Associations of Sugar-sweetened Beverages, Artificially Sweetened Beverages, and Pure Fruit Juices with Non-alcoholic Fatty Liver Disease: Cross-sectional and Longitudinal Study

Objective:
Sugar intake has been related to nonalcoholic fatty liver disease (NAFLD), but the association of different types of beverages on NAFLD risk was unclear. We aimed to test the associations between sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs) and pure fruit juices (PJs) intake and risk of NAFLD. We further examined whether traditional risk factors could modify the above associations.

Methods:
From UK Biobank, 136,277 participants (45.0% men and age 55.8±8.0 years) were included. Consumption of SSBs, ASBs, and PJs were self-reported via a 24-h dietary questionnaire. Logistic regression and Cox proportional hazard models were used for cross-sectional setting where NAFLD was defined by fatty liver index ≥60, and longitudinal setting where hospital admission for NAFLD was defined as the incident severe NAFLD.

Results:
Compared with each beverage non-consumers, the odds ratios (ORs) (95% confidence interval) of NAFLD were 1.10 (1.05-1.15) and 1.11 (1.05-1.17) for participants consumed SSBs and ASBs >0-1 unit/day, 1.05 (0.98-1.14) and 1.20 (1.11-1.31) for their consumption of >1 unit/day after adjusted for traditional risk factors. During a median follow-up of 10.2 years, 1,043 case of severe NAFLD were recorded. Participants who consuming ASBs >1 and >0-1 unit/day were associated with 34% (hazards ratio 1.34, 1.10-1.64) and 14% (1.14, 0.97-1.34) increased risk of severe NAFLD respectively (p for trend =0.003). However, the associations of SSBs and PJs with risk of severe NAFLD was not significant. The significant interactions were observed between waist circumference and both ASBs and PJs consumption for NAFLD (p=0.045 and 0.046).

Discussion/Conclusion:
The consumption of SSBs, ASBs rather than PJs, were related to NAFLD prevalence. Excessive intake of artificially sweetened beverages may even increase the risk of developing severe NAFLD.