Reduction in Free Sugars Improves NAFLD in Young Boys

Pediatric male patients with nonalcoholic fatty liver disease (NAFLD) could benefit from a diet low in free sugars, according to an open-label, randomized, clinical trial. 

“Pediatric guidelines for the management of nonalcoholic fatty liver disease (NAFLD) recommend a healthy diet as treatment,” the researchers noted. “Reduction of sugary foods and beverages is a plausible but unproven treatment.” 

The World Health Organization (WHO) defines free sugar as “monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus the sugars that are naturally present in honey, syrups and fruit juices.” The definition of free sugar is similar to the widely accepted definition of added sugar in the United States but is more specific, according to the WHO: “For example, it is unclear whether concentrated fruit juice contains added sugar while there is no doubt that it contains free sugars.” 

The present eight-week study included 40 male NAFLD patients aged between 11 and 16 years with proven disease activity (hepatic steatosis >10% and alanine aminotransferase level ≥45 U/L). Patients were randomized to follow an intervention diet low in free sugars or continue their normal eating habits. Each cohort included 20 patients (mean age, 13 years; 95% Hispanic). Patients on the intervention diet received individualized meal plans that limited their free sugar intake to no more than 3% of their overall caloric intake. Participants were contacted twice a week via phone to check diet adherence. The primary outcome was hepatic steatosis change as evidenced by MRI. Secondary outcomes included diet adherence and alanine aminotransferase level changes. 

From baseline to eight weeks, the intervention group had a significantly greater decrease in hepatic steatosis (25% to 17%) than the usual diet group (21% to 20%), as well as a larger decrease in alanine aminotransferase level: 103 U/L to 61 U/L vs. 82 U/L to 75 U/L, respectively. Nearly all (n = 18/20) of the intervention diet patients successfully kept their free sugar intake below 3% of their calories. No adverse events occurred. 

The study is considered a preliminary communication, and researchers said that further research is needed to determine long-term outcomes. 

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Source: JAMA