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Guney C, Bal NB, Akar F. The impact of dietary fructose on gut permeability, microbiota, abdominal adiposity, insulin signaling and reproductive function. Heliyon 2023; 9:e18896. [PMID: 37636431 PMCID: PMC10447940 DOI: 10.1016/j.heliyon.2023.e18896] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023] Open
Abstract
The excessive intake of fructose in the regular human diet could be related to global increases in metabolic disorders. Sugar-sweetened soft drinks, mostly consumed by children, adolescents, and young adults, are the main source of added fructose. Dietary high-fructose can increase intestinal permeability and circulatory endotoxin by changing the gut barrier function and microbial composition. Excess fructose transports to the liver and then triggers inflammation as well as de novo lipogenesis leading to hepatic steatosis. Fructose also induces fat deposition in adipose tissue by stimulating the expression of lipogenic genes, thus causing abdominal adiposity. Activation of the inflammatory pathway by fructose in target tissues is thought to contribute to the suppression of the insulin signaling pathway producing systemic insulin resistance. Moreover, there is some evidence that high intake of fructose negatively affects both male and female reproductive systems and may lead to infertility. This review addresses dietary high-fructose-induced deteriorations that are obvious, especially in gut permeability, microbiota, abdominal fat accumulation, insulin signaling, and reproductive function. The recognition of the detrimental effects of fructose and the development of relevant new public health policies are necessary in order to prevent diet-related metabolic disorders.
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Affiliation(s)
| | | | - Fatma Akar
- Department of Pharmacology, Faculty of Pharmacy, Gazi University, Ankara, Turkey
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Putakala M, Gujjala S, Nukala S, Desireddy S. Beneficial Effects of Phyllanthus amarus Against High Fructose Diet Induced Insulin Resistance and Hepatic Oxidative Stress in Male Wistar Rats. Appl Biochem Biotechnol 2017; 183:744-764. [PMID: 28353042 DOI: 10.1007/s12010-017-2461-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/15/2017] [Indexed: 12/29/2022]
Abstract
Insulin resistance (IR) is a characteristic feature of obesity, type 2 diabetes mellitus, and cardiovascular diseases. Emerging evidence suggests that the high-fructose consumption is a potential and important factor responsible for the rising incidence of IR. The present study investigates the beneficial effects of aqueous extract of Phyllanthus amarus (PAAE) on IR and oxidative stress in high-fructose (HF) fed male Wistar rats. HF diet (66% of fructose) and PAAE (200 mg/kg body weight/day) were given concurrently to the rats for a period of 60 days. Fructose-fed rats showed weight gain, hyperglycemia, hyperinsulinemia, impaired glucose tolerance, impaired insulin sensitivity, dyslipidemia, hyperleptinemia, and hypoadiponectinemia (P < 0.05) after 60 days. Co-administration of PAAE along with HF diet significantly ameliorated all these alterations. Regarding hepatic antioxidant status, higher lipid peroxidation and protein oxidation, lower reduced glutathione levels and lower activities of enzymatic antioxidants, and the histopathological changes like mild to severe distortion of the normal architecture as well as the prominence and widening of the liver sinusoids observed in the HF diet-fed rats were significantly prevented by PAAE treatment. These findings indicate that PAAE is beneficial in improving insulin sensitivity and attenuating metabolic syndrome and hepatic oxidative stress in fructose-fed rats.
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Affiliation(s)
- Mallaiah Putakala
- Department of Biochemistry, Sri Krishnadevaraya University, Anantapuramu, Andhra Pradesh, 515 003, India
| | - Sudhakara Gujjala
- Department of Biochemistry, Sri Krishnadevaraya University, Anantapuramu, Andhra Pradesh, 515 003, India
| | - Srinivasulu Nukala
- Department of Biochemistry, Sri Krishnadevaraya University, Anantapuramu, Andhra Pradesh, 515 003, India
| | - Saralakumari Desireddy
- Department of Biochemistry, Sri Krishnadevaraya University, Anantapuramu, Andhra Pradesh, 515 003, India.
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Rippe JM, Sievenpiper JL, Lê KA, White JS, Clemens R, Angelopoulos TJ. What is the appropriate upper limit for added sugars consumption? Nutr Rev 2017; 75:18-36. [PMID: 27974597 PMCID: PMC5916235 DOI: 10.1093/nutrit/nuw046] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Dramatic increases in obesity and diabetes have occurred worldwide over the past 30 years. Some investigators have suggested that these increases may be due, in part, to increased added sugars consumption. Several scientific organizations, including the World Health Organization, the Scientific Advisory Council on Nutrition, the Dietary Guidelines Advisory Committee 2015, and the American Heart Association, have recommended significant restrictions on upper limits of sugars consumption. In this review, the scientific evidence related to sugars consumption and its putative link to various chronic conditions such as obesity, diabetes, heart disease, nonalcoholic fatty liver disease, and the metabolic syndrome is examined. While it appears prudent to avoid excessive calories from sugars, the scientific basis for restrictive guidelines is far from settled.
