Consumption of fructose- but not glucose-sweetened beverages for 10 weeks increases circulating concentrations of uric acid, retinol binding protein-4, and gamma-glutamyl transferase activity in overweight/obese humans Effects of 4-week very-high-fructose/glucose diets on insulin sensitivity, visceral fat and intrahepatic lipids: an exploratory trial. Inulin supplementation prevents high fructose diet-induced hypertension in rats. Effect of prior ingestion of glucose or fructose on the performance of exercise of intermediate duration High-fructose corn syrup and sucrose have equivalent effects on energy-regulating hormones at normal human consumption levels. Blood lipids, lipoproteins, apoproteins, and uric acid in men fed diets containing fructose or high-amylose cornstarch. Grape Polyphenols Prevent Fructose-Induced Oxidative Stress and Insulin Resistance in First-Degree Relatives of Type 2 Diabetic Patients Acute effects of feeding fructose, glucose and sucrose on blood lipid levels and systemic inflammation Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Moderate Amounts of Fructose Consumption Impair Insulin Sensitivity in Healthy Young Men Consequences of incomplete carbohydrate absorption from fruit juice consumption in infants. A pilot study on the impact of a low fructose diet and allopurinol on clinic blood pressure among overweight and prehypertensive subjects: a randomized placebo controlled trial. Acute effects of fructose and glucose ingestion with and without caffeine in young and old humans. Effects of Two Energy-Restricted Diets Containing Different Fruit Amounts on Body Weight Loss and Macronutrient Oxidation Consumption of fructose-sweetened beverages for 10 weeks reduces net fat oxidation and energy expenditure in overweight/obese men and women Effects of dietary fructose on plasma lipids in healthy subjects. Day-long glucose, insulin, and fructose responses of hyperinsulinemic and nonhyperinsulinemic men adapted to diets containing either fructose or high-amylose cornstarch. The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study. Effect of glucose, sucrose and fructose on plasma glucose and insulin responses in normal humans: comparison with white bread Tamoxifen use in breast cancer patients who subsequently develop corpus cancer is not associated with a higher incidence of adverse histologic features. Colon Hypersensitivity to Distension, Rather Than Excessive Gas Production, Produces Carbohydrate-Related Symptoms in Individuals With Irritable Bowel Syndrome. Consumption of a Diet Low in Advanced Glycation End Products for 4 Weeks Improves Insulin Sensitivity in Overweight Women Beneficial Effects of Palatable Guar and Guar Plus Fructose Diets in Diabetic Children
Background Prospect i ve studies in humans examining the effects of fructose consumption on biological markers associated with the development of metabolic syndrome are lacking . Therefore we investigated the relative effects of 10 wks of fructose or glucose consumption on plasma uric acid and RBP-4 concentrations , as well as liver enzyme ( AST , ALT , and GGT ) activities in men and women . Methods As part of a parallel arm study , older ( age 40–72 ) , overweight and obese male and female subjects ( BMI 25–35 kg/m2 ) consumed glucose- or fructose-sweetened beverages providing 25 % of energy requirements for 10 wks . Fasting and 24-h blood collection s were performed at baseline and following 10 wks of intervention and plasma concentrations of uric acid , RBP-4 and liver enzyme activities were measured . Results Consumption of fructose , but not glucose , led to significant increases of 24-h uric acid profiles ( P < 0.0001 ) and RBP-4 concentrations ( P = 0.012 ) , as well as plasma GGT activity ( P = 0.04 ) . Fasting plasma uric acid concentrations increased in both groups ; however , the response was significantly greater in subjects consuming fructose ( P = 0.002 for effect of sugar ) . Within the fructose group male subjects exhibited larger increases of RBP-4 levels than women ( P = 0.024 ) . Conclusions These findings suggest that consumption of fructose at 25 % of energy requirements for 10 wks , compared with isocaloric consumption of glucose , may contribute to the development of components of the metabolic syndrome by increasing circulating uric acid , GGT activity , suggesting alteration of hepatic function , and the production of RBP-4 An increasing amount of fructose in the diet is suggested to play a causal role in the pathogenesis of the metabolic syndrome , type 2 diabetes and fatty liver . Our aim was to investigate and compare the effects of very high fructose and very high glucose in hyperenergetic diets on glucose and lipid metabolism and on fat depots in healthy humans . We conducted an exploratory , prospect i ve , r and omised , single-blinded , intervention trial . Participants in addition to a balanced weight-maintaining diet received 150 g of fructose or glucose/d for 4 weeks . Insulin sensitivity was estimated from oral glucose tolerance tests . Visceral and subcutaneous abdominal fat was determined with MRI . Liver fat and intramyocellular lipids of the tibialis anterior muscle were measured with (1)H magnetic resonance