Fructose Intake at Current Levels in the United States May Cause Gastrointestinal Distress in Normal Adults

doi:10.1016/j.jada.2005.07.002

Journal of the American Dietetic Association

Volume 105, Issue 10, October 2005, Pages 1559-1566

https://doi.org/10.1016/j.jada.2005.07.002 Get rights and content

Abstract

Objective

Fructose intake has increased considerably in the United States, primarily as a result of increased consumption of high-fructose corn syrup, fruits and juices, and crystalline fructose. The purpose was to determine how often fructose, in amounts commonly consumed, would result in malabsorption and/or symptoms in healthy persons.

Design

Fructose absorption was measured using 3-hour breath hydrogen tests and symptom scores were used to rate subjective responses for gas, borborygmus, abdominal pain, and loose stools.

Subjects/Setting

The study included 15 normal, free-living volunteers from a medical center community and was performed in a gastrointestinal specialty clinic.

Intervention

Subjects consumed 25- and 50-g doses of crystalline fructose with water after an overnight fast on separate test days.

Main Outcome Measures

Mean peak breath hydrogen, time of peak, area under the curve (AUC) for breath hydrogen and gastrointestinal symptoms were measured during a 3-hour period after subjects consumed both 25- and 50-g doses of fructose.

Statistical Analyses

Differences in mean breath hydrogen, AUC, and symptom scores between doses were analyzed using paired t tests. Correlations among peak breath hydrogen, AUC, and symptoms were also evaluated.

Results

More than half of the 15 adults tested showed evidence of fructose malabsorption after 25 g fructose and greater than two thirds showed malabsorption after 50 g fructose. AUC, representing overall breath hydrogen response, was significantly greater after the 50-g dose. Overall symptom scores were significantly greater than baseline after each dose, but scores were only marginally greater after 50 g than 25 g. Peak hydrogen levels and AUC were highly correlated, but neither was significantly related to symptoms.

Conclusions

Fructose, in amounts commonly consumed, may result in mild gastrointestinal distress in normal people. Additional study is warranted to evaluate the response to fructose-glucose mixtures (as in high-fructose corn syrup) and fructose taken with food in both normal people and those with gastrointestinal dysfunction. Because breath hydrogen peaks occurred at 90 to 114 minutes and were highly correlated with 180-minute breath hydrogen AUC, the use of peak hydrogen measures may be considered to shorten the duration of the exam.

Section snippets

Subjects and Methods

Fifteen subjects were selected for the study and met the following inclusion and exclusion criteria: the subject must have been older than age 18 years; nonsmoker; free of GI disorders or diseases, hereditary fructose intolerance, diabetes, and pulmonary disease; and had not recently used laxatives, antibiotics, or medications that would likely alter GI motility.

Subjects were recruited from the medical center faculty, staff, and students. Subjects were provided an explanation of the nature of

Subjects

All 15 subjects consumed the 25-g and 50-g fructose doses and completed the breath hydrogen studies without complications. Six subjects were men with a mean weight of 166±18.4 lb and a mean age of 40±15.8 years. The nine female subjects averaged 140±119 lb and age 37±13.9 years. All volunteers were white.

Peak Hydrogen Levels and Mean Time of Peaks

Eight of the 15 subjects (53%) exceeded the minimum level (20 ppm) considered clinical evidence of fructose malabsorption after the 25-g fructose dose, and 11 of the 15 subjects (73%) were

Malabsorption

The percent of fructose malabsorbers is consistent with past studies (1, 12, 13, 18), in which about half of adult subjects malabsorbed a 25-g load of fructose and 58% to 80% malabsorbed a 50-g fructose load using the same breath hydrogen cutpoint for malabsorption (20 ppm). Mishkin and colleagues (19) retrospectively reviewed the hydrogen breath tests of 520 patients with dyspepsia and irritable bowel syndrome who had received 25 g fructose. They reported that 53% of their patients

Conclusions

Our study and those reported herein support that it is likely that the amounts of fructose consumed today, at least in some forms, could be responsible for adverse GI complaints in normal, healthy people. Approximately half of normal people are likely to malabsorb a significant portion of a 25-g dose of crystalline fructose in water and about three fourths will malabsorb a significant portion of a 50-g dose.

The form in which fructose is consumed apparently matters. Absorption of fructose is

P. L. Beyer is an associate professor, Department of Dietetics and Nutrition, and R. W. McCallum is director, Center for Gastrointestinal Nerve and Muscle Function and the Division of GI Motility, University of Kansas Medical Center, Kansas City.

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Pesquisar a má absorção de frutose em crianças e adolescentes com dor abdominal associada com distúrbios funcionais gastrintestinais. Como objetivo adicional, estudou-se a relação entre a má absorção intestinal de frutose e a ingestão alimentar, inclusive a estimativa de consumo de frutose, peso e a estatura dos pacientes e a capacidade de fermentação de lactulose.
Foram incluídos 31 pacientes com dor abdominal (11 com dispepsia funcional, 10 com síndrome do intestino irritável e 10 com dor abdominal funcional). O teste de hidrogênio no ar expirado foi usado para pesquisar a má absorção de frutose e a fermentação de lactulose na luz intestinal. O consumo alimentar foi avaliado por registro alimentar. Foram mensurados também o peso e a estatura dos pacientes.
Má absorção de frutose foi caracterizada em 21 (67,7%) pacientes (nove com síndrome do intestino irritável, sete com dor abdominal funcional e cinco com dispepsia funcional). Intolerância após administração de frutose foi observada em seis (28,6%) dos 21 pacientes com má absorção de frutose. Má absorção de frutose associou-se com maior produção de hidrogênio após ingestão de lactulose (p < 0,05), maior consumo de energia e carboidratos (p < 0,05) e maior valor de escore z de IMC para a idade (p < 0,05). As medianas da estimativa de ingestão diária de frutose pelos pacientes com e sem má absorção de frutose foram, respectivamente, 16,1 e 10,5 g/dia (p = 0,087).
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E. M. Caviar is an infant nutrition representative with Nestle Nutritional Products, Overland Park, KS; at the time of the study, she was with the Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City.

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ResearchCurrent ResearchFructose Intake at Current Levels in the United States May Cause Gastrointestinal Distress in Normal Adults

Abstract

Objective

Design

Subjects/Setting

Intervention

Main Outcome Measures

Statistical Analyses

Results

Conclusions

Section snippets

Subjects and Methods

Subjects

Peak Hydrogen Levels and Mean Time of Peaks

Malabsorption

Conclusions

Gastroenterology

Am J Gastroenterol

Fructose and related food carbohydrates

Scan J Gastroenterol

Manufacturing, composition and applications of fructose

Am J Clin Nutr

Worldwide production of high fructose syrup and crystalline fructose

Am J Clin Nutr

Patterns and trends in food portion sizes, 1977-1998

JAMA

Food portions are positively related to energy intake and body weight in children

J Pediatr

Health effects of dietary fructose

Am J Clin Nutr

Fruit juice consumption by infants and childrenA review

J Am Coll Nutr

Digestion and absorption of fruit juice carbohydrates

J Am Coll Nutr

Gastric physiology and function effects of fruit juices

J Am Coll Nutr

Intestinal fructose absorptionClinical and molecular aspects

J Pediatr Gastroenterol Nutr

Fructose absorption

Am J Clin Nutr

Digestion and metabolism of sugars

Am J Clin Nutr

The use of the H2 breath-analysis tests in gastrointestinal diagnosis

Curr Concepts Gastroenterol

Research
Current Research
Fructose Intake at Current Levels in the United States May Cause Gastrointestinal Distress in Normal Adults