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Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WMM, Vlachopoulos C, Wood DA, Zamorano JL, Cooney MT. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016; 37:2999-3058. [PMID: 27567407 DOI: 10.1093/eurheartj/ehw272] [Citation(s) in RCA: 1874] [Impact Index Per Article: 234.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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152
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Osman I, Poulose N, Ganapathy V, Segar L. High fructose-mediated attenuation of insulin receptor signaling does not affect PDGF-induced proliferative signaling in vascular smooth muscle cells. Eur J Pharmacol 2016; 791:703-710. [PMID: 27729247 DOI: 10.1016/j.ejphar.2016.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/05/2016] [Accepted: 10/07/2016] [Indexed: 12/11/2022]
Abstract
Insulin resistance is associated with accelerated atherosclerosis. Although high fructose is known to induce insulin resistance, it remains unclear as to how fructose regulates insulin receptor signaling and proliferative phenotype in vascular smooth muscle cells (VSMCs), which play a major role in atherosclerosis. Using human aortic VSMCs, we investigated the effects of high fructose treatment on insulin receptor substrate-1 (IRS-1) serine phosphorylation, insulin versus platelet-derived growth factor (PDGF)-induced phosphorylation of Akt, S6 ribosomal protein, and extracellular signal-regulated kinase (ERK), and cell cycle proteins. In comparison with PDGF (a potent mitogen), neither fructose nor insulin enhanced VSMC proliferation and cyclin D1 expression. d-[14C(U)]fructose uptake studies revealed a progressive increase in fructose uptake in a time-dependent manner. Concentration-dependent studies with high fructose (5-25mM) showed marked increases in IRS-1 serine phosphorylation, a key adapter protein in insulin receptor signaling. Accordingly, high fructose treatment led to significant diminutions in insulin-induced phosphorylation of downstream signaling components including Akt and S6. In addition, high fructose significantly diminished insulin-induced ERK phosphorylation. Nevertheless, high fructose did not affect PDGF-induced key proliferative signaling events including phosphorylation of Akt, S6, and ERK and expression of cyclin D1 protein. Together, high fructose dysregulates IRS-1 phosphorylation state and proximal insulin receptor signaling in VSMCs, but does not affect PDGF-induced proliferative signaling. These findings suggest that systemic insulin resistance rather than VSMC-specific dysregulation of insulin receptor signaling by high fructose may play a major role in enhancing atherosclerosis and neointimal hyperplasia.
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Affiliation(s)
- Islam Osman
- Center for Pharmacy and Experimental Therapeutics, University of Georgia College of Pharmacy, Augusta, GA, USA; Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - Ninu Poulose
- Center for Pharmacy and Experimental Therapeutics, University of Georgia College of Pharmacy, Augusta, GA, USA; Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - Vadivel Ganapathy
- Department of Biochemistry and Molecular Biology, Augusta University, Augusta, GA, USA
| | - Lakshman Segar
- Center for Pharmacy and Experimental Therapeutics, University of Georgia College of Pharmacy, Augusta, GA, USA; Charlie Norwood VA Medical Center, Augusta, GA, USA; Vascular Biology Center, Department of Pharmacology and Toxicology, Augusta University, Augusta, GA, USA; Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA.
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153
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Jamnik J, Rehman S, Blanco Mejia S, de Souza RJ, Khan TA, Leiter LA, Wolever TMS, Kendall CWC, Jenkins DJA, Sievenpiper JL. Fructose intake and risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies. BMJ Open 2016; 6:e013191. [PMID: 27697882 PMCID: PMC5073537 DOI: 10.1136/bmjopen-2016-013191] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The prevalence of hyperuricemia and gout has increased in recent decades. The role of dietary fructose in the development of these conditions remains unclear. OBJECTIVE To conduct a systematic review and meta-analysis of prospective cohort studies investigating the association fructose consumption with incident gout and hyperuricemia. DESIGN MEDLINE, EMBASE and the Cochrane Library were searched (through September 2015). We included prospective cohort studies that assessed fructose consumption and incident gout or hyperuricemia. 2 independent reviewers extracted relevant data and assessed study quality using the Newcastle-Ottawa Scale. We pooled natural-log transformed risk ratios (RRs) using the generic inverse variance method. Interstudy heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS 2 studies involving 125 299 participants and 1533 cases of incident gout assessed the association between fructose consumption and incident gout over an average of 17 years of follow-up. No eligible studies assessed incident hyperuricemia as an outcome. Fructose consumption was associated with an increase in the risk of gout (RR=1.62, 95% CI 1.28 to 2.03, p<0.0001) with no evidence of interstudy heterogeneity (I2=0%, p=0.33) when comparing the highest (>11.8% to >11.9% total energy) and lowest (<6.9% to <7.5% total energy) quantiles of consumption. LIMITATIONS Despite a dose-response gradient, the overall quality of evidence as assessed by GRADE was low, due to indirectness. There were only two prospective cohort studies involving predominantly white health professionals that assessed incident gout, and none assessed hyperuricemia. CONCLUSIONS Fructose consumption was associated with an increased risk of developing gout in predominantly white health professionals. More prospective studies are necessary to understand better the role of fructose and its food sources in the development of gout and hyperuricemia. PROTOCOL REGISTRATION NUMBER NCT01608620.
