American Diabetes Association
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Fructose Intake From Fruit Juice and Sugar-Sweetened Beverages Is Associated With Higher Intrahepatic Lipid Content: The Maastricht Study

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posted on 2022-02-14, 14:24 authored by Amée M. Buziau, Simone J.P.M. Eussen, M. Eline Kooi, Carla J.H. van der Kallen, Martien C.J.M. van Dongen, Nicolaas C. Schaper, Ronald M.A. Henry, Miranda T. Schram, Pieter C. Dagnelie, Marleen M.J. van Greevenbroek, Anke Wesselius, Otto Bekers, Steven J.R. Meex, Casper G. Schalkwijk, Coen D.A. Stehouwer, Martijn C.G.J. Brouwers
Objective: Epidemiological evidence regarding the relationship between fructose intake and intrahepatic lipid content (IHL) is inconclusive. We, therefore, assessed the relationship between different sources of fructose and IHL at the population level.

Research Design and Methods: We used cross-sectional data from The Maastricht Study, a population-based cohort (n=3,981;60±9years;50%women). We assessed the relationship between fructose intake (assessed by a food frequency questionnaire) – total and derived from fruit, fruit juice and sugar-sweetened beverages (SSB) – and IHL (quantified by 3T-Dixon-MRI) with adjustment for age, sex, type 2 diabetes, education, smoking status, physical activity, and intakes of total energy, alcohol, saturated fat, protein, vitamin E, and dietary fiber.

Results: Energy-adjusted total fructose intake and energy-adjusted fructose from fruit was not associated with IHL in the fully adjusted model (p=0.647 and p=0.767).

In contrast, energy-adjusted intake of fructose from fruit juice and SSB was associated with higher IHL in the fully adjusted models (p=0.019 and p=0.009). Individuals in the highest tertile of energy-adjusted intake of fructose from fruit juice and SSB had a 1.04-fold (95%CI: 0.99;1.11) and 1.09-fold (95%CI: 1.03;1.16) higher IHL, respectively, when compared to the lowest tertile in the fully adjusted model. Finally, the association for fructose from fruit juice was stronger in individuals with type 2 diabetes (p for interaction=0.071).

Conclusions: Fructose from fruit juice and SSB is independently associated with higher IHL. These cross-sectional findings contribute to current knowledge in support of measures to reduce the intake of fructose-containing beverages as a means to prevent non-alcoholic fatty liver disease at the population level.


This study was supported by the Dutch Diabetes Research Foundation (personal grant #2017.82.004 to MCGJB). The Maastricht Study was supported by the European Regional Development Fund via OP-Zuid, the Province of Limburg, the Dutch Ministry of Economic Affairs (grant 31O.041), Stichting De Weijerhorst (Maastricht, the Netherlands), the Pearl String Initiative Diabetes (Amsterdam, the Netherlands), School for Cardiovascular Diseases (CARIM, Maastricht, the Netherlands), School for Public Health and Primary Care (CAPHRI, Maastricht, the Netherlands), School for Nutrition and Translational Research in Metabolism (NUTRIM, Maastricht, the Netherlands), Stichting Annadal (Maastricht, the Netherlands), Health Foundation Limburg (Maastricht, the Netherlands), and by unrestricted grants from Janssen-Cilag B.V. (Tilburg, the Netherlands), Novo Nordisk Farma B.V. (Alphen aan den Rijn, the Netherlands), Sanofi-Aventis Netherlands B.V. (Gouda, the Netherlands), and Medtronic (Tolochenaz, Switzerland).


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