Higher intake of Sugar-sweetened beverages linked to increased liver fat and incident NAFLD

Over 6 years of follow-up, it was found that higher average sugar-sweetened beverages (SSB) intake can increase liver fat and also the odds of incident NAFLD among the older cohort, but the younger third Generation cohort showed no consistent association. The study results were published in the journal Clinical Gastroenterology and Hepatology. 

Nonalcoholic fatty liver disease (NAFLD) is a global major public health problem. Obesity and unhealthy lifestyles like Diets high in glycemic load and sugar-sweetened beverage (SSB) consumption are strong modifiable risk factors that contribute to NAFLD development. Previous literature showed that there is a positive correlation between SSBs and NAFLD, but the results were inconsistent. Hence researchers conducted a study in the prospective cohort of the Framingham Heart Study (FHS) to investigate the prospective association between intake of SSB or diet soda and changes in liver fat, as measured by computed tomography (CT), over 6 years of follow-up in the FHS. 

A prospective observational study of participants from the FHS Third Generation and Offspring cohorts who participated in computed tomography sub-studies was done. Based on the baseline and follow-up food frequency questionnaires, participants were classified according to their average SSB or diet soda consumption as non-consumers having 0–<1/month, occasional consumers with 1/month–<1/week, and frequent consumers consuming ≥1/week–≥1/day. Based on the liver fat attenuation measurements on a computed tomography scan, hepatic fat was quantified. The primary dependent variable was incident NAFLD; the secondary variable was any changes in liver fat.  

Results: 

• The cohorts included 691 Offspring with mean age, of 62.8 ± 8.2 years. Nearly 57.7% were women. 
• There were 945 Third Generation participants with a mean age of 48.4 ± 6.3 years and among these 46.6% were women.
• A dose-response relationship between SSB consumption and incident NAFLD was found in the Offspring cohort.
• Nearly 2.53 times increased odds of incident NAFLD was found in the frequent SSB consumers when compared with non-consumers (95% confidence interval, 1.36–4.7) after multivariable analysis.
• For Offspring cohort participants, occasional and frequent consumers of SSB had a more adverse increase in liver fat compared with non-consumers. 

Take home message: 

• This prospective study used data from the Framingham Heart Study to determine the association between sugar-sweetened beverage (SSB) consumption and the incident development of NAFLD. In the Offspring cohort (mean age, 62.8 years) there was a dose-dependent increase in the risk for hepatic steatosis with increasing consumption of SSB. Individuals who frequently consumed SSBs had a 2.53-times higher risk of the development of NAFLD than non-consumers.
• A high level of SSB consumption is associated with an increase in liver fat content over a 6-year follow-up period and with an increased risk of NAFLD. 

Further reading: Park WY, Yiannakou I, Petersen JM, Hoffmann U, Ma J, Long MT. Sugar-Sweetened Beverage, Diet Soda, and Nonalcoholic Fatty Liver Disease Over 6 Years: The Framingham Heart Study. Clin Gastroenterol Hepatol. 2022;20(11):2524-2532.e2. doi: 10.1016/j.cgh.2021.11.001