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Affiliation(s)
- James M Rippe
- J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA.
| | - John L Sievenpiper
- J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA
| | - Kim-Anne Lê
- J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA
| | - John S White
- J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA
| | - Roger Clemens
- J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA
| | - Theodore J Angelopoulos
- J.M. Rippe is with the Rippe Lifestyle Institute, Shrewsbury, Massachusetts, USA; and the Department of Biomedical Sciences, University of Central Florida, Orlando, Florida, USA. J.L. Sievenpiper is with the Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and the Division of Endocrinology and Metabolism, St Michael's Hospital; the Li Ka Shing Knowledge Institute, St Michael's Hospital; the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St Michael's Hospital; and the Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada. K.-A. Lê is with Nestec Ltd, Nestlé Research Center, Lausanne, Switzerland. J.S. White is with White Technical Research, Argenta, Illinois, USA. R. Clemens is with the Department of Pharmacology and Pharmaceutical Sciences, University of Southern California School of Pharmacy, University of Southern California; and the International Center for Regulatory Science, University of Southern California, Los Angeles, California, USA. T.J. Angelopoulos is with the School of Health Sciences, Emory and Henry College, Emory, Virginia, USA
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Afifi NA, Ramadan A, Erian EY, Saleh DO, Sedik AA, Badawi M, El Hotaby W. Trigonelline attenuates hepatic complications and molecular alterations in high-fat high-fructose diet-induced insulin resistance in rats. Can J Physiol Pharmacol 2016; 95:427-436. [PMID: 28157387 DOI: 10.1139/cjpp-2016-0269] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The present study aimed to evaluate the effect of trigonelline (TRG) on the hepatic complications associated with high-fat high-fructose (HFHF) diet-induced insulin resistance (IR) in rats. IR was induced by giving a saturated fat diet and 10% fructose in drinking water to rats for 8 weeks. Insulin-resistant rats were orally treated with TRG (50 and 100 mg/kg), sitagliptin (SIT; 5 mg/kg), or a combination of TRG (50 mg/kg) and SIT (5 mg/kg) for 14 days. Liver homogenates were used for assessment of hepatic lipids, oxidative stress biomarkers, and inflammatory cytokines. Histopathological and DNA cytometry examinations were carried out for hepatic and pancreatic tissues. Hepatic tissues were examined using Fourier-transform infrared spectroscopy for assessment of any molecular changes. Results of the present study revealed that oral treatment of insulin-resistant rats with TRG or TRG in combination with SIT significantly decreased homeostatic model assessment of IR, hepatic lipids, oxidative stress biomarkers, and the inflammatory cytokines. TRG or TRG in combination with SIT ameliorated the histopathological, DNA cytometry, and molecular alterations induced by a HFHF diet. Finally, it can be concluded that TRG has beneficial effects on the hepatic complications associated with IR due to its hypoglycemic effect and antioxidant potential.
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Affiliation(s)
- Nehal A Afifi
- a Pharmacology Department, Faculty of Veterinary Medicine, Cairo University
| | - Amer Ramadan
- a Pharmacology Department, Faculty of Veterinary Medicine, Cairo University
| | - Emad Y Erian
- b Pharmacology Department, National Research Centre, Cairo, Egypt
| | - Dalia O Saleh
- b Pharmacology Department, National Research Centre, Cairo, Egypt
| | - Ahmed A Sedik
- b Pharmacology Department, National Research Centre, Cairo, Egypt
| | - Manal Badawi
- c Pathology Department, National Research Centre, Cairo, Egypt
| | - Walid El Hotaby
- d Biophysics Department, National Research Centre, Cairo, Egypt
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Ajiboye TO, Raji HO, Adeleye AO, Adigun NS, Giwa OB, Ojewuyi OB, Oladiji AT. Hibiscus sabdariffa calyx palliates insulin resistance, hyperglycemia, dyslipidemia and oxidative rout in fructose-induced metabolic syndrome rats. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2016; 96:1522-1531. [PMID: 25965053 DOI: 10.1002/jsfa.7254] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 04/10/2015] [Accepted: 05/07/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND The effect of Hibiscus sabdariffa calyx extract was evaluated in high-fructose-induced metabolic syndrome rats. Insulin resistance, hyperglycemia, dyslipidemia and oxidative rout were induced in rats using high-fructose diet. High-fructose diet-fed rats were administered 100 and 200 mg kg(-1) body weight of H. sabdariffa extract for 3 weeks, starting from week 7 of high-fructose diet treatment. RESULTS High-fructose diet significantly (P < 0.05) increased the serum levels of blood glucose, insulin, total cholesterol (TC), triacylglycerol (TAG), low-density lipoprotein cholesterol (LDLc) and very-low-density lipoprotein cholesterol (VLDLc), with a concomitant reduction in high-density lipoprotein cholesterol (HDLc). These alterations were significantly ameliorated by the extract. High-fructose diet-mediated decreases in the activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), glutathione reductase (GSH-red) and glucose 6-phosphate dehydrogenase (Glc 6-PD) were significantly (P < 0.05) attenuated. Altered levels of reduced glutathione (GSH) and glutathione disulfide (GSSG) were significantly (P < 0.05) restored to normal. High-fructose diet-mediated increases in the concentrations of malondialdehyde, conjugated dienes, lipid hydroperoxides, protein carbonyl and percentage fragmented DNA were significantly (P < 0.05) lowered by the Hibiscus extract. CONCLUSION Overall, aqueous extract of H. sabdariffa palliates insulin resistance, hyperglycemia, dyslipidemia and oxidative rout in high-fructose-induced metabolic syndrome rats.
