Sugar-sweetened beverage, diet soda, and nonalcoholic fatty liver disease over 6 Years: the framingham heart study
Open accessAbstract
Background & aims Nonalcoholic fatty liver disease (NAFLD) is associated with sugar-sweetened beverage (SSB) consumption in cross-sectional studies. In a prospective cohort, we examined the association of beverage consumption (SSB and diet soda) with incident NAFLD and changes in hepatic fat in the Framingham Heart Study (FHS).Methods We conducted a prospective observational study of participants from the FHS Third Generation and Offspring cohorts who participated in computed tomography sub-studies. Participants were classified according to their average SSB or diet soda consumption, which was derived from baseline and follow-up food frequency questionnaires: non-consumers (0-<1/month), occasional consumers (1/month-<1/week), and frequent consumers (≥1/week-≥1/day). Hepatic fat was quantified by the liver fat attenuation measurements on computed tomography scan. The primary dependent variable was incident NAFLD; secondarily, we investigated change in liver fat.Results The cohorts included 691 Offspring (mean age, 62.8 ± 8.2 years; 57.7% women) and 945 Third Generation participants (mean age, 48.4 ± 6.3 years; 46.6% women). In the Offspring cohort, there was a dose-response relationship with SSB consumption and incident NAFLD. Frequent SSB consumers had 2.53 times increased odds of incident NAFLD compared with non-consumers (95% confidence interval, 1.36-4.7) after multivariable analysis. For Offspring cohort participants, occasional and frequent consumers of SSB had a more adverse increase in liver fat compared with non-consumers.Conclusions Higher average SSB intake is associated with increase in liver fat over 6 years of follow-up and increased odds of incident NAFLD especially among the older cohort, whereas no consistent association was observed for the younger Third Generation cohort.
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Evidence from RCTs and a large prospective observational study shows an association of dietary added sugars, especially in the form of sugar-sweetened beverages, with increased liver steatosis, the incidence and prevalence of MASLD, and potentially the risk of MASH.
“Evidence from RCTs and a large prospective observational study shows an association of dietary added sugars, especially in the form of sugarsweetened beverages, with increased liver steatosis, the incidence and prevalence of MASLD, 305 -307 and potentially the risk of MASH. 308”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [307]
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12 167Metabolische Dysfunktion-assoziierte steatotische Lebererkrankung (MASLD)
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- Authors
- Park, W. Y., Yiannakou, I., Petersen, J. M., Hoffmann, U., Ma, J., & Long, M. T.
- Affiliations
- Boston University (US)
- Harvard University (US)
- National Heart, Lung, and Blood Institute (US)
- Corresponding author
- Long, Michelle T.
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2022-11
- Volume
- 20
- Issue
- 11
- Pages
- 2524-2532.e2
- ISSN
- 1542-3565 (ISSN-L)
- PMC
- PMC9236136
- OpenAlex
- W3212545769
- Cited by
- 53
- References
- 35
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 11 · 2023: 14 · 2022: 5
- FWCI
- 5.40
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Clinical and Translational Science Institute, Boston University (UL1 TR001430)
- National Heart, Lung, and Blood Institute (75N92019D00031, HHSN268201500001, N01-HC-25195)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23 DK113252)
- Doris Duke Charitable Foundation (2019085)
- Gilead Sciences
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- sugar-sweetened beverages, diet soda, non-alcoholic fatty liver disease, liver fat, beverage consumption, dose-response relationship, Framingham Offspring cohort
- MeSH terms
- Sugar-Sweetened Beverages, Adult, Aged, Cross-Sectional Studies, Diet, Female, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Non-alcoholic Fatty Liver Disease
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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