spectroscopy . A total of twenty healthy subjects ( fructose group n 10 and glucose group n 10 ; twelve males and eight females ) completed the study . They had a mean age of 30·5 ( SEM 2·0 ) years and a mean BMI of 25·9 ( SEM 0·5 ) kg/m(2 ) . Insulin sensitivity appeared to decrease both in the fructose and glucose groups . TAG markedly increased in the fructose group . No strong alterations or treatment effects were found for liver fat , visceral fat , subcutaneous abdominal fat and intramyocellular lipids of the tibialis anterior muscle . In conclusion , the effects of very high fructose and very high glucose in hyperenergetic diets on glucose metabolism and body fat composition were not different in the healthy participants of the present study . However , elevation of plasma TAG seemed to be fructose-specific BACKGROUND & AIMS The aim of this experiment was to evaluate the potential beneficial effect of supplementation with different inulin-type fructan fractions against common features of the metabolic syndrome in a rat model of this syndrome ( fructose-fed rat ) . METHODS Forty Wistar rats were r and omly divided into five groups and the animals received for 4 weeks either a semi-purified starch or fructose-based diet , or diets in which fructose was partially substituted with various fructans : 10 g/100 g of long-chain inulin or oligofructose , or an oligofructose-enriched inulin . After this period , blood pressure was measured and sample s of blood and tissues were collected for selected biochemical analyses . RESULTS As compared to the starch-fed group , the fructose-fed rats presented : hypertriglyceridemia , hypertension , increased susceptibility to heart peroxidation and renal damages . Long-chain inulin and oligofructose-enriched inulin supplementation prevented fructose induced elevated blood pressure , susceptibility to heart peroxidation and renal damages . All inulin-type fructans containing diets prevented fructose induced hypertriglyceridemia . CONCLUSIONS These results suggest that supplementation with inulin-type fructans is efficient against fructose induced hypertension and that effects are most pronounced for long-chain inulin and oligofructose-enriched inulin . We hypothesize that the anti-hypertensive effect of inulin could be explained by the reduction of the high fructose induced oxidative stress The metabolic responses induced by the ingestion of a beverage containing glucose ( G ) , fructose ( F ) or placebo ( W ) 30 min before exercise of high intensity and intermediate duration have been investigated ; in these conditions the energy processes are mostly dependent on aerobic reactions . A group of 11 male recreational sportsmen ran on a treadmill , at an intensity corresponding to 82 % of peak oxygen consumption , until exhaustion on three different occasions ( after ingestion of a beverage containing 75 g of G , 75 g of F or W ) . Plasma glucose , insulin , and lactic acid concentrations were determined just prior to the ingestion of the beverages , 30 min afterwards and 10 and 30 min after completion of the exercise . The mean endurance time was 644 ( SD 261 ) s after the ingestion of G , 611 ( SD 227 ) s after the ingestion of F and 584 ( SD 189 ) s after the ingestion of the W ( P < 0.05 between G and W ) . No differences in the oxygen uptake , respiratory quotient or lactate concentrations between the three trials were observed . Both plasma glucose and insulin concentrations determined in sample s obtained immediately before the onset of exercise were higher when G was ingested than when F ( P < 0.05 and P < 0.05 , respectively ) or W ( P < 0.001 and P < 0.005 , respectively ) were ingested . These findings would suggest that the ingestion of G prior to an effort of intermediate duration may improve physical performance Intake of high-fructose corn syrup ( HFCS ) has been suggested to contribute to the increased prevalence of obesity , whereas a number of studies and organizations have reported metabolic equivalence between HFCS and sucrose . We hypothesized that HFCS and sucrose would have similar effects on energy-regulating hormones and metabolic substrates at normal levels of human consumption and that these values would not change over a 10-week , free-living period at these consumption levels . This was a r and omized , prospect i ve , double-blind , parallel group study in which 138 adult men and women consumed 10 weeks of low-fat milk sweetened with either HFCS or sucrose at levels of the 25th , 50th , and 90th percentile population consumption of fructose ( the equivalent of 40 , 90 , or 150 g of sugar per day in a 2000-kcal diet ) . Before and after the 10-week intervention , 24-hour blood sample s were collected . The area under the curve ( AUC ) for glucose , insulin , leptin , active ghrelin , triglyceride , and uric acid was measured . There were no group differences at baseline or posttesting for all outcomes ( interaction , P > .05 ) . The AUC response of glucose , active ghrelin , and uric acid did not change between baseline and posttesting ( P > .05 ) , whereas the AUC response of insulin ( P < .05 ) , leptin ( P < .001 ) , and triglyceride ( P < .01 ) increased over the course of the intervention