title: Dietary and commercialized fructose: Sweet or sour?
abstract: Metabolic syndrome and diabetes are main health problems of modern life in the twenty-first century. Alarming ratios of global prevalence lead to conduct more and more researches about etiological factors and pathogenesis. Disease mechanism is elementary for advancing more efficient and practicable treatment methods. Concurrent increase in both fructose consumption with Western diet and metabolic syndrome has revealed fructose hypothesis that suggests fructose as one of etiological factor of metabolic syndrome (insulin resistance, central obesity, hypertension, etc.). Recent studies have increasingly lightened the unknowns about role of fructose on pathogenesis. This review discusses fructose hypothesis by exploring current studies and their results in wide perspective. Potential mechanisms covering low-grade inflammation or de novo lipogenesis, etc., in the development of insulin resistance and obesity are explained. Clinical trials have revealed connection of fructose-induced hyperuricemia with insulin resistance and chronic inflammatory state leading to hepatosteatosis or obesity. Further, novel hypothesizes suggesting role of fructose-induced modifications in epigenetics, gut microbiota and oxidative stress on disease pathogenesis are reviewed based on recent clinical trials. More innovative theories including fructose-induced malignancy; decreased satiety feeling, and unfavorable bone health are argued covering fructose-induced neurotransmitter changes in central nervous system, more aggressive malignancy phenotype and impaired calcium absorption.
authors.affiliation: School of Medicine, Koç University, Rumelifeneri Yolu, Sariyer, 34450, Istanbul, Turkey.
authors.forename: Aslihan
authors.initials: A
authors.lastname: Yerlikaya
authors.affiliation: Division of Nephrology, Department of Medicine, Koc University Hospital, Istanbul, Turkey.
authors.forename: Tuncay
authors.initials: T
authors.lastname: Dagel
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado, Denver, CO, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: King
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado, Denver, CO, USA.
authors.forename: Masanari
authors.initials: M
authors.lastname: Kuwabara
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado, Denver, CO, USA.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Lanaspa
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado, Denver, CO, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Andres-Hernando
authors.affiliation: Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON' University Hospital, Iasi, Romania.|'Grigore T. Popa' University of Medicine Iasi, Iasi, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.affiliation: Department of Hypertension and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Manitius
authors.affiliation: Division of Interventional Radiology, Department of Radiology, School of Medicine, Koç University, Istanbul, Turkey.
authors.forename: Alan A
authors.initials: AA
authors.lastname: Sag
authors.affiliation: School of Medicine, Koç University, Rumelifeneri Yolu, Sariyer, 34450, Istanbul, Turkey. mkanbay@ku.edu.tr.|Division of Nephrology, Department of Medicine, Koc University Hospital, Istanbul, Turkey. mkanbay@ku.edu.tr.
authors.forename: Mehmet
authors.identifier: http://orcid.org/0000-0002-1297-0675
authors.initials: M
authors.lastname: Kanbay
mesh_terms: D000818:Animals; D000073417:Dietary Sugars / Q000009:adverse effects*; D044127:Epigenesis, Genetic; D005632:Fructose / Q000009:adverse effects* / Q000378:metabolism*; D000069196:Gastrointestinal Microbiome / Q000187:drug effects; D066248:High Fructose Corn Syrup / Q000009:adverse effects; D006801:Humans; D033461:Hyperuricemia / Q000209:etiology; D050155:Lipogenesis; D024821:Metabolic Syndrome / Q000209:etiology* / Q000235:genetics / Q000378:metabolism; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology; D053040:Nephrolithiasis / Q000209:etiology; D065626:Non-alcoholic Fatty Liver Disease / Q000209:etiology; D009765:Obesity / Q000209:etiology* / Q000378:metabolism; D051436:Renal Insufficiency, Chronic / Q000209:etiology; D012307:Risk Factors
chemical_list: D000073417:Dietary Sugars; D066248:High Fructose Corn Syrup; D005632:Fructose
keywords: Cardiovascular disease; Fructose; Hypertension; Kidney disease; Obesity