For you pop drinkers.....fructose info...

[Kathe]

http://www.medscape.com/viewarticle/577279?src=mp&uac=88870AK

Fructose Intake Has Increased to More Than 10% of Daily Energy in US Diet CME/CE

News Author: Laurie Barclay, MD
CME Author: Laurie Barclay, MD
Release Date: July 9, 2008;

Laurie Barclay, MD
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Brande Nicole Martin
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.





July 9, 2008 — Intake of fructose has increased in the typical US diets to more than 10% of energy intake, according to the results of a study by Miriam B. Vos, MD, MSPH, from Emory University in Atlanta, Georgia, and colleagues, reported in the July 9 issue of the Medscape Journal of Medicine. Editorialist George A. Bray, MD, discusses the negative effects of this high intake on the health of children and adults.

For a clinical perspective on the health implications of dietary fructose, Medscape also interviewed Michael Dansinger, MD, MS, from the Division of Endocrinology, Diabetes, and Metabolism at Tufts Medical Center in Boston, Massachusetts, and clinical nutrition and obesity editor for the Medscape Journal of Medicine.

"Sadly, less than 20% of the fructose in the American diet is consumed in natural form from fruits and vegetables," Dr. Dansinger told Medscape. "In fruits and vegetables, fructose is not highly concentrated and is accompanied by fiber and other healthy nutrients. These foods are low in calories and they decrease hunger and appetite, and they help maintain a healthy body weight."

"In contrast, the fructose added to soft drinks and processed foods typically lead to increased calorie intake and possible weight gain because the fructose is not accompanied by comparable amounts of fiber or other nutrients that promote healthy weight," Dr. Dansinger said. "Instead, the fructose acts as an unhindered appetite stimulant. In this regard, fruit juice is much like a soft drink because the fiber is lacking and the fructose is much more highly concentrated that in the original fruit."

Dietary data from a nationally representative sample from 1977 to 1978 showed that mean estimated fructose intake was 37 g/day, or 8% of total intake. However, little is known about more recent patterns of fructose consumption.

The goal of the study by Dr. Vos and colleagues was to determine the amount and sources (natural fruit vs fructose added to beverages and other foods) of dietary fructose in 21,483 US adults and children. With a single 24-hour dietary recall administered as part of the third National Health and Examination Survey (NHANES III), patterns of fructose consumption were analyzed by sex, age group, race or ethnicity, socioeconomic status, and body mass index for children and adults. Weighted estimates of fructose intake were tested for significant between-group differences.

Estimated mean consumption of fructose was 54.7 g/day (range, 38.4 - 72.8 g/day), accounting for 10.2% of total energy intake. Adolescents (12 - 18 years of age) had the highest intake (72.8 g/day, or 12.1% of total energy intake). For 25% of adolescents, at least 15% of energy consumed came from fructose. Sugar-sweetened beverages were the largest source of fructose (30%) followed by grains (22%) and fruit or fruit juice (19%).

"Soft drinks are the leading source of fructose, and the increase in soft drink and fruit juice consumption has largely replaced milk intake, especially in children," Dr. Dansinger said. "This means children today are consuming more sugar and less protein, calcium, and vitamin D than their parents and grandparents did."

Dr. Vos and colleagues concluded that more than 10% of daily energy intake in the typical US diet comes from fructose. When compared with a previous nationally representative study, these findings suggest that fructose consumption has increased. The investigators recommend further research to understand the effect of increased intake of fructose on human health.

Limitations of this study include availability of only one 24-hour recall with which to assess dietary intake; nutrient database used by NHANES III for this study different from that used in the 1977 to 1978 study, limiting ability to compare these results; systematic bias created by underreporting of fructose consumption; and inability to determine how data collected from 1988 to 1994 compare with current patterns of fructose consumption.

Dr. Vos and colleagues note that fructose consumption may play a role in health outcomes. High fructose intake has been linked to increased de novo lipogenesis in the liver as well as increased plasma triglyceride levels, insulin resistance, and obesity. In short-term studies, fructose intake increases plasma triglyceride levels in healthy adults. Although no studies to date have looked at the effect of fructose feeding on triglyceride levels in children, there have been reports of correlations between fructose intake and plasma lipid levels.

