Sugar-Sweetened Beverages and Artificially Sweetened Beverages Consumption and the Risk of Nonalcoholic Fatty Liver (NAFLD) and Nonalcoholic Steatohepatitis (NASH)

Abstract

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are fast becoming the most common chronic liver disease and are often preventable with healthy dietary habits and weight management. Sugar-sweetened beverage (SSB) consumption is associated with obesity and NAFLD. However, the impact of different types of SSBs, including artificially sweetened beverages (ASBs), is not clear after controlling for total sugar intake and total caloric intake. The aim of this study was to examine the association between the consumption of different SSBs and the risk of NAFLD and NASH in US adults. The representativeness of 3739 US adults aged ≥20 years old who had completed 24 h dietary recall interviews and measurements, including dietary, SSBs, smoking, physical activity, and liver stiffness measurements, were selected from the National Health and Nutrition Examination Survey 2017-2020 surveys. Chi-square tests, t-tests, and weighted logistic regression models were utilized for analyses. The prevalence of NASH was 20.5%, and that of NAFLD (defined without NASH) was 32.7% of US. adults. We observed a higher prevalence of NASH/NAFLD in men, Mexican-Americans, individuals with sugar intake from SSBs, light-moderate alcohol use, lower physical activity levels, higher energy intake, obesity, and medical comorbidities. Heavy sugar consumption through SSBs was significantly associated with NAFLD (aOR = 1.60, 95% CI = 1.05-2.45). In addition, the intake of ASBs only (compared to the non-SSB category) was significantly associated with NAFLD (aOR = 1.78, 95% CI = 1.04-3.05), after adjusting for demographic, risk behaviors, and body mass index. A higher sugar intake from SSBs and exclusive ASB intake are both associated with the risk of NAFLD.

Keywords: NHANES; artificially sweetened beverages (ASBs); nonalcoholic fatty liver disease (NAFLD); nonalcoholic steatohepatitis (NASH); sugar-sweetened beverage (SSBs).

Figure 1

The effect of sugar intake from SSBs on risk of having NAFLD/NASH based on the multinominal logistical regression model. NAFLD was defined as simple steatosis without NASH. Model 1 was adjusted for age, gender, race, and PIR. Model 2 was adjusted for covariates in Model 1 and lifestyle pattern, including status of smoking, alcohol drinking, physical activity, and medical condition; and daily dietary intake pattern, including total energy, total sugar, and total fat. Model 3 was adjusted for covariates in Model 2 and BMI status. No more than 36 g of added sugar for men and 25 g of added sugar for women was recommended by the American Heart Association (AHA) recommendation. For heavy SSB consumers, ≥72 and ≥50 g of sugar intake from SSBs for men and women were used in this study, respectively.

Figure 2

The effect of type of SSBs or ASBs consumption on risk of having NAFLD/NASH based on the multinominal logistical regression model. NAFLD was defined as simple steatosis without NASH. Model 1 was adjusted for age, gender, race, and PIR. Model 2 was adjusted for covariates in Model 1 and lifestyle pattern, including status of smoking, alcohol drinking, physical activity, and medical condition; and daily dietary intake pattern, including total energy, total sugar, and total fat. Model 3 was adjusted for covariates in Model 2 and BMI status. Non-soda intake was defined based on SSBs consumer who did not intake ASBs and regular soda. ASBs-only consumers were defined as individuals who only consumed soda with no-calorie artificial sweetener. Individuals who consumed two or more types of SSBs or ASBs and with any types of SSBs were defined as multiple-SSBs consumers.