when the 6 groups were averaged . We conclude that there are no differences in the metabolic effects of HFCS and sucrose when compared at low , medium , and high levels of consumption Ten hyperinsulinemic and 11 nonhyperinsulinemic men consumed for 5 wk each in a cross-over design a diet , similar to one currently consumed in the United States , with 20 % of the kilocalories from either fructose or high-amylose cornstarch to determine the effects of the two diets on various blood metabolites considered to be risk factors associated with heart disease . In the hyperinsulinemic men the intake of fructose as compared with cornstarch significantly increased total triglycerides and their lipoprotein distribution ; total and very-low-density lipoprotein cholesterol ; apoproteins B-100 , C-II , C-III ; and uric acid . In the nonhyperinsulinemic men  total triglycerides , total and low-density lipoprotein cholesterol and uric acid were significantly greater after the consumption of fructose than after cornstarch . The results indicate that in a diet high in saturated fatty acids and cholesterol , fructose increases the levels of risk factors associated with heart disease , especially in hyperinsulinemic men OBJECTIVE To assess the clinical efficacy of nutritional amounts of grape polyphenols ( PPs ) in counteracting the metabolic alterations of high-fructose diet , including oxidative stress and insulin resistance ( IR ) , in healthy volunteers with high metabolic risk . RESEARCH DESIGN AND METHODS Thirty-eight healthy overweight/obese first-degree relatives of type 2 diabetic patients ( 18 men and 20 women ) were r and omized in a double-blind controlled trial between a grape PP ( 2 g/day ) and a placebo ( PCB ) group . Subjects were investigated at baseline and after 8 and 9 weeks of supplementation , the last 6 days of which they all received 3 g/kg fat-free mass/day of fructose . The primary end point was the protective effect of  grape PPs  on fructose-induced IR . RESULTS In the PCB group , fructose induced 1 ) a 20 % decrease in hepatic insulin sensitivity index ( P < 0.05 ) and an 11 % decrease in glucose infusion rate ( P < 0.05 ) as evaluated during a two-step hyperinsulinemic-euglycemic clamp , 2 ) an increase in systemic ( urinary F2-isoprostanes ) and muscle ( thiobarbituric acid – reactive substances and protein carbonylation ) oxidative stress ( P < 0.05 ) , and 3 ) a downregulation of mitochondrial genes and decreased mitochondrial respiration ( P < 0.05 ) . All the deleterious effects of fructose were fully blunted by grape PP supplementation . Antioxidative defenses , inflammatory markers , and main adipokines were affected neither by fructose nor by grape PPs . CONCLUSIONS A natural mixture of grape PPs at nutritional doses efficiently prevents fructose-induced oxidative stress and IR . The current interest in grape PP ingredients and products by the global food and nutrition industries could well make them a stepping-stone of preventive nutrition Background Recent studies have demonstrated a relationship between fructose consumption and risk of developing metabolic syndrome . Mechanisms by which dietary fructose mediates metabolic changes are poorly understood . This study compared the effects of fructose , glucose and sucrose consumption on post-postpr and ial lipemia and low grade inflammation measured as hs-CRP . Methods This was a r and omized , single blinded , cross-over trial involving healthy subjects ( n = 14 ) . After an overnight fast , participants were given one of 3 different isocaloric drinks , containing 50 g of either fructose or glucose or sucrose dissolved in water .  Blood sample s were collected at baseline , 30 , 60 and 120 minutes post intervention for the analysis of blood lipids , glucose , insulin and high sensitivity C-reactive protein ( hs-CRP ) . Results Glucose and sucrose supplementation initially result ed in a significant increase in glucose and insulin levels compared to fructose supplementation and returned to near baseline values within 2 hours . Change in plasma cholesterol , LDL and HDL-cholesterol ( measured as area under curve , AUC ) was significantly higher when participants consumed fructose compared with glucose or sucrose ( P < 0.05 ) . AUC for plasma triglyceride levels however remained unchanged regardless of the dietary intervention . Change in AUC for hs-CRP was also significantly higher in subjects consuming fructose compared with those consuming glucose ( P < 0.05 ) , but not sucrose ( P = 0.07 ) . Conclusion This study demonstrates that fructose as a sole source of energy modulates plasma lipids and hsCRP levels in healthy individuals . The significance of increase in HDL-cholesterol with a concurrent increase in LDL-cholesterol and elevated hs-CRP levels remains to be delineated when considering health effects of feeding fructose-rich diets . Registration number for clinical BACKGROUND & AIMS Observational studies suggest dietary fructose restriction might lead to sustained symptomatic response in patients with irritable bowel syndrome ( IBS ) and fructose malabsorption . The aims of this study were first to determine whether the efficacy of this dietary change is due to dietary