Calorie-sweetened beverages and fructose: what have we learned 10 years later

Calorie Control Council Comments

Bray GA, Popkin BM. Calorie-sweetened beverages and fructose: what have we learned 10 years later. Pediatr Obes 2013.

Bray & Popkin (with Nielsen) drew attention to high-fructose corn syrup (HFCS) in a 2004 commentary (author ref. 1).  Though primarily supported by correlation with obesity, their HFCS hypothesis nevertheless had two important consequences:  (1) their unproven hypothesis was widely accepted as fact; and (2) omitted sucrose—similar to HFCS in composition, sweetness, calories and functionality—was unwittingly positioned as a ‘healthy’ sweetener alternative.  In a recent paper (1), Bray and Popkin present a new fructose-based hypothesis that is no better supported than the first.

Their new hypothesis asserts that fructose and SSB consumption may be causative for obesity, metabolic syndrome and fatty liver disease.  But as the authors note, correlation is not causation.  Furthermore, recent USDA-ERS (2) and NHANES (3) data do not even support correlation:  fructose, HFCS, added sugars and SSB have declined since 1999.  The authors’ use of scanned product data is a poor proxy for HFCS, incapable of quantifying “the proportion of calories from caloric sweeteners” (quote, reference 14).

Evidence linking fructose to disease states is speculative and poorly supported.  Citations have low evidentiary value (epidemiologic and animal studies); were compromised by hypercaloric fructose dosing and subject weight gain; or reported statistical differences of questionable clinical importance (references 29-33, 39, 49-51, 53-56).  There is now convincing research that (1) HFCS and sucrose are metabolically similar; and (2) glucose, fructose, HFCS and sucrose give comparable and clinically normal responses over the range of human exposure (4).

This new hypothesis is simply HFCS redux, with no better support than the original.

References
  • Bray GA, Popkin BM. Calorie-sweetened beverages and fructose: what have we learned 10 years later. Pediatr Obes 2013.
  • Welsh JA, Sharma AJ, Grellinger L, Vos MB. Consumption of added sugars is decreasing in the United States. Am J Clin Nutr 2011;94:726-34.
  • Rippe JM, Angelopoulos TJ. Sucrose, high-fructose corn syrup, and fructose, their metabolism and potential health effects: what do we really know? Adv Nutr 2013;4:236-45.
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