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Affiliation(s)
- Joseph Jamnik
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sara Rehman
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Russell J de Souza
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Thomas M S Wolever
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David J A Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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154
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Vitale M, Masulli M, Cocozza S, Anichini R, Babini AC, Boemi M, Bonora E, Buzzetti R, Carpinteri R, Caselli C, Ceccarelli E, Cignarelli M, Citro G, Clemente G, Consoli A, Corsi L, De Gregorio A, Di Bartolo P, Di Cianni G, Fontana L, Garofolo M, Giorda CB, Giordano C, Grioni S, Iovine C, Longhitano S, Mancastroppa G, Mazzucchelli C, Montani V, Mori M, Perriello G, Rinaldi ME, Ruffo MC, Salvi L, Sartore G, Scaranna C, Tonutti L, Zamboni C, Zogheri A, Krogh V, Cappellini F, Signorini S, Riccardi G, Vaccaro O. Sex differences in food choices, adherence to dietary recommendations and plasma lipid profile in type 2 diabetes - The TOSCA.IT study. Nutr Metab Cardiovasc Dis 2016; 26:879-885. [PMID: 27212622 DOI: 10.1016/j.numecd.2016.04.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/08/2016] [Accepted: 04/01/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Diabetic women have a more adverse plasma lipid profile than men. Sex differences in dietary habits may play a role, but are little investigated. The study evaluates the quality of diet, adherence to the nutritional recommendations of the Diabetes and Nutrition Study Group and their relation with plasma lipid in men and women with diabetes. METHODS AND RESULTS We studied 2573 people, aged 50-75, enrolled in the TOSCA.IT study (clinicaltrials.gov; NCT00700856). Plasma lipids were measured centrally. Diet was assessed with a semi-quantitative food frequency questionnaire. Women had a more adverse plasma lipid profile than men. Women consumed significantly more legumes, vegetables, fruits, eggs, milk, vegetable oils, and added sugar, whereas men consumed more starchy foods, soft drinks and alcoholic beverages. This stands for a higher proportion (%) of energy intake from saturated fat and added sugar (12.0 ± 2.4 vs 11.5 ± 2.5 and 3.4 ± 3.2 vs 2.3 ± 3.2, P < 0.04), and a higher intake of fiber (11.2 ± 2.8 vs 10.4 ± 2.6 g/1000 Kcal/day) in women. Adherence to the recommendations for saturated fat and fiber consumption was associated with significantly lower LDL-cholesterol regardless of sex. Adherence to the recommendations for added sugars was associated with significantly lower triglycerides and higher HDL-cholesterol in men and women. CONCLUSIONS Men and women with diabetes show significant differences in adherence to nutritional recommendations, but sex differences in plasma lipid profile are unlikely to be explained by nutritional factors. Adherence to the nutritional recommendations is associated with a better plasma lipid profile regardless of sex, thus reinforcing the importance of substituting saturated for unsaturated fat sources, increasing fiber and reducing added sugar intake.
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Affiliation(s)
- M Vitale
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - M Masulli
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - S Cocozza
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - R Anichini
- UO di Diabetologia, USL 3, Pistoia, Italy
| | - A C Babini
- Diabetologia, Ospedale Infermi, Rimini, Italy
| | - M Boemi
- UOC Malattie Metaboliche e Diabetologia, Istituto INRCA-IRCCS, Ancona, Italy
| | - E Bonora
- Dipartimento di Medicina, Divisione di Endocrinologia, Diabete e Metabolismo, Università di Verona, Italy
| | - R Buzzetti
- UOC di Diabetologia Universitaria, Ospedale Santa Maria Goretti, Latina, Italy
| | - R Carpinteri
- UO di Malattie Metaboliche e Diabetologia, AO Treviglio, Italy
| | - C Caselli
- UOD Endocrinologia e Diabetologia, AUSL della Romagna, Cesena, Italy
| | - E Ceccarelli
- UOC Diabetologia, Dipartimento di Medicina, Chirurgia e Neuroscienze, Università di Siena, Italy
| | | | - G Citro
- UO Endocrinologia e Diabetologia, ASP, Potenza, Italy
| | - G Clemente
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - A Consoli
- DMSI e CeSI-Met, Università di Chieti-Pescara, Italy
| | - L Corsi
- SSD Diabetologia e Malattie Metaboliche, ASL 4 Chiavarese, Genova, Italy
| | - A De Gregorio
- UOSD Diabetologia, Ospedale San Salvatore, L'Aquila, Italy
| | - P Di Bartolo
- UO di Diabetologia Ravenna, A. Usl Romagna, Italy
| | | | - L Fontana
- UOC Diabetologia e Dietologia, Ospedale S. Pertini, Roma, Italy
| | - M Garofolo
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Italy
| | | | - C Giordano
