When the Beverage Is Sweet, How Does the Liver Feel?
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Purpose of Review
The purpose of this paper is to both review the available data and also highlight the gaps in knowledge, regarding the link between pediatric NASH and different types of sweeteners including caloric sweeteners (CS) and non-caloric sweeteners (NCS).
Studies have demonstrated that patients with NASH generally have had an unhealthy diet, characterized by on overconsumption of carbohydrates especially fructose. Mechanistically, a high-fructose diet reduces hepatic lipid oxidation, increases proinflammatory response, increases intestinal permeability, and decreases microbiome diversity. Consumption and availability of NCS has therefore been increasing dramatically. Most NCS are not considered to be metabolized in the body and therefore thought to be safe for consumption. It was reported that pharmacological properties of rebaudioside, a type of NCS, as a potential hepatoprotector are through anti-inflammatory and antifibrotic mechanisms, associated with enhancing glucose-induced insulin secretion and inducing the difference of microbiome diversity.
Diet is an important factor in the pathogenesis of NAFLD and popular dietary patterns are contributing to the increased replacement of natural sweeteners with NCS. Screening for NAFLD by pediatricians and counseling on the avoidance of sugar-sweetened beverages are recommended. We feel that the various NCS available to the consumer today merit further investigation and may potentially have hitherto unknown effects on hepatic metabolic function.
KeywordsNonalcoholic steatohepatitis Caloric sweeteners Non-caloric sweeteners Microbiome
Nonalcoholic fatty liver disease
De novo lipogenesis
Compliance with Ethical Standards
Conflict of interest
Dong Xi declares that he no conflict of interest. Rohit Kohli declares that he no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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