Children who eat too much sugar have a higher risk of fatty liver disease! Commentary by American scholars

In recent years, the incidence of fatty liver in children has increased year by year along with the increase in the incidence of childhood obesity. It is the most common liver disease in children. Relevant survey data in my country show that the detection rate of fatty liver in obese children is 53.72%.

Recently, American scholars published an article, in which they reviewed and analyzed more than 20 studies and stated that fatty liver disease in children is an increasingly serious dietary problem among children worldwide. The article emphasized that the intake of added sugar (mainly fructose) promotes the occurrence and development of fatty liver disease in children.

The authors stated that fatty liver in children is related to a high-fat diet, long periods of sitting, and lack of exercise. At the same time, excessive intake of added sugars - fructose intake is an important factor in fatty liver in children. Limiting children's excessive consumption of added sugars is an important goal of early intervention to reduce the risk of fatty liver in children.

The study found that children with fatty liver disease tended to consume more fructose in addition to a higher intake of high-fat foods than children without fatty liver disease.

The researchers analyzed that fructose plays a special role in the pathophysiology of fatty liver in children.

Excessive and chronic fructose intake promotes de novo hepatic lipogenesis, impairs fatty acid oxidation, induces endoplasmic stress, and promotes hepatic inflammation through the production of uric acid and enteric endotoxins.

High dietary fructose intake was also associated with changes in the composition of the gut microbiome, with a gradual decrease in the number of beneficial microbial species.

When consumed with a high-fat diet, added fructose further impairs the function of liver cell mitochondria.

High intake of added sugars or fructose has been associated with increased de novo lipogenesis, hepatic insulin resistance, hyperuricemia, liver inflammation, oxidative stress, and visceral obesity.

A large number of studies have confirmed that drinking sugary drinks is the main source of fructose intake for children and leads to a high risk of fatty liver in children, but other sources of fructose are not ruled out.

The authors highlight that obese people may be more susceptible to the harmful effects of fructose.

Studies have found that for obese adolescents, lower fructose intake may prevent the occurrence of fatty liver, while high fructose intake increases the risk of fatty liver.

For example, consuming 1 gram of fructose per day among obese adolescents at age 14 was associated with a 9% increased risk of fatty liver disease three years later.

The authors analyzed that because fructose is mainly metabolized in the liver, fructose intake by obese patients may exceed the liver's ability to metabolize excessive lipids, leading to fat accumulation in the liver.

Other studies have also reported that fructose intake in children is also associated with the severity of fatty liver disease.

The authors point out that there is currently sufficient evidence to show that excessive fructose intake increases the susceptibility of children and adolescents to fatty liver disease, and limiting fructose intake can improve hepatic steatosis and related metabolic and biochemical parameters.

Furthermore, in children and adolescents at high risk for obesity-related liver disease, the consequences of excessive fructose intake and the benefits of fructose reduction may be independent of other cardiometabolic risk factors.

The researchers note that these findings are important because high fructose intake has been linked to more severe liver disease in adults, and multiple studies have shown that children and adolescents with non-steatohepatitis consume more fructose than those with milder forms of fatty liver disease.

source:

[1]DiStefano JK, Shaibi GQ. The relationship between excessive dietary fructose consumption and paediatric fatty liver disease. Pediatr Obes. 2020 Dec 11. Epub ahead of print.

[2] Li Hua, et al. Analysis of risk factors related to fatty liver in children with simple obesity. Chinese Journal of Maternal and Child Health Research, 2017, 28(4): 366.

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