饮料中的添加果糖是糖尿病的主要诱因

Added fructose is 'a principal driver of type 2 diabetes'

　

在《梅奥诊所学报》上，专家们敦促大幅减少添加糖的摄入。

最近的研究表明添加糖，尤其是那些添加的果糖，是糖尿病和糖尿病前期的主要诱因，甚至比其他碳水化合物更诱发糖尿病。临床专家在《梅奥诊所会刊》上撰文，质疑现行的膳食指南，该指南允许每日总热量的25%作为添加糖，并建议大幅减少人们摄入的添加糖，尤其是添加果糖。

 

世界范围内，大约每10个成年人中就有1个患有2型糖尿病，全球患病人数从1980年的1.53亿增加到2008年的3.47亿，增加了一倍多。在美国，2900万成年人(11人中有1人)患有2型糖尿病，另外8600万成年人(超过三分之一)患有糖尿病前期。

 

研究报告的主要作者、位于密苏里州堪萨斯城的圣卢克美国中部心脏研究所的心血管研究科学家詹姆斯·j·迪内科安东尼奥(James J. DiNicolantonio)说:“在目前的水平上，加糖的消费，特别是加果糖的消费，正在加剧2型糖尿病的流行。”“大约40%的美国成年人已经有了一定程度的胰岛素抵抗，据预测，几乎相同比例的人最终会患上显性的糖尿病。”

 

作者说，过量摄入果糖的最终结果是全面代谢紊乱和系统性胰岛素抵抗。其他不含果糖的食糖在这些方面似乎没有那么有害。事实上，一些临床试验表明，与葡萄糖或淀粉相比，与果糖或蔗糖的等热量交换导致空腹胰岛素、空腹血糖和胰岛素/葡萄糖对蔗糖负荷的反应增加。这表明蔗糖(尤其是果糖成分)比其他碳水化合物更有害。

 

迪尼科安东尼奥医生和他的合著者——圣路克美国中部心脏研究所的詹姆斯·H·奥基夫，医学博士，肖恩·c·卢坎，医学博士，阿尔伯特·爱因斯坦医学院的纽约蒙特菲奥医学中心的家庭医生——通过动物实验和人类研究得出了他们的结论。

 

主要作者James J. DiNicolantonio博士谈论了这项研究。

 

最近的试验数据表明，用含果糖的蔗糖(蔗糖)取代只含葡萄糖的淀粉会导致显著的不良代谢影响。随着基线胰岛素抵抗的增加，副作用更大，在饮食中添加更多果糖的影响更大。

 

根据作者的说法，这些证据令人信服地表明，添加糖，尤其是添加果糖(通常以高果糖玉米糖浆和蔗糖的形式出现)是一个严重且日益严重的公共健康问题。

 

2010年《美国人膳食指南》(Dietary Guidelines for Americans)指出，有些人可以从添加糖中摄取高达19%的热量，而美国医学学会(Institute of Medicine)则允许从添加糖中摄取至多25%的热量。相比之下，世界卫生组织建议添加糖的摄入量不应超过一天卡路里摄入量的10%，并建议将这一比例降至5%或更低，以达到最佳健康。这样的水平会更符合作者推荐类似的限制性现有美国心脏协会(AHA)的建议——女性每天消费不超过6茶匙糖(24克)和男性每天不超过9茶匙(36克)每天的糖。

“限制食用含有添加糖的食品和饮料，尤其是添加果糖的食品和饮料，可能是确保一个人未来健康的最有效的策略之一。”

 

虽然果糖在水果和蔬菜等天然食品中都有，但食用这些食品对人体健康没有问题。迪尼科尔安东尼奥博士和他的同事们解释说，的确，食用水果和蔬菜可以预防糖尿病和更广泛的心脏代谢紊乱。作者建议，应该修改膳食指南，鼓励人们用水果和蔬菜等天然食品取代富含添加糖和果糖的加工食品。他们在报告中写道:“大多数现有的指南都没有达到这个标准，因为糖尿病的发病率和相关的心血管疾病和其他后果可能会恶化。”

 

作者还认为应该鼓励工业界减少对食品和饮料添加糖，特别是含果糖的种类。他们得出的结论是，“在个人层面上，限制食用含有添加糖的食品和饮料，尤其是添加果糖，可能是确保一个人未来健康的最有效的策略之一。”

 

读这篇文章

《果糖:2型糖尿病及其后果的主要驱动因素》，《梅奥诊所学报》(2015年3月)。

《梅奥诊所学报》是《梅奥诊所》的旗舰期刊，也是《梅奥诊所学报》的同行评议期刊之一。《梅奥诊所学报》是被最广泛阅读和被高度引用的医师科学刊物之一，发行量约12.5万份。该杂志由梅奥诊所赞助，它欢迎来自世界各地作者的意见，发表文章关注临床医学，支持其读者的专业和教育需要。该杂志由爱思唯尔出版。

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Added fructose is 'a principal driver of type 2 diabetes'

　

In Mayo Clinic Proceedings, experts urge drastic reductions in the consumption of added sugars

By Eileen Leahy     Posted on 29 January 2015

          

Yogurt with added fructose (Photo by Alison Bert)Yogurt with added fructose (Photo by Alison Bert)Recent studies have shown that added sugars, particularly those containing fructose, are a principal driver of diabetes and pre-diabetes, even moreso than other carbohydrates. Clinical experts writing in Mayo Clinic Proceedings challenge current dietary guidelines that allow up to 25 percent of total daily calories as added sugars, and propose drastic reductions in the amount of added sugar, and especially added fructose, people consume.

