Effects of fructose epimers on blood lipid profile: A systematic review and meta-analysis of randomized controlled trials

Abstract

Abstract OBJECTIVES The epimers of fructose may have the benefit of regulating lipid metabolism. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the effects of fructose epimers on blood lipids, including high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG) and free fatty acids (FFA). METHODS PUBMED, EMBASE, Cochrane Library and Web of science databases were retrieved up to November 2022. We included all published RCTs concerning the effects of fructose epimers on fasting or postprandial blood lipid responses. Data were pooled with standardized mean differences (SMD). Subgroup analysis was applied to investigate the heterogeneity. Quality of literature was accessed with version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). RESULTS A meta-analysis of 6 trials including 686 participants was eligible. The pooled data revealed that single dose fructose epimers intervention significantly increase postprandial FFA levels (SMD, 0.64; 95% CI, 0.07 to 1.22; P = 0.027) but no effect on postprandial TG. The daily intervention of fructose epimers significantly ameliorated the fasting plasma HDL-C level (SMD, -0.42; 95% CI, -0.83 to -0.01; P = 0.046). In addition, fructose epimers showed an obvious but not significant effect on reducing fasting TC level (SMD, -0.13; 95% CI, -0.29 to 0.04; P = 0.135). The epimers of fructose have no observable effect on fasting LDL-C and TG levels. CONCLUSIONS Fructose epimers intake leads to modest improvements in blood lipid profiles. Strong and long-term randomized controlled trials are needed to confirm the certainty and sustainability of these improvements.