fructose restriction and second to define whether symptom relief was specific to free fructose or to poorly absorbed short-chain carbohydrates in general . METHODS The double-blinded , r and omized , quadruple arm , placebo-controlled rechallenge trial took place in the general community . The 25 patients who had responded to dietary change were provided all food , low in free fructose and fructans , for the duration of the study . Patients were r and omly challenged by grade d dose introduction of fructose , fructans , alone or in combination , or glucose taken as drinks with meals for maximum test period of 2 weeks , with at least 10-day washout period between . For the main outcome measures , symptoms were monitored by daily diary entries and responses to a global symptom question . RESULTS Seventy percent of patients receiving fructose , 77 % receiving fructans , and 79 % receiving a mixture reported symptoms were not adequately controlled , compared with 14 % receiving glucose ( P < or = 0.002 , McNemar test ) . Similarly , the severity of overall and individual symptoms was significantly and markedly less for glucose than other substances . Symptoms were induced in a dose-dependent manner and mimicked previous IBS symptoms . CONCLUSIONS In patients with IBS and fructose malabsorption , dietary restriction of fructose and /or fructans is likely to be responsible for symptomatic improvement , suggesting efficacy is due to restriction of poorly absorbed short-chain carbohydrates in general OBJECTIVE Adverse effects of hypercaloric , high-fructose diets on insulin sensitivity and lipids in human subjects have been shown repeatedly . The implication s of fructose in amounts close to usual daily consumption , however , have not been well studied . This study assessed the effect of moderate amounts of fructose and sucrose compared with glucose on glucose and lipid metabolism . RESEARCH DESIGN AND METHODS Nine healthy , normal-weight male volunteers ( aged 21–25 years ) were studied in this double-blind , r and omized , cross-over trial . All subjects consumed four different sweetened beverages ( 600 mL/day ) for 3 weeks each : medium fructose ( MF ) at 40 g/day , and high fructose ( HF ) , high glucose ( HG ) , and high sucrose ( HS ) each at 80 g/day . Euglycemic-hyperinsulinemic clamps with [6,6]-2H2 glucose labeling were used to measure endogenous glucose production . Lipid profile , glucose , and insulin were measured in fasting sample s. RESULTS Hepatic suppression of glucose production during the clamp was significantly lower after HF ( 59.4 ± 11.0 % ) than HG ( 70.3 ± 10.5 % , P < 0.05 ) , whereas fasting glucose , insulin , and C-peptide did not differ between the interventions . Compared with HG , LDL cholesterol and total cholesterol were significantly higher after MF , HF , and HS , and free fatty acids were significantly increased after MF , but not after the two other interventions ( P < 0.05 ) . Subjects ’ energy intake during the interventions did not differ significantly from baseline intake . CONCLUSIONS This study clearly shows that moderate amounts of fructose and sucrose significantly alter hepatic insulin sensitivity and lipid metabolism compared with similar amounts of glucose BACKGROUND Most infants consume fruit juices by 6 months of age . However , fruit juices containing sorbitol may be associated with carbohydrate malabsorption without clinical symptoms . We hypothesized that increased physical activity and metabolic rate may be associated with carbohydrate malabsorption . METHODS Physical activity and metabolic rate were determined in 14 healthy infants ( [ mean + /- SD ] age , 5.1 + /- 0.8 months ; weight , 7.8 + /- 1.1 kg ; length , 67 + /- 4.2 cm ; and body fat , 26 % + /- 5 % ) for 3 hours in a respiratory chamber . Seven were fed pear juice , and the other 7 were fed white grape juice ( 120 mL ) after a 2-hour fast . Pear juice contains sorbitol and a high fructose-glucose ratio , whereas white grape juice is sorbitol free and has a low fructose-glucose ratio . Carbohydrate absorption was determined by breath hydrogen gas analysis . The study was double-blinded . RESULTS When compared with the infants without carbohydrate malabsorption ( peak breath hydrogen level < 20 ppm above baseline ) , 5 of the 7 infants fed pear juice and 2 of the 7 infants fed white grape juice exhibited carbohydrate malabsorption ( peak breath hydrogen level > or = 20 ppm above baseline ; P < .01 ) . These infants also exhibited both increased physical activity ( P < .001 ) and metabolic rate ( P < .05 ) after juice consumption in comparison with infants with normal carbohydrate absorption . When grouped according to the type of juice consumed , only infants fed pear juice exhibited increases in physical activity ( P < .01 ) . CONCLUSIONS Carbohydrate malabsorption is associated with increased physical activity and metabolic rate in infants . Most of the infants who had carbohydrate malabsorption consumed pear juice . Therefore , fruit juices containing sorbitol and high levels of fructose may not be optimal for young infants Fructose and sodium intake have been associated with hypertension and metabolic syndrome . Although various mechanisms