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Fructose, uric acid independently associated with NASH in adolescents

Dietary fructose consumption and serum uric acid concentrations were independently associated with NASH in children and adolescents, according to a study published in the Journal of Hepatology.

Additionally, dietary fructose consumption was the only factor independently associated with serum uric acid concentration.

“In this study, we show for the first time that uric acid concentrations and dietary fructose consumption are independently and positively associated with NASH. The development of NASH may markedly affect life expectancy and quality of life in affected individuals and therefore it is crucial to understand the risk factors for NASH in children and adolescents in order to design effective interventions which can be used safely to treat this young group of patients,” Valerio Nobili, MD, chief of the Hepatometabolic Unit Liver Diseases Laboratory, Bambino Gesù Hospital, IRCCS, Rome, Italy, said in a press release.

The researchers assessed 271 overweight or obese children with NAFLD for their daily fructose consumption (g/day) and uric acid concentration (mg/dL). They diagnosed NASH using the fatty liver inhibition of progression algorithm and a NAFLD activity score of 5 or greater. The study population included 155 boys. Mean patient age was 12.5 years. All patients underwent liver biopsy.

Patients with NASH (n = 102) had higher waist circumference, transaminase levels, total cholesterol, triglyceride and uric acid concentrations and a higher level of fructose consumption, compared with the patients who did not have NASH.

Fructose consumption (OR = 1.612; 95% CI, 1.25-1.86) and uric acid concentration (OR = 2.488; 95% CI, 1.87-2.83) were independently associated with NASH in the patient population. Fructose consumption was also independently associated with hyperuricemia (OR = 2.021; 95% CI, 1.66-2.78).

“In the intestine, fructose intake alters the gut microbiome and enhances endotoxin translocation into the portal circulation via increased permeability of tight junctions. In the liver, fructose is rapidly metabolized, consuming adenosine triphosphate, which may result in increased adenosine monophosphate and inosine monophosphate (IMP) and conversion of IMP to uric acid,” the researchers wrote.

Patients answered a fructose frequency questionnaire. Results showed that 52.76% of the patients never ate breakfast, 94.8% consumed morning snacks and 88.9% consumed afternoon snacks, and all patients regularly consumed lunch and dinner. The most common snacks included crackers, pizza, salty food, sweet snacks and yogurt. A percentage of patients ate the following foods every day: cereals (46.8%), vegetables (42.8%) and fruit (39.8%). Foods eaten one to two times per week were meat (91.8%), fish (48.3%) and eggs (44.6%). Eighty-nine percent of the patients reported drinking sodas and soft drinks one or more times a week.

“There is a growing body of evidence that uric acid may have a role in NAFLD, and our data are consistent with studies that have identified hyperuricemia as an independent predictor of fatty liver disease,” the researchers wrote. – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.