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Adverse metabolic effects of dietary fructose: results from the recent epidemiological, clinical, and mechanistic studies

Stanhope, Kimber L.a,b; Schwarz, Jean-Marcc,d; Havel, Peter J.a,b

Current Opinion in Lipidology: June 2013 - Volume 24 - Issue 3 - p 198–206
doi: 10.1097/MOL.0b013e3283613bca
LIPID METABOLISM: Edited by Ernst J. Schaefer

Purpose of review The effects of dietary sugar on risk factors and the processes associated with metabolic disease remain a controversial topic, with recent reviews of the available evidence arriving at widely discrepant conclusions.

Recent findings There are many recently published epidemiological studies that provide evidence that sugar consumption is associated with metabolic disease. Three recent clinical studies, which investigated the effects of consuming relevant doses of sucrose or high-fructose corn syrup along with ad libitum diets, provide evidence that consumption of these sugars increase the risk factors for cardiovascular disease and metabolic syndrome. Mechanistic studies suggest that these effects result from the rapid hepatic metabolism of fructose catalyzed by fructokinase C, which generates substrate for de novo lipogenesis and leads to increased uric acid levels. Recent clinical studies investigating the effects of consuming less sugar, via educational interventions or by substitution of sugar-sweetened beverages for noncalorically sweetened beverages, provide evidence that such strategies have beneficial effects on risk factors for metabolic disease or on BMI in children.

Summary The accumulating epidemiological evidence, direct clinical evidence, and the evidence suggesting plausible mechanisms support a role for sugar in the epidemics of metabolic syndrome, cardiovascular disease, and type 2 diabetes.

aDepartment of Molecular Biosciences, School of Veterinary Medicine

bDepartment of Nutrition, University of California, Davis, Davis, California

cDepartment of Basic Sciences, College of Osteopathic Medicine, Touro University, Vallejo, California

dDepartment of Medicine, University of California, San Francisco, San Francisco, California, USA

Correspondence to Kimber L. Stanhope, Department of Molecular Biosciences, School of Veterinary Medicine, One Shields Avenue, University of California, Davis, Davis, CA 95616, USA. Tel: +1 530 752 3720; e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.