are involved , fructose causes hypertension partly through rising intracellular and serum uric acid . To date , there are no studies in adults that have evaluated the impact of low fructose diets and allopurinol on prehypertensive and overweight subjects . The objective of this study was to compare the effect of low fructose diet and allopurinol or placebo on blood pressure ( BP ) and metabolic syndrome components The study was a controlled clinical trial and consisted of two phases ; in the first phase of intervention ( 4 weeks ) , patients were r and omized to either low fructose diet ( 34 patients ) or control diet ( 38 patients ) . In the second phase of intervention ( weeks 4 - 8 ) , the same groups continued with the same diet prescriptions but were further r and omized to receive placebo or allopurinol ( 300 mg/d ) . Clinic and 24-hour ambulatory BP , anthropometric measures , and laboratory data were determined at baseline , weeks 4 and 8 . Seventy-two patients were included in the trial . At the end of the dietary phase , both diet groups significantly reduced their BP , but there were no between-group differences . Compared to placebo , at the end of follow-up , subjects in the allopurinol group had a lower clinic systolic blood pressure and this was significant within- and between-group comparisons . The percentage of dippers was higher in the allopurinol group , and weight was reduced significantly despite the absence of caloric restriction Allopurinol was associated with a significant reduction in clinic BP , an increase in the percentage of dippers , and significant weight loss . Larger studies with longer follow-up are needed to confirm our findings Aging is associated with a decline in energy expenditure ( EE ) , glucose intolerance , and a reduction in body nitrogen content . In addition , a reduction in the thermic response to glucose but not to fructose or protein has been reported in the elderly . The present study was conducted to further examine nutrient-induced thermogenesis and the effects of specific sugars on amino acid metabolism in relation to age . After 3 days on a weight-maintaining , 250-g carbohydrate diet , 16 healthy non-obese men and women in two age groups ( 18 to 29 and 66 to 80 years ) consumed on 4 different days 500 mL of either a 75-g fructose or 75-g glucose solution , with or without 300 mg caffeine or vitamin C as a placebo .  Blood substrate and hormone levels and EE , using indirect calorimetry , were measured at timed intervals for 3 hours after consumption of the drinks . There was no difference in the carbohydrate-induced increase in EE in either young or old even after adjustments for body weight and fat-free mass ( FFM ) . An approximately 20-fold increase in serum caffeine levels increased EE in both groups ( P < .003 ) , but had minimal effects on substrate and hormone responses . In contrast to glucose , fructose induced a marked elevation in plasma alanine from combined basal levels of 301 + /- 24 to approximately 500 + /- 18 mumol/L ( mean + /- SEM ) in both groups ( P < .001 ) . However , both fructose and glucose ingestion result ed in a similar decline in branched-chain and aromatic amino acids . ( ABSTRACT TRUNCATED AT 250 WORDS The consumption of specific foods in energy-restricted diets may affect the weight loss process . The purpose of this research was to evaluate whether obese women following two hypocaloric diets with distinct fruit content differ in weight loss and metabolic responses .  Fifteen obese women were included , who were r and omly assigned to follow a low or a high-fruit energy-restricted diet for 8 weeks . The main outcome variables were weight and fat losses . Metabolic measurements concerning macronutrient oxidation were also assessed by using 13C labelled fructose and indirect calorimetry . The induced weight loss was similar for both diets ( 6.9 ± 2 % vs. 6.6 ± 2 % , p = 0.785 ) . Both experimental diets similarly improved the lipid plasma profile in the participants , but the cholesterol fall was higher in obese subjects receiving the diet containing more fruit . No statistical differences in lipids carbohydrates and 13C labelled fructose utilisation were observed , but protein oxidation was differently affected by the experimental diets . The compensatory effects of the associated fibre/fructose intake may explain the lack of a specific effect of the fruit amount on hypocaloric diets design ed to weight loss , although the increased fibre content from enriched fruit diets may be involved in the favourable effects on cholesterol plasma levels Background / Objectives : The results of short-term studies in humans suggest that , compared with glucose , acute consumption of fructose leads to increased postpr and ial energy expenditure and carbohydrate oxidation and decreased postpr and ial fat oxidation . The objective of this study was to determine the potential effects of increased fructose consumption compared with isocaloric glucose consumption on substrate utilization and energy expenditure following sustained consumption and under energy-balanced conditions . Subjects/ Methods : As part of a parallel arm study , overweight/obese male and female subjects , 