The Effect High Intake of Fructose On Complication Diabetic Nephropathy In Patients Diabetes Mellitus


  • Hanifah Choirunnisa
  • Waluyo Rudianto
  • Sutarto



Diabetes mellitus, diabetic nephropathy, fructose, hyperglycemia, hyperuricemia.


Diabetes mellitus (DM) is a non-communicable disease with a global incidence of 415 million cases in 2015 which has increased 4 times compared to the 1980s in the adult population. The increase in the number of DM in the world in line with the increase in the number of DM in Indonesia in 2018 compared to 2013, which was 1.5%. The increase in the incidence of DM globally causes an increase in various DM complications, one of them is microvascular complications of nephropathy diabetic with an incidence of 20-40%. Increase complication of nephropathy diabetic in people with DM caused by various factors, one of which is an unhealthy lifestyle by consuming a high intake of fructose found in various carbonated soft drinks. Consumption of fructose that is safe for the body no more than 5% of consumption per day. High intake of fructose in carbonated soft drinks increased the greater risk of complications of nephropathy diabetic due to excessive use of ATP in the process of fructose metabolism in the body. The products of fructose metabolism in the body are fructose-1-phosphate and uric acid. Increased fructose-1-phosphate and uric acid will cause hyperglycemia and hyperuricemia which can cause oxidative stress, endothelial dysfunction, and glomerular dysfunction by activating one of the inflammatory mediators inflammatory transcription factors (NF-κB), increasing the production of advanced glycation end products (AGEs) and macrophage activation. Oxidative stress, endothelial dysfunction, and glomerular dysfunction will induce various inflammatory mediators such as cytokines (IL-1, IL-6, IL-18, JAK, STAT and TNF), chemokines (CCL2), and adhesion molecules (ICAM1, VCAM1 ) which causes kidney infiltration of inflammatory cells (monocytes and lymphocytes) which play a role in the pathogenesis of nephropathy diabetic.


Ruiza G Ang B dan Yu GF. The Role of Fructose in Type 2 Diabetes and Other Metabolic Diseases. Journal of Nutrition & Food Sciences. 2018;08(01):1-4.

Chandramohan R dan Pari L. Protective effect of umbelliferone on high-fructose diet-induced insulin resistance and oxidative stress in rats. Biomedicine and Aging Pathology. 2014;4(1):23-8.

Sanghavi M, Vajir M, Kumar S, Tikoo K. NFAT inhibitor tributylhexadecyl-phosphoniumbromide, ameliorates high fructose induced insulin resistance and nephropathy. Chemico-Biological Interactions. 2015;240:268–77.

Steinman B, Gitzelmann R, Berghe VG, et al. Essential fructosuria, hereditary fructose intolerance, and fructose- 1, 6-diphosphatase deficiency. The online metabolic and molecular bases of inherited disease. 2015:118-40.

Teff KL, Grudziak J, Townsend R, et al. Endocrine and Metabolic Effects of Consuming Fructose- and Glucose-Sweetened Beverages with Meals in Obese Men and Women: Influence of Insulin Resistance on Plasma Triglyceride Responses. The Journal of Clinical Endocrinology & Metabolism. 2009;94(5):1562–9.

International Diabetes Federation (IDF). IDF Diabetes Atlas Sixth Edition. Jurnal online. 2015. [diunduh 23 Agustus 2019]. Tersedia dari:

Kementerian kesehatan Republik Indonesia. Hasil utama Riskesdas 2019. Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI; 2018.

Arora MK dan Singh UK. Molecular mechanisms in the pathogeesis of diabetic nephropathy: An update. Vascular Pharmacology. 2013;58(4):256-71.

Dronavalli S, Duka I, Bakris GL. The pathogenesis of diabetic nephropathy. Nature Clinical Practice Endocrinology & Metabolism. 2008;4(8):444–52.

Prodjosudjadi W. Incidence, prevalence, treatment and cost of end stage renal disease in Indonesia. Ethn Dis. 2006;16(2):S2-14-6.

Hendromartono. Nefropati Diabetik. Dalam: Buku Ajar Ilmu Penyakit Dalam. Edisi V. Jilid III. Jakarta: Pusat Penerbit FKUI; 2009. hal.1942-4.

Kelley GL, Allan G, Azhar S. High Dietary Fructose Induces a Hepatic Stress Response Resulting in Cholesterol and Lipid Dysregulation. Endocrinology. 2004;145(2):548–55.

Sánchez-Lozada LG, Tapia E, Jiménez A, et al. Fructose-induced metabolic syndrome is associated with glomerular hypertension and renal microvascular damage in rats. American Journal of Physiology-Renal Physiology. 2004;292(1):F423–F9.

Fan C-Y, Wang M-X, Ge C-X, et al.Betaine supplementation protects against high-fructose-induced renal injury in rats. The Journal of Nutritional Biochemistry. 2014;25(3):353–62.

Rossing P. Prediction, progression and prevention of diabetic nephropathy. The Minkowski Lecture 2005. Diabetologia. 2006;49(1):11-9.

Tuttle KR, Bakris GL, Bilous RW, et al. Diabetic kidney disease: a report from an ADA Consensus Conference. American journal of kidney diseases. 2014;64(4):510-33.

Derakhshanian H, Abolghassem D, Mohammad HJ, et al. The effect of vitamin D on cellular pathways of diabetic nephropathy. Rep Biochem Mol Biol. 2019;7(2):217-22.

Wada J dan Makino H. Inflamation and the pathogenesis of diabetic nephropathy. Clinical Science. 2013;124(3):139-52.

Walker RW, Kelly AD, Michael IG, et al. Fructose content in popular beverages made with and without high-fructose corn syrup. Nutrition. 2014;30:928–935.

Neilson EG. The Fructose Nation. Journal of the American Society of Nephrology. 2007;18(10):2619–21.

Bray GA, Nielsen SJ, Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. The American Journal of Clinical Nutrition. 2004;79(4):537–43.

Jalal DI, Smits G, Johnson RJ, Chonchol M. Increased Fructose Associates with Elevated Blood Pressure. Journal of the American Society of Nephrology. 2010;21(9):1543–9.

Pepin A, Kimber LS, Pascal I. Are Fruit Juices Healthier Than Sugar-Sweetened Beverages? A Review. Nutrients. 2019;11(1006):1-16

Van DBG. Inborn Errors of Fructose Metabolism. Annual Review of Nutrition. 1994;14(1):41-58.

Johnson RJ, L Gabriela Sanchez-Lozada, dan Takahiko N. The Effect of Fructose on Renal Biology and Disease. J Am Soc Nephrol. 2010;21:2036-9.

Sah OSP dan Qing YX. Associations Between Hyperuricemia and Chronic Kidney Disease: A Review. Nephro Urol. 2015;7(3):11-5.

Toyoda K, Suzuki Y, Muta K, et al. High fructose diet feeding accelerates diabetic nephropathy in Spontaneously Diabetic Torii (SDT) rats. The Journal of Toxicological Sciences. 2018;43(1):45–58.

Bhattacharjee N, Barma S, Konwar N, et al. Mechanistic insight of diabetic nephropathy and its pharmacotherapeutic targets: An update. European Journal of Pharmacology. 2016;791:8-24.



How to Cite

Hanifah Choirunnisa, Waluyo Rudianto, & Sutarto. (2019). The Effect High Intake of Fructose On Complication Diabetic Nephropathy In Patients Diabetes Mellitus. Medical Profession Journal of Lampung, 9(2), 314-321.




Most read articles by the same author(s)