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Affiliation(s)
- Taofeek O Ajiboye
- Antioxidants, Free Radicals, Functional Foods and Toxicology Research Laboratory, Department of Biological Sciences, Al-Hikmah University, Ilorin, Nigeria
| | - Hikmat O Raji
- Antioxidants, Free Radicals and Toxicology Research Laboratory, Department of Chemical Sciences, Fountain University, Osogbo, Nigeria
| | | | | | | | - Oluwayemisi B Ojewuyi
- Antioxidants, Free Radicals, Functional Foods and Toxicology Research Laboratory, Department of Biological Sciences, Al-Hikmah University, Ilorin, Nigeria
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No Effect of Added Sugar Consumed at Median American Intake Level on Glucose Tolerance or Insulin Resistance. Nutrients 2015; 7:8830-45. [PMID: 26512691 PMCID: PMC4632450 DOI: 10.3390/nu7105430] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 08/27/2015] [Accepted: 09/22/2015] [Indexed: 12/14/2022] Open
Abstract
Excess sugar consumption may promote adverse changes in hepatic and total body insulin resistance. Debate continues over the effects of sugars at more typically consumed levels and whether the identity of the sugar consumed is important. In the present study participants (20–60 years old) were randomly assigned to one of five groups, three that consumed low fat milk with added fructose containing sugars in amounts equivalent to the 50th percentile of fructose consumption (US), one which consumed low-fat milk sweetened with glucose, and one unsweetened low-fat milk control group. The intervention lasted ten weeks. In the entire study population there was less than 1 kg increase in weight (73.6 ± 13.0 vs. 74.5 ± 13.3 kg, p < 0.001), but the change in weight was comparable among groups (p > 0.05). There were no changes in fasting glucose (49 ± 0.4 vs. 5.0 ± 0.5 mmol/L), insulin (56.9 ± 38.9 vs. 61.8 ± 50.0 pmol/L), or insulin resistance, as measured by the Homeostasis Model Assessment method (1.8 ± 1.3 vs. 2.0 ± 1.5, all p > 0.05). These data suggest that added sugar consumed at the median American intake level does not produce changes in measures of insulin sensitivity or glucose tolerance and that no sugar has more deleterious effects than others.