40–72 years , consumed glucose- or fructose-sweetened beverages providing 25 % of energy requirements for 10 weeks . Energy expenditure and substrate utilization were assessed using indirect calorimetry at baseline and during the 10th week of intervention . Results : Consumption of fructose , but not glucose , led to significant decreases of net postpr and ial fat oxidation and significant increases of net postpr and ial carbohydrate oxidation ( P<0.0001 for both ) . Resting energy expenditure ( REE ) decreased significantly from baseline values in subjects consuming fructose ( P=0.031 ) but not in those consuming glucose . Conclusions : Increased consumption of fructose for 10 weeks leads to marked changes of postpr and ial substrate utilization including a significant reduction of net fat oxidation . In addition , we report that REE is reduced compared with baseline values in subjects consuming fructose-sweetened beverages for 10 weeks BACKGROUND About 9 % of average dietary energy intake in the United States comes from fructose . Such a high consumption raises concern about the metabolic effects of this sugar . OBJECTIVE The objective of this study was to determine the effect of dietary fructose on plasma lipids . DESIGN The study was conducted in the General Clinical Research Center at Fairview-University of Minnesota Medical Center . The participants were 24 healthy adult volunteers ( 12 men and 12 women ; 6 of each sex were aged < 40 y and 6 of each sex were aged > /=40 y ) . All subjects received 2 isoenergetic study diets assigned by using a r and omized , balanced crossover design . One diet provided 17 % of energy as fructose . The other diet was sweetened with glucose and was nearly devoid of fructose . Each diet was fed for 6 wk . Both diets were composed of common foods and contained nearly identical amounts of carbohydrate , protein , fat , fiber , cholesterol , and saturated , monounsaturated , and polyunsaturated fatty acids . All meals were prepared in the metabolic kitchen of the General Clinical Research Center . RESULTS The responses to the study diets differed by sex . In men , the fructose diet produced significantly higher fasting , postpr and ial , and daylong plasma triacylglycerol concentrations than did the glucose diet . The daylong plasma triacylglycerol concentration after 6 wk of the fructose diet was 32 % greater in men than the corresponding concentration during the glucose diet ( P : < 0.001 ) . The fructose diet had no significant effect on fasting or postpr and ial plasma triacylglycerol concentrations in women . The fructose diet also had no persistent effect on fasting plasma cholesterol , HDL cholesterol , or LDL cholesterol in either men or women . CONCLUSIONS Dietary fructose was associated with increased fasting and postpr and ial plasma triacylglycerol concentrations in men . Diets high in added fructose may be undesirable , particularly for men . Glucose may be a suitable replacement sugar Ten hyperinsulinemic and 11 nonhyperinsulinemic men consumed a typical American diet containing 20 % of calories either as fructose or as high-amylose cornstarch for 5 wk in a crossover design to determine their effects on indices of glucose tolerance . Blood glucose , insulin , and fructose  were determined before and 30 , 60 , 90 , 120 and 180 min after breakfast , lunch , and dinner . Glucose responses were significantly lower 60 and 120 min and the insulin response lower 60 min after the meals containing fructose .  Hyperinsulinemic men showed a tendency toward decreased insulin sensitivity after consuming fructose on the basis of an increased insulin-to-glucose ratio and decreased insulin binding to erythrocytes . These results generally show a beneficial effect of fructose on glucose tolerance ; however , recommendations for including large amounts of fructose in the diet should also be based on a complete evaluation of the effect on other metabolic risk factors BACKGROUND AND AIM Current treatment for irritable bowel syndrome ( IBS ) is suboptimal . Fermentable oligo- , di- , mono-saccharides and polyols ( FODMAPs ) may trigger gastrointestinal symptoms in IBS patients . Our aim was to determine whether a low FODMAP diet improves symptoms in IBS patients . METHODS Irritable bowel syndrome patients , who had performed hydrogen/methane breath testing for fructose and lactose malabsorption and had received dietary advice regarding the low FODMAP diet , were included . The effect of low FODMAP diet was prospect ively evaluated using a symptom question naire . Furthermore , questions about adherence and satisfaction with symptom improvement , dietary advice and diet were assessed . RESULTS Ninety patients with a mean follow up of 15.7 months were studied . Most symptoms including abdominal pain , bloating , flatulence and diarrhoea significantly improved ( p < 0.001 for all ) . 