Is Aerated Soft Drink and Packaged Juice Consumption an Independent Risk Factor to Cause Non-Alcoholic Fatty Liver Disease
Keywords:
Non alcoholic fatty liver disease, Risk factor, soft drinks, metabolic syndrome
Abstract
BACKGROUND: There has been an increase in consumption of aerated sweetened soft drinks and packaged juices high in carbohydrates/fructose by humans across the globe. There have been various studies with contradictory inferences of association of chronic sweetened soft drink (rich in high fructose corn syrup) intake and NAFLD. This study was undertaken with the aim to determine the quantity, frequency, duration and type of sweet soft drinks /packaged fruit juices consumption in patients with NAFLD as compared to that in control population. Other objectives included assessment of the independent role of sweetened soft drinks as a risk factor for NAFLD in the absence of metabolic syndrome and to correlate the level of steatosis (objectively graded by ultrasonography) with the amount of intake of soft drinks in patients of NAFLD. METHOD : 50 patients of NAFLD as diagnosed clinically and by ultrasonography were identified and compared with 50 age matched control population reporting to the hospital with ailments other than NAFLD. The presence or absence of metabolic syndrome was noted in all the patients. The history of soft drink intake was obtained from the patient under following heads: a) quantity consumed, b) type of soft drink/packaged juice consumed, c) period of ingestion and d) frequency of consumption. RESULT : The average monthly consumption, duration of consumption and the mean total sugar consumption of sweetened soft drinks / packaged juices were significantly higher in patients with NAFLD versus those in the control group (p=0.0002; <0.0001; p=0.002 respectively). The quantity and chronicity of intake correlated well with the grade of NAFLD. As the average monthly consumption and mean sugar consumption increased the grade of fatty liver on USG also increased (p= 0.004). A total of 11 patients out of all the 100 patients (study and control groups combined) had a daily intake of 150-300ml of SSD for a period ranging from 5 to 20 years. Two of these had grade I NAFLD whereas 9 had grade II-III NAFLD. Five of these 11 patients had a daily intake of 250ml or greater. All these 5 patients had grade II-III NAFLD documented on ultrasound findings. Conclusion The consumption of sweetened soft drinks and packaged juice is on the rise in India. The intake of these drinks is significantly higher in patients with NAFLD.References
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19. Amarapurkar D, Kamani P, Patel N, Gupte P, Kumar P, Agal S, et al. Prevalence of non-alcoholic fatty liver disease: Population based study. Ann Hepatol 2007;6:161-3.
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21. Singh SP, Nayak S, Swain M, Rout N, Mallik RN, Agrawal O, et al. Prevalence of non-alcoholic fatty liver disease in coastal eastern India: A preliminary ultrasonographic survey. Trop Gastroenterol 2004;25:76-9.
22. Bajaj S, Nigam A, Luthra A, Pandey RM, Kondal D, Bhatt SP, et al. A case-control study on insulin resistance, metabolic co-variates & prediction score in non-alcoholic fatty liver disease. Indian J Med Res 2009;129:285-92.
23. Bugianesi E, Leone N, Vanni E, Marchesini G, Brunello F, Carucci P, Musso A, De Paolis P, Capussotti L, Salizzoni M, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology. 2002;123:134–140.
24. Willner IR, Waters B, Patil SR, Reuben A, Morelli J, Riely CA. Ninety patients with nonalcoholic steatohepatitis: insulin resistance, familial tendency, and severity of disease. Am J Gastroenterol. 2001;96:2957–2961.
25. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346:1221–1231.
26. Hofmann SM, Dong HJ, Li Z, Cai W, Altomonte J, Thung SN, Zeng F, Fisher EA, Vlassara H. Improved insulin sensitivity is associated with restricted intake of dietary glycoxidation products in the db/db mouse. Diabetes. 2002;51:2082–2089.
27. Siddiqi Z, Karoli R, et al. Soft Drinks Consumption and the Risk of Nonalcoholic Fatty Liver Disease. JAPI 2017;65:28-32.
28. Armiliato et al. High-fructose Intake in Obesity-related Nonalcoholic Fatty Liver Disease. J Gastrointest Dig Syst 2015, 5:3.
29. Kanerva N, Sandboge S, Kaartinen NE, Männistö S, Eriksson JG (2014) Higher fructose intake is inversely associated with risk of nonalcoholic fatty liver disease in older Finnish adults. Am J Clin Nutr 100: 1133-1138.
30. Chung M, Ma J, Patel K, Berger S, Lau J, et al. (2014) Fructose, highfructose corn syrup, sucrose, and nonalcoholic fatty liver disease or indexes of liver health: a systematic review and meta-analysis. Am J Clin Nutr 100: 833-849.
2. Boulton J, Hashem KM, Jenner KH, Lloyd-Williams F, Bromley H, Capewell S. How much sugar is hidden in drinks marketed to children? A survey of fruit juices, juice drinks and smoothies. BMJ Open. 2016 Mar 23; 6(3):e010330.
3. Bhaumik S. The public health threat from sugary drinks in India. BMJ. 2014 Oct 21; 349: g6216.
4. Singh GM, Micha R, Khatibzadeh S, Lim S, Ezzati M, on behalf of the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE) D. Estimated Global, Regional, and National Disease Burdens Related to Sugar-Sweetened Beverage Consumption in 2010. Circulation. 2015;132 (8):639-666.
