Research Article| Volume 63, ISSUE 2, P462-469, August 2015

Sugar-sweetened beverage, diet soda, and fatty liver disease in the Framingham Heart Study cohorts

      Background & Aims

      Non-alcoholic fatty liver disease affects ∼30% of US adults, yet the role of sugar-sweetened beverages and diet soda on these diseases remains unknown. We examined the cross-sectional association between intake of sugar-sweetened beverages or diet soda and fatty liver disease in participants of the Framingham Offspring and Third Generation cohorts.


      Fatty liver disease was defined using liver attenuation measurements generated from computed tomography in 2634 participants. Alanine transaminase concentration, a crude marker of fatty liver disease, was measured in 5908 participants. Sugar-sweetened beverage and diet soda intake were estimated using a food frequency questionnaire. Participants were categorized as either non-consumers or consumers (3 categories: 1 serving/month to <1 serving/week, 1 serving/week to <1 serving/day, and ⩾1 serving/day) of sugar-sweetened beverages or diet soda.


      After adjustment for age, sex, smoking status, Framingham cohort, energy intake, alcohol, dietary fiber, fat (% energy), protein (% energy), diet soda intake, and body mass index, the odds ratios of fatty liver disease were 1, 1.16 (0.88, 1.54), 1.32 (0.93, 1.86), and 1.61 (1.04, 2.49) across sugar-sweetened beverage consumption categories (p trend = 0.04). Sugar-sweetened beverage consumption was also positively associated with alanine transaminase levels (p trend = 0.007). We observed no significant association between diet soda intake and measures of fatty liver disease.


      In conclusion, we observed that regular sugar-sweetened beverage consumption was associated with greater risk of fatty liver disease, particularly in overweight and obese individuals, whereas diet soda intake was not associated with measures of fatty liver disease.


      ALT (alanine transaminase), FFQ (food frequency questionnaire), LPR (liver to phantom ratio), MDCT (multidetector computed tomography), NAFLD (nonalcoholic fatty liver disease), SAT (abdominal subcutaneous adipose tissue), SSB (sugar-sweetened beverage), VAT (visceral adipose tissue)


      Linked Article

      • Sugar sweetened beverages and fatty liver disease: Rising concern and call to action
        Journal of HepatologyVol. 63Issue 2
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          Non-alcoholic fatty liver disease (NAFLD) affects 75–100 million US adults and is increasingly recognized worldwide. The intermediate stage of non-alcoholic steatohepatitis (NASH) may progress to advanced hepatic fibrosis and/or cirrhosis. Thus, it is imperative for the medical community to identify and modify potential risks for NAFLD disease acquisition and progression. Recently, increased sugar intake, in particular fructose, has experienced a resurgence of interest and controversy. The rise in dietary fructose consumption, primarily from sugar sweetened beverages (SSB), is at the forefront of interest and controversy from a public health perspective.
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