Fructose-containing food sources and blood pressure: A systematic review and meta-analysis of controlled feeding trials

Abstract

Whether food source or energy mediates the effect of fructose-containing sugars on blood pressure (BP) is unclear. We conducted a systematic review and meta-analysis of the effect of different food sources of fructose-containing sugars at different levels of energy control on BP. We searched MEDLINE, Embase and the Cochrane Library through June 2021 for controlled trials ≥7-days. We prespecified 4 trial designs: substitution (energy matched substitution of sugars); addition (excess energy from sugars added); subtraction (excess energy from sugars subtracted); and ad libitum (energy from sugars freely replaced). Outcomes were systolic and diastolic BP. Independent reviewers extracted data. GRADE assessed the certainty of evidence. We included 93 reports (147 trial comparisons, N = 5,213) assessing 12 different food sources across 4 energy control levels in adults with and without hypertension or at risk for hypertension. Total fructose-containing sugars had no effect in substitution, subtraction, or ad libitum trials but decreased systolic and diastolic BP in addition trials (P<0.05). There was evidence of interaction/influence by food source: fruit and 100% fruit juice decreased and mixed sources (with sugar-sweetened beverages [SSBs]) increased BP in addition trials and the removal of SSBs (linear dose response gradient) and mixed sources (with SSBs) decreased BP in subtraction trials. The certainty of evidence was generally moderate. Food source and energy control appear to mediate the effect of fructose-containing sugars on BP. The evidence provides a good indication that fruit and 100% fruit juice at low doses (up to or less than the public health threshold of ~10% E) lead to small, but important reductions in BP, while the addition of excess energy of mixed sources (with SSBs) at high doses (up to 23%) leads to moderate increases and their removal or the removal of SSBs alone (up to ~20% E) leads to small, but important decreases in BP in adults with and without hypertension or at risk for hypertension. Trial registration: Clinicaltrials.gov: NCT02716870.

Two-Month Consumption of Orange Juice Enriched with Vitamin D3 and Probiotics Decreases Body Weight, Insulin Resistance, Blood Lipids, and Arterial Blood Pressure in High-Cardiometabolic-Risk Patients on a Westernized Type Diet: Results from a Randomized Clinical Trial

“…The lack of change in central hemodynamics could be attributed to the intervention's short duration [46]. Nonetheless, the reduction in peripheral blood pressure was consistent with previous findings on the cardiovascular benefits of fruit juice consumption [47,48], particularly in lowering systolic BP [49][50][51]. Our results are in partial agreement with a meta-analysis reporting that probiotic consumption significantly decreased systolic BP by −3.56 mmHg and diastolic BP by −2.38 mmHg compared to those in control groups, with a greater reduction in BP found with multiple probiotics compared to single probiotics, as well as greater reductions being found in diastolic BP in hypertensive patients [52].…”

Dietary patterns and the risk of cardiovascular diseases

“…A recent meta-analysis of clinical trials shows small doses of 100% fruit juice are beneficial in minimizing hypertension though the effect was minimal but crucial. However, mixing fruit juice with sugar-sweetened beverages (up to ∼23%) moderately increases blood pressure while removal of sugar-sweetened beverages decreases blood pressure irrespective of the presence or absence of hypertension (Liu et al, 2023). Consistently, another observational study from West African countries reported that higher consumption of red meat, dietary fat, salt, junk food, and alcohol are linked with increased blood pressure and hypertension while higher consumption of fruit and vegetables was protective against hypertension (Batubo et al, 2023).…”