Cited by 561Diet, Metabolism, and DiseaseLiver Disease Diagnosis and TreatmentAdipokines, Inflammation, and Metabolic Diseases

Fructose metabolism and metabolic disease

Open access
Hannou, Sarah A., Haslam, Danielle E., McKeown, Nicola M., Herman, Mark A.·2018·Journal of Clinical Investigation

Abstract

Increased sugar consumption is increasingly considered to be a contributor to the worldwide epidemics of obesity and diabetes and their associated cardiometabolic risks. As a result of its unique metabolic properties, the fructose component of sugar may be particularly harmful. Diets high in fructose can rapidly produce all of the key features of the metabolic syndrome. Here we review the biology of fructose metabolism as well as potential mechanisms by which excessive fructose consumption may contribute to cardiometabolic disease.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1172/jci96702

Cites

24 of 24 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • High dietary fructose intake has been proposed to induce adverse health effects and has been associated with the development of metabolic disease.

    “It should be noted that high dietary fructose intake has been proposed to induce adverse health effects and has been associated with the development of metabolic disease (Hannou et al. 2018; Tappy, 2018).”

    From Fructose co‐ingestion to increase carbohydrate availability in athletes (2019) · cites this paper as Hannou et al. 2018

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Part of this paper’s reference list could not be split into single entries.

