What are the consequences of excessive fructose intake?

From the Guidelines

Excessive fructose intake can lead to several harmful health consequences, including non-alcoholic fatty liver disease (NAFLD), insulin resistance, and increased risk of heart disease, emphasizing the need to limit daily fructose consumption. Consuming too much fructose, particularly from added sugars and high-fructose corn syrup, can cause weight gain and increased fat accumulation, especially around the abdomen 1. It may lead to insulin resistance and increase the risk of developing type 2 diabetes. Fructose is primarily metabolized in the liver, and excessive consumption can cause NAFLD, characterized by fat buildup in liver cells. High fructose intake is also associated with elevated triglycerides and LDL cholesterol levels, increasing the risk of heart disease 1. Additionally, it can raise uric acid levels, potentially leading to gout and kidney stones. Fructose doesn't trigger the same fullness signals as other nutrients, which may lead to overconsumption of calories.

To avoid these issues,

• limit added sugar intake to less than 10% of daily calories (ideally less than 5%) 1
• choose whole fruits over fruit juices or processed foods with added sugars
• read nutrition labels to identify hidden sources of fructose in processed foods. The American Heart Association recommends reductions in the intake of added sugars, with a prudent upper limit of intake being half of the discretionary calorie allowance, which for most American women is no more than 100 calories per day and for most American men is no more than 150 calories per day from added sugars 1. Guidelines for adults recommend that added sugars compose less than 5% of total calories, corresponding to 2.5% of calories from fructose 1.

From the Research

Consequences of Excessive Fructose Intake

• Excessive fructose consumption has been linked to various cardiometabolic diseases, including obesity, insulin resistance, type 2 diabetes, non-alcoholic fatty liver disease, and cardiovascular diseases 2, 3, 4, 5, 6
• High fructose intake can lead to decreased satiety, increased adipogenesis, and visceral fat accumulation, inducing insulin resistance, inflammation, and lipid metabolism impairment 2
• Fructose consumption can also increase arterial blood pressure and cause vascular damage, further contributing to the development of cardiometabolic diseases 2
• The mechanisms by which fructose exerts its deleterious effects include the induction of hypertriglyceridemia, increased uric acid production, and impaired hepatic insulin sensitivity 3, 4, 5, 6
• Excessive fructose intake can also lead to oxidative stress, promoting inflammation and cellular damage, and increasing the risk of cardiovascular disease 5

Metabolic Effects of Fructose

• Fructose metabolism occurs predominantly in the liver, where it bypasses normal insulin regulation, leading to increased fat synthesis through de novo lipogenesis 5, 6
• This process contributes to the development of non-alcoholic fatty liver disease and elevates the risk of cardiovascular disease 5
• Fructose-induced adenosine triphosphate depletion activates purine degradation, increasing uric acid levels and exacerbating hyperuricemia 5

Public Health Implications

• The evidence suggests that regulating fructose intake and implementing public health policies are necessary to mitigate the adverse effects of excessive fructose consumption 2, 4, 5
• Adopting lifestyle changes, such as reducing sugar-sweetened beverage consumption and increasing physical activity, can also help to reduce the risk of cardiometabolic diseases associated with excessive fructose intake 4, 5