果糖对糖尿病人群血甘油三酯水平的影响:基于随机对照试验的Meta分析

Effects of fructose on triglycerides in individuals with diabetes:a Meta-analysis of experimental trials

目的采用系统评价的方法 ,从剂量、干预时间、对照碳水化合物种类亚组等方面量化果糖对糖尿病人群血甘油三酯的影响。方法全面检索1970—2014年在Med Line,EMbase,Cochrane图书馆临床对照试验资料库,中国生物医学文献数据库（CNKI）、万方数据库发表的果糖与血脂关系的所有临床随机对照研究文献资料,对符合纳入标准的文献应用Rev Man 5.3软件进行果糖对血甘油三酯（TG）水平影响的Meta分析,并对不同剂量（〈50 g/d,50-100 g/d,≥100 g/d）、不同对照物（蔗糖、淀粉及混合膳食）以及不同干预时间（〈1月组和≥1月）进行亚组分析。结果符合纳入标准的临床随机对照文献共15篇,包含21项研究。Meta亚组分析结果显示,在糖尿病整体人群中,果糖未引起TG升高。但果糖能引起2型糖尿病人群血TG的升高：当果糖摄入剂量〈100 g/d时,对TG无不良影响[加权平均差WMD为-0.20,95%CI（-0.62,0.22）,P=0.35];当≥100 g/d时,则能引起TG升高[WMD0.17,95%CI（0.08,0.25）,P〈0.0001]。当蔗糖和混合膳食作为对照物时,果糖未使TG水平升高;但当淀粉作为对照物时,果糖能使TG升高[WMD 0.13,95%CI（0.02,0.23）,P=0.02]。结论果糖对TG水平影响在2型糖尿病人群中较1型糖尿病人群敏感,当高剂量（≥100g/d）时能引起TG升高,并与对照的碳水化合物种类有关。

Objective To assess the effects of fructose on the blood triglycerides, particularly examining treatment dose, duration, and control of food in individuals with diabetes. Methods A systematic review and Meta-analysis of experimental clinical trials were conducted to investigate the effect of isocaloric fructose exchange for carbohydrate on triglycerides, total cholesterol. MedLine, EMBASE, The Cochrane Library, CMBdisc, CNKI （1970-2014）, and some related journals were searched. Heterogeneity was assessed by 2 tests and quantified by I^2. Meta-analysis was conducted by RevMan 5.3.Results 15 reports（21 trials）met the eligibility criteria. Isocaloric fructose exchange for carbohydrate raised triglycerides under specific conditions in individuals with type 2 diabetes. A triglyceride-raising effect without heterogeneity was seen only in type 2 diabetes when the dose was ≥ 100 g fructose/d （ WMD 0. 17,95% CI0. 08 - 0.25, P 〈 0. 0001 ）. A triglyceride-raising effect with heterogeneity was seen in type 2 diabetes when the reference carbohydrate was starch （ WMD 0. 13,95% CI 0. 02 - 0.23, P = 0. 02 ）. Conclusion Effect of fructose on the level of TG in type 2 diabetes patients is more sensitive than that in type 1 diabetes. The effect on triglycerides is dose dependent and depends on what kinds of carbohydrate is being exchanged with fructose.