Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease

Manal F Abdelmalek, Ayako Suzuki, Cynthia Guy, Aynur Unalp-Arida, Ryan Colvin, Richard J Johnson, Anna Mae Diehl, Bradley Aouizerat, Nonalcoholic Steatohepatitis Clinical Research Network

Research output: Contribution to journalArticle

Abstract

UNLABELLED: The rising incidence of obesity and diabetes coincides with a marked increase in fructose consumption. Fructose consumption is higher in individuals with nonalcoholic fatty liver disease (NAFLD) than in age-matched and body mass index (BMI)-matched controls. Because fructose elicits metabolic perturbations that may be hepatotoxic, we investigated the relationship between fructose consumption and disease severity in NAFLD. We studied 427 adults enrolled in the NASH Clinical Research Network for whom Block food questionnaire data were collected within 3 months of a liver biopsy. Fructose consumption was estimated based on reporting (frequency x amount) of Kool-aid, fruit juices, and nondietary soda intake, expressed as servings per week, and classified into none, minimum to moderate (<7 servings/week), and daily (> or =7 servings/week). The association of fructose intake with metabolic and histological features of NAFLD was analyzed using multiple linear and ordinal logistic regression analyses with and without controlling for other confounding factors. Increased fructose consumption was univariately associated with decreased age (P < 0.0001), male sex (P < 0.0001), hypertriglyceridemia (P < 0.04), low high-density lipoprotein (HDL) cholesterol (<0.0001), decreased serum glucose (P < 0.001), increased calorie intake (P < 0.0001), and hyperuricemia (P < 0.0001). After controlling for age, sex, BMI, and total calorie intake, daily fructose consumption was associated with lower steatosis grade and higher fibrosis stage (P < 0.05 for each). In older adults (age > or = 48 years), daily fructose consumption was associated with increased hepatic inflammation (P < 0.05) and hepatocyte ballooning (P = 0.05).

CONCLUSION: In patients with NAFLD, daily fructose ingestion is associated with reduced hepatic steatosis but increased fibrosis. These results identify a readily modifiable environmental risk factor that may ameliorate disease progression in patients with NAFLD.

Original languageEnglish (US)
Pages (from-to)1961-71
Number of pages11
JournalHepatology
Volume51
Issue number6
DOIs
StatePublished - Jun 2010

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Fructose
Fibrosis
Liver
Non-alcoholic Fatty Liver Disease
Disease Progression
Hepatocytes
Body Mass Index
Obesity
Eating
Logistic Models
Regression Analysis
Inflammation
Biopsy
Food
Incidence
Research

Keywords

  • Adult
  • Age Factors
  • Cross-Sectional Studies
  • Diet
  • Fatty Liver
  • Female
  • Fibrosis
  • Fructose
  • Humans
  • Liver
  • Male
  • Middle Aged

Cite this

Abdelmalek, M. F., Suzuki, A., Guy, C., Unalp-Arida, A., Colvin, R., Johnson, R. J., ... Nonalcoholic Steatohepatitis Clinical Research Network (2010). Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease. Hepatology, 51(6), 1961-71. https://doi.org/10.1002/hep.23535

Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease. / Abdelmalek, Manal F; Suzuki, Ayako; Guy, Cynthia; Unalp-Arida, Aynur; Colvin, Ryan; Johnson, Richard J; Diehl, Anna Mae; Aouizerat, Bradley; Nonalcoholic Steatohepatitis Clinical Research Network.

In: Hepatology, Vol. 51, No. 6, 06.2010, p. 1961-71.

Research output: Contribution to journalArticle

Abdelmalek, MF, Suzuki, A, Guy, C, Unalp-Arida, A, Colvin, R, Johnson, RJ, Diehl, AM, Aouizerat, B & Nonalcoholic Steatohepatitis Clinical Research Network 2010, 'Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease', Hepatology, vol. 51, no. 6, pp. 1961-71. https://doi.org/10.1002/hep.23535
Abdelmalek, Manal F ; Suzuki, Ayako ; Guy, Cynthia ; Unalp-Arida, Aynur ; Colvin, Ryan ; Johnson, Richard J ; Diehl, Anna Mae ; Aouizerat, Bradley ; Nonalcoholic Steatohepatitis Clinical Research Network. / Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease. In: Hepatology. 2010 ; Vol. 51, No. 6. pp. 1961-71.
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AB - UNLABELLED: The rising incidence of obesity and diabetes coincides with a marked increase in fructose consumption. Fructose consumption is higher in individuals with nonalcoholic fatty liver disease (NAFLD) than in age-matched and body mass index (BMI)-matched controls. Because fructose elicits metabolic perturbations that may be hepatotoxic, we investigated the relationship between fructose consumption and disease severity in NAFLD. We studied 427 adults enrolled in the NASH Clinical Research Network for whom Block food questionnaire data were collected within 3 months of a liver biopsy. Fructose consumption was estimated based on reporting (frequency x amount) of Kool-aid, fruit juices, and nondietary soda intake, expressed as servings per week, and classified into none, minimum to moderate (<7 servings/week), and daily (> or =7 servings/week). The association of fructose intake with metabolic and histological features of NAFLD was analyzed using multiple linear and ordinal logistic regression analyses with and without controlling for other confounding factors. Increased fructose consumption was univariately associated with decreased age (P < 0.0001), male sex (P < 0.0001), hypertriglyceridemia (P < 0.04), low high-density lipoprotein (HDL) cholesterol (<0.0001), decreased serum glucose (P < 0.001), increased calorie intake (P < 0.0001), and hyperuricemia (P < 0.0001). After controlling for age, sex, BMI, and total calorie intake, daily fructose consumption was associated with lower steatosis grade and higher fibrosis stage (P < 0.05 for each). In older adults (age > or = 48 years), daily fructose consumption was associated with increased hepatic inflammation (P < 0.05) and hepatocyte ballooning (P = 0.05).CONCLUSION: In patients with NAFLD, daily fructose ingestion is associated with reduced hepatic steatosis but increased fibrosis. These results identify a readily modifiable environmental risk factor that may ameliorate disease progression in patients with NAFLD.

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