Dae Won Jun

Eileen L. Yoon

Clinical and Molecular Hepatology

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Received : Aug. 15, 2023 /  Revised : Aug. 19, 2023 /  Accepted : Aug. 25, 2023Editor: Seung Up Kim, Yonsei University College of Medicine, KoreaCorrespondence on Letter regarding “Risk factors in nonalcoholic fatty liver disease” Eileen L. Yoon1,2 and Dae Won Jun1,21Department of Internal Medicine, Hanyang University College of Medicine; 2Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Korea Keywords: Fructose; Sugars; Risk factor; Fruit; Non-alcoholic fatty liverCopyright © 2023 by Korean Association for the Study of the LiverThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Corresponding author : Dae Won JunDepartment of Internal Medicine, Hanyang University College of Medicine; Hanyang Institute of Bioscience and Biotechnology, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, KoreaTel: +82-2-2290-8338, Fax: +82-2-972-0068, E-mail: noshin@hanyang.ac.krhttps://orcid.org/0000-0002-2875-6139pISSN 2287-2728      eISSN 2287-285XCorrespondenceDear Editor,Thank you for your interest in our paper.1,2 As highlighted, the association of added fructose and sugar-sweetened bev-erages with non-alcoholic fatty liver disease (NAFLD) is well-established.3 The National Health and Nutrition Examination Survey (NHANES) data have demonstrated a link between in-creased added sugar consumption and a higher prevalence of NAFLD and obesity.4 Numerous epidemiological studies have also indicated a dose-response relationship between sugar-sweetened beverage consumption and both NAFLD prevalence and incidence.5 Consumption of fructose causes harmful changes to the composition of the gut microbiome.6The Framingham Heart Study reconfirmed that frequent consumers of sweetened beverages face a significantly ele-vated risk of developing NAFLD compared to non-consum-ers.7 Data from experimental studies have also consistently aligned with these findings. Notably, research involving the administration of sugar-sweetened beverages to healthy subjects resulted in increased liver fat over time measured by magnetic resonance spectroscopy.8 Conversely, studies re-stricting added fructose intake in children with high baseline fructose consumption demonstrated a reduction in liver fat on magnetic resonance spectroscopy. Both experimental and clinical studies have suggested an association between fruc-tose intake and NAFLD. There is a clear association between fructose intake of added sugars and increases in obesity and NAFLD. Therefore, it is recommended to reduce the amount of refined carbohydrates, especially fructose in patients with NAFLD.9 However, the results of studies on the effect of fructose be-yond added sugars, including fructose contained in fruit, on the development of NAFLD have been more diverse. The role of fructose in fruits and added fructose (industrial corn syrup) is thought to be very different. Epidemiological data from Finland revealed an intriguing inverse relationship between fructose intake from fruits and NAFLD.10 This contradictory observation might be attributed to higher levels of fruit con-sumption and the potential mitigating components against fructose’s adverse effects. Although fruit also contains fruc-tose, it is less likely to cause metabolic syndrome because it is low in fructose and contains components that can combat https://doi.org/10.3350/cmh.2023.0310Clinical and Molecular Hepatology 2023;29:1050-10511051Eileen L. Yoon, et al. Correspondence on Letter regarding “Risk factors in nonalcoholic fatty liver disease”http://www.e-cmh.org https://doi.org/10.3350/cmh.2023.0310the effects of fructose. In the Rotterdam Study of 3,882 par-ticipants, monosaccharide and disaccharide intake showed an inverse correlation with NAFLD prevalence, but this effect disappeared after adjusting for metabolic covariates and body mass index. Considering the complexity of this relation-ship, recent systematic reviews have underscored the insuffi-ciency of data on the overall impact of fructose, including natural sources, on NAFLD.11Authors’ contributionFirst drafting: Eileen L. Yoon. Theoretical framework, revi-sion and supervision: Dae Won Jun. AcknowledgementsThis work was supported by a National Research Founda-tion of Korea (NRF) grant funded by the Korea government (MSIT) (RS-2023-00217123).Conflicts of InterestThe authors have no conflicts to disclose.REFERENCES  1. Ko E, Yoon EL, Jun DW. Risk factors in nonalcoholic fatty liver disease. Clin Mol Hepatol 2023;29(Suppl):S79-S85.  2. Pratap A, More U, Phalak P, Deshmukh A. Letter regarding “Risk factors in nonalcoholic fatty liver disease”. Clin Mol Hepatol 2023 Aug 22. doi: 10.3350/cmh.2023.0268.  3. Ahn J, Jun DW, Lee HY, Moon JH. Critical appraisal for low-carbohydrate diet in nonalcoholic fatty liver disease: Review and meta-analyses. Clin Nutr 2019;38:2023-2030.  4. Bedogni G, Bellentani S, Miglioli L, Masutti F, Passalacqua M, Castiglione A, et al. The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol 2006;6:33.  5. Semmler G, Datz C, Trauner M. Eating, diet, and nutrition for the treatment of non-alcoholic fatty liver disease. Clin Mol Hepatol 2023;29(Suppl):S244-S260.  6. Jennison E, Byrne CD. The role of the gut microbiome and diet in the pathogenesis of non-alcoholic fatty liver disease. Clin Mol Hepatol 2021;27:22-43.  7. Park WY, Yiannakou I, Petersen JM, Hoffmann U, Ma J, Long MT. Sugar-sweetened beverage, diet soda, and nonalcoholic fatty liver disease over 6 years: The framingham heart study. Clin Gastroenterol Hepatol 2022;20:2524-2532.e2.  8. Maersk M, Belza A, Stødkilde-Jørgensen H, Ringgaard S, Chabanova E, Thomsen H, et al. Sucrose-sweetened bever-ages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. Am J Clin Nutr 2012;95:283-289.  9. Hydes TJ, Ravi S, Loomba R, E Gray M. Evidence-based clini-cal advice for nutrition and dietary weight loss strategies for the management of NAFLD and NASH. Clin Mol Hepatol 2020;26:383-400. 10. Kanerva N, Sandboge S, Kaartinen NE, Männistö S, Eriksson JG. Higher fructose intake is inversely associated with risk of nonal-coholic fatty liver disease in older Finnish adults. Am J Clin Nutr 2014;100:1133-1138.11. Tsompanaki E, Thanapirom K, Papatheodoridi M, Parikh P, Chotai de Lima Y, Tsochatzis EA. Systematic review and meta-analysis: The role of diet in the development of nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2023;21:1462-1474.e24.Abbreviations: NAFLD, nonalcoholic fatty liver disease; NHANES, National Health and Nutrition Examination Survey

Correspondence on Letter regarding “Risk factors in nonalcoholic fatty liver disease”

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Correspondence on Letter regarding “Risk factors in nonalcoholic fatty liver disease”

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