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Sarı E, Yeşilkaya E, Bolat A, Topal T, Altan B, Fidancı K, Saldır M, Erdem G, Gülgün M, Gülcan Kurt Y, Güven A. Metabolic and Histopathological Effects of Fructose Intake During Pregestation, Gestation and Lactation in Rats and their Offspring. J Clin Res Pediatr Endocrinol 2015; 7:19-26. [PMID: 25800472 PMCID: PMC4439888 DOI: 10.4274/jcrpe.1776] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Studies have demonstrated a significant relationship between maternal fructose intake and metabolic outcome in their offspring. However, there is a paucity of data about the long-term effects of fructose intake on the offspring of fructose-fed dams. Therefore, we planned a study to evaluate the long-term effects of fructose intake on the offspring of dam rats fed a high-fructose diet. METHODS Sixteen virgin female Sprague-Dawley rats were divided into two groups. Group 1 received a regular diet and Group 2 a high-fructose diet. Both groups received their experimental diets for 8 weeks before conception. They were mated and continued to feed with their experimental diet during mating and during their pregnancy and lactation periods. After weaning, the offspring from each group were divided into two groups. Group 1A received a regular diet, Group 1B - a fructose diet, Group 2A - a regular diet and Group 2B received a fructose diet. After weaning, the offspring were anesthetized and blood samples were collected for biochemical analysis. Liver, kidney and retroperitoneal adipose tissue were harvested for histopathological examination. Primary antibodies against inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) were determined as early inflammation markers. RESULTS After weaning, while daily water consumption was found to be significantly higher in Groups 2B and 1B (p<0.01), daily laboratory chow consumption was significantly lower in Groups 1A and 2A (p<0.01). Body weight was significantly higher in Groups 1B and 2B (p<0.01). Serum glucose, triglyceride, low-density lipoprotein cholesterol and very low-density lipoprotein cholesterol levels were found to be increased and high-density lipoprotein cholesterol levels decreased in Group 2B (p<0.05). The intensities of iNOS staining in the retroperitoneal adipose tissue, COX-2 staining in the liver and both iNOS and COX-2 staining in the kidney were higher in Group 2B (p<0.05). CONCLUSION Based on our findings, we believe that the offspring of dams which received a high fructose intake during their pregestation, gestation and lactation periods are at risk of developing metabolic syndrome in their later life only if they continue to receive a high intake of fructose. We therefore propose that the risk of developing metabolic syndrome can probably be reduced by modifying the diet of the offspring after weaning.
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Affiliation(s)
- Erkan Sarı
- Gülhane Military Medical Academy, Department of Pediatric Endocrinology, Ankara, Turkey. E-mail:
| | - Ediz Yeşilkaya
- Gülhane Military Medical Academy, Department of Pediatric Endocrinology, Ankara, Turkey
,* Address for Correspondence: Gülhane Military Medical Academy, Department of Pediatric Endocrinology, Ankara, Turkey Phone: +90 312 304 18 98 E-mail:
| | - Ahmet Bolat
- Gülhane Military Medical Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Turgut Topal
- Gülhane Military Medical Academy, Department of Physiology, Ankara, Turkey
| | - Bilal Altan
- Gülhane Military Medical Academy, Department of Pediatric Surgery, Ankara, Turkey
| | - Kürşat Fidancı
- Gülhane Military Medical Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Mehmet Saldır
- Gülhane Military Medical Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Galip Erdem
- Gülhane Military Medical Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Mustafa Gülgün
- Gülhane Military Medical Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Yasemin Gülcan Kurt
- Gulhane Military Medical Academy, Department of Biochemistry, Ankara, Turkey
| | - Ahmet Güven
- Gülhane Military Medical Academy, Department of Pediatric Surgery, Ankara, Turkey
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Lowndes J, Kawiecki D, Yu Z, Rippe JM. No Dose Response Relationship in the Effects of Commonly Consumed Sugars on Risk Factors for Diabetes across a Range of Typical Human Consumption Levels. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/fns.2015.61011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cozma AI, Sievenpiper JL. The Role of Fructose, Sucrose and High-fructose Corn Syrup in Diabetes. EUROPEAN ENDOCRINOLOGY 2014; 10:51-60. [PMID: 29872464 DOI: 10.17925/ee.2014.10.01.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/28/2013] [Indexed: 11/24/2022]
Abstract
Concerns are growing regarding the role of dietary sugars in the development of obesity and cardiometabolic diseases, including diabetes. High-fructose corn syrup (HFCS) and sucrose are the most important dietary sweeteners. Both HFCS and sucrose have overlapping metabolic actions with adverse effects attributed to their fructose moiety. Ecological studies have linked the rise in fructose availability with the increases in obesity and diabetes worldwide. This link has been largely underpinned by animal models and select human trials of fructose overfeeding at high levels of exposure. Although prospective cohort studies have shown significant associations comparing the highest with the lowest levels of intake sugar-sweetened beverages, these associations are small, do not hold at moderate levels of intake and are subject to collinearity effects from related dietary and lifestyle factors. Most systematic reviews and meta-analyses from controlled feeding trials have shown that fructose-containing sugars in isocaloric exchange for other carbohydrates do not show evidence of harm and, in the case of fructose, may even have advantages for glycaemic control, especially at small doses. Nevertheless, trials in which fructose-containing sugars supplement diets with excess energy have shown adverse effects, effects that appear more attributable to the excess energy than the sugar. There is no unequivocal evidence that fructose intake at moderate doses is directly related with adverse metabolic effects, although there is potentially cause for concern where fructose is provided at high doses or contributes excess energy to diets. Further investigation is warranted due to the significant knowledge gaps and weaknesses in existing research.