Flagged first, then by citations

Research works printed but not linked: 83

  1. Kit BK, Fakhouri TH, Park S, Nielsen SJ, Ogden CL. Trends in sugar-sweetened beverage consumption among youth and adults in the United States: 1999-2010. Am J Clin Nutr. 2013;98(1):180-188. · DOI
  2. Rosinger A, Herrick K, Gahche J, Park S. Sugar- sweetened beverage consumption among U.S. youth, 2011-2014. NCHS Data Brief. 2017(271):1-8.
  3. Vos MB, et al. Added sugars and cardiovascular disease risk in children: a scientific statement from the American Heart Association. Circula- tion. 2017;135(19):e1017-e1034. · DOI
  4. Ter Horst KW, Serlie MJ. Fructose consumption, lipogenesis, and non-alcoholic fatty liver disease. Nutrients. 2017;9(9):E981.
  5. Stanhope KL. Sugar consumption, metabolic disease and obesity: the state of the controversy. Crit Rev Clin Lab Sci. 2016;53(1):52-67. · DOI · Paper page
  6. Ma J, McKeown NM, Hwang SJ, Hoffmann U, Jacques PF, Fox CS. Sugar-sweetened beverage consumption is associated with change of viscer- al adipose tissue over 6 years of follow-up. Circu- lation. 2016;133(4):370-377. · DOI
  7. Green AK, Jacques PF, Rogers G, Fox CS, Meigs JB, McKeown NM. Sugar-sweetened beverages and prevalence of the metabolically abnormal phenotype in the Framingham Heart Study. Obe- sity (Silver Spring). 2014;22(5):E157-E163. · DOI
  8. de Koning L, Malik VS, Kellogg MD, Rimm EB, Willett WC, Hu FB. Sweetened beverage consumption, incident coronary heart disease, and biomarkers of risk in men. Circulation. 2012;125(14):1735-1741. · DOI · Paper page
  9. Hert KA, Fisk PS, Rhee YS, Brunt AR. Decreased consumption of sugar-sweetened beverages improved selected biomarkers of chronic disease risk among US adults: 1999 to 2010. Nutr Res. 2014;34(1):58-65. · DOI
  10. Dhingra R, et al. Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation. 2007;116(5):480-488. · DOI · Paper page
  11. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988;37(12):1595-1607.
  12. Stanhope KL, et al. Consuming fructose-sweet- ened, not glucose-sweetened, beverages increas- es visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009;119(5):1322-1334. · DOI · Paper page
  13. Kuzma JN, et al. No differential effect of beverag- es sweetened with fructose, high-fructose corn syrup, or glucose on systemic or adipose tissue inflammation in normal-weight to obese adults: a randomized controlled trial. Am J Clin Nutr. 2016;104(2):306-314. · DOI
  14. Marriott BP, Cole N, Lee E. National estimates of dietary fructose intake increased from 1977 to 2004 in the United States. J Nutr. 2009;139(6):1228S-1235S. · DOI · Paper page
  15. Chung M, Ma J, Patel K, Berger S, Lau J, Lichtenstein AH. Fructose, high-fructose corn syrup, sucrose, and nonalcoholic fatty liver disease or indexes of liver health: a systematic review and meta-analysis. Am J Clin Nutr. 2014;100(3):833-849. · DOI
  16. Stanhope KL, et al. A dose-response study of consuming high-fructose corn syrup-sweetened beverages on lipid/lipoprotein risk factors for cardiovascular disease in young adults. Am J Clin Nutr. 2015;101(6):1144-1154. · DOI · Paper page
  17. Stanhope KL, Schwarz JM, Havel PJ. Adverse met- abolic effects of dietary fructose: results from the recent epidemiological, clinical, and mechanistic studies. Curr Opin Lipidol. 2013;24(3):198-206. · DOI
  18. Patel C, Douard V, Yu S, Gao N, Ferraris RP. Transport, metabolism, and endosomal trafficking- dependent regulation of intestinal fructose absorption. FASEB J. 2015;29(9):4046-4058. · DOI
  19. Barone S, et al. Slc2a5 (Glut5) is essential for the absorption of fructose in the intestine and gen- eration of fructose-induced hypertension. J Biol Chem. 2009;284(8):5056-5066. · DOI
  20. Gibson PR, Newnham E, Barrett JS, Shepherd SJ, Muir JG. Review article: Fructose malabsorption and the bigger picture. Aliment Pharmacol Ther. 2007;25(4):349-363.
  21. Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc. 2009;109(7):1204-1214. · DOI
  22. Rumessen JJ. Fructose and related food car- bohydrates. Sources, intake, absorption, and clinical implications. Scand J Gastroenterol. 1992;27(10):819-828. · DOI
  23. Rumessen JJ, Gudmand-Høyer E. Absorption capacity of fructose in healthy adults. Compar- ison with sucrose and its constituent monosac- charides. Gut. 1986;27(10):1161-1168. · DOI
  24. Skoog SM, Bharucha AE. Dietary fructose and gastrointestinal symptoms: a review. Am J Gastro- enterol. 2004;99(10):2046-2050. · DOI
  25. Dotimas JR, et al. Diabetes regulates fructose absorption through thioredoxin-interacting pro- tein. Elife. 2016;5:e18313.
  26. Iizuka K, Bruick RK, Liang G, Horton JD, Uyeda K. Deficiency of carbohydrate response ele- ment-binding protein (ChREBP) reduces lipo- genesis as well as glycolysis. Proc Natl Acad Sci U S A. 2004;101(19):7281-7286. · DOI
  27. Kim M, et al. Intestinal, but not hepatic, ChREBP is required for fructose tolerance. JCI Insight. 2017;2(24):e96703.
  28. Sugimoto K, et al. Lowering of postprandial hyperfructosemia in humans by eucalyptus leaf jci.org Volume 128 Number 2 February 2018 extract: a randomized, double-blind, placebo- controlled crossover study. Food Sci Technol Res. 2010;16(5):509-512. · DOI
