Elsevier

Advances in Nutrition

Volume 4, Issue 2, March 2013, Pages 246-256
Advances in Nutrition

Challenging the Fructose Hypothesis: New Perspectives on Fructose Consumption and Metabolism

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Abstract

The field of sugar metabolism, and fructose metabolism in particular, has experienced a resurgence of interest in the past decade. The “fructose hypothesis” alleges that the fructose component common to all major caloric sweeteners (sucrose, high-fructose corn syrup, honey, and fruit juice concentrates) plays a unique and causative role in the increasing rates of cardiovascular disease, hypertension, diabetes, cancer, and nonalcoholic fatty liver disease. This review challenges the fructose hypothesis by comparing normal U.S. levels and patterns of fructose intake with contemporary experimental models and looking for substantive cause-and-effect evidence from real-world diets. It is concluded that 1) fructose intake at normal population levels and patterns does not cause biochemical outcomes substantially different from other dietary sugars and 2) extreme experimental models that feature hyperdosing or significantly alter the usual dietary glucose-to-fructose ratio are not predictive of typical human outcomes or useful to public health policymakers. It is recommended that granting agencies and journal editors require more physiologically relevant experimental designs and clinically important outcomes for fructose research.

Abbreviations used

CVD
cardiovascular disease
% E
percentage of total energy
HFCS
high-fructose corn syrup
SSB
sugar-sweetened beverage

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Presented at the symposium “Fructose, Sucrose and High Fructose Corn Syrup. Modern Scientific Findings and Health Implications,” held April 22, 2012, at the ASN Scientific Sessions and Annual Meeting at Experimental Biology 2012 in San Diego, CA. The symposium was sponsored by the American Society for Nutrition and supported in part by an educational grant from the Corn Refiners Association. A summary of the symposium “Fructose, Sucrose and High Fructose Corn Syrup. Modern Scientific Findings and Health Implications” was published in the September 2012 issue of Advances in Nutrition.

Partial funding was also received from the American Society for Nutrition.

Author disclosures: J. S. White: As a consultant and advisor to the food and beverage industry in the area of nutritive sweeteners, the author receives compensation from scientific societies, research institutes, food industry councils, trade organizations, and individual companies. Clients have an ongoing interest in nutritive sweetener research, development, production, applications, safety, nutrition, and education.