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Affiliation(s)
- Adrian I Cozma
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - John L Sievenpiper
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada.,Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Pereira CD, Severo M, Araújo JR, Guimarães JT, Pestana D, Santos A, Ferreira R, Ascensão A, Magalhães J, Azevedo I, Monteiro R, Martins MJ. Relevance of a Hypersaline Sodium-Rich Naturally Sparkling Mineral Water to the Protection against Metabolic Syndrome Induction in Fructose-Fed Sprague-Dawley Rats: A Biochemical, Metabolic, and Redox Approach. Int J Endocrinol 2014; 2014:384583. [PMID: 24672546 PMCID: PMC3941211 DOI: 10.1155/2014/384583] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 11/24/2013] [Accepted: 11/28/2013] [Indexed: 12/14/2022] Open
Abstract
The Metabolic Syndrome increases the risk for atherosclerotic cardiovascular disease and type 2 Diabetes Mellitus. Increased fructose consumption and/or mineral deficiency have been associated with Metabolic Syndrome development. This study aimed to investigate the effects of 8 weeks consumption of a hypersaline sodium-rich naturally sparkling mineral water on 10% fructose-fed Sprague-Dawley rats (Metabolic Syndrome animal model). The ingestion of the mineral water (rich in sodium bicarbonate and with higher potassium, calcium, and magnesium content than the tap water used as control) reduced/prevented not only the fructose-induced increase of heart rate, plasma triacylglycerols, insulin and leptin levels, hepatic catalase activity, and organ weight to body weight ratios (for liver and both kidneys) but also the decrease of hepatic glutathione peroxidase activity and oxidized glutathione content. This mineral-rich water seems to have potential to prevent Metabolic Syndrome induction by fructose. We hypothesize that its regular intake in the context of modern diets, which have a general acidic character interfering with mineral homeostasis and are poor in micronutrients, namely potassium, calcium, and magnesium, could add surplus value and attenuate imbalances, thus contributing to metabolic and redox health and, consequently, decreasing the risk for atherosclerotic cardiovascular disease.
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Affiliation(s)
- Cidália Dionísio Pereira
- Department of Biochemistry (U38/FCT), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Milton Severo
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - João Ricardo Araújo
- Department of Biochemistry (U38/FCT), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - João Tiago Guimarães
- Department of Biochemistry (U38/FCT), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of Clinical Pathology, São João Hospital Centre, EPE, 4200-319 Porto, Portugal
| | - Diogo Pestana
- Department of Biochemistry (U38/FCT), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Alejandro Santos
- Faculty of Nutrition and Food Sciences, University of Porto, 4200-465 Porto, Portugal
| | - Rita Ferreira
- QOPNA, Mass Spectrometry Centre, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| | - António Ascensão
- CIAFEL, Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
| | - José Magalhães
- CIAFEL, Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
| | - Isabel Azevedo
- Department of Biochemistry (U38/FCT), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Rosário Monteiro
- Department of Biochemistry (U38/FCT), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Maria João Martins
- Department of Biochemistry (U38/FCT), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- *Maria João Martins:
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Ramesh B, Saralakumari D. Antihyperglycemic, hypolipidemic and antioxidant activities of ethanolic extract of Commiphora mukul gum resin in fructose-fed male Wistar rats. J Physiol Biochem 2012; 68:573-82. [PMID: 22581434 DOI: 10.1007/s13105-012-0175-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 04/27/2012] [Indexed: 01/11/2023]
Abstract
High fructose feeding (66 % of fructose) induces type-2 diabetes in rats, which is associated with the insulin resistance, hyperinsulinemia, hypertriglyceridemia and oxidative stress. The present study was undertaken to evaluate the effect of ethanol extract of Commiphora mukul gum resin (CMEE) on blood glucose, plasma insulin, lipid profiles, reduced glutathione, lipid peroxidation, protein oxidation and enzymatic antioxidants like superoxide dismutase, catalase, glutathione reductase, glutathione peroxidase, glutathione-S-transferase in fructose-induced type-2 diabetic rats. A significant gain in body weight, hyperglycemia, hyperinsulinemia, increased lipid profiles, lipid peroxidation, protein oxidation and decreased reduced glutathione, activities of enzymatic antioxidants and insulin sensitivity (increased homeostasis assessment assay) were observed in high-fructose-induced diabetic rats. The administration of CMEE (200 mg/kg/day) daily for 60 days in high-fructose-induced diabetic rats reversed the above parameters significantly. CMEE has the ability to improve insulin sensitivity and delay the development of insulin resistance, aggravate antioxidant status in diabetic rats and may be used as an adjuvant therapy for patients with insulin resistance.
