Obese youth who have some build-up of fats in their livers and a diet high in fructose may be more likely to develop serious chronic liver damage common in adult alcoholics, a new study suggests.
Most people have a little bit of fat in their liver. Fatty liver disease can occur when more than 5 percent of the liver by weight is made up of fat. Excessive drinking can damage the liver and cause fat to accumulate, a condition known as alcoholic fatty liver.
When people don't drink much they can develop non-alcoholic fatty liver disease (NAFLD), which is associated with obesity and certain eating habits.
NAFLD is the most common liver disease in western children. And it is now recognized as the liver’s "manifestation" of metabolic syndrome – a constellation of traits and symptoms that raise a person’s risk for diabetes and heart disease.
All kids had some degree of fatty liver
For the current study, researchers examined data on 271 obese children and teens in Italy and the UK who underwent liver biopsies to assess fat accumulation. They used food questionnaires to assess fructose consumption and also examined blood levels of uric acid, which can be elevated in people with chronic liver disease.
Foods high in fructose include anything with high fructose corn syrup, like sweetened drinks, candy and many processed foods, but this type of sugar also occurs naturally in fruits, fruit juices and honey.
Cells don't use fructose for energy, so 100 percent of fructose consumed is metabolized in your liver. The body turns fructose into LDL (bad) cholesterol and triglycerides, fats that are stored as body fat. That's why excess fructose going into the liver results in a fatty liver.
All of the study participants had at least some degree of nonalcoholic fatty liver disease. About 38 percent of them had more extensive liver damage known as nonalcoholic steatohepatitis (NASH) that happens when fat buildup leads to swelling in the liver and impairs liver function. Many kids with NASH also had high uric acid.
9 in 10 kids drank soft drinks at least once per week
Overall, 53 percent of the children reported always skipping breakfast and another 26 percent said they had a morning meal infrequently.
However, 95 percent of the youth said they regularly had a morning snack and 89 percent routinely had an afternoon snack. Morning snacks most often included crackers, pizza and salty food, while afternoon snacks often consisted of biscuits or yogurt.
About 47 percent of the children ate cereal daily, while 43 percent had vegetables every day and 40 percent consumed fruit each day.
Roughly nine in 10 participants had soda at least once a week.
Kids with more extensive liver damage consumed more fructose
The youth with NASH had higher average consumption of fructose. Their median intake – meaning half of them consumed more – was about 70 grams of fructose daily. Median fructose consumption of children and teens without NASH was about 53 grams a day. The difference in fructose consumption amounted to one glass of a sugar-sweetened drink, but it could also be the amount a child might get from pears or grapes.
The study also didn't examine whether there was a difference in liver outcomes based on how much fructose participants got from whole fruits, fruit juices or sodas. The impact of fructose from fruit is not thought to be the same as fructose from drinks.
For parents, these findings underscore the importance limiting added sugars in their child’s diet.
Source: Journal of Hepatology, online February 14, 2017.
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