Lower Fructose Intake Reduces Waist Circumference and Fasting Glucose Levels in Obese Individuals

by | May 18, 2020 | 2020, Blood Sugar, Cardiovascular Health, Diabetes, Obesity

Written by Angeline A. De Leon, Staff Writer. Study shows that while a lower fructose diet did not reduce insulin resistance, it did reduce waist circumference and fasting blood glucose concentration, suggesting a decrease in hepatic insulin resistance.

health hazard - insulin resistanceInsulin resistance (IR), referring to poor insulin response resulting in higher blood sugar levels, has been found to share a direct link to both cardiovascular disease (CVD) and diabetes 1,2. Evidence suggests that intake of fructose, sugar from fruit, may increase risk of hepatic IR 3, however, this has been verified primarily only in healthy patients of normal weight and not in overweight and obese populations 4. The exact relationship between fructose intake and risk of obesity and diabetes remains unclear 5. Obesity has been linked to development of nonalcoholic fatty liver disease (NAFLD), which fructose is known to contribute to through indirect induction of IR 6. Fructose consumption may also contribute to hepatic IR by disrupting normal mitochondrial function 7. Evidence from one study found that decreasing fructose intake led to significant reduction of visceral and hepatic fat in children 8, suggesting one pathway through which low fructose intake may help lower hepatic IR. In a 2020 study 9 published in Nutrients, researchers in Spain carried out a field trial with non-diabetic overweight and obese patients to test whether lower fructose consumption could effectively decrease IR.

A randomized, single-blind open field trial was carried out in 239 overweight and obese patients (body mass index between 29 and 40.99 kg/m2) (mean age = 47.9 years), 121 of which were assigned to a low fructose diet (LFD, involving removal of sweetened diet foods, processed foods with high fructose content, and high-fructose fruits and vegetables) and 118 of which were assigned to a standard diet (SD, no dietary restrictions) for 24 weeks. Both diets were 30-40% less than the kcal/day of participants’ individual energy requirements. At baseline, Week 24, and at 48-week follow-up, fasting blood samples were collected to determine lipid profile and fasting blood glucose, and an oral glucose tolerance test was performed to measure IR (homeostatic model assessment of insulin resistance, HOMA2-IR). Anthropometric measures and blood pressure (BP) were also assessed at baseline, at 48-week follow-up, and at regular 4-week intervals throughout the study period.

According to results, although both diet groups exhibited a similar decrease in HOMA2-IR from baseline to Week 24, no significant between-group differences were evident. However, at the end of 24 weeks, the LFD group, relative to SD, showed significant reductions in waist circumference (WC) (mean difference = -2.2 cm, 95% Confidence Interval: -3.7 to –0.7) and fasting blood glucose (-0.14 mmol/L, 95% CI: -0.028 to –0.02) (p < 0.05 for both). In terms of nutrient intake, LFD was also verified to have lower total fructose intake (-1.4, 95% CI: -2.6 to –0.3), relative to SD, and also showed higher protein intake (1.4, 95% CI: 0.1 to 2.7).

Although findings did not support evidence of reduced IR as a result of lower fructose intake, LFD was seen to significantly impact WC and fasting blood glucose in overweight and obese patients. Such a decrease in WC may reflect a reduction in abdominal and liver fat, potentially leading to lower hepatic IR eventually. However, further studies are needed to confirm this. It would also be important to replicate findings without the addition of a hypocaloric diet (to determine the exclusive effects of LFD) and to implement a double-blind study design. Potential study limitations relate to reliance on only 4 self-report food diaries to track patient diet throughout the study and the failure to record vitamins and other trace minerals which could have also influenced insulin sensitivity. Overall, a low-fructose diet appears to have favorable effects on aspects of the cardiometabolic profile of overweight and obese individuals, however, a finer understanding of the relationship between LFD and hepatic IR is still needed.

Source: Dominguez-Coello S, Carrillo-Fernandez L, Gobierno-Hernandez J, et al. Decreased consumption of added fructose reduces waist circumference and blood glucose concentration in patients with overweight and obesity. The DISFRUTE study: a randomized trial in primary care. Nutrients. 2020; 12: 1149. DOI: 10.3390/nu12041149.

 © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

Posted May 18, 2020.

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Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

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