The effect of fructose consumption on plasma cholesterol in adults: a meta-analysis of controlled feeding trials1,2,3
Tao An4,5, Rong Cheng Zhang4,5, Yu Hui Zhang4, Qiong Zhou4, Yan Huang4, Jian Zhang4, *.
4 State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
5Tao An and Rong Cheng Zhang contributed equally to this study.
3 Supplemental Table 1 and supplemental Figures 1-
4 are available as Online Supporting Material with the online posting of this paper at
RUNNING TITLE: Fructose and cholesterol
WORD COUNT: 5618; NUMBER OF FIGUREA: 3; NUMBER OF TABLES: 2 SUPPLEMENTARY MATERIAL: Online Supporting Materials: 5
AUTHOR LIST FOR INDEXING: An, Zhang, Zhang, Zhou, Huang, Zhang
1 The study was supported by the Ministry of Science and Technology of China with grant of the National High-tech Research and Development Program of China to Dr Jian Zhang.
2 Author disclosures: T. An, R.C. Zhang, Y.H. Zhang, Q. Zhou, Y. Hung, J. Zhang
have no conflicts of interest.
* To whom correspondence should be addressed. Mailing address: Heart Failure
Center, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, 167 Beilishilu, Beijing, China; Zip code: 100000; Telephone number: 86-10-88396180; Fax number: 86-10-88396180; E-mail: Fwzhangjian62@
PROSPERO REGISTRATION NUMBERS: CRD42012003351
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ABSTRACT
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Fructose is widely used as a sweetener in production of many foods, yet the relation 3
between fructose intake and cholesterol remains uncertain. We performed a systematic 4
review and meta-analysis of human controlled feeding trials of isocaloric fructose 5
exchange for other carbohydrates to quantify the effects of fructose on total 6
cholesterol (TC), LDL cholesterol (LDL-C), and HDL cholesterol (HDL-C) in adult 7
humans. Weighted mean differences were calculated for changes from baseline 8
cholesterol concentrations by using generic inverse variance random-effects models. 9
The Heyland Methodological Quality was used to assess study quality. Subgroup 10
analyses and meta-regression were conducted to explore possible influence of study 11
characteristics. Twenty-four trials (with a total of 474 subjects) were included in our 12
meta-analysis. In an overall pooled estimate, fructose exerted no effect on TC, LDL-C 13
and HDL-C. Meta-regression analysis indicated that fructose dose was positively 14
correlated with the effect sizes of TC and LDL-C. Subgroup analyses showed that 15
isocaloric fructose exchange for carbohydrates could significantly increase TC by 16
12.97 mg/dL (95%CI: 4.66, 21.29; P = 0.002) and LDL-C by 11.59 mg/dL (95%CI: 17
4.39, 18.78; P = 0.002) at >100g fructose/d but had no effect on TC and LDL-C when 18
fructose intake was ≤100g/d. In conclusion, very high fructose intake (>100g/d) 19
could lead to significantly increase in serum LDL-C and TC. Larger, longer and 20
higher-quality human controlled feeding trials are needed to confirm these results.
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Key words: fructose, cholesterol, meta-analysis
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