The Role of Fructose as a Cardiovascular Risk Factor: An Update
Stefan-Sebastian Busnatu,
Teodor Salmen,
Maria-Alexandra Pana,
Manfredi Rizzo,
Tiziana Stallone,
Nikolaos Papanas,
Djordje Popovic,
Denisa Tanasescu,
Dragos Serban,
Anca Pantea Stoian
Affiliations
Stefan-Sebastian Busnatu
Cardiology Department Bucharest, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
Teodor Salmen
Department of Diabetes, Nutrition and Metabolic Diseases, “Prof. Dr. N.C.Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 030167 Bucharest, Romania
Maria-Alexandra Pana
Cardiology Department Bucharest, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
Manfredi Rizzo
Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), School of Medicine, University of Palermo, 90100 Palermo, Italy
Tiziana Stallone
Italian Council and Pension Funds for Biologist Enpab, 00153 Rome, Italy
Nikolaos Papanas
Second Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, University Hospital of Alexandroupolis, 68100 Alexandroupoli, Greece
Djordje Popovic
Medical Faculty, University of Novi Sad, 21102 Novi Sad, Serbia
Denisa Tanasescu
Fourth Department of Dental Medicine and Nursing, Faculty of Medicine, ‘Lucian Blaga’ University, 550024 Sibiu, Romania
Dragos Serban
Department of General Surgery, Carol Davila University of Medicine, 020021 Bucharest, Romania
Anca Pantea Stoian
Department of Diabetes, Nutrition, and Metabolic Diseases, Carol Davila University of Medicine, 050474 Bucharest, Romania
There is increasing presence of fructose in food and drinks, and some evidence suggests that its higher consumption increases cardiovascular risk, although the mechanisms still remain not fully elucidated. Cardiovascular diseases (CVD) are still responsible for one-third of deaths worldwide, and therefore, their prevention should be assessed and managed comprehensively and not by the evaluation of individual risk factor components. Lifestyle risk factors for CVD include low degree of physical activity, high body mass index, alcohol consumption, smoking, and nutritional factors. Indeed, nutritional risk factors for CVD include unhealthy dietary behaviors, such as high intake of refined foods, unhealthy fats, added sugars, and sodium and a low intake of fruits, vegetables, whole grains, fiber, fish, and nuts. Even though there is no definitive association between CVD incidence and high consumption of total sugar, such as sucrose and fructose, there is, however, evidence that total sugars, added sugars, and fructose are harmfully associated with CVD mortality. Since high fructose intake is associated with elevated plasma triglyceride levels, as well as insulin resistance, diabetes hyperuricemia, and non-alcoholic fatty liver disease, further longitudinal studies should be conducted to fully elucidate the potential association between certain sugars and CVD.