Fructose and Cardiometabolic Health: What the Evidence from Sugar-Sweetened Beverages Tells Us

Abstract

Recent attention has focused on fructose as having a unique role in the pathogenesis cardiometabolic diseases. However since 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. Intake of these 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 risk of obesity, diabetes and cardiovascular disease addressing potential biological mechanisms with an emphasis on fructose physiology. We also discuss strategies to reduce intake of fructose-containing beverages.