BACKGROUND: Fructose consumption increases risk factors for cardiometabolic disease . It is assumed that the effects of free sugars on risk factors are less potent because they contain less fructose . We compared the effects of consuming fructose, glucose or their combination, high fructose corn syrup (HFCS), on cardiometabolic risk factors .
METHODS: Adults (18-40â¯years; BMI 18-35â¯kg/m2) participated in a parallel, double-blinded dietary intervention during which beverages sweetened with aspartame, glucose (25% of energy requirements (ereq) ), fructose or HFCS (25% and 17.5% ereq) were consumed for two weeks . Groups were matched for sex, baseline BMI and plasma lipid/lipoprotein concentrations . 24-h serial blood samples were collected at baseline and after the intervention . Primary outcomes were 24-h triglyceride AUC, LDL-cholesterol (C), and apolipoprotein (apo) B. Interactions between fructose and glucose were assessed post hoc . FINDINGS: 145 subjects (26.0â¯±â¯5.8â¯years; body mass index 25.0â¯±â¯3.7â¯kg/m2) completed the study . As expected, the increase of 24-h triglycerides compared with aspartame was highest during fructose consumption (25% : 6.66â¯mmol/Lx24h 95% CI [1.90 to 11.63], Pâ¯=â¯0.0013 versus aspartame), intermediate during HFCS consumption (25% : 4.68â¯mmol/Lx24h 95% CI [-0.18 to 9.55], Pâ¯=â¯0.066 versus aspartame) and lowest during glucose consumption . In contrast, the increase of LDL-C was highest during HFCS consumption (25% : 0.46â¯mmol/L 95% CI [0.16 to 0.77], Pâ¯=â¯0.0002 versus aspartame) and intermediate during fructose consumption (25% : 0.33â¯mmol/L 95% CI [0.03 to 0.63], Pâ¯=â¯0.023 versus aspartame), as was the increase of apoB (HFCS-25% : 0.108â¯g/L 95% CI [0.032 to 0.184], Pâ¯=â¯0.001; fructose 25% : 0.072â¯g/L 95% CI [-0.004 to 0.148], Pâ¯=â¯0.074 versus aspartame). The post hoc analyses showed significant interactive effects of fructose*glucose on LDL-C and apoB (both Pâ¯ <â¯0.01), but not on 24-h triglyceride (Pâ¯=â¯0.340).
CONCLUSION: A significant interaction between fructose and glucose contributed to increases of lipoprotein risk factors when the two monosaccharides were co-ingested as HFCS . Thus, the effects of HFCS on lipoprotein risks factors are not solely mediated by the fructose content and it cannot be assumed that glucose is a benign component of HFCS . Our findings suggest that HFCS may be as harmful as isocaloric amounts of pure fructose and provide further support for the urgency to implement strategies to limit free sugar consumption.