Fructose Tied to Advanced Liver Disease in Children and Teens

By Lisa Rapaport

February 22, 2017

(Reuters Health) - Obese youth with non-alcoholic fatty liver disease (NAFLD) and a diet high in fructose may be more likely to develop serious chronic liver damage common in adult alcoholics, a study suggests.

NAFLD is the most common liver disease in western children, the authors point out in the Journal of Hepatology, online February 14. It is now recognized as the liver’s "manifestation" of metabolic syndrome, they add.

For their study, Dr. Valerio Nobili of Bambino Gesu Children's Hospital in Rome and colleagues examined data on 271 obese children and teens with NAFLD. About 38 percent of them (n=102) had more extensive liver damage (nonalcoholic steatohepatitis, NASH).

Participants underwent liver biopsies to assess fat accumulation. Fructose consumption was assessed by food frequency questionnaire, and uric acid was measured in serum.

Hyperuricemia (uric acid 5.9 mg/dl or greater) was present in 47% of patients with NASH compared with 29.7% of non-NASH patients (p=0.003), the researchers report.

Both uric acid concentration (odds ratio, 2.48, 95% CI: 1.87–2.83, p=0.004) and fructose consumption (OR, 1.61, 95% CI 1.25–1.86, p=0.001) were independently associated with NASH, after adjustment for multiple (and all) measured confounders, they say.

Fructose consumption was also independently associated with hyperuricemia (OR, 2.02, 95% CI: 1.66–2.78, p=0.01). The youth with NASH had higher average consumption of fructose. Their median intake was about 70 grams of fructose daily. Median fructose consumption of children and teens without NASH was about 53 grams a day.

One limitation of the study is that it relied on children and teens to accurately recall and report what they ate, the authors note. The study also didn't examine whether there was a difference in liver outcomes based on how much fructose participants got from whole fruits, fruit juices or sodas.

"Our understanding of the role of fructose in fatty liver is still evolving," said Dr. Jeffrey Schwimmer, a researcher at the University of California, San Diego and director of the Fatty Liver Clinic at Rady Children's Hospital.

"We don't think that the impact of fructose from fruit is the same as fructose from drinks," Schwimmer, who wasn't involved in the study, said by email.

The difference in fructose consumption between youth with and without NASH in the study would be in one glass of sweetened tea or soda, but also the amount a child might get from pears or grapes, Schwimmer added.

He advises parents to "limit added sugars while further research is done to better understand" how fructose impacts the liver.


J Hepatol 2017.