Diabetes and Fibrotic Disease Research Unit, Translational Genomics Research Institute, Phoenix, Arizona, USA.
Center for Health Promotion and Disease Prevention, Edson College of Nursing, Arizona State University, Phoenix, Arizona, USA.
Pediatr Obes. 2021 Jun;16(6):e12759. doi: 10.1111/ijpo.12759. Epub 2020 Dec 11.
The global prevalence of non-alcoholic fatty liver disease (NAFLD) in children and adolescents is escalating and currently represents the most common chronic liver disease in the paediatric population. NAFLD is associated with high daily caloric intake and sedentary behaviour, with excessive consumption of added sugar emerging as an important contributor to NAFLD risk in children. This is a particularly important factor for adolescents with obesity, who are the heaviest consumers of added sugar. Table sugar, or sucrose, is a disaccharide comprised of fructose and glucose, yet only fructose has been strongly linked to NAFLD pathogenesis largely due to the unique characteristics of its metabolism and detrimental effects on key metabolic pathways. To date, the relationship between excessive fructose intake and risk of NAFLD in children and adolescents remains incompletely understood, and it is not yet known whether fructose actually causes NAFLD or instead exacerbates hepatic fat accumulation and possible hepatocellular injury only within the context of cardiometabolic factors. The purpose of this review is to summarize recent studies linking fructose consumption with NAFLD in the paediatric population and integrate results from interventional studies of fructose restriction in children and adolescents on NAFLD and related metabolic markers. Given the overall positive impact of lifestyle modifications in the management of paediatric NAFLD, reduction of added sugar consumption may represent an important, early opportunity to mitigate or prevent NAFLD in high-risk children and adolescents.
全球儿童和青少年非酒精性脂肪性肝病 (NAFLD) 的患病率正在上升，目前是儿科人群中最常见的慢性肝病。NAFLD 与高热量摄入和久坐行为有关，过量摄入添加糖已成为儿童患 NAFLD 的一个重要因素。对于肥胖的青少年来说，这是一个特别重要的因素，他们是添加糖的最大消费者。食糖或蔗糖是由果糖和葡萄糖组成的二糖，但只有果糖与 NAFLD 的发病机制密切相关，这主要是由于其代谢的独特特征及其对关键代谢途径的有害影响。迄今为止，过量摄入果糖与儿童和青少年患 NAFLD 的风险之间的关系仍不完全清楚，也不知道果糖是否真的会导致 NAFLD，或者只是在心血管代谢因素的背景下加剧肝脂肪堆积和可能的肝细胞损伤。本综述的目的是总结最近将果糖摄入与儿科人群中的 NAFLD 联系起来的研究，并整合关于果糖限制对儿童和青少年 NAFLD 及相关代谢标志物的干预研究结果。鉴于生活方式改变对儿童 NAFLD 管理的整体积极影响，减少添加糖的摄入可能是减轻或预防高危儿童和青少年 NAFLD 的一个重要早期机会。
