Dietary sugars and cardiometabolic risk factors: a network meta-analysis on isocaloric substitution interventions.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of randomized controlled trials
PubMed 31711109 · doi:10.1093/ajcn/nqz273
What was done
Authors conducted a random-effects network meta-analysis of 38 randomized controlled trials (1,383 participants) evaluating the effects of isocaloric substitutions between dietary sugars (fructose, glucose, sucrose) and starch on cardiometabolic markers. Outcomes assessed included LDL cholesterol, triglycerides, fasting glucose, HbA1c, HOMA-IR, uric acid, C-reactive protein, liver enzymes (ALT, AST), and liver fat. Evidence certainty was evaluated using the Confidence In Network Meta-Analysis framework.
What was found
Replacing sucrose or fructose with starch lowered LDL cholesterol (sucrose to starch: mean difference [MD] -0.23 mmol/L, 95% CI -0.38 to -0.07; fructose to starch: MD -0.22 mmol/L, 95% CI -0.39 to -0.05). Fasting glucose was lower when sucrose was replaced by starch (MD -0.14 mmol/L, 95% CI -0.29 to 0.01). Replacing fructose with glucose reduced HOMA-IR (MD -0.36, 95% CI -0.71 to -0.02) and uric acid (MD -23.77 µmol/L, 95% CI -44.21 to -3.32). No significant effects were seen for triglycerides, HbA1c, CRP, ALT, or AST.
Why it matters
This review shows that carbohydrate type matters independently of total calorie intake, indicating that exchanging sucrose and fructose for starch or glucose can selectively improve lipid, glycemic, and uric acid profiles.
Limits
The certainty of evidence was rated very low to moderate across outcomes. The average trial sample size was small (~36 participants per study), and results are based on intermediate surrogate markers rather than hard clinical cardiovascular outcomes.
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