Meta-analysis of the association between major foods with added fructose and non-alcoholic fatty liver disease.
Level 3 - non-randomized controlled study
Meta-analysis of observational cohort and cross-sectional studies
PubMed 37291946 · doi:10.1039/d3fo00882g
What was done
Authors conducted a systematic search in PubMed and Web of Science through July 2022 for studies examining associations between intake of at least one food source with added fructose (biscuits/cookies, cake, sugar-sweetened beverages, sweets, candies, chocolate, or ice cream) and non-alcoholic fatty liver disease (NAFLD) in general adult populations. Random- or fixed-effects models were used to pool odds ratios and 95% confidence intervals.
What was found
A total of 15 studies with 65,149 participants were included. Consumption of foods with added fructose was associated with higher NAFLD prevalence (OR = 1.31, 95% CI: 1.17-1.48). Subgroup analyses showed significant positive associations across cohort and cross-sectional studies, sugar-sweetened beverages, Asian and North American populations, imaging modalities (ultrasound, CT, MRI), and dietary recall or food frequency questionnaires.
Why it matters
This review pools available observational data to confirm that intake of foods high in added fructose, particularly sugar-sweetened beverages, is consistently linked to increased NAFLD prevalence across diverse settings.
Limits
The analysis relies entirely on observational (including cross-sectional) designs, preventing causal conclusions. Dietary intake relied on self-reported recalls and questionnaires subject to recall bias, and residual confounding from total energy intake or other dietary components cannot be excluded.