In children aged 6 to 19 years, dietary sucrose has been linked to increased plasma triglyceride and low high-density lipoprotein (HDL) cholesterol levels. Total fructose intake in normal-weight and overweight children was a significant predictor of smaller low-density lipoprotein (LDL) cholesterol particle size, which in turn has been linked to an increased risk for cardiovascular disease. On the basis of their review of the literature, the investigators suggest that there may be a threshold level for the effects of fructose.

In an accompanying editorial, George A. Bray, MD, chief of clinical obesity and metabolism at the Pennington Biomedical Research Center in Baton Rouge, Louisiana, notes that dietary fructose comes from 3 main sources: sucrose (common table sugar), high-fructose corn syrup (HFCS) made from corn starch, and fruit. Fructose intake from sugar or HFCS-sweetened beverages provides no other nutrients, whereas intake of fruit containing fructose provides a variety of natural, beneficial nutrients.

The more energetically (calorically) sweetened soft drinks consumed by young people, the more they are shortchanged of valuable nutrients found in natural foods, and the less milk they consume, which also shortchanges them on calcium and vitamin D. The amount of energy (calories) in energetically (calorically) sweetened beverages is not perceived by the body in the same way as those in solid food, in that they do not suppress intake of other foods by the amount of energy (calories) in the soft drinks, thereby contributing to the current epidemic of obesity.

"The main cause of the obesity epidemic is increased calorie intake throughout society during the past 50 years," Dr. Dansinger said. "The addition of sugar and high-fructose corn syrup (which are both around 50% fructose) to processed foods and beverages is a major cause of the increased caloric intake, not only from the calories in the sugars themselves, but [because] they are added to foods that already have high calorie counts, such as doughnuts and ice cream. In other words, many high calorie foods have sugar added, and this drives much of the obesity epidemic."

Other negative effects of fructose consumption include increased levels of serum uric acid, indirectly contributing to hypertension and cardiovascular disease and directly related to the risk for gout in men. Consumption of soft drinks has been associated with the development of cardiometabolic risk factors and the metabolic syndrome in participants in the Framingham Study.

"Compared to other sugars, fructose worsens levels of cholesterol, triglycerides, and uric acid, [which] may accelerate heart disease risk," Dr. Dansinger concluded. "The best approach is to stick as much as possible to a whole-foods diet consisting of fruits, vegetables, and healthy proteins. Avoid foods with added sugars."

"It is amazing to me that many of our public schools have resorted to financial contracts with beverage companies to make calorie-containing soft drinks that have little nutritional value available on school premises," Dr. Bray wrote. "How we can put the children who are susceptible to obesity at risk by this strategy has perplexed me for years. Maybe it is time for the public to worry about what fructose may be doing to their children and themselves."

Dr. Vos was supported by the Joseph W. Crooks Faculty Development Award. The study authors have disclosed no relevant financial relationships. The findings and conclusions in the study by Dr. Vos and colleagues are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Dr. Bray has disclosed various financial relationships with Merck, Takeda, sanofi-aventis, Orexigen, and Amylin. Dr. Dansinger is the Nutrition Doctor for NBC's "The Biggest Loser."
Medscape J Med. Published online July 9, 2008.
Clinical Context

Fructose is a monosaccharide found naturally, primarily in fruits. It is typically consumed as sucrose (table sugar), which consists of equal parts of fructose and glucose or as a component of HFCS. Both HFCS and sucrose are frequently added as sweeteners to many processed foods and beverages. Patterns of fructose consumption among US children and adults have not been well described previously, although a study by Bray and colleaguesin the April 2004 issue of the American Journal of Clinical Nutrition estimated that total fructose intake for US adults and children 2 years of age and older increased from 8.8% from 1977 to 1978 to 9.4% between 1989 and 1991 and 11.5% between 1994 and 1998.
Animal studies suggest that long-term fructose consumption causes dyslipidemia, insulin resistance, obesity, and other features of the metabolic syndrome. There are no long-term, controlled trials in humans, but short-term studies have shown that fructose concentrations ranging from 7.5% to 25% of total kilocalories per day may result in hyperlipidemia and insulin resistance.
Study Highlights

