The effects of dietary fructose on blood pressure are modified by the food matrix

Background and aims: Fruits and sugar-sweetened beverages have opposing effects on cardiometabolic health, despite comparable amounts of fructose per serving. Here, we sought evidence for a role of the food matrix in modifying serum fructose dynamics and blood pressure. Methods: We first performed multiple linear regression analyses to assess the association between energy-adjusted intake of fructose from different sources (total, fruit, fruit juice and sugar-sweetened beverages) and blood pressure (24-h ambulatory, 7-day ambulatory, and office) using data from The Maastricht Study, a large population-based cohort (n = 5,426-6,471). Next, we conducted a randomized crossover trial in which healthy individuals (n = 21) were exposed to a fixed amount of fructose (20g) from different matrices (apple, mashed apple, apple juice, and fructose dissolved in water), and measured the serum fructose and blood pressure response. Results: The intake of fructose from sugar-sweetened beverages, but not from fruits or fruit juice, was associated with higher ambulatory 7-day mean blood pressure, higher office blood pressure, and greater risk of hypertension (OR: 1.29, 95%CI 1.12; 1.50 per 10g fructose). In the crossover study, pure fructose intake yielded the greatest serum fructose excursions (p < 0.05 for all comparisons). The systolic blood pressure response was higher after pure fructose compared to the other matrices (+1.8 mmHg, 95%CI 0.02; 3.5). Conclusions: Here, we provide epidemiological and experimental evidence that highlights the relevance of the food matrix on fructose dynamics and blood pressure, independent of the caloric value of fructose.