5. Gaby AR. Adverse effects of dietary fructose. Altern Med Rev. 2005;10:294–306.
6. Vlassara H, Cai W, Crandall J, Goldberg T, Oberstein R, Dardaine V, Peppa M, Rayfield EJ. Inflammatory mediators are induced by dietary glycotoxins, a major risk factor for diabetic angiopathy. Proc Natl Acad Sci USA. 2002;99:15596–15601.
7. Mezey E. Dietary fat and alcoholic liver disease. Hepatology. 1998;28:901–905.
8. Fernández MI, Torres MI, Gil A, Ríos A. Steatosis and collagen content in experimental liver cirrhosis are affected by dietary monounsaturated and polyunsaturated fatty acids. Scand J Gastroenterol. 1997;32:350–356.
9. Assy N, Nasser G, Kamayse I, Nseir W, Beniashvili Z, Djibre A, Grosovski M. Soft drink consumption linked with fatty liver in the absence of traditional risk factors. Can J Gastroenterol. 2008;22:811–816.
10. Abid A, Taha O, Nseir W, Farah R, Grosovski M, Assy N. Soft drink consumption is associated with fatty liver disease independent of metabolic syndrome. J Hepatol. 2009;51:918–924.
11. Huang PL. A comprehensive definition for metabolic syndrome. Dis Model Mech. 2009 May-Jun; 2(5-6): 231–237.
12. Kleiner DE, Brunt EM, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41:1313-21.
13. Dasarathy S, Dasarathy J, Khiyami A, et al. Validity of real time ultrasound in the diagnosis of hepatic steatosis: A prospective study. J Hepatol 2009; 51:1061– 7.
14. Riley TR, Bruno MA. Sonographic measurement of the thickness of subcutaneous tissues in nonalcoholic fatty liver disease versus other chronic liver diseases. J Clin Ultrasound. 2005; 33:439–441.
15. Singh D, Das CJ, Baruah MP. Imaging of non alcoholic fatty liver disease. A road less travelled. Indian J Endocr Metab 2013;17:990-995
16. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, Grundy SM, Hobbs HH. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40:1387–1395.
17. Majumdar A, Misra P, Sharma S, Kant S, Krishnan A, Pandav CS. Prevalence of nonalcoholic fatty liver disease in an adult population in a rural community of Haryana, India. Indian J Public Health 2016;60:26-33.
18. Mohan V, Farooq S, Deepa M, Ravikumar R, Pitchumoni CS. Prevalence of non-alcoholic fatty liver disease in urban South Indians in relation to different grades of glucose intolerance and metabolic syndrome. Diabetes Res Clin Pract 2009;84:84-91.
19. Amarapurkar D, Kamani P, Patel N, Gupte P, Kumar P, Agal S, et al. Prevalence of non-alcoholic fatty liver disease: Population based study. Ann Hepatol 2007;6:161-3.
20. Das K, Das K, Mukherjee PS, Ghosh A, Ghosh S, Mridha AR, et al. Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease. Hepatology 2010;51:1593-602.
21. Singh SP, Nayak S, Swain M, Rout N, Mallik RN, Agrawal O, et al. Prevalence of non-alcoholic fatty liver disease in coastal eastern India: A preliminary ultrasonographic survey. Trop Gastroenterol 2004;25:76-9.
22. Bajaj S, Nigam A, Luthra A, Pandey RM, Kondal D, Bhatt SP, et al. A case-control study on insulin resistance, metabolic co-variates & prediction score in non-alcoholic fatty liver disease. Indian J Med Res 2009;129:285-92.
23. Bugianesi E, Leone N, Vanni E, Marchesini G, Brunello F, Carucci P, Musso A, De Paolis P, Capussotti L, Salizzoni M, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology. 2002;123:134–140.
24. Willner IR, Waters B, Patil SR, Reuben A, Morelli J, Riely CA. Ninety patients with nonalcoholic steatohepatitis: insulin resistance, familial tendency, and severity of disease. Am J Gastroenterol. 2001;96:2957–2961.
25. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346:1221–1231.
26. Hofmann SM, Dong HJ, Li Z, Cai W, Altomonte J, Thung SN, Zeng F, Fisher EA, Vlassara H. Improved insulin sensitivity is associated with restricted intake of dietary glycoxidation products in the db/db mouse. Diabetes. 2002;51:2082–2089.
27. Siddiqi Z, Karoli R, et al. Soft Drinks Consumption and the Risk of Nonalcoholic Fatty Liver Disease. JAPI 2017;65:28-32.
28. Armiliato et al. High-fructose Intake in Obesity-related Nonalcoholic Fatty Liver Disease. J Gastrointest Dig Syst 2015, 5:3.
29. Kanerva N, Sandboge S, Kaartinen NE, Männistö S, Eriksson JG (2014) Higher fructose intake is inversely associated with risk of nonalcoholic fatty liver disease in older Finnish adults. Am J Clin Nutr 100: 1133-1138.
30. Chung M, Ma J, Patel K, Berger S, Lau J, et al. (2014) Fructose, highfructose corn syrup, sucrose, and nonalcoholic fatty liver disease or indexes of liver health: a systematic review and meta-analysis. Am J Clin Nutr 100: 833-849.
Published
2020-07-30
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