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

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.