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November 4, 2009 (San Diego, California) — High fructose consumption is independently associated with high blood pressure, according to findings presented here at Renal Week 2009: American Society of Nephrology 2009 Annual Meeting.
An analysis of data from more than 4500 participants in the National Health and Nutrition Examination Survey (NHANES) showed that consuming 74 grams or more of fructose per day — equivalent to about 2.5 12-ounce cans of sugary soda — correlated significantly with blood pressure of at least 135/85 mm Hg; the relation grew stronger as blood pressure rose. The survey participants had no history of hypertension.
Fructose consumption, in the form of added sugar, has been rising in Western nations since the 1900s, and parallels the growing prevalence of hypertension, said lead investigator Diana I. Jalal, MD, assistant professor of renal medicine at the University of Colorado Health Sciences Center in Aurora.
To examine the relation between the 2, she and her colleagues used the NHANES data to evaluate median fructose intake from food high in added sugar, including bakery products, dairy desserts, chocolate and other candy, dried fruits, honeys, jams, jellies, syrups, and sugar-sweetened soft drinks. Soft drinks alone account for 33% to 40% of fructose consumption in the United States, Dr. Jalal noted.
Fresh fruits were excluded from the analysis because they contain ascorbate, antioxidants, and potassium, which counteract the effect of fructose, Dr. Jalal said during her presentation. Using responses on self-administered dietary questionnaires, the investigators calculated median fructose intake of the participants to be 74 g/day. They then studied the relation between fructose consumption and blood pressure, adjusting for demographics, physical activity, other dietary factors, cardiovascular risk factors, and findings on laboratory tests. Data from 4528 adults were included in the analysis.
Daily fructose consumption of 74 g or more was independently associated with a 28% increased risk for blood pressure of 135/85 mm Hg or higher, a 36% increased risk for blood pressure of140/90 mm Hg or higher, and an 87% increased risk for blood pressure of 160/100 mm Hg or higher.
The relation was seen only between systolic blood pressure and fructose intake, Dr. Jalal said. There was no correlation between fructose consumption and diastolic blood pressure.
"In subjects with no history of hypertension, there is an independent and significant graded association between high fructose intake and systolic blood pressure levels," she concluded. The mechanism underlying the relation is unclear.
Among other variables, black ethnicity and waist circumference were significantly associated with higher levels of fructose intake, independent of calorie or carbohydrate consumption. Inverse correlations were seen for sodium and alcohol consumption and fructose. "It seems that people either like their alcohol or they like their sugar, and they like their salt or they like their sugar," Dr. Jalal told Medscape Nephrology.
This study shows that "we must pay more attention to the nutritional needs of our patients," said Talal Ikizler, MD, associate professor of medicine at Vanderbilt University, and medical director of the Vanderbilt University Outpatient Dialysis Unit in Nashville, Tennessee.
Nephrologists rarely catch patients at the early stages of renal disease, when risk factor modification might still be possible, explained Dr. Ikizler, who was not involved in this research. However, internists and other primary care physicians do have these opportunities. Whenever possible, patients should be "warned of the consequences of their dietary choices early on."
Dr. Jalal and Dr. Ikizler have disclosed no relevant financial relationships.
Renal Week 2009: American Society of Nephrology (ASN) 2009 Annual Meeting: Abstract TH-FC037. Presented October 29, 2009.
Authors and Disclosures
Norra MacReady is a freelance medical writer for Medscape.