ESPE Yearbook of Paediatric Endocrinology

Cell metabolism 2021;33(12):2316-28. doi: 10.1016/j.cmet.2021.09.004

Brief Summary: This paper reviews the links between fructose consumption and health, and the mechanisms by which fructose may damage health.

Comment: Fructose is a plant-derived monosaccharide. Its natural form is found in certain fruits and vegetables. High-fructose corn syrup (HFCS) is a liquid fructose–glucose sweetener produced from corn that has been milled into corn starch, then turned into corn syrup. Then glucose isomerase enzymes are added to convert some of the glucose in the corn syrup into fructose. “HFCS 42” and “HFCS 55” refer to dry weight fructose compositions of 42% and 55%, respectively, the rest being glucose. HFCS commonly substitutes for sugar in processed foods (HFCS 42) and soft drinks (HFCS 55).

Whereas most postprandial glucose from dietary intake is metabolized in peripheral tissues, leaving little for storage as fat in the liver, fructose metabolism is not regulated by insulin or hepatic energy needs. Unlike glucose, most fructose is metabolized and stored by the liver, with little metabolism in peripheral tissues. Fructose also induces de novo lipogenesis, resulting in hepatic fat accumulation and subsequently elevated plasma triglyceride (TG) concentrations. Further, excess fructose consumption disrupts gut barrier integrity, resulting in systemic endotoxemia and leading to the inflammatory cascade and hepatosteatosis.

Evidence is presented that high fructose intake can cause hypertension and hyperuricemia, as well as increased CVD. Data are reviewed on a possible association between fructose consumption and cancer, mainly pancreatic cancer and hepatocellular carcinoma. A critique of this evidence is that results cannot be generalized to the effects of HFCS because pure fructose was investigated at very high concentrations.¹

Reference: 1. Khorshidian N, Shadnoush M, Zabihzadeh Khajavi M, et al. Fructose and high fructose corn syrup: are they a two-edged sword? International Journal of Food Sciences and Nutrition 2021;72(5):592–614. doi: 10.1080/09637486.2020.1862068.