75.6 % , 37.8 % and 13.3 % of patients had fructose , lactose malabsorption or small intestinal bacterial overgrowth respectively . Fructose malabsorption was significantly associated with symptom improvement ( abdominal pain odds ratio ( OR ) 7.09 [ 95 % confidence interval ( CI ) 2.01 - 25.0 ] , bloating OR 8.71 ( 95 % CI 2.76 - 27.5 ) , flatulence OR 7.64 ( 95 % CI 2.53 - 23.0 ) and diarrhoea OR 3.39 ( 95 % CI 1.17 - 9.78 ) , p < 0.029 for all ) . Most patients ( 75.6 % ) were adherent to the diet , which was associated with symptom improvement ( abdominal pain , bloating , flatulence and diarrhoea all significantly associated with adherence , r > 0.27 , p < 0.011 ) . Most patients ( 72.1 % ) were satisfied with their symptoms . CONCLUSIONS The low FODMAP diet shows efficacy for IBS patients . The current strategy of breath testing and dietary advice provides a good basis to underst and and adhere to the diet Objective : To determine the plasma glucose and insulin responses of various doses of glucose , sucrose , fructose and white bread in normal human subjects . Design : Plasma glucose and insulin were measured before and at various times after 8 subjects ate 13 different test meals in r and omized order on separate days after an overnight fast . Test meals consisted of 500 ml of tea or water to which was added either nothing , 25 , 50 , or 100 g of glucose or sucrose , 25 or 50 g fructose , 50 g glucose plus 50 g fructose , or a 25 , 50 or 100 g carbohydrate portion of white bread . The glycaemic ( GI ) and insulinaemic index ( II ) values of the sugars were calculated by expressing the incremental areas under the plasma glucose and insulin curves ( AUC ) after glucose , sucrose and fructose as a percentage of the respective AUC after white bread containing the same amount of carbohydrate . Setting : University teaching hospital clinical nutrition centre . Subjects : Lean , normal subjects ( 4 male , 4 female ) 21–33 y of age . Results : Plasma insulin responses increased nearly linearly as carbohydrate intake increased from 0 to 100 g , but glycaemic responses increased by only 68 % and 38 % as carbohydrate intake increased from 25 to 50 g and 50 to 100 g , respectively . The GI and II values of glucose , 149±16 and 147±18 , respectively , were significantly greater than those of bread ( 100 ; P<0.05 ) , while the values for fructose , 16±4 and 22±3 were significantly less than those of bread ( P<0.001 ) . GI values did not differ significantly from II values . Conclusions : It is concluded that , in normal subjects , as carbohydrate intake is increased from 0 to 100 g , plasma insulin responses increase at a greater rate than plasma glucose responses . The insulinaemic responses elicited by glucose , sucrose or fructose are similar to those that would be expected from a starchy food with the same glycaemic index . Descriptors Several reports have noted an association between the use of tamoxifen in breast cancer patients and the subsequent development of endometrial carcinoma . Magriples et al. ( J. Clin . Oncol . 11 , 485 - 490 , 1993 ) recently reported that 67 % of uterine cancers that developed in 15 breast cancer patients on tamoxifen  had high- grade lesions or high-risk histologies , compared to 24 % of those developing in 38 breast cancer patients not receiving tamoxifen .  To confirm these results , we conducted a retrospective review of 73 patients with a history of breast cancer who subsequently developed uterine cancer and underwent surgery at our institution . Twenty-three ( 32 % ) had received tamoxifen for at least 1 year , with a median duration of use of 4.5 years , while 50 ( 68 % ) did not receive tamoxifen . The median interval between diagnosis of breast and corpus cancer was less in the group that received tamoxifen than in the group that did not ( 4.6 vs 6.7 years ) , but this was not statistically significant . Seventy-four percent of the corpus cancers in the tamoxifen group were adenocarcinomas , while 26 % were considered high-risk histologies , which was identical to the findings for the group that did not receive tamoxifen . The distribution by FIGO stage was I , 15 ( 65 % ) ; II , 2 ( 9 % ) ; III , 5 ( 22 % ) ; and IV , 1 ( 4 % ) for the tamoxifen group , and I , 37 ( 74 % ) ; II , 1 ( 2 % ) ; III , 8 ( 16 % ) ; IV , 3 ( 6 % ) ; and unstaged , 1 ( 2 % ) for the group not receiving tamoxifen ( P = NS ) . For patients with endometrial adenocarcinoma , 23 % of the tamoxifen group had grade 3 lesions , compared with 19 % of the no tamoxifen group ( P = NS ) . Our review of corpus cancers developing in breast cancer patients demonstrated no significant difference in stage , grade , or histologic subtype based on tamoxifen use BACKGROUND & AIMS Poorly digested , fermentable carbohydrates may induce symptoms of irritable bowel syndrome ( IBS ) via unclear mechanisms . We performed a r and omized trial with magnetic resonance imaging ( MRI ) analysis to investigate correlations between symptoms and changes in small- and large-bowel contents after oral challenge . METHODS We performed a 3-period , cross-over study of 29 adult patients with IBS ( based on Rome III criteria , with symptoms of abdominal pain or discomfort for at least 2 days/wk ) and reported bloating . In parallel , we performed the same study of 29 healthy individuals ( controls ) . Studies were performed in the United Kingdom from January 2013 through February 2015 . On 3 separate occasions ( at least 7 days apart ) , subjects were given a 500-mL drink containing 40 g of carbohydrate ( glucose