  29. Wahjudi PN, Patterson ME, Lim S, Yee JK, Mao CS, Lee WN. Measurement of glucose and fruc- tose in clinical samples using gas chromatogra- phy/mass spectrometry. Clin Biochem. 2010; 43(1-2):198-207.
  30. Preston GM, Calle RA. Elevated serum sorbitol and not fructose in type 2 diabetic patients. Bio- mark Insights. 2010;5:33-38.
  31. Tappy L, Lê KA. Does fructose consumption con- tribute to non-alcoholic fatty liver disease? Clin Res Hepatol Gastroenterol. 2012;36(6):554-560. · DOI
  32. Sugimoto K, et al. Eucalyptus leaf extract sup- presses the postprandial elevation of portal, car- diac and peripheral fructose concentrations after sucrose ingestion in rats. J Clin Biochem Nutr. 2010;46(3):205-211. · DOI
  33. Manolescu AR, Witkowska K, Kinnaird A, Cess- ford T, Cheeseman C. Facilitated hexose trans- porters: new perspectives on form and function. Physiology (Bethesda). 2007;22:234-240.
  34. Wood IS, Trayhurn P. Glucose transporters (GLUT and SGLT): expanded families of sugar transport proteins. Br J Nutr. 2003;89(1):3-9. · DOI · Paper page
  35. Karim S, Adams DH, Lalor PF. Hepatic expres- sion and cellular distribution of the glucose transporter family. World J Gastroenterol. 2012;18(46):6771-6781. · DOI · Paper page
  36. Debosch BJ, Chen Z, Saben JL, Finck BN, Moley KH. Glucose transporter 8 (GLUT8) mediates fruc- tose-induced de novo lipogenesis and macroste- atosis. J Biol Chem. 2014;289(16):10989-10998. · DOI
  37. Boscá L, Corredor C. Is phosphofructokinase the rate-limiting step of glycolysis? Trends Biochem Sci. 1984;9(9):372-373. · DOI
  38. Hers HG, Van Schaftingen E. Fructose 2,6-bis- phosphate 2 years after its discovery. Biochem J. 1982;206(1):1-12. · DOI
  39. Sestoft L, Fleron P. Determination of the kinetic constants of fructose transport and phosphory- lation in the perfused rat liver. Biochim Biophys Acta. 1974;345(1):27-38. · DOI
  40. Sahebjami H, Scalettar R. Effects of fructose infusion on lactate and uric acid metabolism. Lancet. 1971;1(7695):366-369.
  41. Burch HB, Max P, Ghyu K, Lowry OH. Metabolic intermediates in liver of rats given large amounts of fructose or dihydroxyacetone. Biochem Biophys Res Commun. 1969;34(5):619-626. · DOI
  42. Topping DL, Mayes PA. Comparative effects of fructose and glucose on the lipid and carbohy- drate metabolism of perfused rat liver. Br J Nutr. 1976;36(1):113-126. · DOI
  43. Mavrias DA, Mayer RJ. Metabolism of fructose in the small intestine. 1. The effect of fructose feeding on fructose transport and metabolism in rat small intestine. Biochim Biophys Acta. 1973;291(2):531-537. · DOI
  44. Ginsburg V, Hers HG. On the conversion of fruc- tose to glucose by guinea pig intestine. Biochim Biophys Acta. 1960;38:427-434. · DOI
  45. Cui XL, Soteropoulos P, Tolias P, Ferraris RP. Fructose-responsive genes in the small intestine of neonatal rats. Physiol Genomics. 2004;18(2):206-217. · DOI
  46. Patel C, Douard V, Yu S, Tharabenjasin P, Gao N, Ferraris RP. Fructose-induced increases in expression of intestinal fructolytic and gluco- neogenic genes are regulated by GLUT5 and KHK. Am J Physiol Regul Integr Comp Physiol. 2015;309(5):R499-R509. · DOI
  47. Bismut H, Hers HG, Van Schaftingen E. Con- version of fructose to glucose in the rabbit small intestine. A reappraisal of the direct pathway. Eur J Biochem. 1993;213(2):721-726. · DOI
  48. Holdsworth CD, ed. Sugars in Nutrition. New York, New York, USA: Raven Press; 1991.
  49. Brown KS, Kalinowski SS, Megill JR, Durham SK, Mookhtiar KA. Glucokinase regulatory protein may interact with glucokinase in the hepatocyte nucleus. Diabetes. 1997;46(2):179-186.
  50. Agius L. Glucokinase and molecular aspects of liver glycogen metabolism. Biochem J. 2008;414(1):1-18. · DOI
  51. McGuinness OP, Cherrington AD. Effects of fruc- tose on hepatic glucose metabolism. Curr Opin Clin Nutr Metab Care. 2003;6(4):441-448.
  52. Thurston JH, Jones EM, Hauhart RE. Decrease and inhibition of liver glycogen phosphorylase after fructose. An experimental model for the study of hereditary fructose intolerance. Diabe- tes. 1974;23(7):597-604. · DOI
  53. Van Den Berghe G, Hue L, Hers HG. Effect of administration of the fructose on the glycogeno- lytic action of glucagon. An investigation of the pathogeny of hereditary fructose intolerance. Biochem J. 1973;134(2):637-645. · DOI
  54. Eggleston LV, Woods HF. Activation of liver pyru- vate kinase by fructose-1-phosphate. FEBS Lett. 1970;6(1):43-45. · DOI · Paper page
  55. Van Schaftingen E. A protein from rat liver confers to glucokinase the property of being antagonistically regulated by fructose 6-phos- phate and fructose 1-phosphate. Eur J Biochem. 1989;179(1):179-184. · DOI
  56. Lanaspa MA, Tapia E, Soto V, Sautin Y, Sán- chez-Lozada LG. Uric acid and fructose: poten- tial biological mechanisms. Semin Nephrol. 2011;31(5):426-432. · DOI
  57. van den Berghe G, Bronfman M, Vanneste R, Hers HG. The mechanism of adenosine tri- phosphate depletion in the liver after a load of fructose. A kinetic study of liver adenylate deam- inase. Biochem J. 1977;162(3):601-609. · DOI
  58. Raivio KO, Becker MA, Meyer LJ, Greene ML, Nuki G, Seegmiller JE. Stimulation of human purine synthesis de novo by fructose infusion. Metab Clin Exp. 1975;24(7):861-869. · DOI
