British Journal of Nutrition

  • British Journal of Nutrition / Volume 108 / Issue 03 / August 2012, pp 418-423
  • Copyright © The Authors 2012. The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence <>. The written permission of Cambridge University Press must be obtained for commercial re-use.
  • DOI: (About DOI), Published online: 21 February 2012

Systematic Review with Meta-analysis

‘Catalytic’ doses of fructose may benefit glycaemic control without harming cardiometabolic risk factors: a small meta-analysis of randomised controlled feeding trials

John L. Sievenpipera1a2 c1, Laura Chiavarolia2a3, Russell J. de Souzaa2a4a5, Arash Mirrahimia2a3, Adrian I. Cozmaa2a3, Vanessa Haa2a3, D. David Wanga2a3, Matthew E. Yua2a3, Amanda J. Carletona2a3a6, Joseph Beyenea4a7a8, Marco Di Buonoa9, Alexandra L. Jenkinsa2, Lawrence A. Leitera2a3a10a11, Thomas M. S. Wolevera2a3a10, Cyril W. C. Kendalla2a3a12 and David J. A. Jenkinsa2a3a10a11

a1 Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

a2 Clinical Nutrition and Risk Factor Modification Centre, Saint Michael's Hospital, #6130-61 Queen Street East, Toronto, ON, Canada M5C 2T2

a3 Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

a4 Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

a5 Department of Nutrition, Harvard School of Public Health, Boston, MA, USA

a6 Undergraduate Medical Education (MD Program), Faculty of Medicine, University of Toronto, Toronto, ON, Canada

a7 Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

a8 Population Health Sciences Research Institute, Hospital for Sick Children, Toronto, ON, Canada

a9 Heart and Stroke Foundation of Ontario, Toronto, ON, Canada

a10 Keenan Research Center of the Li Ka Shing Knowledge Institute and Division of Endocrinology and Metabolism, Saint Michael's Hospital, Toronto, ON, Canada

a11 Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

a12 College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada


Contrary to concerns that fructose may have adverse metabolic effects, there is evidence that small, ‘catalytic’ doses ( ≤ 10 g/meal) of fructose decrease the glycaemic response to high-glycaemic index meals in human subjects. To assess the longer-term effects of ‘catalytic’ doses of fructose, we undertook a meta-analysis of controlled feeding trials. We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library. Analyses included all controlled feeding trials ≥ 7 d featuring ‘catalytic’ fructose doses ( ≤ 36 g/d) in isoenergetic exchange for other carbohydrates. Data were pooled by the generic inverse variance method using random-effects models and expressed as mean differences (MD) with 95 % CI. Heterogeneity was assessed by the Q statistic and quantified by I 2. The Heyland Methodological Quality Score assessed study quality. A total of six feeding trials (n 118) met the eligibility criteria. ‘Catalytic’ doses of fructose significantly reduced HbA1c (MD − 0·40, 95 % CI − 0·72, − 0·08) and fasting glucose (MD − 0·25, 95 % CI − 0·44, − 0·07). This benefit was seen in the absence of adverse effects on fasting insulin, body weight, TAG or uric acid. Subgroup and sensitivity analyses showed evidence of effect modification under certain conditions. The small number of trials and their relatively short duration limit the strength of the conclusions. In conclusion, this small meta-analysis shows that ‘catalytic’ fructose doses ( ≤ 36 g/d) may improve glycaemic control without adverse effects on body weight, TAG, insulin and uric acid. There is a need for larger, longer ( ≥ 6 months) trials using ‘catalytic’ fructose to confirm these results.

(Received June 08 2011)

(Revised October 24 2011)

(Accepted January 06 2012)

(Online publication February 21 2012)


c1 Corresponding author: Dr J. L. Sievenpiper, fax +1 416 867 7495, email


Abbreviations: GI, glycaemic index; MD, mean differences; MQS, Methodological Quality Score