- Endocrinologia e Malattie Metaboliche, Università di Palermo, Italy
| | - S Grioni
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy
| | - C Iovine
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - S Longhitano
- Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Italy
| | - G Mancastroppa
- Dipartimento di Medicina Clinica e Sperimentale, Università di Parma, Italy
| | | | - V Montani
- UOSD, Presidio Ospedaliero di Atri, Italy
| | - M Mori
- SSD Diabetologia, ASL 1, Massa Carrara, Italy
| | | | - M E Rinaldi
- Dipartimento di Medicina dei Sistemi, Università degli Studi di Roma "Tor Vergata", Italy
| | - M C Ruffo
- Dipartimento di Medicina Interna, Policlinico di Messina, Italy
| | - L Salvi
- Dipartimento di Medicina Clinica e Molecolare, Università "La Sapienza", Roma, Italy
| | - G Sartore
- DPT Medicina, Università degli Studi di Padova, Italy
| | - C Scaranna
- USC Malattie Endocrine e Diabetologia, AO Papa Giovanni XXIII, Bergamo, Italy
| | - L Tonutti
- SOC di Endocrinologia e Malattie del Metabolismo, AOU S. Maria della Misericordia, Udine, Italy
| | - C Zamboni
- UO Malattie Metaboliche, Dietologia e Nutrizione Clinica, AOU Arcispedale S. Anna, Ferrara, Italy
| | - A Zogheri
- UO di Diabetologia, Ospedale di Prato, Italy
| | - V Krogh
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy
| | - F Cappellini
- Dipartimento di Patologia Sperimentale, Ospedale di Desio, Università di Milano Bicocca, Italy
| | - S Signorini
- Dipartimento di Patologia Sperimentale, Ospedale di Desio, Università di Milano Bicocca, Italy
| | - G Riccardi
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy
| | - O Vaccaro
- Dipartimento di Medicina Clinica e Chirurgia, Università "Federico II" di Napoli, Italy.
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155
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Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WM, Vlachopoulos C, Wood DA, Zamorano JL. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Atherosclerosis 2016; 253:281-344. [DOI: 10.1016/j.atherosclerosis.2016.08.018] [Citation(s) in RCA: 558] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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156
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Herman MA, Samuel VT. The Sweet Path to Metabolic Demise: Fructose and Lipid Synthesis. Trends Endocrinol Metab 2016; 27:719-730. [PMID: 27387598 PMCID: PMC5035631 DOI: 10.1016/j.tem.2016.06.005] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 01/04/2023]
Abstract
Epidemiological studies link fructose consumption with metabolic disease, an association attributable in part to fructose-mediated lipogenesis. The mechanisms governing fructose-induced lipogenesis and disease remain debated. Acutely, fructose increases de novo lipogenesis through the efficient and uninhibited action of ketohexokinase and aldolase B which yields substrates for fatty-acid synthesis. Chronic fructose consumption further enhances the capacity for hepatic fructose metabolism by activating several key transcription factors (i.e., SREBP1c and ChREBP) which augment the expression of lipogenic enzymes, increasing lipogenesis and further compounding hypertriglyceridemia and hepatic steatosis. Hepatic insulin resistance develops from diacylglycerol-PKCɛ-mediated impairment of insulin signaling and possibly additional mechanisms. Initiatives that decrease fructose consumption and therapies that block fructose-mediated lipogenesis will be necessary to avert future metabolic pandemics.
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Affiliation(s)
- Mark A Herman
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Varman T Samuel
- Yale University School of Medicine, 950 Campbell Avenue, West Haven, CT 06516, USA; Veterans Affairs Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA.
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157
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The majority of lipoprotein lipase in plasma is bound to remnant lipoproteins: A new definition of remnant lipoproteins. Clin Chim Acta 2016; 461:114-25. [DOI: 10.1016/j.cca.2016.06.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 06/18/2016] [Accepted: 06/20/2016] [Indexed: 12/17/2022]
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158
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Brinton EA. The time has come to flag and reduce excess fructose intake. Atherosclerosis 2016; 253:262-264. [PMID: 27596814 DOI: 10.1016/j.atherosclerosis.2016.08.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 08/26/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Eliot A Brinton
- Atherometabolic Research, Utah Foundation for Biomedical Research, and Utah Lipid Center, 419 Wakara Way, Suite 211, Salt Lake City, 84108 UT, USA.
