TY - JOUR T1 - Relation of total sugars, fructose and sucrose with incident type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies JF - Canadian Medical Association Journal JO - CMAJ SP - E711 LP - E720 DO - 10.1503/cmaj.160706 VL - 189 IS - 20 AU - Christine S. Tsilas AU - Russell J. de Souza AU - Sonia Blanco Mejia AU - Arash Mirrahimi AU - Adrian I. Cozma AU - Viranda H. Jayalath AU - Vanessa Ha AU - Reem Tawfik AU - Marco Di Buono AU - Alexandra L. Jenkins AU - Lawrence A. Leiter AU - Thomas M.S. Wolever AU - Joseph Beyene AU - Tauseef Khan AU - Cyril W.C. Kendall AU - David J.A. Jenkins AU - John L. Sievenpiper Y1 - 2017/05/23 UR - http://www.cmaj.ca/content/189/20/E711.abstract N2 - BACKGROUND: Sugar-sweetened beverages are associated with type 2 diabetes. To assess whether this association holds for the fructose-containing sugars they contain, we conducted a systematic review and meta-analysis of prospective cohort studies.METHODS: We searched MEDLINE, Embase, CINAHL and the Cochrane Library (through June 2016). We included prospective cohort studies that assessed the relation of fructose-containing sugars with incident type 2 diabetes. Two independent reviewers extracted relevant data and assessed risk of bias. We pooled risk ratios (RRs) using random effects meta-analyses. The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.RESULTS: Fiffeen prospective cohort studies (251 261 unique participants, 16 416 cases) met the eligibility criteria, comparing the highest intake (median 137, 35.2 and 78 g/d) with the lowest intake (median 65, 9.7 and 25.8 g/d) of total sugars, fructose and sucrose, respectively. Although there was no association of total sugars (RR 0.91, 95% confidence interval [CI] 0.76–1.09) or fructose (RR 1.04, 95% CI 0.84–1.29) with type 2 diabetes, sucrose was associated with a decreased risk of type 2 diabetes (RR 0.89, 95% CI 0.80–0.98). Our confidence in the estimates was limited by evidence of serious inconsistency between studies for total sugars and fructose, and serious imprecision in the pooled estimates for all 3 sugar categories.INTERPRETATION: Current evidence does not allow us to conclude that fructose-containing sugars independent of food form are associated with increased risk of type 2 diabetes. Further research is likely to affect our estimates.Trial registration: ClinicalTrials.gov, no. NCT01608620 ER -