Sugary drinks have a higher risk of diabetes than other sugary foods

Sugar drinks are at a higher risk of type 2 diabetes than most other foods containing fructose, a naturally occurring sugar, according to an analysis of evidence published by The BMJ aujourd & # 39; hui.

The results suggest that fruits and other foods containing fructose do not appear to have a negative effect on blood sugar, while sugary drinks and some other foods that add excess "nutrient-poor" energy to the diet can have adverse effects.

"These findings could help guide recommendations on essential fructose sources in the prevention and management of diabetes," said Dr. John Sievenpiper, lead author of the study and researcher at the Clinical Modification and Modification Center. Risk Factors at St. Michael's Hospital in Toronto, Canada. "But the level of evidence is low and more high-quality studies are needed."

The role of sugars in the development of diabetes and heart disease is the subject of much debate and there is growing evidence that fructose may be particularly harmful to health.

Fructose is naturally present in a variety of foods, including whole fruits and vegetables, natural fruit juices and honey. It is also added to foods, such as soft drinks, breakfast cereals, baked goods, sweets and desserts as "free sugars".

Current dietary recommendations recommend reducing free sugars, especially fructose content in sweetened beverages, but it is unclear if this is valid for all dietary sources of these sugars.

Researchers from St. Michael's and the University of Toronto in Canada, therefore, analyzed the results of 155 studies evaluating the effect of different dietary sources of glucose sugars on fructose in people with and without diabetes monitored for up to 12 weeks.

The results were based on four types of studies: substitution (comparison of sugars with other carbohydrates), addition (energy from sugars added to the diet), subtraction (energy from sugars removed from the diet) or ad libitum. (sugar energy freely replaced).

The results were glycated hemoglobin or HbA1c (amount of glucose attached to red blood cells), fasting glucose and fasting insulin (blood glucose and insulin levels after a period of fasting).

Studies were also evaluated for biases and certainty of evidence. Overall, no serious risk of bias was detected, but the certainty of the evidence was low.

The results show that most foods containing fructose sugar do not have an adverse effect on blood glucose levels when these foods do not provide an excess of calories. However, a detrimental effect on fasting insulin in some studies.

Specific food analysis suggests that fruits and juices, when these foods do not provide an excess of calories, can have beneficial effects on the control of blood glucose and insulin, especially in diabetics , while particularly sweet drinks and fruit juices, seem to have harmful effects.

The low glycemic index (GI) of fructose compared to other carbohydrates and the higher fiber content of fruits could explain the improvement in blood glucose levels by slowing the release of sugars, the researchers said.

They point to some limitations, such as small sample sizes, short follow-up periods, and limited variety of foods in some studies. However, strengths included a thorough research and selection process and a thorough assessment of the quality of evidence.

They conclude, "Until more information is available, public health professionals should be aware that the harmful effects of fructose sugars on blood glucose levels appear to be mediated by energy." and the food source ".

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More information:
BMJ (2018). DOI: 10.1136 / bmj.k4644, http://www.bmj.com/content/363/bmj.k4644