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159
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Abstract
PURPOSE OF REVIEW Modulation of diet is the primary lifestyle approach for reducing cardiovascular disease (CVD) risk, with a major focus of current guidelines being to lower LDL cholesterol by reducing intake of saturated fatty acids. However, dietary effects on lipid-related CVD risk factors extend beyond LDL cholesterol, with growing emphasis on the prevention and management of atherogenic dyslipidemia, which includes elevated triglyceride, small dense LDL, and reduced HDL cholesterol, and which is associated with excess adiposity and insulin resistance. We here review recent studies of dietary macronutrient effects on CVD risk that may act through effects on plasma lipid and lipoprotein metabolism. RECENT FINDINGS Effects of reducing saturated fatty acids on CVD risk have been evaluated both in terms of the replacement macronutrient(s) and the food and dietary context in which the macronutrients are consumed. Although weight loss remains the most important goal for reducing cardiometabolic risk among overweight and obese individuals, a variety of lines of evidence support limitation of added sugars and processed starches for improving features of atherogenic dyslipidemia. SUMMARY Increasing understanding of the complexity of nutrient-disease relationships has shifted the framework for CVD prevention from a focus on macronutrient content of diets to foods and dietary patterns.
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160
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Short-term isocaloric fructose restriction lowers apoC-III levels and yields less atherogenic lipoprotein profiles in children with obesity and metabolic syndrome. Atherosclerosis 2016; 253:171-177. [PMID: 27451002 DOI: 10.1016/j.atherosclerosis.2016.06.048] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/23/2016] [Accepted: 06/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Dietary fructose may play a role in the pathogenesis of metabolic syndrome (MetS). In a recently published study of obese children with MetS, we showed that isocaloric fructose restriction reduced fasting triglyceride (TG) and LDL-cholesterol (LDL-C). In these ancillary analyses, we tested the hypothesis that these effects were also accompanied by improved quantitative and qualitative changes in LDL and HDL subclasses and their apolipoproteins; as well as change in VLDL, particularly apoC-III. METHODS Obese children with MetS (n = 37) consumed a diet that matched self-reported macronutrient composition for nine days, with the exception that dietary fructose was reduced from 11.7 ± 4.0% to 3.8 ± 0.5% of daily calories and substituted with glucose (in starch). Participants underwent fasting biochemical analyses on Days 0 and 10. HDL and LDL subclasses were analyzed using the Lipoprint HDL and LDL subfraction analysis systems from Quantimetrix. RESULTS Significant reductions in apoB (78 ± 24 vs. 66 ± 24 mg/dl) apoC-III (8.7 ± 3.5 vs. 6.5 ± 2.6 mg/dl) and apoE (4.6 ± 2.3 vs. 3.6 ± 1.1 mg/dl), all p < 0.001) were observed. LDL size increased by 0.87 Å (p = 0.008). Small dense LDL was present in 25% of our cohort and decreased by 68% (p = 0.04). Small HDL decreased by 2.7% (p < 0.001) and large HDL increased by 2.4% (p = 0.04). The TG/HDL-C ratio decreased from 3.1 ± 2.5 to 2.4 ± 1.4 (p = 0.02). These changes in fasting lipid profiles correlated with changes in insulin sensitivity. CONCLUSIONS Isocaloric fructose restriction for 9 days improved lipoprotein markers of CVD risk in children with obesity and MetS. The most dramatic reduction was seen for apoC-III, which has been associated with atherogenic hypertriglyceridemia.
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161
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Abstract
PURPOSE OF REVIEW There is considerable political and public awareness of new recommendations to reduce sugars and sugar-sweetened beverages in our diets. It is therefore timely to review the most recent changes in guidelines, with a focus on evidence for metabolic health, recent research in the area and gaps in our knowledge. RECENT FINDINGS Sufficient evidence links a high intake of sugar to dental caries and obesity, and high intakes of sugar-sweetened beverages in particular to increased risk of type 2 diabetes. This has led to the updating of dietary recommendations related to added sugars in the diet. The effects of specific sugars at usual intakes as part of an isoenergetic diet are less clear. The glycaemic response to food is complex and mediated by many factors, but sugar intake is not necessarily the major component. SUMMARY There are many challenges faced by healthcare professionals and government bodies in order to improve the health of individuals and nations through evidence-based diets. Sufficiently powered long-term mechanistic studies are still required to provide evidence for the effects of reducing dietary sugars on metabolic health. However, there are many challenges for research scientists in the implementation of these studies.
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Affiliation(s)
- J Bernadette Moore
- aDepartment of Nutritional Sciences, University of Surrey, Guildford, Surrey bSchool of Food Science and Nutrition, University of Leeds, Leeds, UK
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162
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Abstract
PURPOSE OF REVIEW This review highlights the recent research on the effects of dietary carbohydrate (CHO) content and quality in body weight control, glucose homeostasis and cardiovascular risk. RECENT FINDINGS There is some evidence for a role of CHO content and glycemic index in long-term weight control. Prospective cohort studies show that a high glycemic index and a high glycemic load diet increase the risk for diabetes. A controlled short-term feeding study indicates that the glycemic index is less important in insulin sensitivity and cardio-metabolic risk in the context of an overall healthy diet in high-risk individuals. In one of the few dietary intervention studies, taken cardiovascular disease as outcome, it has been shown that a Mediterranean diet reduced the incidence of cardiovascular events in individuals at increased risk. SUMMARY Overall, energy restriction is the primary factor producing weight loss, and it is increasingly understood that distinct macronutrients may vary in energy yield and effects on satiety, also based on individuals' phenotype and genotype. Although an overall healthy diet, either Mediterranean or a low-fat, high-complex CHO diet may be effective in diabetes and cardiovascular prevention, insight is increasing that dietary prevention or treatment may require more personalized approaches to become most effective.