• The purpose of this study was to provide a more detailed description of fructose intake according to individual, single 24-hour dietary recall administered in NHANES III from 1988 to 1994.
• The investigators determined the amount and sources (natural fruit vs fructose added to beverages and other foods) of dietary fructose in 21,483 US adults and children.
• For children and adults, patterns of fructose consumption were analyzed by sex, age group, race or ethnicity, socioeconomic status, and body mass index, and weighted estimates of fructose intake were tested for significant between-group differences.
• Estimated mean fructose consumption was 54.7 g/day (range, 38.4 - 72.8 g/day) or 10.2% of total energy. This is an increase of nearly 50% from that estimated with data from 1977 to 1978.
• Adolescents aged 12 to 18 years had the highest intake (72.8 g/day), or 12.1% of total energy.
• For 25% of adolescents, fructose accounted for 15% or more of energy consumed.
• The largest sources of fructose were sugar-sweetened beverages (30%), grains (22%), and fruit or fruit juice (19%).
• Breads and cereals alone contributed 12% in children 2 to 18 years and 11% in adults.
• If all sources of fructose were eliminated other than whole fruit and vegetables, children and adults would eliminate 82% and 75% of fructose from their diets, respectively.
• The investigators recommended additional studies to clarify the effect of increased intake of fructose on human health.
• Limitations of the study include use of only one 24-hour dietary intake, nutrient database used in this study different from that used in the 1977 to 1978 study, underreporting of fructose intake causing bias, and inability to determine how data collected in 1988 to 1994 compare with current fructose intake.
• Fructose consumption may affect health outcomes.
• In short-term studies, fructose intake increased plasma triglyceride levels in healthy adults.
• Correlations between fructose intake and plasma lipid levels have been reported in children, but no studies to date have yet evaluated the effect of fructose feeding on triglyceride levels.
• In children aged 6 to 19 years, sucrose intake has been linked to increased plasma triglyceride levels and low HDL cholesterol levels. Total fructose intake predicted smaller LDL cholesterol particle size, which may increase the risk for cardiovascular disease.
• Literature reviewed by the investigators suggests a threshold level for effects of fructose.
• An accompanying editorial notes that fructose intake from sugar or HFCS-sweetened beverages provide no other nutrients, whereas intake of fruit containing fructose provides a variety of natural, beneficial nutrients.
• Higher intake of HFCS-sweetened soft drinks in young people may result in proportionately less intake of natural nutrients, such as those in milk.
• The amount of energy (calories) in HFCS-sweetened beverages does not suppress intake of other foods by the amount of energy (calories) in the soft drinks, thereby contributing to the current epidemic of obesity.
• Other negative effects of fructose consumption include increased levels of serum uric acid, indirectly contributing to hypertension and cardiovascular disease and directly related to the risk for gout in men.
• In the Framingham Study, soft drink intake was associated with the development of cardiometabolic risk factors and the metabolic syndrome.

Pearls for Practice

• The estimated mean fructose consumption was 54.7 g/day (approximately 10% of total energy). Adolescents aged 12 to 18 years had the highest energy intake (72.8 g/day), or 12.1% of total energy. The largest sources of fructose were sugar-sweetened beverages (30%), grains (22%), and fruit or fruit juice (19%).
• Fructose consumption may adversely affect health outcomes. In short-term studies, fructose intake increases plasma triglyceride levels in healthy adults, and correlations between fructose intake and plasma lipid levels have been reported in children. Other negative effects of fructose consumption include increased serum uric acid levels, increased risk for cardiovascular disease, increased risk for gout in men, and development of cardiometabolic risk factors.

[RCKnep3]

This is so true, I used to drink alot of soda. I ate soso but kept gaining weight. I realized how many calories I drank daily and stopped. Just cutting out that fake sugar, I stopped gaining weight and slowly lost just from that simple change.

[nicole4tanning]

I just love soda!!!!

[Kathe]

You love soda because the sugar in it is addicting. It pulls you in.

[nicole4tanning]

Damn Soda.

[solaraz]

I live on diet pepsi!

[nicole4tanning]

Yep. A lot of diet pepsi here too.

[RCKnep3]

Yeah if I have soda it's diet...I like coke Zero. I know it's also not good but vs reg soda I figure it's still a better choice. I do like the flavored waters so I buy them when I can. Love vitamin water but still alot of calories in most (I drank 2 today, should never have stocked up on them for the salon!)

[JustTans]

I cut everything but water and the occassional tea out of my diet and didn't lose anything!

[Mr Derf]

MMMMmmmm Fructose...