Sugar-sweetened beverages, low/no-calorie beverages, fruit juice and non-alcoholic fatty liver disease defined by fatty liver index: the SWEET project.

Jason C G Halford, Novita D Naomi, Joy Ngo, Elske M Brouwer-Brolsma, Marion E C Buso, Sabita S Soedamah-Muthu, Carmen Pérez-Rodrigo, Joanne A Harrold, Anne Raben, Johanna M Geleijnse, Lluis Serra-Majem, Edith J M Feskens

Journal: Nutrition & diabetes 2023;13(1):6

PMID: 37085478

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Plain Language Summary

Non-alcoholic fatty liver disease (NAFLD) refers to a broad range of liver disorders and the major determinants of NAFLD include sedentary lifestyles and poor-quality diets, namely high sugar intake. The main aim of this study was to investigate the association between sugar-sweetened beverages (SSB), low/no-calorie beverages (LNCB), and fruit juice (FJ) intakes and fatty liver index (FLI)-defined NAFLD. This study represents harmonised data of four European studies; Lifelines Cohort study, the Nutrition Questionnaire Plus study, the PREDIMED-Plus study, and the Alpha Omega Cohort. Results showed adverse associations between SSB and LNCB intakes and FLI-defined NAFLD prevalence, as well as between replacement of SSB with the same amount of LNCB and FLI-defined NAFLD. Furthermore, there was a beneficial association between moderate intake of FJ and FLI-defined NAFLD at intake level of ≤2 servings/day when compared to no intake. Authors conclude that long-term prospective studies with objective methods determining the intake of sugar and sweeteners are warranted to further substantiate the findings of their study.

Abstract

BACKGROUND

Sweetened beverage intake may play a role in non-alcoholic fatty liver disease (NAFLD) development, but scientific evidence on their role is limited. This study examined associations between sugar-sweetened beverages (SSB), low/no-calorie beverages (LNCB) and fruit juice (FJ) intakes and NAFLD in four European studies.

METHODS

Data for 42,024 participants of Lifelines Cohort, NQPlus, PREDIMED-Plus and Alpha Omega Cohort were cross-sectionally analysed. NAFLD was assessed using Fatty Liver Index (FLI) (≥60). Restricted cubic spline analyses were used to visualize dose-response associations in Lifelines Cohort. Cox proportional hazard regression analyses with robust variance were performed for associations in individual cohorts; data were pooled using random effects meta-analysis. Models were adjusted for demographic, lifestyle, and other dietary factors.

RESULTS

Each additional serving of SSB per day was associated with a 7% higher FLI-defined NAFLD prevalence (95%CI 1.03-1.11). For LNCB, restricted cubic spline analysis showed a nonlinear association with FLI-defined NAFLD, with the association getting stronger when consuming ≤1 serving/day and levelling off at higher intake levels. Pooled Cox analysis showed that intake of >2 LNCB servings/week was positively associated with FLI-defined NAFLD (PR 1.38, 95% CI 1.15-1.61; reference: non-consumers). An inverse association was observed for FJ intake of ≤2 servings/week (PR 0.92, 95% CI: 0.88-0.97; reference: non-consumers), but not at higher intake levels. Theoretical replacement of SSB with FJ showed no significant association with FLI-defined NAFLD prevalence (PR 0.97, 95% CI 0.95-1.00), whereas an adverse association was observed when SSB was replaced with LNCB (PR 1.12, 95% CI 1.03-1.21).

CONCLUSIONS

Pooling results of this study showed that SSB and LNCB were positively associated with FLI-defined NAFLD prevalence. Theoretical replacement of SSB with LNCB was associated with higher FLI-defined NAFLD prevalence. An inverse association was observed between moderate intake of FJ and FLI-defined NAFLD. Our results should be interpreted with caution as reverse causality cannot be ruled out.

Address: Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands.; Nutrition Research Foundation, Barcelona Science Park, Barcelona, Spain.; Center of Research on Psychological Disorders and Somatic Diseases (CORPS) Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.; Institute for Food, Nutrition and Health, University of Reading, Berkshire, UK.; Department of Psychology, University of Liverpool, Liverpool, UK.; School of Psychology, University of Leeds, Leeds, UK.; Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.; Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark.; Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Preventive Medicine Service, Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, Las Palmas, Spain.; Centro de Investigación Biomédica en Red Fisiopatologia de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain.; Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands. [email protected].

DOI: 10.1038/s41387-023-00237-3