Total Fructose Intake and Risk of Hypertension: A Systematic Review and Meta-Analysis of Prospective Cohorts

Viranda H. Jayalath, John L. Sievenpiper, Russell J. de Souza, Vanessa Ha, Arash Mirrahimi, Ingrid D. Santaren, Sonia Blanco Mejia, Marco Di Buono, Alexandra L. Jenkins, Lawrence A. Leiter, Thomas M. S. Wolever, Joseph Beyene (+2 others)
2014 Journal of the American College of Nutrition  
Objectives: Although most controlled feeding trials have failed to show an adverse effect of fructose on blood pressure, concerns continue to be raised regarding the role of fructose in hypertension. To quantify the association between fructose-containing sugar (high-fructose corn syrup, sucrose, and fructose) intake and incident hypertension, a systematic review and meta-analysis of prospective cohort studies was undertaken. Methods: MEDLINE, EMBASE, CINAHL and the Cochrane Library (through
more » ... ruary 5, 2014) were searched for relevant studies. Two independent reviewers reviewed and extracted relevant data. Risk estimates were aggregated comparing the lowest (reference) quintile with highest quintile of intake using inverse variance random effect models and expressed as risk ratios (RR) with 95% confidence intervals (CIs). Interstudy heterogeneity was assessed (Cochran Q statistic) and quantified (I 2 statistic). The Newcastle-Ottawa Scale assessed study quality. Clinicaltrials.gov NCT01608620. Results: Eligibility criteria were met by 3 prospective cohorts (n = 37,375 men and 185,855 women) with 58,162 cases of hypertension observed over 2,502,357 person-years of follow-up. Median fructose intake was 5.7-6.0% total energy in the lowest quintile and 13.9-14.3% total energy in the highest quintile. Fructose intake was not associated with incident hypertension (RR = 1.02, 95% CI, 0.99-1.04), with no evidence of heterogeneity (I 2 = 0%, p = 0.59). Spline curve modeling showed a U-shaped relationship with a negative association at intakes ≤50th percentile (∼10% total energy) and a positive association at higher intakes. Conclusions: Total fructose intake was not associated with an increased risk of hypertension in 3 large prospective cohorts of U.S. men and women. and cardiovascular morbidity [3]. Treatment of hypertension and its associated complications is estimated to account for 10% the health budget of developed countries [4] . Despite its high prevalence, blood pressure remains highly modifiable, particularly through diet and lifestyle interventions [3] [4] [5] [6] . A Calculated by adding number of cases through all quintiles. † †Calculated by adding number of person-years through all quintiles. ‡ ‡Quality score was assessed using the NewCastle-Ottawa Assessment Scale for Cohort Studies, where a maximum of 9 points can be awarded. § §Agency funding is that from government, university, or not-for-profit health agency.
doi:10.1080/07315724.2014.916237 pmid:25144126 pmcid:PMC4261182 fatcat:powkf2lyqrh2lmdebmfugiqmx4