Dietary fructose and its association with the metabolic syndrome in Lebanese healthy adults: a cross-sectional study

Rita Aoun; Fatima Al Zahraa Chokor; Mandy Taktouk; Mona Nasrallah; Hussain Ismaeel; Hani Tamim; Lara Nasreddine

doi:10.1186/s13098-022-00800-5

Dietary fructose and its association with the metabolic syndrome in Lebanese healthy adults: a cross-sectional study

Diabetol Metab Syndr. 2022 Feb 9;14(1):29. doi: 10.1186/s13098-022-00800-5.

Authors

Rita Aoun¹, Fatima Al Zahraa Chokor¹, Mandy Taktouk¹, Mona Nasrallah^{2

3}, Hussain Ismaeel^{3

4}, Hani Tamim^{5

6}, Lara Nasreddine⁷

Affiliations

¹ Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.
² Department of Internal Medicine, Division of Endocrinology, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
³ Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon.
⁴ Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
⁵ Department of Internal Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon. htamim@aub.edu.lb.
⁶ Clinical Research Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon. htamim@aub.edu.lb.
⁷ Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon. ln10@aub.edu.lb.

Abstract

Background: Epidemiological studies investigating the association between dietary fructose intake and the metabolic syndrome (MetS) are scarce and have produced controversial findings. This study aimed at (1) assessing total dietary fructose intake in a sample of Lebanese healthy adults, and determining the intake levels of natural vs. added fructose; (2) investigating the association of dietary fructose with MetS; and (3) identifying the socioeconomic and lifestyle factors associated with high fructose intake.

Methods: A cross-sectional survey was conducted on a representative sample of adults living in Beirut, Lebanon (n = 283). Anthropometric and biochemical data were collected, and dietary intake was assessed using a food frequency questionnaire. Intakes of naturally-occurring fructose from fructose-containing food sources, such as fruits, vegetables, honey, were considered as "natural fructose". Acknowledging that the most common form of added sugar in commodities is sucrose or High Fructose Corn Syrup (HFCS), 50% of added sugar in food products was considered as added fructose. Total dietary fructose intake was calculated by summing up natural and added fructose intakes. Logistic regression analyses were conducted to investigate the association of total, added and natural fructose intakes with the MetS and to identify the socioeconomic predictors of high fructose intake.

Results: Mean intake of total fructose was estimated at 51.42 ± 35.54 g/day, representing 6.58 ± 3.71% of energy intakes (EI). Natural and added fructose intakes were estimated at 12.29 ± 8.57 and 39.12 ± 34.10 g/day (1.78 ± 1.41% EI and 4.80 ± 3.56% EI), respectively. Participants in the highest quartile of total and added fructose intakes had higher odds of MetS (OR = 2.84, 95%CI: 1.01, 7.94 and OR = 3.18, 95%CI: 1.06, 9.49, respectively). In contrast, natural fructose intake was not associated with MetS. Age, gender and crowding index were identified as factors that may modulate dietary fructose intakes.

Conclusions: The observed association between high added fructose intake and the MetS highlights the need for public health strategies aimed at limiting sugar intake from industrialized foods and promoting healthier dietary patterns in Lebanon.

Keywords: Added fructose; Adults; Cross-sectional study; Dietary fructose; Lebanon; Metabolic syndrome; Natural fructose.