title: Total fructose intake and risk of hypertension: a systematic review and meta-analysis of prospective cohorts.
abstract: OBJECTIVE
  Although most controlled feeding trials have failed to show an adverse effect of fructose on blood pressure, concerns continue to be raised regarding the role of fructose in hypertension. To quantify the association between fructose-containing sugar (high-fructose corn syrup, sucrose, and fructose) intake and incident hypertension, a systematic review and meta-analysis of prospective cohort studies was undertaken.
  
  
  METHODS
  MEDLINE, EMBASE, CINAHL and the Cochrane Library (through February 5, 2014) were searched for relevant studies. Two independent reviewers reviewed and extracted relevant data. Risk estimates were aggregated comparing the lowest (reference) quintile with highest quintile of intake using inverse variance random effect models and expressed as risk ratios (RR) with 95% confidence intervals (CIs). Interstudy heterogeneity was assessed (Cochran Q statistic) and quantified (I(2) statistic). The Newcastle-Ottawa Scale assessed study quality. Clinicaltrials.gov NCT01608620.
  
  
  RESULTS
  Eligibility criteria were met by 3 prospective cohorts (n = 37,375 men and 185,855 women) with 58,162 cases of hypertension observed over 2,502,357 person-years of follow-up. Median fructose intake was 5.7-6.0% total energy in the lowest quintile and 13.9-14.3% total energy in the highest quintile. Fructose intake was not associated with incident hypertension (RR = 1.02, 95% CI, 0.99-1.04), with no evidence of heterogeneity (I(2) = 0%, p = 0.59). Spline curve modeling showed a U-shaped relationship with a negative association at intakes ≤50th percentile (∼10% total energy) and a positive association at higher intakes.
  
  
  CONCLUSIONS
  Total fructose intake was not associated with an increased risk of hypertension in 3 large prospective cohorts of U.S. men and women.
authors.affiliation: a Toronto 3D Knowledge Synthesis and Clinical Trials Unit , Clinical Nutrition and Risk Factor Modification Center , Toronto , Ontario , CANADA.
authors.forename: Viranda H
authors.initials: VH
authors.lastname: Jayalath
authors.forename: John L
authors.initials: JL
authors.lastname: Sievenpiper
authors.forename: Russell J
authors.initials: RJ
authors.lastname: de Souza
authors.forename: Vanessa
authors.initials: V
authors.lastname: Ha
authors.forename: Arash
authors.initials: A
authors.lastname: Mirrahimi
authors.forename: Ingrid D
authors.initials: ID
authors.lastname: Santaren
authors.forename: Sonia
authors.initials: S
authors.lastname: Blanco Mejia
authors.forename: Marco
authors.initials: M
authors.lastname: Di Buono
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Jenkins
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Leiter
authors.forename: Thomas M S
authors.initials: TM
authors.lastname: Wolever
authors.forename: Joseph
authors.initials: J
authors.lastname: Beyene
authors.forename: Cyril W C
authors.initials: CW
authors.lastname: Kendall
authors.forename: David J A
authors.initials: DJ
authors.lastname: Jenkins
mesh_terms: D001794:Blood Pressure; D016208:Databases, Factual; D005632:Fructose / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000453:epidemiology; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D005632:Fructose
keywords: fructose; hypertension; meta-analysis; prospective cohort; systematic review