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Affiliation(s)
- B Ramesh
- Department of Biochemistry, Sri Venkateswara University, Tirupati 517502, Andhra Pradesh, India
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Lipid profile and insulin sensitivity in rats fed with high-fat or high-fructose diets. Br J Nutr 2011; 106 Suppl 1:S206-10. [PMID: 22005430 DOI: 10.1017/s0007114511004454] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The occurrence and severity of obesity- and insulin resistance-related disorders vary according to the diet. The aim of the present longitudinal study was to examine the effects of a high-fat or a high-fructose diet on body weight (BW), body fat mass, insulin sensitivity (IS) and lipid profiles in a rat model of dietary-induced obesity and low IS. A total of eighteen, 12-week-old male Wistar rats were divided into three groups, and were fed with a control, a high-fat (65 % lipid energy) or a high-fructose diet (65 % fructose energy) for 10 weeks. BW, body fat mass ((2)H2O dilution method), IS (euglycaemic-hyperinsulinaemic clamp technique), plasma glucose, insulin, NEFA, TAG and total cholesterol were assessed before and at the end of 10-week period. Cholesterol was measured in plasma lipoproteins separated from pooled samples of each group and each time period by using fast-protein liquid chromatography. All rats had similar BW at the end of the 10-week period. Body fat mass was higher in the high-fat group compared to the control group. There was no change in basal glycaemia and insulinaemia. The IS was lower in the high-fat group and was unchanged in the high-fructose group, compared to the control group. Plasma TAG concentration and cholesterol distribution in lipoproteins did not change over time in any group. Plasma NEFA concentration decreased, whereas plasma TAG concentration increased over time, regardless of the diet in both cases. The 10-week high-fat diet led to obesity and low IS, whereas rats fed with the high-fructose diet exhibited no change in IS and lipidaemia. The high-fat diet had more deleterious response than high-fructose diet to induce obesity and low IS in rats.
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Abdulla MH, Sattar MA, Johns EJ. The Relation between Fructose-Induced Metabolic Syndrome and Altered Renal Haemodynamic and Excretory Function in the Rat. Int J Nephrol 2011; 2011:934659. [PMID: 21785727 PMCID: PMC3139200 DOI: 10.4061/2011/934659] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 04/30/2011] [Accepted: 05/15/2011] [Indexed: 11/20/2022] Open
Abstract
This paper explores the possible relationships between dietary fructose and altered neurohumoral regulation of renal haemodynamic and excretory function in this model of metabolic syndrome. Fructose consumption induces hyperinsulinemia, hypertriglyceridaemia, insulin resistance, and hypertension. The pathogenesis of fructose-induced hypertension is dubious and involves numerous pathways acting both singly and together. In addition, hyperinsulinemia and hypertension contribute significantly to progressive renal disease in fructose-fed rats. Moreover, increased activity of the renin-angiotensin and sympathetic nervous systems leading to downregulation of receptors may be responsible for the blunted vascular sensitivity to angiotensin II and catecholamines, respectively. Various approaches have been suggested to prevent the development of fructose-induced hypertension and/or metabolic alteration. In this paper, we address the role played by the renin-angiotensin and sympathetic nervous systems in the haemodynamic alterations that occur due to prolonged consumption of fructose.
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Affiliation(s)
- Mohammed H Abdulla
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, 11800 Penang, Malaysia
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Health implications of fructose consumption: A review of recent data. Nutr Metab (Lond) 2010; 7:82. [PMID: 21050460 PMCID: PMC2991323 DOI: 10.1186/1743-7075-7-82] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 11/04/2010] [Indexed: 12/29/2022] Open
Abstract
This paper reviews evidence in the context of current research linking dietary fructose to health risk markers.Fructose intake has recently received considerable media attention, most of which has been negative. The assertion has been that dietary fructose is less satiating and more lipogenic than other sugars. However, no fully relevant data have been presented to account for a direct link between dietary fructose intake and health risk markers such as obesity, triglyceride accumulation and insulin resistance in humans. First: a re-evaluation of published epidemiological studies concerning the consumption of dietary fructose or mainly high fructose corn syrup shows that most of such studies have been cross-sectional or based on passive inaccurate surveillance, especially in children and adolescents, and thus have not established direct causal links. Second: research evidence of the short or acute term satiating power or increasing food intake after fructose consumption as compared to that resulting from normal patterns of sugar consumption, such as sucrose, remains inconclusive. Third: the results of longer-term intervention studies depend mainly on the type of sugar used for comparison. Typically aspartame, glucose, or sucrose is used and no negative effects are found when sucrose is used as a control group.Negative conclusions have been drawn from studies in rodents or in humans attempting to elucidate the mechanisms and biological pathways underlying fructose consumption by using unrealistically high fructose amounts.The issue of dietary fructose and health is linked to the quantity consumed, which is the same issue for any macro- or micro nutrients. It has been considered that moderate fructose consumption of ≤50g/day or ~10% of energy has no deleterious effect on lipid and glucose control and of ≤100g/day does not influence body weight. No fully relevant data account for a direct link between moderate dietary fructose intake and health risk markers.
