Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2015 Aug;63(2):462-9.
doi: 10.1016/j.jhep.2015.03.032. Epub 2015 Jun 5.

Sugar-sweetened Beverage, Diet Soda, and Fatty Liver Disease in the Framingham Heart Study Cohorts

Free PMC article
Multicenter Study

Sugar-sweetened Beverage, Diet Soda, and Fatty Liver Disease in the Framingham Heart Study Cohorts

Jiantao Ma et al. J Hepatol. .
Free PMC article


Background & aims: Non-alcoholic fatty liver disease affects ∼30% of US adults, yet the role of sugar-sweetened beverages and diet soda on these diseases remains unknown. We examined the cross-sectional association between intake of sugar-sweetened beverages or diet soda and fatty liver disease in participants of the Framingham Offspring and Third Generation cohorts.

Methods: Fatty liver disease was defined using liver attenuation measurements generated from computed tomography in 2634 participants. Alanine transaminase concentration, a crude marker of fatty liver disease, was measured in 5908 participants. Sugar-sweetened beverage and diet soda intake were estimated using a food frequency questionnaire. Participants were categorized as either non-consumers or consumers (3 categories: 1 serving/month to <1 serving/week, 1 serving/week to <1 serving/day, and ⩾1 serving/day) of sugar-sweetened beverages or diet soda.

Results: After adjustment for age, sex, smoking status, Framingham cohort, energy intake, alcohol, dietary fiber, fat (% energy), protein (% energy), diet soda intake, and body mass index, the odds ratios of fatty liver disease were 1, 1.16 (0.88, 1.54), 1.32 (0.93, 1.86), and 1.61 (1.04, 2.49) across sugar-sweetened beverage consumption categories (p trend=0.04). Sugar-sweetened beverage consumption was also positively associated with alanine transaminase levels (p trend=0.007). We observed no significant association between diet soda intake and measures of fatty liver disease.

Conclusion: In conclusion, we observed that regular sugar-sweetened beverage consumption was associated with greater risk of fatty liver disease, particularly in overweight and obese individuals, whereas diet soda intake was not associated with measures of fatty liver disease.

Keywords: Alanine transaminase; Diet soda; Fatty liver disease; Sugar-sweetened beverages.

Conflict of interest statement

Conflict of interest

The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.


Fig. 1
Fig. 1
BMI-stratified associations between sugar-sweetened beverage intake and liver-phantom ratio. Symbols are means and 95% CI. Diamonds represent BMI <25 kg/m2 and squares represent BMI ⩾25 kg/m2. Models were adjusted for age, gender, Framingham cohort, energy intake, alcohol intake, dietary fiber, dietary fat (% of energy), dietary protein (% energy), diet soda intake, smoking status, and BMI. SSB: Sugar-sweetened beverages.

Comment in

Similar articles

See all similar articles

Cited by 42 articles

See all "Cited by" articles

Publication types