How Do Non-Soda Fructose-Containing Foods Affect Metabolic Syndrome Risk? Interview with:
Zhila Semnani-Azad, Ph.D. Candidate 
Department of Nutritional Sciences
Faculty of Medicine, University of Toronto
Toronto, ON, Canada What is the background for this study?

Response: Dietary fructose-containing sugars have been suggested to be an important contributing factor to increased metabolic syndrome risk. Several studies have consistently shown a strong association between sugar-sweetened beverages and increased incidence of metabolic syndrome. There is little information, however, on the role of other food sources of fructose-containing sugars in the development of metabolic syndrome. What are the main findings?

fruit-nutritionResponse: In our meta-analysis of 13 prospective cohort studies including 49,591 participants, we found that the harmful effects of sugar-sweetened beverages on incident metabolic syndrome cannot be extrapolated to all sources of sugars as we noted protective effects for yogurts and fruit at all doses, and protective effects up to moderate doses of 100% fruit juice and mixed fruit juice. What should readers take away from your report?

Response: Food source and dose of food intake matter. We showed that certain food sources like fruit, yogurt, and mixed and 100% fruit juices (at low-to-moderate doses) were associated with a reduced risk of metabolic syndrome. This suggests that sugar reduction strategies that limit these foods may not have the intended benefit, or worse may have unintended harm if replaced with other potentially “less healthy” foods. What recommendations do you have for future research as a result of this work?

Response: There is a great need for additional prospective studies and high-quality, large randomized clinical trials to better improve our estimates and to understand the dose-response associations between important food sources of fructose-containing sugars and incident metabolic syndrome. Furthermore, there needs to be assessments on other major food sources of fructose-containing sugars, including grains and grain-based products. Is there anything else you would like to add?

Response: Our findings from this study should emphasize the importance for current policies and guidelines to be re-examined with a food-based lens.


Semnani-Azad Z, Khan TA, Blanco Mejia S, et al. Association of Major Food Sources of Fructose-Containing Sugars With Incident Metabolic Syndrome: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(7):e209993. doi:10.1001/jamanetworkopen.2020.9993


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Last Updated on July 9, 2020 by Marie Benz MD FAAD