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Affiliation(s)
- Ellen E Blaak
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
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163
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Gallagher C, Keogh JB, Pedersen E, Clifton PM. Fructose acute effects on glucose, insulin, and triglyceride after a solid meal compared with sucralose and sucrose in a randomized crossover study. Am J Clin Nutr 2016; 103:1453-7. [PMID: 27099245 DOI: 10.3945/ajcn.115.129866] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/22/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Fructose, which is a sweetener with a low glycemic index, has been shown to elevate postprandial triglyceride compared with glucose. There are limited data on the effect of fructose in a solid mixed meal containing starch and protein. OBJECTIVE We determined the effects of sucrose, fructose, and sucralose on triglyceride, glucose, and insulin in an acute study in healthy, overweight, and obese individuals. DESIGN The study had a randomized crossover design. Twenty-seven participants with a mean age of 44 y and a mean body mass index (in kg/m(2)) of 26 completed the study. Fructose (52 g), sucrose (65 g), and sucralose (0.1 g) were delivered as sweet-taste-balanced muffins with a total fat load (66 g). Blood samples were taken at baseline and every 30 min for 4-h glucose, triglyceride, and insulin concentrations, and the area under the curve (AUC) and the incremental area under the curve (iAUC) were analyzed. RESULTS No significant difference was shown between the 3 sweeteners for triglyceride and glucose concentrations and the AUC. The glucose iAUC was lower for fructose than for sucrose and sucralose (P < 0.05). Insulin concentrations differed significantly by the type of muffin (P = 0.001), the interaction of time by type of muffin (P = 0.035), the AUC (P < 0.001), and the iAUC (P < 0.001). Fructose had a significantly lower insulin response than that of either sucrose (P-treatment = 0.006) or sucralose (P-treatment = 0.041). CONCLUSIONS Fructose, at a moderate dose, did not significantly elevate triglyceride compared with sucrose or sucralose and lowered the glucose iAUC. These results indicate that these sweeteners, at an equivalent sweetness, can be used in normal solid meals. Fructose showed a lower insulin response, which may be beneficial in the long term in individuals at risk of type 2 diabetes. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN12615000279527.
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Affiliation(s)
- Clare Gallagher
- Dublin Institute of Technology, Dublin, Ireland; Trinity College Dublin, Dublin, Ireland; and Alliance for Research in Exercise, Nutrition and Activity, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Jennifer B Keogh
- Alliance for Research in Exercise, Nutrition and Activity, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Eva Pedersen
- Alliance for Research in Exercise, Nutrition and Activity, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Peter M Clifton
- Alliance for Research in Exercise, Nutrition and Activity, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
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164
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Lechner K, Parhofer KG. [Dietary advice for preventing and treating T2DM: A shift of paradigm]. MMW Fortschr Med 2016; 158:41-44. [PMID: 27071584 DOI: 10.1007/s15006-016-8060-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Katharina Lechner
- Klinikum der Universität München Medizinische Klinik und Poliklinik II - Großhadern, Marchioninistraße 15, D-81377, München, Deutschland
| | - Klaus G Parhofer
- Klinikum der Universität München Medizinische Klinik und Poliklinik II - Großhadern, Marchioninistraße 15, D-81377, München, Deutschland.
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165
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Li P, Zhang M, Zhu Y, Liu W, Zhang Y, Gao Y, Huang G. Dietary patterns and changes in cardiovascular risk factors in apparently healthy Chinese women: a longitudinal study. J Clin Biochem Nutr 2016; 58:232-9. [PMID: 27257349 PMCID: PMC4865601 DOI: 10.3164/jcbn.15-78] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/03/2015] [Indexed: 12/15/2022] Open
Abstract
Little is known of the relationships between dietary patterns and cardiovascular risk factors in China. We therefore designed a 3-year longitudinal study to evaluate the impacts of dietary patterns on changes in these factors among Chinese women. A total of 1,028 subjects who received health examination in 2011 and 2014 were recruited. Three major dietary patterns (“vegetable pattern”, “meat pattern”, and “animal offal-dessert-and-alcohol pattern”) were derived by principal component analysis based on validated food frequency questionnaires. Cardiovascular risk factors were standardized to create within-cohort z-scores and the changes in them were calculated as the differences between 2011 and 2014. Relationships between dietary patterns and changes in cardiovascular risk factors were assessed using general linear model. After adjustment for potential confounders, changes in total cholesterol and fasting blood glucose decreased across the tertiles of vegetable pattern (p for trend = 0.01 and 0.04, respectively). While, changes in diastolic blood pressure, total cholesterol and low density lipoprotein cholesterol increased across the tertiles of animal offal-dessert-and-alcohol pattern (p for trend = 0.02, 0.01, and 0.02, respectively). The findings suggest that vegetable pattern was beneficially related to cardiovascular risk factors, whereas animal offal-dessert-and-alcohol pattern was detrimental related to these factors among apparently healthy Chinese women.
