Abstract P277: ‘Catalytic’ Doses of Fructose Improve Glycemic Control but Not Insulin Resistance: A Systematic Review and Meta-Analysis of Controlled Feeding Trials
Bibliographic record
Abstract
Objective: Contrary to concerns that fructose may have adverse metabolic effects, an emerging literature has shown that low-dose fructose at a level obtainable from fruit ( < 40-g/day) may benefit glycemic control. This effect appears to be mediated by upregulation of glucokinase, leading to increased hepatic glycogen synthesis. Whether this ‘catalytic’ mechanism of fructose will manifest as an increase in hepatic insulin sensitivity is unclear. To address this question, we synthesized evidence from controlled feeding trials assessing the effect of small ‘catalytic’ fructose doses on HbA1c, fasting blood glucose, and homeostasis model assessment of insulin resistance (HOMA-IR). Methods: We searched MEDLINE, EMBASE, and Cochrane Library through October 6, 2015. We included controlled feeding trials of > 7 days investigating the effect of small ‘catalytic’ fructose doses ( < 40-g/day) in isoenergetic exchange for other carbohydrates. Two independent reviewers extracted relevant data and risk of bias (Cochrane Risk of Bias Tool). Data were pooled using the generic inverse variance method and expressed as mean differences (MD) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q statistic) and quantified (I 2 statistic). Results: Nine trials (n= 153) met the eligibility criteria. ‘Catalytic’ doses of fructose significantly reduced HbA1c (MD= -0.40% [95% CI -0.72 to -0.08%]) and fasting blood glucose (MD= -0.18 mmol/L [95% CI -0.35 to -0.02 mmol/L]). There was no effect on HOMA-IR (MD= 0.04 [95% CI -0.14 to 0.22]). Limitations: The available trials were small (median sample size, n= 20) and of short duration (median follow-up, 2 weeks). Conclusion: Pooled analyses indicate that small ‘catalytic’ doses of fructose in isoenergetic exchange for other carbohydrates improve aspects of glycemic control, but the effect does not appear to be mediated through an improvement in hepatic insulin sensitivity. There is a need for larger and longer ( > 6 months) high quality randomized trials to confirm these results.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.048 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.023 | 0.023 |
| Bibliometrics | 0.007 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".