(P28-36-26) Major Food Sources of Fructose-Containing Sugars and Obesity: A Systematic Review and Meta-Analysis of Prospective Cohort Studies in Adults and Children

Objectives: To assess the relation of food sources of fructose-containing sugars with obesity outcomes, we undertook a systematic review and meta-analysis of prospective cohort studies.

Methods: We searched MEDLINE, EMBASE and Cochrane Library through August 2025 for prospective studies in adults or children of ≥ 1 year follow up. Two reviewers extracted data and assessed risk of bias. The primary outcome was incident overweight/obesity (OW/OB). Data were pooled using generic-inverse variance method (random effects) and expressed as relative risks (RR) for incident outcomes and mean differences (MD) for continuous outcomes with 95% confidence intervals (CI). The certainty of evidence was assessed by GRADE. (ClinicalTrials.gov, NCT02558920)

Results: We identified 32 adult (n=870,831) and 31 pediatric (n=104,445) cohort studies of 4 food sources: sugar-sweetened beverages (SSBs), 100% fruit juice, fruit and yogurt. In adults, SSBs were associated with increased incident OW/OB (1.28, 1.00 to 1.64) and abdominal obesity (1.14, 1.06 to 1.24) and weight gain (0.56 kg/serving, 0.23 to 0.89) but not waist circumference (WC). 100% fruit juice was associated with weight gain (0.12 kg/serving, 0.02 to 0.22) but not incident OW/OB or abdominal obesity or WC. Fruit was associated with lower incident OW/OB (0.87, 0.80 to 0.95) and abdominal obesity (0.68, 0.58–0.80) and reduced WC (−0.23 cm, −0.33 to −0.13) but not body weight. Yogurt was associated with lower incident abdominal obesity (0.76, 0.59 to 0.98), body weight (−0.39 kg, −0.58 to −0.19) and WC (−0.22 cm, −0.41 to −0.04), but not incident OW/OB. In children, SSBs were associated with increased incident OW/OB (1.20, 1.12 to 1.30) and BMI Z-score (0.03/serving, 0.01 to 0.04). 100% fruit juice was associated with increased incident OW/OB (1.32, 1.12 to 1.55) but not BMI Z-score. Fruit was not associated with incident OW/OB or BMI Z-score. The certainty of evidence was generally low.

Conclusions: The relation of fructose-containing sugars with obesity outcomes differs by food source. There is some indication that SSBs increase while fruit and yogurt decrease adiposity in adults and SSBs increase adiposity in children with mixed results for 100% fruit juice in both groups. Research is needed for other food sources.

Funding Sources: ASN Foundation, CIHR, Diabetes Canada