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Affiliation(s)
- Ping Li
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - Meilin Zhang
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - Yufeng Zhu
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
| | - Weiqiao Liu
- Health Education and Guidance Center of Heping District, Tianjin 300040, China
| | - Yuwen Zhang
- Health Education and Guidance Center of Heping District, Tianjin 300040, China
| | - Yuxia Gao
- Department of Cardiology, General Hospital of Tianjin Medical University, Tianjin 300052, China
| | - Guowei Huang
- Department of Nutrition and Food Science, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China
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166
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Malik VS, Hu FB. Fructose and Cardiometabolic Health: What the Evidence From Sugar-Sweetened Beverages Tells Us. J Am Coll Cardiol 2016; 66:1615-1624. [PMID: 26429086 DOI: 10.1016/j.jacc.2015.08.025] [Citation(s) in RCA: 254] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/10/2015] [Accepted: 08/17/2015] [Indexed: 01/04/2023]
Abstract
Recent attention has focused on fructose as having a unique role in the pathogenesis of cardiometabolic diseases. However, because we rarely consume fructose in isolation, the major source of fructose in the diet comes from fructose-containing sugars, sucrose and high fructose corn syrup, in sugar-sweetened beverages and foods. Intake of sugar-sweetened beverages has been consistently linked to increased risk of obesity, type 2 diabetes, and cardiovascular disease in various populations. Putative underlying mechanisms include incomplete compensation for liquid calories, adverse glycemic effects, and increased hepatic metabolism of fructose leading to de novo lipogenesis, production of uric acid, and accumulation of visceral and ectopic fat. In this review we summarize the epidemiological and clinical trial evidence evaluating added sugars, especially sugar-sweetened beverages, and the risk of obesity, diabetes, and cardiovascular disease and address potential biological mechanisms with an emphasis on fructose physiology. We also discuss strategies to reduce intake of fructose-containing beverages.
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Affiliation(s)
- Vasanti S Malik
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
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167
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Lírio LM, Forechi L, Zanardo TC, Batista HM, Meira EF, Nogueira BV, Mill JG, Baldo MP. Chronic fructose intake accelerates non-alcoholic fatty liver disease in the presence of essential hypertension. J Diabetes Complications 2016; 30:85-92. [PMID: 26597602 DOI: 10.1016/j.jdiacomp.2015.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/03/2015] [Accepted: 10/14/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND The growing epidemic of metabolic syndrome has been related to the increased use of fructose by the food industry. In fact, the use of fructose as an ingredient has increased in sweetened beverages, such as sodas and juices. We thus hypothesized that fructose intake by hypertensive rats would have a worse prognosis in developing metabolic disorder and non-alcoholic fatty liver disease. METHODS Male Wistar and SHR rats aged 6weeks were given water or fructose (10%) for 6weeks. Blood glucose was measured every two weeks, and insulin and glucose sensitivity tests were assessed at the end of the follow-up. Systolic blood pressure was measure by plethysmography. Lean mass and abdominal fat mass were collected and weighed. Liver tissue was analyzed to determine interstitial fat deposition and fibrosis. RESULTS Fasting glucose increased in animals that underwent a high fructose intake, independent of blood pressure levels. Also, insulin resistance was observed in normotensive and mostly in hypertensive rats after fructose intake. Fructose intake caused a 2.5-fold increase in triglycerides levels in both groups. Fructose intake did not change lean mass. However, we found that fructose intake significantly increased abdominal fat mass deposition in normotensive but not in hypertensive rats. Nevertheless, chronic fructose intake only increased fat deposition and fibrosis in the liver in hypertensive rats. CONCLUSIONS We demonstrated that, in normotensive and hypertensive rats, fructose intake increased triglycerides and abdominal fat deposition, and caused insulin resistance. However, hypertensive rats that underwent fructose intake also developed interstitial fat deposition and fibrosis in liver.
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Affiliation(s)
- Layla Mendonça Lírio
- Department of Physiological Sciences, Federal University of Espírito Santo, Av Marechal Campos 1468, Maruipe, 29042-755, Vitória, ES, Brazil
| | - Ludimila Forechi
- Department of Physiological Sciences, Federal University of Espírito Santo, Av Marechal Campos 1468, Maruipe, 29042-755, Vitória, ES, Brazil
| | - Tadeu Caliman Zanardo
- Department of Morphology, Federal University of Espírito Santo, Av Marechal Campos 1468, Maruipe, 29042-755, Vitória, ES, Brazil
| | - Hiago Martins Batista
- Department of Pharmacy and Nutrition, Federal University of Espírito Santo, Rod Alto Universitário, Guararema, 29500-000, Alegre, ES, Brazil
| | - Eduardo Frizera Meira
- Department of Physiological Sciences, Federal University of Espírito Santo, Av Marechal Campos 1468, Maruipe, 29042-755, Vitória, ES, Brazil; Department of Pharmacy and Nutrition, Federal University of Espírito Santo, Rod Alto Universitário, Guararema, 29500-000, Alegre, ES, Brazil
| | - Breno Valentim Nogueira
- Department of Morphology, Federal University of Espírito Santo, Av Marechal Campos 1468, Maruipe, 29042-755, Vitória, ES, Brazil
| | - José Geraldo Mill
- Department of Physiological Sciences, Federal University of Espírito Santo, Av Marechal Campos 1468, Maruipe, 29042-755, Vitória, ES, Brazil
| | - Marcelo Perim Baldo
- Department of Physiological Sciences, Federal University of Espírito Santo, Av Marechal Campos 1468, Maruipe, 29042-755, Vitória, ES, Brazil.