  59. Jamnik J, et al. Fructose intake and risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies. BMJ Open. 2016;6(10):e013191. · DOI
  60. Liu M, et al. Association between serum uric acid level and metabolic syndrome and its sex differ- ence in a chinese community elderly population. Int J Endocrinol. 2014;2014:754678.
  61. Puig JG, Martínez MA. Hyperuricemia, gout and the metabolic syndrome. Curr Opin Rheumatol. 2008;20(2):187-191. · DOI
  62. Lanaspa MA, et al. Uric acid induces hepatic steatosis by generation of mitochondrial oxida- tive stress: potential role in fructose- dependent and -independent fatty liver. J Biol Chem. 2012;287(48):40732-40744. · DOI
  63. Sautin YY, Nakagawa T, Zharikov S, Johnson RJ. Adverse effects of the classic antioxidant uric acid in adipocytes: NADPH oxidase-mediated oxidative/nitrosative stress. Am J Physiol Cell Physiol. 2007;293(2):C584-C596. · DOI
  64. Tapia E, et al. Synergistic effect of uricase blockade plus physiological amounts of fruc- tose-glucose on glomerular hypertension and oxidative stress in rats. Am J Physiol Renal Physiol. 2013;304(6):F727-F736. · DOI
  65. Choi YJ, et al. Uric acid induces endothelial dys- function by vascular insulin resistance associated with the impairment of nitric oxide synthesis. FASEB J. 2014;28(7):3197-3204. · DOI
  66. Lanaspa MA, et al. Uric acid stimulates fruc- tokinase and accelerates fructose metabolism in the development of fatty liver. PLoS One. 2012;7(10):e47948. · DOI
  67. Li X, et al. Serum uric acid levels and multiple health outcomes: umbrella review of evidence from observational studies, randomised con- trolled trials, and Mendelian randomisation stud- ies. BMJ. 2017;357:j2376.
  68. Belfiore F, Romeo F, Iannello S, Salamone C. The glucose-6-phosphatase/glucokinase ratio in the liver of obese-diabetic subjects. Biochem Med Metab Biol. 1989;41(1):77-80. · DOI
  69. Huupponen R, Karvonen I, Sotaniemi E. Activity of hepatic glucose phosphorylating and NADPH generating enzymes in Zucker rats. Diabetes Res. 1989;10(3):143-146.
  70. Bonthron DT, Brady N, Donaldson IA, Stein- mann B. Molecular basis of essential fructosuria: molecular cloning and mutational analysis of human ketohexokinase (fructokinase). Hum Mol Genet. 1994;3(9):1627-1631. · DOI
  71. Hayward BE, Bonthron DT. Structure and alter- native splicing of the ketohexokinase gene. Eur J Biochem. 1998;257(1):85-91. · DOI
  72. Diggle CP, et al. Ketohexokinase: expression and localization of the principal fructose- metabolizing enzyme. J Histochem Cytochem. 2009;57(8):763-774. · DOI
  73. Asipu A, Hayward BE, O'Reilly J, Bonthron DT. Properties of normal and mutant recombinant human ketohexokinases and implications for the pathogenesis of essential fructosuria. Diabetes. 2003;52(9):2426-2432. · DOI
  74. Ishimoto T, et al. Opposing effects of fructoki- nase C and A isoforms on fructose-induced metabolic syndrome in mice. Proc Natl Acad Sci U S A. 2012;109(11):4320-4325. · DOI
  75. Steinitz H, Mizrahy O. Essential fructosuria and hereditary fructose intolerance. N Engl J Med. 1969;280(4):222.
  76. Softic S, et al. Divergent effects of glucose and fructose on hepatic lipogenesis and insulin sig- naling. J Clin Invest. 2017;127(11):4059-4074. · DOI
  77. Mirtschink P, et al. HIF-driven SF3B1 induces KHK-C to enforce fructolysis and heart disease. Nature. 2015;522(7557):444-449. · DOI
  78. Li X, et al. A splicing switch from ketohexoki- nase-C to ketohexokinase-A drives hepato- cellular carcinoma formation. Nat Cell Biol. 2016;18(5):561-571. · DOI
  79. Hers HG, Joassin G. [Anomaly of hepatic aldolase in intolerance to fructose]. Enzymol Biol Clin (Basel). 1961;1:4-14. · DOI
  80. Ali M, Rellos P, Cox TM. Hereditary fructose intolerance. J Med Genet. 1998;35(5):353-365. · DOI
  81. Oppelt SA, Sennott EM, Tolan DR. Aldolase-B knockout in mice phenocopies hereditary fruc- tose intolerance in humans. Mol Genet Metab. 2015;114(3):445-450. · DOI
  82. Spangler R, Wittkowski KM, Goddard NL, Avena NM, Hoebel BG, Leibowitz SF. Opiate-like effects of sugar on gene expression in reward areas of the rat brain. Brain Res Mol Brain Res. 2004;124(2):134-142. 168. Tellez LA, et al. Separate circuitries encode the hedonic and nutritional values of sugar. Nat Neu- rosci. 2016;19(3):465-470. 169. Shapiro A, Mu W, Roncal C, Cheng KY, Johnson RJ, Scarpace PJ. Fructose-induced leptin resis- tance exacerbates weight gain in response to subsequent high-fat feeding. Am J Physiol Regul Integr Comp Physiol. 2008;295(5):R1370-R1375. 170. · DOI
  83. Chotiwat C, Sharp C, Teff K, Harris RBS. Feeding a high-fructose diet induces leptin resistance in rats. Appetite. 2007;49(1):284. 171. Teff KL, et al. Dietary fructose reduces cir- culating insulin and leptin, attenuates post- prandial suppression of ghrelin, and increases triglycerides in women. J Clin Endocrinol Metab. 2004;89(6):2963-2972. 172. Luo S, Monterosso JR, Sarpelleh K, Page KA. Differential effects of fructose versus glucose on brain and appetitive responses to food cues and decisions for food rewards. Proc Natl Acad Sci U S A. 2015;112(20):6509-6514. 173. Page KA, et al. Effects of fructose vs glucose on regional cerebral blood flow in brain regions involved with appetite and reward pathways. JAMA. 2013;309(1):63-70. 174. · DOI · Paper page

