose And Its Epimers In Acute Single‐Meal Feeding Trials: A Systematic Review And Meta‐Analysis Of Controlled Trials
Author(s) -
Braunstein Catherine Rose,
Noronha Jarvis C,
Mejia Sonia Blanco,
Kahn Tauseef A,
Wolever Thomas MS,
Josse Robert G,
Kendall Cyril WC,
Sievenpiper John L
Publication year - 2017
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.31.1_supplement.798.12
Subject(s) - postprandial , medicine , glycemic , meta analysis , randomized controlled trial , meal , fructose , diabetes mellitus , gastroenterology , endocrinology , insulin , food science , chemistry
Objective ‘Catalytic’ doses (<10g/meal or 36g/day) of fructose and its epimers (allulose, tagatose, and sorbose) may reduce postprandial glycemic responses to carbohydrate loads in people with and without diabetes by inducing glycogen synthesis. To synthesize the evidence of the effects of fructose and its epimers on acute postprandial carbohydrate metabolism, we conducted a systematic review and meta‐analysis of controlled trials. Methods We searched Medline, EMBASE, and the Cochrane Library (through Feb 12 2016). We included controlled, single‐meal feeding trials (≥2 hours) investigating the effect of fructose and its epimers (allulose, tagatose, and sorbose) on the postprandial metabolic responses to carbohydrate control meals compared to the same control meals without the sugars. Two independent reviewers extracted all relevant data and assessed risk of bias of individual trials using the Cochrane Risk of Bias Tool. Outcomes included plasma glucose and insulin incremental area‐under‐the‐curve (iAUC). Data were pooled using the generic inverse variance method and expressed as mean differences (MD) with 95% confidence intervals (95% CI). Heterogeneity was assessed by the Cochran Q statistic and quantified by the I 2 statistic. Results Eligibility criteria were met by 9 controlled feeding trials involving 144 participants in people with and without diabetes. Fructose (5 trial comparisons, MD= −28.65 mmol/L*min [95% CI, −55.36 to −1.93], p=0.04) and allulose (5 trial comparisons, MD= −39.79 mmol/L*min [95% CI, −67.35 to 12.22], p= 0.005) but not tagatose (15 trial comparisons) significantly reduced the postprandial plasma glucose iAUC responses to the carbohydrate control meals. Only allulose significantly reduced the postprandial plasma insulin iAUC to the carbohydrate control meals (MD= −2950.59 pmol/L*min [95% CI, −4844.11 to −1057.06], p=0.002). There was no evidence of heterogeneity in any of the analyses (P>0.1). Conclusions Pooled analyses indicate that small doses of fructose and allulose but not tagatose may improve the postprandial glycemic responses to carbohydrate meals without adversely affecting insulin response. There is a need for long‐term randomized controlled trials to assess whether these acute single‐meal effects lead to sustainable benefits in people with and without diabetes. Protocol registration: clinicaltrials.gov identifier, NCT02776722. Support or Funding Information The Tate and Lyle Nutritional Research Fund at the University of Toronto, Canadian Diabetes Association (CDA), Banting & Best Diabetes Centre, and PSI Foundation.