Children with NAFLD are more sensitive to the adverse metabolic effects of fructose beverages than children without NAFLD

J Clin Endocrinol Metab. 2012 Jul;97(7):E1088-98. doi: 10.1210/jc.2012-1370. Epub 2012 Apr 27.


Context: Dietary fructose induces unfavorable lipid alterations in animal models and adult studies. Little is known regarding metabolic tolerance of dietary fructose in children.

Objectives: The aim of the study was to evaluate whether dietary fructose alters plasma lipids in children with nonalcoholic fatty liver disease (NAFLD) and in healthy children.

Design and setting: We performed a 2-d, crossover feeding study at the Inpatient Clinical Interaction Site of the Atlanta Clinical and Translational Science Institute at Emory University Hospital.

Participants and intervention: Nine children with NAFLD and 10 matched controls without NAFLD completed the study. We assessed plasma lipid levels over two nonconsecutive, randomly assigned, 24-h periods under isocaloric, isonitrogenous conditions with three macronutrient-balanced, consecutive meals and either: 1) a fructose-sweetened beverage (FB); or 2) a glucose beverage (GB) being consumed with each meal.

Main outcome measures: Differences in plasma glucose, insulin, triglyceride, apolipoprotein B, high-density lipoprotein cholesterol, and nonesterified free fatty acid levels were assessed using mixed models and 24-h incremental areas under the time-concentration curve.

Results: After FB, triglyceride incremental area under the curve was higher vs. after GB both in children with NAFLD (P = 0.011) and those without NAFLD (P = 0.027); however, incremental response to FB was greater in children with NAFLD than those without NAFLD (P = 0.019). For all subjects, high-density lipoprotein cholesterol declined in the postprandial and overnight hours with FB, but not with GB (P = 0.0006). Nonesterified fatty acids were not impacted by sugar but were significantly higher in NAFLD.

Conclusions: The dyslipidemic effect of dietary fructose occurred in both healthy children and those with NAFLD; however, children with NAFLD demonstrated increased sensitivity to the impact of dietary fructose.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Beverages / adverse effects*
  • Blood Glucose / analysis
  • Blood Glucose / drug effects
  • Child
  • Cross-Over Studies
  • Dietary Carbohydrates / administration & dosage
  • Dietary Carbohydrates / adverse effects
  • Disease Susceptibility
  • Double-Blind Method
  • Fatty Liver / complications
  • Fatty Liver / metabolism*
  • Female
  • Fructose / administration & dosage
  • Fructose / adverse effects*
  • Humans
  • Insulin / blood
  • Lipids / blood
  • Male
  • Metabolic Diseases / blood
  • Metabolic Diseases / chemically induced*
  • Metabolic Diseases / etiology
  • Non-alcoholic Fatty Liver Disease
  • Risk Factors


  • Blood Glucose
  • Dietary Carbohydrates
  • Insulin
  • Lipids
  • Fructose