Serum uric acid concentrations and fructose consumption are independently associated with NASH in children and adolescents
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Background & aims Recent research has suggested that dietary fructose intake may increase serum uric acid (UA) concentrations. Both UA concentration and fructose consumption maybe also increase in NAFLD. It is not known whether dietary fructose consumption and UA concentration are independently associated with non-alcoholic steatohepatitis (NASH). Our aim was to investigate the factors associated with NASH in children and adolescents with proven NAFLD, and to test whether UA concentrations and fructose consumption are independently associated with NASH.Methods Obese children with NAFLD were studied (n=271). NASH was diagnosed by a NAFLD activity score ⩾5 and the fatty liver inhibition of progression (FLIP) algorithm. Fructose consumption (g/day) was assessed by food frequency questionnaire, and UA (mg/dl) was measured in serum. Binary logistic regression with adjustment for covariates and potential confounders was undertaken to test factors independently associated with NASH.Results NASH occurred in 37.6% of patients. Hyperuricaemia (UA ⩾5.9mg/dl) was present in 47% of patients with NASH compared with 29.7% of non-NASH patients (p=0.003). Both UA concentration (OR=2.488, 95% CI: 1.87-2.83, p=0.004) and fructose consumption (OR=1.612, 95% CI 1.25-1.86, p=0.001) were independently associated with NASH, after adjustment for multiple (and all) measured confounders. Fructose consumption was independently associated with hyperuricaemia (OR=2.021, 95% CI: 1.66-2.78, p=0.01). These data were confirmed using the FLIP algorithm.Conclusions Both dietary fructose consumption and serum UA concentrations are independently associated with NASH. Fructose consumption was the only factor independently associated with serum UA concentration.Lay summary Currently, it is not known whether dietary fructose consumption and uric acid (UA) concentration are linked with non-alcoholic steatohepatitis (NASH) in children and adolescents. Our aim was to test whether UA concentrations and fructose consumption are independently associated with NASH in children and adolescents with proven non-alcoholic fatty liver disease (NAFLD). We show that both dietary fructose consumption and serum UA concentrations are independently associated with NASH and fructose consumption was independently linked with high serum UA concentrations.
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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 [308]
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References 31 · Cited by 161
- Authors
- Mosca, A., Nobili, V., De Vito, R., Crudele, A., Scorletti, E., Villani, A., Alisi, A., & Byrne, C. D.
- Affiliations
- Bambino Gesù Children's Hospital (IT)
- University Hospital Southampton NHS Foundation Trust (GB)
- ORCID
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2017-05
- Volume
- 66
- Issue
- 5
- Pages
- 1031-1036
- ISSN
- 0168-8278 (ISSN-L)
- OpenAlex
- W2588250733
- Cited by
- 161
- References
- 31
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 14 · 2023: 17 · 2022: 18 · 2021: 18 · 2020: 18 · 2019: 21 · 2018: 24 · 2017: 18
- FWCI
- 17.34
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Journal of Hepatology (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Funders
- Southampton NIHR Biomedical Research Centre
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Nephrology › Gout, Hyperuricemia, Uric Acid
- Keywords
- nonalcoholic steatohepatitis, non-alcoholic fatty liver disease, serum uric acid, hyperuricemia, dietary fructose intake, children and adolescents, obesity, NAFLD activity score, metabolic syndrome risk factors, insulin resistance, dyslipidemia, type 2 diabetes risk, cardiovascular risk
- MeSH terms
- Adolescent, Child, Female, Fructose, Humans, Insulin Resistance, Male, Uric Acid, Logistic Models, Non-alcoholic Fatty Liver Disease
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