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      Effect of a Low Free Sugar Diet vs Usual Diet on Nonalcoholic Fatty Liver Disease in Adolescent Boys : A Randomized Clinical Trial

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          Abstract

          Pediatric guidelines for the management of nonalcoholic fatty liver disease (NAFLD) recommend a healthy diet as treatment. Reduction of sugary foods and beverages is a plausible but unproven treatment.

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          Dietary fructose in nonalcoholic fatty liver disease.

          Miriam B Vos, Joel E Lavine (2013)
          Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in adults and children. A number of genetic and environmental factors are known to predispose individuals to NAFLD. Certain dietary sugars, particularly fructose, are suspected to contribute to the development of NAFLD and its progression. The increasing quantity of fructose in the diet comes from sugar additives (most commonly sucrose and high fructose corn syrup) in beverages and processed foods. Substantial links have been demonstrated between increased fructose consumption and obesity, dyslipidemia, and insulin resistance. Growing evidence suggests that fructose contributes to the development and severity of NAFLD. In human studies, fructose is associated with increasing hepatic fat, inflammation, and possibly fibrosis. Whether fructose alone can cause NAFLD or if it serves only as a contributor when consumed excessively in the setting of insulin resistance, positive energy balance, and sedentary lifestyle is unknown. Sufficient evidence exists to support clinical recommendations that fructose intake be limited through decreasing foods and drinks high in added (fructose-containing) sugars. Copyright © 2013 American Association for the Study of Liver Diseases.
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            Agreement Between Magnetic Resonance Imaging Proton Density Fat Fraction Measurements and Pathologist-Assigned Steatosis Grades of Liver Biopsies From Adults With Nonalcoholic Steatohepatitis.

            Michael Middleton, Elhamy Heba, Catherine A Hooker … (2017)
            We assessed the diagnostic performance of magnetic resonance imaging (MRI) proton density fat fraction (PDFF) in grading hepatic steatosis and change in hepatic steatosis in adults with nonalcoholic steatohepatitis (NASH) in a multi-center study, using central histology as reference.
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              Artificial sweeteners: a systematic review of metabolic effects in youth.

              Douglas Brown, Kristina I. Rother, J. de Visscher (2010)
              Epidemiological data have demonstrated an association between artificial sweetener use and weight gain. Evidence of a causal relationship linking artificial sweetener use to weight gain and other metabolic health effects is limited. However, recent animal studies provide intriguing information that supports an active metabolic role of artificial sweeteners. This systematic review examines the current literature on artificial sweetener consumption in children and its health effects. Eighteen studies were identified. Data from large, epidemiologic studies support the existence of an association between artificially-sweetened beverage consumption and weight gain in children. Randomized controlled trials in children are very limited, and do not clearly demonstrate either beneficial or adverse metabolic effects of artificial sweeteners. Presently, there is no strong clinical evidence for causality regarding artificial sweetener use and metabolic health effects, but it is important to examine possible contributions of these common food additives to the global rise in pediatric obesity and diabetes.
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                Author and article information

                Journal
                Title: JAMA
                Abbreviated Title: JAMA
                Publisher: American Medical Association (AMA)
                ISSN (Print): 0098-7484
                Publication date Created: January 22 2019
                Publication date (Print): January 22 2019
                Volume: 321
                Issue: 3
                Page: 256
                Affiliations
                [1 ]Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, School of Medicine, University of California, San Diego, La Jolla
                [2 ]Department of Gastroenterology, Rady Children’s Hospital San Diego, San Diego, California
                [3 ]Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Emory University, Atlanta, Georgia
                [4 ]Children’s Healthcare of Atlanta, Atlanta, Georgia
                [5 ]Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia
                [6 ]Department of Radiology, Children’s Healthcare of Atlanta, Atlanta, Georgia
                [7 ]Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, La Jolla
                [8 ]Liver Imaging Group, Department of Radiology, University of California, San Diego, La Jolla
                [9 ]Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia
                Article
                DOI: 10.1001/jama.2018.20579
                PMC ID: 6440226
                PubMed ID: 30667502
                SO-VID: af82fb9c-7b15-4e6a-8a7b-0223e2c2f3eb
                Copyright © © 2019
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