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“Catalytic” Doses of Fructose and its Epimers on Glycemic Control: A Systematic Review and Meta‐Analysis of Controlled Feeding Trials
Author(s) -
Noronha Jarvis C,
Braunstein Catherine,
Mejia Sonia Blanco,
Cozma Adrian I,
Khan Tauseef,
Glenn Andrea,
Noseworthy Rebecca,
Kendall Cyril W.C.,
Wolever Thomas M,
Leiter Lawrence A,
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.798.8
Subject(s) - glycemic , medicine , meta analysis , fructose , randomized controlled trial , adverse effect , gastroenterology , endocrinology , diabetes mellitus , chemistry , biochemistry
Objective Contrary to the concerns that fructose may have adverse metabolic effects, an emerging literature has shown that small, ‘catalytic’ doses (≤ 50‐g/day) of fructose and its epimers (allulose, tagatose and sorbose) decrease the glycemic response to high glycemic index meals in humans. This effect appears to be mediated by upregulation of glucokinase, leading to increased hepatic glycogen synthesis. Whether this acute ‘catalytic’ mechanism of fructose and its epimers will manifest as an improvement in long term glycemic control is unclear. To address this question, we synthesized evidence from controlled feeding trials assessing the effect of small, ‘catalytic’ doses of fructose and its epimers on HbA1c. Methods We searched MEDLINE, EMBASE, and Cochrane Library through Feb 12, 2016. We included controlled feeding trials of ≥ 2 weeks investigating the effect of small, ‘catalytic’ doses (≤ 50‐g/day) of fructose and its epimers in comparison to control diets. Two independent reviewers extracted relevant data. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Data were pooled using the generic inverse variance method and expressed as mean differences (MD) with 95% confidence intervals (CIs). Heterogeneity was assessed using the Cochran Q statistic and quantified using the I 2 statistic. The overall quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results 7 trials (n = 467) over a median follow‐up of 3 months met the eligibility criteria. ‘Catalytic’ doses of fructose significantly reduced HbA 1c (MD = −0.40% [95% CI −0.72 to − 0.08]), but not allulose and tagatose for which there was only one trial comparison for each of the sugars. The overall quality of the evidence was graded as “moderate” quality for a decreasing effect of fructose on HbA 1c due to a downgrade for serious imprecision. The evidence for allulose and tagatose was not graded. Conclusion Pooled analyses indicated that small, ‘catalytic’ doses of fructose improve glycemic control over the shorter term. The evidence for allulose and tagatose remains inconclusive due to the limited number of trials. There is a need for large high quality, long‐term randomized trials for all 3 sugars to improve our confidence in the effect estimates. Protocol registration: clinicaltrials.gov identifier, NCT02776722 Support or Funding Information Funding: The Tate and Lyle Nutritional Research Fund at the University of Toronto, Canadian Diabetes Association (CDA), Banting & Best Diabetes Centre, and PSI foundation.