Added Sugars May Contribute to Liver Disease in Children


The global rise of nonalcoholic fatty-liver disease in pediatric populations has highlighted the need to understand the potential cause of this growing trend.

The global rise of nonalcoholic fatty-liver disease (NAFLD) in pediatric populations has highlighted the need to understand the potential cause of this growing trend, according to a review published in Pediatric Obesity by researchers at Arizona State University and the Translational Genomics Research Institute (TGen), an affiliate of City of Hope.

"The prevalence of fatty-liver disease is escalating not only in adults, but also in children," said senior author Johanna DiStefano, PhD, a professor and head of TGen's Diabetes and Fibrotic Disease Unit, in a press release. "Like type 2 diabetes, NAFLD used to be considered a disease that developed only in adulthood, but that is no longer true."

According to the data, more than 1 out of 10 children in the United States are affected by NAFLD, making it the most common chronic liver disease among this US population. NAFLD is known to lead to nonalcoholic steatohepatitis (NASH), which is a chronic condition that can cause serious illness, liver transplants, and even death. Currently, known risk factors for NAFLD are obesity and family history.

Based on the data, NAFLD has been found to be associated with a lack of exercise and an excessive consumption of sucrose, which is more commonly known as table sugar. Sucrose is comprised of both fructose and glucose; although both can be found naturally in whole foods, they are also both used as additives in processed foods.

In a prior study conducted by DiStefano, she found that fructose, which is converted by the liver into glucose so that the body can use it for energy, was found to increase gene expression, alter proper cell function, and lead to liver disease.

Due to this prior finding, the investigators focused in the review on assessing the link between excessive fructose intake and occurrences of NAFLD in children, as well as investigating potential interventions that restricted fructose and the identification of related metabolic biomarkers.

The review’s findings demonstrated that the restriction of the excessive consumption of added sugars in youth may be an important target for reducing the risk of NAFLD. However, the investigators also noted that diagnosing NAFLD remains difficult, as there are not overt symptoms for the disease and current biomarkers do not provide a highly accurate basis for assessment.

Additionally, NAFLD is most commonly suspected among children who are obese with abnormal liver enzymes based on their blood samples, but this must be confirmed with further testing. Also, with advanced imaging tests, current assessment methods do not provide an adequate differentiation as to the spectrum of NAFLD, and the diagnosis of NASH still requires a biopsy.

"We hope to develop better tools to help clinicians decide which kids need a sophisticated work-up and which ones don't," said author Gabriel Shaibi, PhD, director of ASU's Center for Health Promotion and Disease Prevention in the Edson College of Nursing and Health Innovation, in the press release. "By getting a better handle on diagnosis and disease severity, we will have a more individualized approach to management where some kids will respond well to diet and exercise while others may need a more aggressive intervention."

However, Shaibi also noted that this research can help to further the ability to identify genomic biomarkers that track changes in liver health. This identification could potentially clarify the molecular mechanisms underpinning NAFLD risk in those children at the greatest risk.

Currently, the investigators explained that further studies are needed to better understand the short and long-term effects of high fructose consumption in relation to the growing number of children with NAFLD. But for now, they noted that the data demonstrates that efforts to reduce the global consumption of added sugars would result in a positive impact on the health of children due to its relative simplicity as a method of risk reduction.


TGen-ASU review suggests added sugars are contributing to liver disease among children. Phoenix, AZ: Translational Genomics Research Institute; March 29, 2021. Accessed April 5, 2021.

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