Soft drink consumption and risk of nonalcoholic fatty liver disease: results from the Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) cohort study
Open accessAbstract
Background Epidemiological evidence for the association of soft drink consumption with nonalcoholic fatty liver disease (NAFLD) is inconsistent, and such association has not been prospectively examined in the general adult population.Objectives We aimed to investigate the prospective association between soft drink consumption and the risk of NAFLD in a Chinese adult population.Methods This prospective cohort study investigated 14,845 participants [mean age: 39.3 y; 6203 (41.8%) men] who were free of liver disease, cardiovascular disease, and cancer at baseline. Soft drink consumption (mainly sugar-containing carbonated beverages) was measured at baseline using a validated FFQ. NAFLD was diagnosed based on abdominal ultrasound without significant alcohol consumption and other causes of liver disease. Hepatic steatosis index (HSI) was calculated based on sex, BMI, and blood transaminase levels. Cox proportional hazards regression models were used to examine the association of soft drink consumption with incident NAFLD.Results A total of 2888 first-incident cases of NAFLD occurred during 42,048 person-years of follow-up (median follow-up: 4.2 y). After adjusting for demographic characteristics, lifestyle factors, dietary intake, and inflammatory markers, the multivariable HRs (95% CIs) for incident NAFLD were 1.00 (reference) for <1 serving/wk, 1.18 (1.03, 1.34) for 1 serving/wk, 1.23 (1.08, 1.40) for 2-3 servings/wk, and 1.47 (1.25, 1.73) for ≥4 servings/wk, respectively (P for trend < 0.0001). Further sensitivity analysis showed that the corresponding multivariable HRs (95% CIs) for incident HSI-defined NAFLD were 1.00 (reference), 0.96 (0.70, 1.31), 1.16 (0.83, 1.62), and 1.59 (1.07, 2.37), respectively (P for trend < 0.0001).Conclusions The results from our prospective study indicate that soft drink consumption is associated with an increased risk of NAFLD in Chinese adults. This study was registered at UMIN Clinical Trials Registry as UMIN000027174.
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Prospective studies showed that sugar-sweetened beverages and red meat consumption (unprocessed and processed) were associated with an increased risk of developing MASLD in a dose-dependent manner, liver cancer and liver disease-related mortality.
“With regard to speci fi c nutrients or foods, prospective studies showed that sugar-sweetened beverages and red meat consumption (unprocessed and processed) were associated with an increased risk of developing MASLD (in a dose-dependent manner), 109,110 liver cancer and liver disease-related mortality.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [110]
A prospective cohort study showed a dose-response association between soft drink consumption and MASLD; a consumption of >-4 servings per week was related to a 45% increased risk of developing MASLD.
“A prospective cohort study showed a doseresponse association between soft drink consumption and MASLD; a consumption of > -4 servings per week was related to a 45% increased risk of developing MASLD. 110”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [110]
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- Authors
- Zhang, S., Gu, Y., Bian, S., Lu, Z., Zhang, Q., Liu, L., Meng, G., Yao, Z., Wu, H., Wang, Y., Zhang, T., Wang, X., Sun, S., Wang, X., Zhou, M., Jia, Q., Song, K., Qi, L., & Niu, K.
- Affiliations
- Tianjin Medical University (CN)
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- Second Hospital of Tianjin Medical University (CN)
- Tianjin Medical University General Hospital (CN)
- Tulane University (US)
- Corresponding author
- Qi, Lu
- Niu, Kaijun
- ORCID
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2021-05
- Volume
- 113
- Issue
- 5
- Pages
- 1265-1274
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W3128577976
- Cited by
- 70
- References
- 49
- Citations by year
- 2026: 7 · 2025: 16 · 2024: 12 · 2023: 14 · 2022: 15 · 2021: 6
- FWCI
- 6.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (81673166, 81941024, 81872611, 91746205)
- 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
- non-alcoholic fatty liver disease, soft drink consumption, hepatic steatosis index, Chinese adults, dietary intake
- MeSH terms
- Adult, Carbonated Beverages, China, Diet, Feeding Behavior, Female, Humans, Inflammation, Male, Middle Aged, Prospective Studies, Cohort Studies, Non-alcoholic Fatty Liver Disease
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