Cited by

Sorted by citations

Authors
Hannou, S. A., Haslam, D. E., McKeown, N. M., & Herman, M. A.
Affiliations
  • Duke University (US)
  • Tufts University (US)
Corresponding author
Herman, Mark A.
Venue
Journal of Clinical Investigation
Published
2018-02-01
Volume
128
Issue
2
Pages
545-555
ISSN
  • 0021-9738 (ISSN-L)
  • 1558-8238
OpenAlex
W2785515118
Cited by
561
References
24
Citations by year
2026: 45 · 2025: 73 · 2024: 65 · 2023: 67 · 2022: 88 · 2021: 105 · 2020: 67 · 2019: 37 · 2018: 13 · 2014: 1
FWCI
8.54
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Investigation (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • DukeSpace (Duke University) (submittedVersion, cc-by-nc-nd)
Funders
  • U.S. Department of Agriculture (58-1950-4-003)
  • American Heart Association (16CSA28590003)
  • National Institutes of Health
  • Agricultural Research Service (58-1950-4-003)
  • National Heart, Lung, and Blood Institute (T32HL069772)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100425)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
Keywords
fructose metabolism, fructose consumption, metabolic syndrome, obesity, diabetes mellitus, cardiometabolic disease, sugar consumption
MeSH terms
Sugars, Animals, Fructose, Glucose, Humans, Hypertension, Liver, Risk Factors, Gene Expression Profiling, Metabolic Syndrome, Adiposity, Glucose Transporter Type 2

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.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review