Dietary fructose from added sugar beverages and foods is positively associated with homocysteine: NHANES 2003-2006.

Homocysteine (Hcy) is an independent risk factor for cardiovascular disease (CVD). However, the impact of fructose on Hcy concentrations and whether fructose intake increases disease risk through elevated Hcy remains unclear. We hypothesized that fructose intake is related to Hcy concentrations, and Hcy acts as a mediator linking fructose with CVD and hypertension. We analyzed 2003 to 2006 NHANES data using multivariate logistic regression and restricted cubic spline (RCS) analyses to examine the relationships between fructose intake from different food sources and Hcy concentrations, and to assess whether Hcy mediates the association between fructose intake and CVD or hypertension. After adjusting for confounders, Hcy concentrations were positively associated with the intake of all beverages and foods with added sugars that contain fructose, with an odds ratio of 1.23 (95% CI: 1.01-1.48). RCS analyses showed a "J-shaped" association between Hcy concentrations and the intake of coffee/tea with added sugars, other foods (excluding coffee/tea) with added sugars, tomato catsup, and total juice. An "inverted U-shaped" association was observed with cake intake (all P < .05). Hcy mediated the associations between 4 food sources of fructose (nondiet soft drinks, coffee/tea with added sugars, high-fructose corn syrup sweetened beverages, all beverages and foods with added sugars that contain fructose) and CVD (indirect effects [IE]: 0.03%, 0.03%, 0.04%, and 0.03%) and hypertension (IE: 0.16%, 0.18%, 0.20%, and 0.14%), all P < .05. The findings suggested that various food sources of fructose are associated with Hcy concentrations, and Hcy mediates the relationship between fructose intake and CVD and hypertension.