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168
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Clayton ZE, Vickers MH, Bernal A, Yap C, Sloboda DM. Early Life Exposure to Fructose Alters Maternal, Fetal and Neonatal Hepatic Gene Expression and Leads to Sex-Dependent Changes in Lipid Metabolism in Rat Offspring. PLoS One 2015; 10:e0141962. [PMID: 26562417 PMCID: PMC4643022 DOI: 10.1371/journal.pone.0141962] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 10/15/2015] [Indexed: 02/06/2023] Open
Abstract
Aim Fructose consumption is associated with altered hepatic function and metabolic compromise and not surprisingly has become a focus for perinatal studies. We have previously shown that maternal fructose intake results in sex specific changes in fetal, placental and neonatal outcomes. In this follow-up study we investigated effects on maternal, fetal and neonatal hepatic fatty acid metabolism and immune modulation. Methods Pregnant rats were randomised to either control (CON) or high-fructose (FR) diets. Fructose was given in solution and comprised 20% of total caloric intake. Blood and liver samples were collected at embryonic day 21 (E21) and postnatal day (P)10. Maternal liver samples were also collected at E21 and P10. Liver triglyceride and glycogen content was measured with standard assays. Hepatic gene expression was measured with qPCR. Results Maternal fructose intake during pregnancy resulted in maternal hepatic ER stress, hepatocellular injury and increased levels of genes that favour lipogenesis. These changes were associated with a reduction in the NLRP3 inflammasome. Fetuses of mothers fed a high fructose diet displayed increased hepatic fructose transporter and reduced fructokinase mRNA levels and by 10 days of postnatal age, also have hepatic ER stress, and elevated IL1β mRNA levels. At P10, FR neonates demonstrated increased hepatic triglyceride content and particularly in males, associated changes in the expression of genes regulating beta oxidation and the NLRP3 inflammasome. Further, prenatal fructose results in sex-dependant changes in levels of key clock genes. Conclusions Maternal fructose intake results in age and sex-specific alterations in maternal fetal and neonatal free fatty acid metabolism, which may be associated in disruptions in core clock gene machinery. How these changes are associated with hepatic inflammatory processes is still unclear, although suppression of the hepatic inflammasome, as least in mothers and male neonates may point to impaired immune sensing.
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Affiliation(s)
- Zoe E. Clayton
- Liggins Institute and Gravida: National Centre for Growth and Development, University of Auckland, Aukland, New Zealand
| | - Mark H. Vickers
- Liggins Institute and Gravida: National Centre for Growth and Development, University of Auckland, Aukland, New Zealand
| | - Angelica Bernal
- Liggins Institute and Gravida: National Centre for Growth and Development, University of Auckland, Aukland, New Zealand
| | - Cassandra Yap
- Liggins Institute and Gravida: National Centre for Growth and Development, University of Auckland, Aukland, New Zealand
| | - Deborah M. Sloboda
- Departments of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, Canada
- Department of Pediatrics, McMaster University, Hamilton, Canada
- * E-mail:
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169
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Stanhope KL. Sugar consumption, metabolic disease and obesity: The state of the controversy. Crit Rev Clin Lab Sci 2015; 53:52-67. [PMID: 26376619 DOI: 10.3109/10408363.2015.1084990] [Citation(s) in RCA: 397] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The impact of sugar consumption on health continues to be a controversial topic. The objective of this review is to discuss the evidence and lack of evidence that allows the controversy to continue, and why resolution of the controversy is important. There are plausible mechanisms and research evidence that supports the suggestion that consumption of excess sugar promotes the development of cardiovascular disease (CVD) and type 2 diabetes (T2DM) both directly and indirectly. The direct pathway involves the unregulated hepatic uptake and metabolism of fructose, leading to liver lipid accumulation, dyslipidemia, decreased insulin sensitivity and increased uric acid levels. The epidemiological data suggest that these direct effects of fructose are pertinent to the consumption of the fructose-containing sugars, sucrose and high fructose corn syrup (HFCS), which are the predominant added sugars. Consumption of added sugar is associated with development and/or prevalence of fatty liver, dyslipidemia, insulin resistance, hyperuricemia, CVD and T2DM, often independent of body weight gain or total energy intake. There are diet intervention studies in which human subjects exhibited increased circulating lipids and decreased insulin sensitivity when consuming high sugar compared with control diets. Most recently, our group has reported that supplementing the ad libitum diets of young adults with beverages containing 0%, 10%, 17.5% or 25% of daily energy requirement (Ereq) as HFCS increased lipid/lipoprotein risk factors for CVD and uric acid in a dose-response