Fructose-containing sugars and metabolic risk: a systematic review and meta-analysis

Prasetya Guntari; Astina Junaida; Palupi Eny; Namkieat  Pichamon; Jiamjarasrangsi Wiroj; Sapwarobol Suwimol

doi:10.29219/fnr.v69.11062

Prasetya Guntari Department of Nutrition, STIKES Mitra Keluarga, Bekasi, Indonesia https://orcid.org/0000-0001-6931-6650
Astina Junaida Noora Health Indonesia, Jakarta Selatan, Indonesia https://orcid.org/0000-0001-7004-3928
Palupi Eny Department of Community Nutrition, Faculty of Human Ecology, IPB University, Bogor, Indonesia https://orcid.org/0000-0003-2029-3106
Namkieat Pichamon The Medical Food Research Unit, Department of Nutrition and Dietetics, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
Jiamjarasrangsi Wiroj epartment of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand https://orcid.org/0000-0002-0610-6848
Sapwarobol Suwimol he Medical Food Research Unit, Department of Nutrition and Dietetics, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand

DOI: https://doi.org/10.29219/fnr.v69.11062

Keywords: fructose, glycaemic response, serum insulin, uric acid, meta-analysis

Abstract

Background: Fructose-containing sugars are widely consumed, yet their metabolic effects remain debated.

Objective: This meta-analysis aimed to evaluate the impact of different fructose-containing sugars on glycaemic control, lipid profiles, and uric acid levels in adults.

Methods: A total of 17 study codes from seven clinical trials were included, with intervention durations ranging from 7 h to 49 days. Interventions were classified as fructose, fructose-glucose mixtures (F/G), honey, or sucrose. Comparators varied and included unsweetened beverages, artificial sweeteners, and habitual diets. Meta-analyses using random-effects models assessed outcomes including fasting blood glucose (FBG), serum insulin, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), very low-density lipoprotein cholesterol (VLDL-c), and uric acid. Effect sizes were reported as Hedges’ g.

Results: Fructose-glucose mixtures intake significantly increased FBG (Hedges’ g = 0.474, P = 0.002) and serum insulin (Hedges’ g = 0.592, P < 0.001), while fructose, honey, and sucrose showed no significant effects. Monosaccharide intake modestly increased insulin (P = 0.006). Fructose and sucrose alone did not affect TC, but their combined intake resulted in a significant increase (Hedges’ g = 0.412, P = 0.009). No significant changes were observed in LDL-c, VLDL-c, or pooled metabolic outcomes. Fructose intake was strongly associated with increased uric acid (Hedges’ g = 1.628, P < 0.001), and pooled analysis of fructose, F/G, and honey also showed a significant increase (Hedges’ g = 0.550, P = 0.028).

Conclusion: The short-term consumption of added sugars – fructose, sucrose, and F/G mixtures – had minimal effects on FBG, insulin, triglycerides (TG), non-esterified fatty acids (NEFAs), high-density lipoprotein cholesterol (HDL-c), and VLDL-c. However, significant increases in TC and LDL-c were observed, particularly with fructose and sucrose, indicating adverse effects on lipid metabolism. Some fructose interventions, especially those using high-fructose corn syrup, also showed marked increases in uric acid. While acute metabolic changes were limited, these findings suggest that regular intake of added sugars may elevate cardiometabolic risk. Long-term studies are warranted to clarify chronic effects and inform dietary guidelines.

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