Food sources of fructose-containing sugars and glycaemic control: systematic review and meta-analysis of controlled intervention studies.
Food sources of fructose-containing sugars and glycaemic control: systematic review and meta-analysis of controlled intervention studies.
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DOI：
10.1136/bmj.k4644
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发表时间：
2018-11-21
期刊：
影响因子：
--
通讯作者：
Sievenpiper JL
中科院分区：
文献类型：
--
作者：
Choo VL;Viguiliouk E;Blanco Mejia S;Cozma AI;Khan TA;Ha V;Wolever TMS;Leiter LA;Vuksan V;Kendall CWC;de Souza RJ;Jenkins DJA;Sievenpiper JL
在不同的能量控制水平下，评估不同食物来源含果糖糖对血糖控制的影响。对照干预研究的系统回顾和荟萃分析。截至2018年4月25日，医学，Embase和Cochrane图书馆。研究包括为期至少7天的对照干预研究，评估不同食物来源的含果糖糖对糖尿病患者和非糖尿病患者血糖控制的影响。在能量控制的基础上预先指定了四项研究设计：替代研究（能量中的糖与其他宏量营养素相匹配的比较），添加研究（添加到饮食中的糖的多余能量），减法研究（从饮食中减去的糖的能量）和随意研究（糖在不控制能量的情况下被其他宏量营养素自由替代）。结果是糖化血红蛋白（HbA1c）、空腹血糖和空腹血糖胰岛素。四名独立审稿人提取相关数据并评估偏倚风险。数据通过随机效应模型和GRADE方法评估的证据的总体确定性进行汇总（建议评估、发展和评价的分级）。纳入155项研究比较（n=5086）。在替代或减法研究中，总含果糖糖对任何结果都没有有害影响，替代研究中HbA1c下降(平均差异为- 0.22%(95%置信区间为- 0.35%至- 0.08%),- 25.9 mmol/mol(- 27.3至- 24.4))，但在另外的研究中发现空腹胰岛素有有害影响（4.68 pmol/L(1.40至7.96)）和随意研究中发现空腹胰岛素有有害影响（7.24 pmol/L(0.47至14.00)）。食物来源之间存在相互作用，在替代研究中，特定的食物来源显示出有益的影响（水果和果汁）或有害的影响（甜牛奶和混合来源），在另外的研究中，有害的影响（含糖饮料和果汁）至少有一种结果。大多数证据的质量都很低。能量控制和食物来源似乎介导了含果糖糖对血糖控制的影响。虽然这些糖的大多数食物来源（尤其是水果）在与其他大量营养素的能量匹配替代方面没有有害影响，但几种含果糖糖的食物来源（尤其是含糖饮料）在饮食中增加了多余的能量，产生了有害影响。然而，这些估计的确定性很低，需要更多高质量的随机对照试验。Clinicaltrials.gov (NCT02716870)。
To assess the effect of different food sources of fructose-containing sugars on glycaemic control at different levels of energy control. Systematic review and meta-analysis of controlled intervention studies. Medine, Embase, and the Cochrane Library up to 25 April 2018. Controlled intervention studies of at least seven days’ duration and assessing the effect of different food sources of fructose-containing sugars on glycaemic control in people with and without diabetes were included. Four study designs were prespecified on the basis of energy control: substitution studies (sugars in energy matched comparisons with other macronutrients), addition studies (excess energy from sugars added to diets), subtraction studies (energy from sugars subtracted from diets), and ad libitum studies (sugars freely replaced by other macronutrients without control for energy). Outcomes were glycated haemoglobin (HbA1c), fasting blood glucose, and fasting blood glucose insulin. Four independent reviewers extracted relevant data and assessed risk of bias. Data were pooled by random effects models and overall certainty of the evidence assessed by the GRADE approach (grading of recommendations assessment, development, and evaluation). 155 study comparisons (n=5086) were included. Total fructose-containing sugars had no harmful effect on any outcome in substitution or subtraction studies, with a decrease seen in HbA1c in substitution studies (mean difference −0.22% (95% confidence interval to −0.35% to −0.08%), −25.9 mmol/mol (−27.3 to −24.4)), but a harmful effect was seen on fasting insulin in addition studies (4.68 pmol/L (1.40 to 7.96)) and ad libitum studies (7.24 pmol/L (0.47 to 14.00)). There was interaction by food source, with specific food sources showing beneficial effects (fruit and fruit juice) or harmful effects (sweetened milk and mixed sources) in substitution studies and harmful effects (sugars-sweetened beverages and fruit juice) in addition studies on at least one outcome. Most of the evidence was low quality. Energy control and food source appear to mediate the effect of fructose-containing sugars on glycaemic control. Although most food sources of these sugars (especially fruit) do not have a harmful effect in energy matched substitutions with other macronutrients, several food sources of fructose-containing sugars (especially sugars-sweetened beverages) adding excess energy to diets have harmful effects. However, certainty in these estimates is low, and more high quality randomised controlled trials are needed. Clinicaltrials.gov (NCT02716870).
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