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

• Published in: Nutrition & diabetes Vol. 13; no. 1; p. 6
• Main Authors: Naomi, Novita D., Ngo, Joy, Brouwer-Brolsma, Elske M., Buso, Marion E. C., Soedamah-Muthu, Sabita S., Pérez-Rodrigo, Carmen, Harrold, Joanne A., Halford, Jason C. G., Raben, Anne, Geleijnse, Johanna M., Serra-Majem, Lluis, Feskens, Edith J. M.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 21-04-2023; Nature Publishing Group
• Subjects: 692/699/2743/137; 692/699/2743/2037; Beverages; Clinical Nutrition; Diabetes; Energy Intake; Epidemiology; Fruit and Vegetable Juices; Fruit juices; Humans; Internal Medicine; Liver diseases; Medicine; Medicine & Public Health; Metabolic Diseases; Non-alcoholic Fatty Liver Disease - epidemiology; Sugar-Sweetened Beverages
• ISSN: 2044-4052
• DOI: 10.1038/s41387-023-00237-3

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.