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Suwannaphet W, Meeprom A, Yibchok-Anun S, Adisakwattana S. Preventive effect of grape seed extract against high-fructose diet-induced insulin resistance and oxidative stress in rats. Food Chem Toxicol 2010; 48:1853-7. [DOI: 10.1016/j.fct.2010.04.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 04/02/2010] [Accepted: 04/15/2010] [Indexed: 10/19/2022]
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Abstract
BACKGROUND Research on trends in consumption of added sugar and high-fructose corn syrup (HFCS) in the United States has largely focused on calorically sweetened beverages and ignored other sources. OBJECTIVE We aimed to examine US consumption of added sugar and HFCS to determine long-term trends in availability and intake from beverages and foods. DESIGN We used 2 estimation techniques and data from the Nationwide Food Consumption Surveys (1965 and 1977), Continuing Survey of Food Intake by Individuals (1989-1991), and the National Health and Nutrition Examination Surveys (1999-2000, 2001-2002, and 2003-2004) to examine trends in HFCS and added sugar both overall and within certain food and beverage groups. RESULTS Availability and consumption of HFCS and added sugar increased over time until a slight decline between 2000 and 2004. By 2004, HFCS provided roughly 8% of total energy intake compared with total added sugar of 377 kcal x person(-1) x d(-1), accounting for 17% of total energy intake. Although food and beverage trends were similar, soft drinks and fruit drinks provided the most HFCS (158 and 40 kcal x person(-1) x d(-1) in 2004, respectively). Moreover, among the top 20% of individuals, 896 kcal x person(-1) x d(-1) of added sugar was consumed compared with 505 kcal x person(-1) x d(-1) of HFCS. Among consumers, sweetened tea and desserts also represented major contributors of calories from added sugar (>100 kcal x person(-1) x d(-1)). CONCLUSION Although increased intake of calories from HFCS is important to examine, the health effect of overall trends in added caloric sweeteners should not be overlooked.
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Affiliation(s)
- Kiyah J Duffey
- Department of Nutrition, University of North Carolina, Chapel Hill, NC 27516, USA
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17
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Abstract
OBJECTIVE To examine the relation between intake of sugar sweetened soft drinks and fructose and the risk of incident gout in men. DESIGN Prospective cohort over 12 years. SETTING Health professionals follow-up study. PARTICIPANTS 46 393 men with no history of gout at baseline who provided information on intake of soft drinks and fructose through validated food frequency questionnaires. MAIN OUTCOME MEASURE Incident cases of gout meeting the American College of Rheumatology survey criteria for gout. RESULTS During the 12 years of follow-up 755 confirmed incident cases of gout were reported. Increasing intake of sugar sweetened soft drinks was associated with an increasing risk of gout. Compared with consumption of less than one serving of sugar sweetened soft drinks a month the multivariate relative risk of gout for 5-6 servings a week was 1.29 (95% confidence interval 1.00 to 1.68), for one serving a day was 1.45 (1.02 to 2.08), and for two or more servings a day was 1.85 (1.08 to 3.16; P for trend=0.002). Diet soft drinks were not associated with risk of gout (P for trend=0.99). The multivariate relative risk of gout according to increasing fifths of fructose intake were 1.00, 1.29, 1.41, 1.84, and 2.02 (1.49 to 2.75; P for trend <0.001). Other major contributors to fructose intake such as total fruit juice or fructose rich fruits (apples and oranges) were also associated with a higher risk of gout (P values for trend <0.05). CONCLUSIONS Prospective data suggest that consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men. Furthermore, fructose rich fruits and fruit juices may also increase the risk. Diet soft drinks were not associated with the risk of gout.
