Background & Aims
Recent research has suggested that dietary fructose intake may increase serum uric
acid (UA) concentrations. Both UA concentration and fructose consumption maybe also
increase in NAFLD. It is not known whether dietary fructose consumption and UA concentration
are independently associated with non-alcoholic steatohepatitis (NASH). Our aim was
to investigate the factors associated with NASH in children and adolescents with proven
NAFLD, and to test whether UA concentrations and fructose consumption are independently
associated with NASH.
Methods
Obese children with NAFLD were studied (n = 271). NASH was diagnosed by a NAFLD activity score ⩾5 and the fatty liver inhibition
of progression (FLIP) algorithm. Fructose consumption (g/day) was assessed by food
frequency questionnaire, and UA (mg/dl) was measured in serum. Binary logistic regression
with adjustment for covariates and potential confounders was undertaken to test factors
independently associated with NASH.
Results
NASH occurred in 37.6% of patients. Hyperuricaemia (UA ⩾5.9 mg/dl) was present in 47% of patients with NASH compared with 29.7% of non-NASH patients
(p = 0.003). Both UA concentration (OR = 2.488, 95% CI: 1.87–2.83, p = 0.004) and fructose consumption (OR = 1.612, 95% CI 1.25–1.86, p = 0.001) were independently associated with NASH, after adjustment for multiple (and
all) measured confounders. Fructose consumption was independently associated with
hyperuricaemia (OR = 2.021, 95% CI: 1.66–2.78, p = 0.01). These data were confirmed using the FLIP algorithm.
Conclusions
Both dietary fructose consumption and serum UA concentrations are independently associated
with NASH. Fructose consumption was the only factor independently associated with
serum UA concentration.
Lay summary
Currently, it is not known whether dietary fructose consumption and uric acid (UA)
concentration are linked with non-alcoholic steatohepatitis (NASH) in children and
adolescents. Our aim was to test whether UA concentrations and fructose consumption
are independently associated with NASH in children and adolescents with proven non-alcoholic
fatty liver disease (NAFLD). We show that both dietary fructose consumption and serum
UA concentrations are independently associated with NASH and fructose consumption
was independently linked with high serum UA concentrations.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: February 14, 2017
Accepted:
December 28,
2016
Received in revised form:
December 1,
2016
Received:
October 13,
2016
Identification
Copyright
© 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
