Exploring the Association of Dietary Fructose and Advanced Glycation End Products

Background: Sugars form advanced glycation end products (AGEs) throughnatural metabolism and interactions with proteins, lipids, and nucleic acids, which accumulate in tissues and have been implicated in the etiology of chronic diseases. Due to the increased consumption of fructose and its high ability to form AGEs, a further understanding of this association is important to clarify the role of sugars in disease. The objective was to explore the association between usual fructose intake and serum levels of AGEs, as measured by carboxymethyl-lysine (CML) and methylglyoxal derivative (MG-H1), in healthy adults. Methods: This is a secondary analysis of a 15-d controlled feeding study (n=100) with participants consuming their usual diet conducted in the Phoenix metropolitan area. To assess participants’ usual diet, they were asked to complete two 7-d food diaries, which were then used to create custom 15-d menu plans administered during the feeding period. Forty participants were selected based on their 15-d mean total fructose intake for this analysis [top and bottom 20% of the sample distribution (median, IQR); high fructose (HF) n= 20, 72.6 (66.1-90.4) g/day, low fructose (LF) n= 20, 28.8 (22.7-32.2) g/day. Fasting serum collected five weeks after the feeding period were analyzed for CML and MG-H1, two well-established AGEs, using ELISA kits. A database of 549 common foods with known CML amounts was used to calculate exogenous CML intake based on daily food intake data. A general linear model was fitted to investigate the difference in serum CML and MG-H1 between LF and HF groups while adjusting for age, gender, BMI, and exogenous CML intake. Results: Participants in the HF group had significantly higher serum CML and lower MG-H1 levels compared to participants in the LF group (p=0.013 and p=0.002, respectively). This difference remained statistically significant after adjusting for covariates. Conclusions: The findings suggest that endogenous CML formation may be an explanation for the significantly higher serum CML levels in the HF compared to the LF group. This is significant in further understanding mechanisms of fructose intake and disease etiology and could have implications for at-risk populations consuming a high fructose diet.