Abstract P056: Fructose Intake May Decrease Diastolic and Mean Arterial Blood Pressure: A Systematic Review and Meta-analysis of Controlled Feeding Trials
Background: Concerns have been raised about the adverse effect of fructose on blood pressure. International dietary guidelines for the prevention of hypertension, however, have not addressed fructose intake directly.
Purpose: A systematic review and meta-analysis was conducted to assess the effect of fructose in isocaloric exchange for other carbohydrate on systolic (SBP), diastolic (DBP), and mean arterial blood pressure (MAP).
Hypothesis: We hypothesized fructose intake in isocaloric and hypercaloric exchange for other carbohydrate sources would not have a significant effect on SBP, DBP, and MAP.
Methods: Studies were identified using MEDLINE, EMBASE, and Cochrane databases (through September 29 2011). Human clinical trials that investigated isocaloric oral fructose exchange for other carbohydrate sources for at least 7 days were included in the analysis. A generic inverse variance method using random effects weighting was used to pool data. Pooled data were expressed as mean differences (MD) with 95% confidence intervals. Heterogeneity was assessed by the Q statistic and quantified by I2. Study quality was assessed using the Heyland Methodological Quality Score (MQS).
Results: Thirteen isocaloric (n= 325 participants) and two hypercaloric (n= 24) trials met the eligibility criteria. Overall, fructose intake in isocaloric exchange for other carbohydrate decreased DBP (MD=−1.40 [95% CI: −2.69, −0.10]) and MAP (MD= −1.16 [95% CI: −2.11, −0.20]). There was no significant effect of fructose on SBP (MD= −1.05 [95% CI: −2.46, 0.36]). However, subgroup analyses revealed potentially important heterogeneous findings. In a priori subgroups, fructose format (fluid) was a significant modifier of the SBP effect. The effects of both DBP and MAP were modified by aspects of study design (non-randomization, parallel design) and study quality (MQS <8). Furthermore, the DBP effect was modified under conditions of follow-up >4weeks and MAP by carbohydrate comparator (high fructose corn syrup). The two hypercaloric fructose feeding trials found no significant MAP effect of fructose in comparison to other carbohydrate. Limitations: A small number of isocaloric trials and two hypercaloric trials were included, limiting the strength of the conclusion.
Conclusion: Contrary to previous concerns, we found isocaloric substitution of fructose for other carbohydrate did not adversely affect SBP, DBP, or MAP in humans. Further larger and longer trials are needed to confirm results.
- © 2012 by American Heart Association, Inc.