The association of sugar-sweetened beverages with an increased risk of metabolic syndrome does not extend to other sources of fructose-containing sugars, researchers found.
In fact, those researchers found that yogurt and fruit were associated with a reduced risk of metabolic syndrome.
The study by Zhila Semnani-Azad, BSc, Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, and colleagues, was published in JAMA Network Open.
It is well known that consumption of fructose-containing sugars such as sucrose and high-fructose corn syrup are contributing factors to an increased metabolic syndrome (MetS) risk and that sugar-sweetened beverages (SSBs) are associated with an increased incidence of MetS. However, Semnani-Azad and colleagues pointed out that the role that other sources of fructose-containing sugars play in MetS is not entirely clear.
Here, the authors conducted a systematic review and dose-response meta-analysis of 13 prospective cohort studies in order to evaluate the association of those food sources of fructose-containing sugars and incident MetS.
The studies included 49,591 participants (median age 51), 14,205 of whom had MetS. The inclusion criteria included prospective cohort studies of 1 year or longer that evaluated the association of food sources of fructose-containing sugars with incident MetS in participants who were free of MetS when the study started.
Eight different sources of fructose-containing sugars were identified within the 13 studies, including sugar free beverages, 100% fruit juice, mixed fruit juice, yogurt, fruit, honey, ice cream, and confectionary.
Semnani-Azad and colleagues found an adverse linear dose-response association for sugar-sweetened beverages with MetS (RR for 355 mL/d, 1.14; 95% CI, 1.05-1.23) and an L-shaped protective dose-response association for yogurt (RR for 85 g/d, 0.66; 95% CI, 0.58-0.76) and fruit (RR for 80 g/d, 0.82; 95% CI, 0.78-0.86).
Mixed and 100% fruit juices had a dose-response association with MetS, with a protective association between 75 and 150 mL/d and an adverse association for more than 175 to 200 mL/d.
There was no association between honey, ice cream, and confectionary and MetS incidence.
The authors noted that their results regarding SSBs and MetS are consistent with previous research and suggested that the association between SSBs and MetS could reflect “a general unhealthy lifestyle whereby individuals with greater SSB intake are likely to have a poorer diet quality, higher caloric intake, and a sedentary lifestyle.” On the other hand, the protective association of yogurt and MetS could be a result of yogurt’s rich micronutrient composition, they added.
Food composition is also important, they pointed out. “SSBs are without beneficial nutrients and thus offer an unchecked source of fructose-containing sugar, whereas in other foods (e.g., yogurt), nutrients other than sugars (e.g., polyphenols, minerals, and fiber) may offer protection that might overcome harms from added sugars.”
“Thus, well-intentioned policies and guidelines to limit sources of free sugars, such as fruit juice or sweetened yogurts, based on evidence from SSBs may need to be reexamined with a food-based lens, such as those of the new Canada’s Food Guide or Scientific Advisory Committee on Nutrition,” Semnani-Azad and colleagues concluded. “Additional prospective studies are needed to improve our estimates and better understand the dose-response association between important food sources of fructose-containing sugars and MetS.”
In a commentary accompanying the study, Kristie J. Lancaster, PhD, RDN, Steinhardt School of Culture, Education and Human Development, New York University, noted that despite the protective effects of yogurt, fruit, and mixed and 100% fruit juice, adults in the United States, on average, consume limited amounts of these food sources. Thus, Lancaster wrote, most people are not getting the benefit of potentially MetS-protective effects of yogurt, fruit juice, or fruit. In addition, she pointed out that persons with lower economic status (SES) and African Americans consume more SSBs and fruit juice and fewer servings of whole fruits and yogurt than non-Hispanic white people.
“More studies are needed that examine fructose-rich foods and MetS in general and especially in low-SES and diverse populations,” she wrote. “In addition, more interventions are needed to identify efficacious methods of motivating Americans to adopt dietary patterns that reflect recommendations. Future studies should also take into account factors that could limit at-risk populations’ ability to purchase the protective foods mentioned in this study, such as availability and affordability.”
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While sugar-sweetened beverages are associated with a higher risk of metabolic syndrome, that association does not extend to other sources of fructose-containing sugars, such as yogurt and fruit.
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Be aware that in this study, yogurt and fruit proved protective against metabolic syndrome, as were fruit juices in limited amounts, but more study is needed.
Michael Bassett, Contributing Writer, BreakingMED™
Lancaster reported receiving honorarium from the Academy of Nutrition and Dietetics Foundation and serving on the planning committee of the American Heart Association’s EPI/Lifestyle Scientific Sessions.
Cat ID: 307
Topic ID: 76,307,305,307,139,140,252,192,518,94,917,925
