High fructose corn syrup and apple juice intakes are associated with incident asthma, the early childhood longitudinal study

High fructose corn syrup (HFCS) and apple juice contain high unpaired fructose (≥ 55%), which exceeds pediatric fructose malabsorption dosages (5 g). Research/case-study evidence link HFCS/apple juice with the US asthma epidemic. Murine/human research/randomized controlled trials (RCTs) link unpaired fructose with gut-dysbiosis, and gut-dysbiosis with childhood asthma. Fructose-malabsorption-associated/asthma-triggering/gut immunogen formation via gut-fructosylation, has been shown via invitro GI simulation studies. Fructosylation can also dysregulate/deactivate gut incretins (GLP-1/GIP)-regulators of blood glucose/lipid metabolism/satiety. GLP-1/GIP equivalents are being investigated for asthma which is associated with metabolic syndrome/inflammatory bowel/gut-dysbiosis/autoimmune/heart disease/permanent lung damage/low GLP-1. Paired fructose is readily absorbed/slows metabolism. The question? Whether unpaired fructose, other than in whole fruits, is associated with incident asthma and safe for children. Nationally representative Early-Childhood-Longitudinal-Study-Birth-Cohort (weight-adjusted) data (~ birth-5y) of children born in 2001 were used to assess HFCS/100% juice intake associations with asthma/asthma ER visit/hospitalization using Cox proportional hazards models. Apple juice, a high unpaired fructose juice, is the most consumed juice by this age-group. There were significant dose–response relationships between HFCS/100% juice intake and asthma/asthma ER visits-hospitalizations (P-trend < 0.001/P-trend = 0.001), even at moderate intake (3-times/wk). Asthma/asthma ER visit/hospitalization risk (15–43%/60–106%), incidence (16–66%/21–56%) and incident cases/1000/y increased (68%/57%) with increasing intake. Findings are consistent with epidemiological studies that link HFCS and apple juice intake with asthma, and with murine research/human trials that link unpaired fructose to gut dysbiosis and gut dysbiosis to childhood asthma. FDA safety review of unpaired fructose in food/beverages and more controlled trials of unpaired fructose and the gut-lung-asthma axis are needed.