The Relationship Between Major Food Sources of Fructose and Cardiovascular Disease, Cancer, and All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Cohort Studies Publisher Pubmed



Kazemi A¹ ; Soltani S² ; Mokhtari Z³ ; Khan T⁴ ; Golzarand M⁵ ; Hosseini E³ ; Jayedi A⁶ ; Ebrahimpourkoujan S⁷ ; Akhlaghi M⁸ Show Affiliations
Source: Critical Reviews in Food Science and Nutrition Published:2023

Abstract

We aimed to summarize the associations between food sources of fructose and cardiovascular diseases (CVD), cancer, and all-cause mortality risk using a systematic review and meta-analysis. We searched PubMed, Scopus, and Web of Science up to November 2020. We included cohort studies that investigated the relationship between mortality risk (all-cause, CVD, specific CVD, and total and site-specific cancers) and intake of ≥1 food source of fructose (fruit, fruit juice, breakfast cereals, sugar-sweetened beverages (SSBs), sweets, and yogurt) in general adult population. Summary hazard ratios and 95% CIs were estimated using a random-effects model for linear and nonlinear relationships. Findings indicated that each 100 g/d increase in fruit intake was associated with 8-13% lower risk of CVDs, stroke, gastrointestinal, and lung cancer mortality. For all-cause mortality, there was a beneficial relationship up to 200 g/d fruit, and then plateaued. For ischemic heart disease and cancer mortality, there was a beneficial relationship up to 300 g/d followed by a slight increase. Ingestion of breakfast cereals and sweets was also associated with lower risk of all-cause mortality. For yogurt, a non-linear marginal decrease in all-cause mortality was found. Ingestion of each 200 g/d yogurt was associated with a 14% lower risk of CVD mortality. Every 60 g/d increase in sweet intake was linked to a 5% lower risk of all-cause mortality. Contrariwise, every 250 g/d increase in SSBs intake was associated with 7–10% higher risk of all-cause and CVD mortality. In conclusion, beneficial associations were found between fruit, breakfast cereals, sweets, and yogurt with all-cause and/or CVD mortality risk. Fruit intake had also an inverse link with cancer mortality. Conversely, SSBs had a harmful relationship with all-cause and CVD mortality. Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.2000361. Registry number: CRD42019144956. © 2021 Taylor & Francis Group, LLC.