Important Food Sources of Fructose-Containing Sugars and Incident Hypertension: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

Qi Liu, Sabrina Ayoub-Charette, Tauseef Ahmad Khan, Fei Au-Yeung, Sonia Blanco Mejia, Russell J de Souza, Thomas M S Wolever, Lawrence A Leiter, Cyril W C Kendall, John L Sievenpiper, Qi Liu, Sabrina Ayoub-Charette, Tauseef Ahmad Khan, Fei Au-Yeung, Sonia Blanco Mejia, Russell J de Souza, Thomas M S Wolever, Lawrence A Leiter, Cyril W C Kendall, John L Sievenpiper

Abstract

Background Sugar-sweetened beverages are associated with hypertension. We assessed the relation of important food sources of fructose-containing sugars with incident hypertension using a systematic review and meta-analysis of prospective cohort studies. Methods and Results We searched MEDLINE, EMBASE, and Cochrane (through December week 2, 2018) for eligible studies. For each food source, natural log-transformed risk ratios (RRs) for incident hypertension were pooled using pair-wise meta-analysis and linear and nonlinear dose-response meta-analyses. Certainty in our evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. We identified 26 reports, including 15 prospective cohorts (930 677 participants; 363 459 cases). Sugar-sweetened beverages showed harmful (RRper-355-mL, 1.10 [95% CI, 1.08, 1.12]) whereas fruit (RRper-240-g, 0.94 [95% CI, 0.96, 0.99]) and yogurt showed protective associations (RRper-125-g, 0.95 [95% CI, 0.94, 0.97]) with incident hypertension throughout the dose range. One hundred percent fruit juice showed a protective association only at moderate doses (RRat-100-mL, 0.97 [95% CI, 0.94, 0.99]). The pair-wise protective association of dairy desserts was not supported by linear dose-response analysis. Fruit drinks or sweet snacks were not associated with hypertension. Certainty of the evidence was "low" for sugar-sweetened beverages, 100% fruit juice, fruit, and yogurt and "very low" for fruit drinks, sweet snacks, and dairy desserts. Conclusions The harmful association between sugar-sweetened beverages and hypertension does not extend to other important food sources of fructose-containing sugars. Further research is needed to improve our estimates and better understand the dose-response relationship between food sources of fructose-containing sugars and hypertension. Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02702375.

Keywords: SSBs; dairy; fruit; fruit juice; hypertension; yogurt.

Figures

Figure 1
Figure 1
Flow of the literature search.
Figure 2
Figure 2
Relation of sources of fructose‐containing sugars and incident hypertension. Pair‐wise summary estimates were derived from pooled risk ratios for highest vs lowest intake of the food sources. Estimates of linear and nonlinear dose‐response relationships are presented per intake level indicated in the column, “dose comparison.” Dose‐ranges are rounded to the nearest five. Data are expressed as risk ratios (RRs) with 95% CIs. Values of I2≥50% indicate substantial heterogeneity. RRs >1.0 indicate a harmful association. The Grading of Recommendations, Assessment, Development and Evaluation of prospective cohort studies are rated as “low” certainty of evidence and can be downgraded by 5 domains and upgraded by 3 domains. Filled black squares indicate downgrade or upgrades for each outcome. NA indicates not applicable.
Figure 3
Figure 3
Dose‐response relation between sources of fructose‐containing sugars and incident hypertension. Dose‐response relationship between intake of SSBs, fruit, 100% fruit juice, yogurt, fruit drink, dairy desserts, and sweet snacks with risk of hypertension. Red line represents the linear, and black lines represent the nonlinear models, respectively. Dotted lines represent 95% CIs of the nonlinear model. RR indicates risk ratio; SSBs, sugar‐sweetened beverages.

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Source: PubMed

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