 

Worldwide, approximately one in 10 adults has type 2 diabetes, with the number of individuals afflicted by the disease across the globe more than doubling from 153 million in 1980 to 347 million in 2008. In the United States, 29 million adults (one in 11) have type 2 diabetes, and another 86 million (more than one in three) have pre-diabetes.

　

　

"At current levels, added-sugar consumption, and added-fructose consumption in particular, are fueling a worsening epidemic of type 2 diabetes," said lead author James J. DiNicolantonio, PharmD, a cardiovascular research scientist at Saint Luke's Mid America Heart Institute in Kansas City, Missouri. "Approximately 40 percent of US adults already have some degree of insulin resistance, with projections that nearly the same percentage will eventually develop frank diabetes."

 

　

The net result of excess consumption of added fructose is derangement of both overall metabolism and global insulin resistance say the authors. Other dietary sugars not containing fructose seem to be less detrimental in these respects. Indeed, several clinical trials have shown that compared to glucose or starch, isocaloric exchange with fructose or sucrose leads to increases in fasting insulin, fasting glucose, and the insulin/glucose responses to a sucrose load. This suggests that sucrose (in particular the fructose component) is more harmful compared to other carbohydrates," explained Dr. DiNicolantonio.

 

Dr. DiNicolantonio and his co-authors — James H O'Keefe, MD, of Saint Luke's Mid America Heart Institute, and Sean C. Lucan, MD, MPH, a family physician at Montefiore Medical Center, Albert Einstein College of Medicine, in New York — examined animal experiments and human studies to come to their conclusions.

 

Data from recent trials suggest that replacing glucose-only starch with fructose-containing table sugar (sucrose) results in significant adverse metabolic effects. Adverse effects are broader with increasing baseline insulin resistance and more profound with greater proportions of added fructose in the diet. 

 

The totality of the evidence is compelling to suggest that added sugar, and especially added fructose (usually in the form of high-fructose corn syrup and table sugar), are a serious and growing public health problem, according to the authors.

 

The 2010 Dietary Guidelines for Americans say it is acceptable for some people to consume up to 19 percent of calories from added sugars, and the Institute of Medicine permits up to 25 percent of total calories from added sugars. In contrast, the World Health Organization recommends that added sugars should make up no more than 10 percent of an entire day's caloric intake, with a proposal to lower this level to 5 percent or less for optimal health. Such levels would be more in line with what the authors would recommend and similarly restrictive to existing American Heart Association (AHA) recommendations — to consume no more than six teaspoons (24 grams) of sugar per day for women and no more than nine teaspoons (36 grams) of sugar per day for men.

 

"Limiting consumption of foods and beverages that contain added sugars, particularly added fructose, may be one of the single most effective strategies for ensuring one's robust future health."

While fructose is found naturally in some whole foods like fruits and vegetables, consuming these foods poses no problem for human health. Indeed consuming fruits and vegetables is likely protective against diabetes and broader cardiometabolic dysfunction, explained Dr. DiNicolantonio and his colleagues. The authors propose that dietary guidelines should be modified to encourage individuals to replace processed foods, laden with added sugars and fructose, with whole foods like fruits and vegetables. "Most existing guidelines fall short of this mark at the potential cost of worsening rates of diabetes and related cardiovascular and other consequences," they wrote.

 

The authors also think there should be incentives for industry to add less sugars, especially fructose-containing varieties, to food-and-beverage products. And they conclude that at "an individual level, limiting consumption of foods and beverages that contain added sugars, particularly added fructose, may be one of the single most effective strategies for ensuring one's robust future health."

 

Read the article

James J. DiNicolantonio, PharmD, James H O'Keefe, MD, and Sean C. Lucan, MD, MPH, MS: "Added Fructose: A Principal Driver of Type 2 Diabetes and its Consequences," Mayo Clinic Proceedings (March 2015).

 

The flagship journal of Mayo Clinic and one of the premier peer-reviewed clinical journals in general medicine, Mayo Clinic Proceedings is among the most widely read and highly cited scientific publications for physicians, with a circulation of approximately 125,000. While the journal is sponsored by the Mayo Clinic, it welcomes submissions from authors worldwide, publishing articles that focus on clinical medicine and support the professional and educational needs of its readers. The journal is published by Elsevier.

 

Added fructose is 'a principal driver of type 2 diabetes'  https://www.elsevier.com/connect/added-fructose-is-key-driver-of-type-2-diabetes