Fructose and Cardiometabolic Health
Open accessAbstract
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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Evidence has shown a positive relationship between SSB consumption and type 2 diabetes among adults.
“While evidence has shown a positive relationship between SSB consumption and type 2 diabetes among adults [5, 12, 109], the available literature among child and adolescents is limited.”
From The negative impact of sugar-sweetened beverages on children’s health: an update of the literature (2018) · cites this paper as [109]
High and habitual consumption of sugar-sweetened beverages is associated with an increased risk of developing type 2 diabetes, independent of total energy intake or body mass.
“The outcomes of epidemiological studies indicate that high and habitual consumption of sugar-sweetened beverages is associated with an increased risk of developing type 2 diabetes, independent of total energy intake or body mass (77,82).”
From Gut mechanisms linking intestinal sweet sensing to glycemic control (2018) · cites this paper as [77]
This rapid digestion may induce multiple adverse effects, potentially stimulating reward/craving areas in the brain, activating hepatic de novo lipogenesis, increasing uric acid production, and promoting visceral adiposity.
“This rapid digestion may induce multiple adverse effects, potentially stimulating reward/craving areas in the brain, activating hepatic de novo lipogenesis, increasing uric acid production, and promoting visceral adiposity.49, 162-166”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [166]
High doses of rapidly digested glucose induce postprandial hyperglycemia, hyperinsulinemia, and related metabolic disturbances.
“High doses of rapidly digested glucose induce postprandial hyperglycemia, hyperinsulinemia, and related metabolic disturbances.”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [166]
There are important metabolic differences between glucose and fructose.
“In contrast, there are important metabolic differences between glucose and fructose – each equally present in both high-fructose corn syrup and natural sugar (sucrose).”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [166]
There are few expected or observed physiologic or health differences between high-fructose corn syrup vs. sucrose.
“Consequently, there are few expected or observed physiologic or health differences between high-fructose corn syrup vs. sucrose.165, 166, 334”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [166]
High doses of rapidly digested fructose have little influence on blood glucose or insulin levels, but more directly stimulate hepatic de novo lipogenesis, hepatic and visceral adiposity, and uric acid production.
“In comparison, high doses of rapidly digested fructose have little influence on blood glucose or insulin levels, but more directly stimulate hepatic de novo lipogenesis, hepatic and visceral adiposity, and uric acid production.164-166”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [166]
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- Authors
- Malik, V. S., & Hu, F. B.
- Affiliations
- Harvard University (US)
- Corresponding author
- Hu, Frank B.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 66
- Issue
- 14
- Pages
- 1615-1624
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC4592517
- OpenAlex
- W1759512595
- Cited by
- 408
- References
- 68
- Citations by year
- 2026: 14 · 2025: 30 · 2024: 40 · 2023: 51 · 2022: 44 · 2021: 40 · 2020: 56 · 2019: 32 · 2018: 30 · 2017: 34 · 2016: 37
- FWCI
- 5.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (DK46200)
- National Heart, Lung, and Blood Institute (HL60712, R01HL060712)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK058845, P30DK046200, P30 DK-46200)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Biochemical Analysis and Sensing Techniques
- Keywords
- fructose, cardiometabolic disease, sugar-sweetened beverages, added sugars, high fructose corn syrup, sucrose, obesity, type 2 diabetes, cardiovascular disease, de novo lipogenesis, uric acid, visceral fat, ectopic fat, glycemic effects
- MeSH terms
- Adolescent, Adult, Beverages, Energy Intake, Cardiovascular Diseases, Child, Child, Preschool, Diabetes Mellitus, Type 2, Dietary Carbohydrates, Feeding Behavior, Fructose, Humans, Obesity, Sweetening Agents, Young Adult
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