Fructose Intake, Hypertension and Cardiometabolic Risk Factors in Children and Adolescents: From Pathophysiology to Clinical Aspects. A Narrative Review

Abstract

Arterial hypertension, dyslipidemia, alterations in glucose metabolism and fatty liver, either alone or in association, are frequently observed in obese children and may seriously jeopardize their health. For obesity to develop, an excessive intake of energy-bearing macronutrients is required; however, ample evidence suggests that fructose may promote the development of obesity and/or metabolic alterations, independently of its energy intake. Fructose consumption is particularly high among children, because they do not have the perception, and more importantly, neither do their parents, that high fructose intake is potentially dangerous. In fact, while this sugar is erroneously viewed favorably as a natural nutrient, its excessive intake can actually cause adverse cardio-metabolic alterations. Fructose induces the release of pro-inflammatory cytokines, and reduces the production of anti-atherosclerotic cytokines, such as adiponectin. Furthermore, by interacting with hunger and satiety control systems, particularly by inducing leptin resistance, it leads to increased caloric intake. Fructose, directly or through its metabolites, promotes the development of obesity, arterial hypertension, dyslipidemia, glucose intolerance and fatty liver. This review aims to highlight the mechanisms by which the early and excessive consumption of fructose may contribute to the development of a variety of cardiometabolic risk factors in children, thus representing a potential danger to their health. It will also describe the main clinical trials performed in children and adolescents that have evaluated the clinical effects of excessive intake of fructose-containing drinks and food, with particular attention to the effects on blood pressure. Finally, we will discuss the effectiveness of measures that can be taken to reduce the intake of this sugar.

Acute Intake of Fructose Increases Arterial Pressure in Humans: A Meta-Analysis and Systematic Review

“…Our meta-analysis is consistent with these findings in that fructose increases heart rate as well as systolic, diastolic, and mean blood pressure. In addition, our results are consistent with studies that revealed that chronic fructose consumption increases systolic and diastolic blood pressure [ 19 , 22 ]. Preclinical studies strongly suggest that the effect of fructose on cardiac function may be further influenced by the dose and duration of fructose intake.…”

“…According to the United States Department of Agriculture (USDA), fructose intake has continuous increased with an average fructose intake of 37 g/day in 1977 but 49 g/day in 2004 [ 21 ]. The fructose contents of foods and condiments promotes obesity and has an independent effect on hypertension, glucose intolerance and fatty liver diseases [ 22 ].…”

Dietary Factors and the Risk of Depression among Women with Polycystic Ovary Syndrome

“…It is also worth noting that, although high levels of fructose in the Western diet are associated with intestinal microbiota disorders, the origin of the fructose is also important: although it is naturally contained in fruit, the amounts are minimal relative to the weight of the fruit itself. Its main sources in the diet are thus fruit juices, as well as nonalcoholic drinks and energy drinks [ 52 ]. Moreover, animal studies have shown that the long-term consumption of high amounts of fructose leads to the development of depression.…”

Food Intolerances, Food Allergies and IBS: Lights and Shadows

“…Among FODMAPs, fructose is a simple sugar that can be investigated independently, unlike other FODMAPs, because of its unique absorption mechanism in the body and the several metabolic pathways in which it is involved [ 72 ]. Additionally, it can be found in large amounts in fruits, honey, and syrups and is often added to several processed foods in the Western diet as sucrose or high fructose corn syrup, resulting in its consistent consumption over the past few decades [ 73 ].…”