in the first period , fructose in the second , and inulin in the third , in a r and om order ) . Levels of breath hydrogen were measured and intestinal content was assessed by MRI before and at various time points after consumption of each drink . Symptoms were determined based on subjects ' responses to the Hospital Anxiety and Depression Scale question naire and the Patient Health Question naire-15 . The primary end point was whether participants had a clinical ly important symptom response during the 300 minutes after consumption of the drink . RESULTS More patients with IBS reached the predefined symptom threshold after intake of inulin ( 13 of 29 ) or fructose ( 11 of 29 ) than glucose ( 6 of 29 ) . Symptoms peaked sooner after intake of fructose than inulin . Fructose increased small-bowel water content in both patients and controls whereas inulin increased colonic volume and gas in both . Fructose and inulin  increased breath hydrogen levels in both groups , compared with glucose ; fructose produced an earlier increase than inulin . Controls had lower symptom scores during the period after drink consumption than patients with IBS , despite similar MRI parameters and breath hydrogen responses . In patients who reached the symptom threshold after inulin intake , peak symptom intensity correlated with peak colonic gas ( r = 0.57 ; P < .05 ) . Changes in MRI features and peak breath hydrogen levels were similar in patients who did and did not reach the symptom threshold . CONCLUSIONS Patients with IBS and healthy individuals without IBS ( controls ) have similar physiological responses after intake of fructose or inulin ; patients reported symptoms more frequently after inulin than controls . In patients with a response to inulin , symptoms related to levels of intraluminal gas , but peak gas levels did not differ significantly between responders , nonresponders , or controls . This indicates that colonic hypersensitivity to distension , rather than excessive gas production , produces carbohydrate-related symptoms in patients with IBS . Clinical trials.gov no : NCT01776853 OBJECTIVE High-heat cooking of food induces the formation of advanced glycation end products ( AGEs ) , which are thought to impair glucose metabolism in type 2 diabetic patients . High intake of fructose might additionally affect endogenous formation of AGEs . This parallel intervention study investigated whether the addition of fructose or cooking methods influencing the AGE content of food affect insulin sensitivity in overweight individuals . RESEARCH DESIGN AND METHODS Seventy-four overweight women were r and omized to follow either a high- or low-AGE diet for 4 weeks , together with consumption of either fructose or glucose drinks .  Glucose and insulin concentrations — after fasting and 2 h after an oral glucose tolerance test — were measured before and after the intervention . Homeostasis model assessment of insulin resistance ( HOMA-IR ) and insulin sensitivity index were calculated . Dietary and urinary AGE concentrations were measured ( liquid chromatography t and em mass spectrometry ) to estimate AGE intake and excretion . RESULTS When adjusted for changes in anthropometric measures during the intervention , the low-AGE diet decreased urinary AGEs , fasting insulin concentrations , and HOMA-IR , compared with the high-AGE diet . Addition of fructose did not affect any outcomes . CONCLUSIONS Diets with high AGE content may increase the development of insulin resistance . AGEs can be reduced by modulation of cooking methods but is unaffected by moderate fructose intake This r and omized cross‐over study evaluates the effects of extended , guar and guar + fructose diets on the metabolic balance of children with insulin‐dependent diabetes mellitus ( IDDM ) . We studied 22 children ; mean age 12.2 years , mean duration of diabetes 4.4 years . The diet was supplemented for three weeks with guar in palatable form ( 5 % of daily carbohydrate intake ) and with guar + fructose ( 1 g of fructose/kg body weight , max 30 g/d ) for another three weeks . A control group ( 8 children , mean age 12.3 , duration of diabetes 4.3 years ) followed the same experimental protocol without guar supplementation .  The metabolic balance was assessed by glucosuria index ( per cent of tests with less than 1 % glucosuria from all urine tests ) and measurements of red cell glycohaemoglobin A1c ( HbA1c ) . Serum total and HDL‐choiesterol , C‐peptide , pancreatic and enteroglucagon were also measured . HbA1c decreased during guar ( p<0.001 ) and guar + fructose diet ( p<0.001 ) . The glucosuria index improved ( p<0.02 ) and the serum total cholesterol concentration decreased ( p<0.02 ) during the experimental guar diets . Guar in acceptable form and quantity in the diet appears to improve metabolic control of diabetic children
The results did not show any evidence of publication bias .
CONCLUSION Fructose consumption from industrialized foods has significant effects on most components of metabolic syndrome
OBJECTIVE The aim of this study was to review the current corpus of human studies to determine the association of various doses and duration s of fructose consumption on metabolic syndrome .