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Affiliation(s)
- Hyon K Choi
- Arthritis Research Centre of Canada, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1L7, Canada
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Choi JWJ, Ford ES, Gao X, Choi HK. Sugar-sweetened soft drinks, diet soft drinks, and serum uric acid level: The third national health and nutrition examination survey. ACTA ACUST UNITED AC 2007; 59:109-16. [DOI: 10.1002/art.23245] [Citation(s) in RCA: 303] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Wu T, Giovannucci E, Pischon T, Hankinson SE, Ma J, Rifai N, Rimm EB. Fructose, glycemic load, and quantity and quality of carbohydrate in relation to plasma C-peptide concentrations in US women. Am J Clin Nutr 2004; 80:1043-9. [PMID: 15447918 DOI: 10.1093/ajcn/80.4.1043] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Circulating C-peptide concentrations are associated with insulin resistance and the development of type 2 diabetes. However, associations between fructose and the quantity and quality of total carbohydrate intake in relation to C-peptide concentrations have not been adequately examined. OBJECTIVE We assessed the association of dietary fructose, glycemic load, and carbohydrate intake with fasting C-peptide concentrations. DESIGN Plasma C-peptide concentrations were measured in a cross-sectional setting in 1999 healthy women from the Nurses' Health Study I and II. Dietary fructose, glycemic load, and carbohydrate intake were assessed with the use of semiquantitative food-frequency questionnaires. RESULTS After multivariate adjustment, subjects in the highest quintile of energy-adjusted fructose intake had 13.9% higher C-peptide concentrations (P for trend = 0.01) than did subjects in the lowest quintile. Similarly, in the multivariate model, subjects in the highest quintile of glycemic load had 14.1% (P for trend = 0.09) and 16.1% (P for trend = 0.04) higher C-peptide concentrations than did subjects in the lowest quintile after further adjustment for total fat or carbohydrate intake, respectively. In contrast, subjects with high intakes of cereal fiber had 15.6% lower (P for trend = 0.03) C-peptide concentrations after control for other covariates. CONCLUSIONS Our results suggest that high intakes of fructose and high glycemic foods are associated with higher C-peptide concentrations, whereas consumption of carbohydrates high in fiber, such as whole-grain foods, is associated with lower C-peptide concentrations. Furthermore, our study suggests that these nutrients play divergent roles in the development of insulin resistance and type 2 diabetes.
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Affiliation(s)
- Tianying Wu
- Department of Nutrition, Harvard School of Public Health, Boston, USA.
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Elliott SS, Keim NL, Stern JS, Teff K, Havel PJ. Fructose, weight gain, and the insulin resistance syndrome. Am J Clin Nutr 2002; 76:911-22. [PMID: 12399260 DOI: 10.1093/ajcn/76.5.911] [Citation(s) in RCA: 646] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This review explores whether fructose consumption might be a contributing factor to the development of obesity and the accompanying metabolic abnormalities observed in the insulin resistance syndrome. The per capita disappearance data for fructose from the combined consumption of sucrose and high-fructose corn syrup have increased by 26%, from 64 g/d in 1970 to 81 g/d in 1997. Both plasma insulin and leptin act in the central nervous system in the long-term regulation of energy homeostasis. Because fructose does not stimulate insulin secretion from pancreatic beta cells, the consumption of foods and beverages containing fructose produces smaller postprandial insulin excursions than does consumption of glucose-containing carbohydrate. Because leptin production is regulated by insulin responses to meals, fructose consumption also reduces circulating leptin concentrations. The combined effects of lowered circulating leptin and insulin in individuals who consume diets that are high in dietary fructose could therefore increase the likelihood of weight gain and its associated metabolic sequelae. In addition, fructose, compared with glucose, is preferentially metabolized to lipid in the liver. Fructose consumption induces insulin resistance, impaired glucose tolerance, hyperinsulinemia, hypertriacylglycerolemia, and hypertension in animal models. The data in humans are less clear. Although there are existing data on the metabolic and endocrine effects of dietary fructose that suggest that increased consumption of fructose may be detrimental in terms of body weight and adiposity and the metabolic indexes associated with the insulin resistance syndrome, much more research is needed to fully understand the metabolic effect of dietary fructose in humans.
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Affiliation(s)
- Sharon S Elliott
- Department of Nutrition, University of California, Davis 95616, USA
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Dai S, McNeill JH. Fructose-induced hypertension in rats is concentration- and duration-dependent. J Pharmacol Toxicol Methods 1995; 33:101-7. [PMID: 7766916 DOI: 10.1016/1056-8719(94)00063-a] [Citation(s) in RCA: 134] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The present study determined the most suitable concentration and duration of fructose treatment for inducing hypertension in Wistar rats. The correlation between fructose-induced hypertension and hyperinsulinemia was also evaluated. The rats were treated with 5%, 10%, or 20% fructose in drinking water. The greatest changes, including increases in blood pressure, fluid intake, and plasma levels of insulin, glucose, and triglycerides, and a decrease in food intake following fructose treatment, were observed with the 10% solution. The times of the onset and maximum response differed for the various parameters measured. The increase in blood pressure occurred earlier than the increase in the plasma insulin level. All abnormalities disappeared rapidly after fructose withdrawal. There was no significant correlation between plasma insulin level and systolic blood pressure. In conclusion, treatment with 10% fructose in drinking water (equivalent to a diet containing 48-57% fructose) for one week or longer is appropriate for the rapid production of fructose-induced hypertension in Wistar rats, which is associated with elevated levels of plasma insulin, glucose, and triglycerides.
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Affiliation(s)
- S Dai
- Division of Pharmacology and Toxicology, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
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