manner. However, un-confounded studies conducted in healthy humans under a controlled, energy-balanced diet protocol that enables determination of the effects of sugar with diets that do not allow for body weight gain are lacking. Furthermore, recent reports conclude that there are no adverse effects of consuming beverages containing up to 30% Ereq sucrose or HFCS, and the conclusions from several meta-analyses suggest that fructose has no specific adverse effects relative to any other carbohydrate. Consumption of excess sugar may also promote the development of CVD and T2DM indirectly by causing increased body weight and fat gain, but this is also a topic of controversy. Mechanistically, it is plausible that fructose consumption causes increased energy intake and reduced energy expenditure due to its failure to stimulate leptin production. Functional magnetic resonance imaging (fMRI) of the brain demonstrates that the brain responds differently to fructose or fructose-containing sugars compared with glucose or aspartame. Some epidemiological studies show that sugar consumption is associated with body weight gain, and there are intervention studies in which consumption of ad libitum high-sugar diets promoted increased body weight gain compared with consumption of ad libitum low- sugar diets. However, there are no studies in which energy intake and weight gain were compared in subjects consuming high or low sugar, blinded, ad libitum diets formulated to ensure both groups consumed a comparable macronutrient distribution and the same amounts of fiber. There is also little data to determine whether the form in which added sugar is consumed, as beverage or as solid food, affects its potential to promote weight gain. It will be very challenging to obtain the funding to conduct the clinical diet studies needed to address these evidence gaps, especially at the levels of added sugar that are commonly consumed. Yet, filling these evidence gaps may be necessary for supporting the policy changes that will help to turn the food environment into one that does not promote the development of obesity and metabolic disease.
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Affiliation(s)
- Kimber L Stanhope
- a Department of Molecular Biosciences , School of Veterinary Medicine and.,b Department of Nutrition , University of California , Davis , CA , USA
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170
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Deakin T, Garden L. ‘Saturated fat doesn't increase coronary heart disease in people with diabetes’. PRACTICAL DIABETES 2015. [DOI: 10.1002/pdi.1967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Trudi Deakin
- X-PERT Health (registered charity); Hebden Bridge West Yorkshire UK
| | - Leonie Garden
- The James Cook University Hospital, NHS South Tees; Middlesbrough UK
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171
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Guelinckx I, Ferreira-Pêgo C, Moreno LA, Kavouras SA, Gandy J, Martinez H, Bardosono S, Abdollahi M, Nasseri E, Jarosz A, Ma G, Carmuega E, Babio N, Salas-Salvadó J. Intake of water and different beverages in adults across 13 countries. Eur J Nutr 2015; 54 Suppl 2:45-55. [PMID: 26072214 PMCID: PMC4473281 DOI: 10.1007/s00394-015-0952-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/03/2015] [Indexed: 02/08/2023]
Abstract
Purpose To describe the intake of water and all other fluids and to evaluate the proportion of adults exceeding the World Health Organisation (WHO) recommendations on energy intake from free sugar, solely from fluids. Methods A total of 16,276 adults (46 % men, mean age 39.8 years) were recruited in 13 countries from 3 continents. A 24-h fluid-specific record over 7 days was used for fluid assessment. Results In Spain, France, Turkey, Iran, Indonesia and China, fluid intake was characterised by a high contribution of water (47–78 %) to total fluid intake (TFI), with a mean water intake between 0.76 and 1.78 L/day, and a mean energy intake from fluids from 182 to 428 kcal/day. Between 11 and 49 % of adults exceeded the free sugar WHO recommendations, considering solely fluids. In Germany, UK, Poland and Japan, the largest contributors to TFI were hot beverages (28–50 %) and water (18–32 %). Mean energy intake from fluids ranged from 415 to 817 kcal/day, and 48–62 % of adults exceeded free sugar WHO recommendations. In Mexico, Brazil and Argentina, the contribution of juices and regular sugar beverages (28–41 %) was as important as the water contribution to TFI (17–39 %). Mean energy intake from fluids ranged 565–694 kcal/day, and 60–66 % of the adults exceeded the free sugar WHO recommendation. Conclusions The highest volumes recorded in most of the countries were for water, mean energy intake from fluids was up to 694 kcal/day, and 66 % of adults exceeded the free sugar WHO recommendation solely by fluids. Actions to create an environment in favour of water consumption and reduce sugar intake from fluids therefore are warranted. Electronic supplementary material The online version of this article (doi:10.1007/s00394-015-0952-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- I Guelinckx
- Hydration and Health Department, Danone Research, Palaiseau, France
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