Heterogeneous effects of fructose on blood lipids in individuals with type 2 diabetes: systematic review and meta-analysis of experimental trials in humans.

Description

In this paper, Sievenpiper et al. have conducted a systematic review and meta-analysis of 16 trials investigating the effect of isocaloric fructose exchange for carbohydrate on plasma triglyceride (TG), total cholesterol, LDL cholesterol and HDL cholesterol levels in 236 subjects with type 2 diabetes. Isocaloric fructose exchange for carbohydrate was found to raise triglycerides and reduce total cholesterol with no other lipid effect. Fructose raised TG in isocaloric exchange for starch but not for sucrose or mixed carbohydrate sources in type 2 diabetes. Analysis of dose thresholds suggested a dose breakpoint of 60 g/day (R2 =0.13). A total cholesterol-lowering effect was only seen in type 2 diabetes under the following conditions: no randomization and poor quality study. In conclusion, fructose used as a nutritional sweetener seems to have a modest TG-raising effect in patients with type 2 diabetes at doses >60g/day with a follow-up of up to 4 weeks or when the reference carbohydrate is starch. Further studies are warranted to address the heterogeneity in the patients’ response.