Meta-analysis of the association between major foods with added fructose and non-alcoholic fatty liver disease

Abstract

Objectives: The relationship between the consumption of foods with added fructose and non-alcoholic fatty liver disease (NAFLD) was inconsistent in previous epidemiological studies, and no meta-analysis has been performed on the pooled results. Hence, this study aims to assess the associations between the consumption of major foods with added fructose and NAFLD in a meta-analysis. Methods: Through PubMed and Web of Science, an extensive literature search of publications before July 2022 was conducted. We included studies that investigated the associations between the intake of ≥1 food sources with added fructose (biscuits and cookies, cake, sugar-sweetened beverages [SSBs], sweets, candies, chocolate, or ice cream) and NAFLD in a general adult population. Random- or fixed-effects models were used to pool odds ratios [ORs, 95% confidence intervals (95% CIs)] depending on the degree of heterogeneity. Results: A total of 15 studies with 65 149 participants were finally brought into the meta-analysis. Based on the results, it seems that the prevalence of NAFLD was higher among those who consumed foods with added fructose (OR = 1.31, 95% CI = 1.17-1.48). Subgroup analysis showed that consumption of foods with added fructose was associated with a greater prevalence of NAFLD in subgroups of cohort and cross-sectional studies, of SSBs, participants from Asia or North America, disease assessment using ultrasound, CT, or MRI, and exposure assessment using dietary recall and food frequency questionnaires. Conclusion: Our results indicated that major foods with added fructose intake have a positive association with the prevalence of NAFLD. Reduction of added fructose consumption may represent an early opportunity to mitigate or prevent NAFLD.