When the Beverage Is Sweet, How Does the Liver Feel?

  • Dong Xi
  • Rohit KohliEmail author
Pediatric Gastroenterology (SA Saeed and K Sandberg, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Pediatric Gastroenterology


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).

Recent Findings

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.


Nonalcoholic steatohepatitis Caloric sweeteners Non-caloric sweeteners Microbiome 



Nonalcoholic fatty liver disease


Nonalcoholic steatohepatitis


Caloric sweeteners


Non-caloric sweeteners


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.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital Los AngelesUniversity of Southern CaliforniaLos AngelesUSA

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