VANESSA HA, HBSC1,2

OBJECTIVEdThe effect of fructose on cardiometabolic risk in humans is controversial. We conducted a systematic review andmeta-analysis of controlled feeding trials to clarify the effect of fructose on glycemic control in individuals with diabetes. RESEARCH DESIGN AND METHODSdWe searched MEDLINE, EMBASE, and the Cochrane Library (through 22 March 2012) for relevant trials lasting$7 days. Data were aggre-gated by the generic inverse variance method (random-effects models) and expressed as mean difference (MD) for fasting glucose and insulin and standardized MD (SMD) with 95 % CI for glycated hemoglobin (HbA1c) and glycated albumin. Heterogeneity was assessed by the Cochran Q statistic and quantified by the I2 statistic. Trial quality was assessed by the Heyland method-ological quality score (MQS). RESULTSdEighteen trials (n = 209) met the eligibility criteria. Isocaloric exchange of fructose for carbohydrate reduced glycated blood proteins (SMD 20.25 [95 % CI 20.46 to 20.04]; P = 0.02) with significant intertrial heterogeneity (I2 = 63%; P = 0.001). This reduction is equivalent to a;0.53 % reduction in HbA1c. Fructose consumption did not significantly affect fasting glucose or insulin. A priori subgroup analyses showed no evidence of effect modification o