Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease
Open accessAbstract
Currently, we are experiencing an epidemic of cardiorenal disease characterized by increasing rates of obesity, hypertension, the metabolic syndrome, type 2 diabetes, and kidney disease. Whereas excessive caloric intake and physical inactivity are likely important factors driving the obesity epidemic, it is important to consider additional mechanisms. We revisit an old hypothesis that sugar, particularly excessive fructose intake, has a critical role in the epidemic of cardiorenal disease. We also present evidence that the unique ability of fructose to induce an increase in uric acid may be a major mechanism by which fructose can cause cardiorenal disease. Finally, we suggest that high intakes of fructose in African Americans may explain their greater predisposition to develop cardiorenal disease, and we provide a list of testable predictions to evaluate this hypothesis.
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A 2015 meta-analysis reported a relative risk for incident CHD of 1.17 (95% CI 1.10, 1.24) per serving/d increase in SSB consumption.
“A 2015 meta-analysis reported a relative risk for incident CHD of 1.17 (95 % CI: 1.10, 1.24) per serving/d increase in SSB consumption (129).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [129]
A meta-analysis of 4 cohort studies reported a linear association between SSB and hypertension risk [RR: 1.08 (95% CI: 1.04, 1.12) per serving/d].
“A meta-analysis of 4 cohort studies reported a linear association between SSB and hypertension risk [RR: 1.08 (95 % CI: 1.04, 1.12) per serving/d] (129).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [129]
Sugars added to processed food, particularly fructose, can contribute to obesity but also appear to have properties that increase diabetes risk independently from obesity.
“Sugars added to processed food, in particular the monosaccharide fructose, can contribute to obesity [14], but also appear to have properties that increase diabetes risk independently from obesity [15].”
From The relationship of sugar to population-level diabetes prevalence: an econometric analysis of repeated cross-sectional data (2013) · cites this paper as [14]
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BackgroundUric acid in metabolic syndrome: From an innocent bystander to a central player
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- Authors
- Johnson, R. J., Segal, M. S., Sautin, Y., Nakagawa, T., Feig, D. I., Kang, D.-H., Gersch, M. S., Benner, S., & Sánchez-Lozada, L. G.
- Affiliations
- University of Florida (US)
- Baylor College of Medicine (US)
- Foundation for Applied Molecular Evolution (US)
- ORCID
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2007-10
- Volume
- 86
- Issue
- 4
- Pages
- 899-906
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2110673357
- Cited by
- 1,075
- References
- 122
- Citations by year
- 2026: 16 · 2025: 36 · 2024: 34 · 2023: 76 · 2022: 43 · 2021: 53 · 2020: 64 · 2019: 59 · 2018: 78 · 2017: 74 · 2016: 72 · 2015: 83 · 2014: 86 · 2013: 72 · 2012: 54
- FWCI
- 6.03
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL-79352, HL‑68607, R01HL079352, R01HL068607)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK 52121, R01DK052121)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- fructose, sugar consumption, cardiorenal disease, hypertension, obesity, metabolic syndrome, type 2 diabetes, kidney disease, cardiovascular disease, uric acid, African Americans
- MeSH terms
- Animals, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Fructose, Humans, Hypertension, Kidney Diseases, Obesity, Risk Factors, Sweetening Agents, Uric Acid, Comorbidity, Genetic Predisposition to Disease, Metabolic Syndrome, Hyperuricemia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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