“Catalytic” Doses of Fructose and its Epimers on Glycemic Control: A Systematic Review and Meta‐Analysis of Controlled Feeding Trials
Bibliographic record
Abstract
Objective Contrary to the concerns that fructose may have adverse metabolic effects, an emerging literature has shown that small, ‘catalytic’ doses (≤ 50‐g/day) of fructose and its epimers (allulose, tagatose and sorbose) decrease the glycemic response to high glycemic index meals in humans. This effect appears to be mediated by upregulation of glucokinase, leading to increased hepatic glycogen synthesis. Whether this acute ‘catalytic’ mechanism of fructose and its epimers will manifest as an improvement in long term glycemic control is unclear. To address this question, we synthesized evidence from controlled feeding trials assessing the effect of small, ‘catalytic’ doses of fructose and its epimers on HbA1c. Methods We searched MEDLINE, EMBASE, and Cochrane Library through Feb 12, 2016. We included controlled feeding trials of ≥ 2 weeks investigating the effect of small, ‘catalytic’ doses (≤ 50‐g/day) of fructose and its epimers in comparison to control diets. Two independent reviewers extracted relevant data. Risk of bias was assessed using the 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 using the Cochran Q statistic and quantified using the I 2 statistic. The overall quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results 7 trials (n = 467) over a median follow‐up of 3 months met the eligibility criteria. ‘Catalytic’ doses of fructose significantly reduced HbA 1c (MD = −0.40% [95% CI −0.72 to − 0.08]), but not allulose and tagatose for which there was only one trial comparison for each of the sugars. The overall quality of the evidence was graded as “moderate” quality for a decreasing effect of fructose on HbA 1c due to a downgrade for serious imprecision. The evidence for allulose and tagatose was not graded. Conclusion Pooled analyses indicated that small, ‘catalytic’ doses of fructose improve glycemic control over the shorter term. The evidence for allulose and tagatose remains inconclusive due to the limited number of trials. There is a need for large high quality, long‐term randomized trials for all 3 sugars to improve our confidence in the effect estimates. Protocol registration: clinicaltrials.gov identifier, NCT02776722 Support or Funding Information Funding: The Tate and Lyle Nutritional Research Fund at the University of Toronto, Canadian Diabetes Association (CDA), Banting & Best Diabetes Centre, and PSI foundation.
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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 | 0.017 | 0.049 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.024 | 0.026 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
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".