Abstract
Glucose is a major energy source for the entire body, while fructose metabolism occurs mainly in the liver. Fructose consumption has increased over the last decade globally and is suspected to contribute to the increased incidence of non-alcoholic fatty liver disease (NAFLD). NAFLD is a manifestation of metabolic syndrome affecting about one-third of the population worldwide and has progressive pathological potential for liver cirrhosis and cancer through non-alcoholic steatohepatitis (NASH). Here we have reviewed the possible contribution of fructose to the pathophysiology of NAFLD. We critically summarize the current findings about several regulators, and their potential mechanisms, that have been studied in humans and animal models in response to fructose exposure. A novel hypothesis on fructose-dependent perturbation of liver regeneration and metabolism is advanced. Fructose intake could affect inflammatory and metabolic processes, liver function, gut microbiota, and portal endotoxin influx. The role of the brain in controlling fructose ingestion and the subsequent development of NAFLD is highlighted. Although the importance for fructose (over)consumption for NAFLD in humans is still debated and comprehensive intervention studies are invited, understanding of how fructose intake can favor these pathological processes is crucial for the development of appropriate noninvasive diagnostic and therapeutic approaches to detect and treat these metabolic effects. Still, lifestyle modification, to lessen the consumption of fructose-containing products, and physical exercise are major measures against NAFLD. Finally, promising drugs against fructose-induced insulin resistance and hepatic dysfunction that are emerging from studies in rodents are reviewed, but need further validation in human patients.
Similar content being viewed by others
Abbreviations
- CYP2E1:
-
Cytochrome 450 2E1
- ER:
-
Endoplasmic reticulum
- GLUT:
-
Glucose transporter
- HDL:
-
High-density lipoprotein
- HFCS:
-
High-fructose corn syrup
- HFD:
-
High-fat diet
- IR:
-
Insulin resistance
- IRS-1/2:
-
Insulin receptor substrate 1/2
- LCN2:
-
Lipocalin 2
- LDL:
-
High-density lipoprotein
- LPS:
-
Lipopolysaccharide
- Ltf:
-
Lactoferrin
- MC4R:
-
Melanocortin receptor 4
- MetS:
-
Metabolic syndrome
- NAFLD:
-
Non-alcoholic fatty liver disease
- NASH:
-
Non-alcoholic steatohepatitis
- PAI-1:
-
Plasminogen activator inhibitor-1
- ROS:
-
Reactive oxygen species
- T2D:
-
Type 2 diabetes mellitus
- TG:
-
Triglycerides
- TLR4:
-
Toll-like receptor 4
- TNF-α:
-
Tumor necrosis factor-α
References
Abdelmalek MF, Suzuki A, Guy C et al (2010) Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease. Hepatology 51:1961–1971. doi:10.1002/hep.23535
Abdelmalek MF, Lazo M, Horska A et al (2012) Higher dietary fructose is associated with impaired hepatic adenosine triphosphate homeostasis in obese individuals with type 2 diabetes. Hepatology 56:952–960. doi:10.1002/hep.25741
Agrawal R, Noble E, Vergnes L et al (2015) Dietary fructose aggravates the pathobiology of traumatic brain injury by influencing energy homeostasis and plasticity. J Cereb Blood Flow Metab 36:941–953. doi:10.1177/0271678X15606719
Ahmad S, Sultan S, Naz N et al (2014) Regulation of iron uptake in primary culture rat hepatocytes: the role of acute-phase cytokines. Shock 41:337–345. doi:10.1097/SHK.0000000000000107
Albuquerque D, Estévez MN, Víbora PB et al (2014) Novel variants in the MC4R and LEPR genes among severely obese children from the iberian population. Ann Hum Genet 78:195–207. doi:10.1111/ahg.12058
Al-Busafi SA, Bhat M, Wong P et al (2012) Antioxidant therapy in nonalcoholic steatohepatitis. Hepat Res Treat 2012:947575. doi:10.1155/2012/947575
Alwahsh SM, Ramadori G (2015) How does bariatric surgery improve type II diabetes? The neglected importance of the liver in clearing glucose and insulin from the portal blood. J Obes Weight Loss Ther 5:5–8. doi:10.4172/2165-7904.1000280
Alwahsh SM, Xu M, Schultze FC et al (2014a) Combination of alcohol and fructose exacerbates metabolic imbalance in terms of hepatic damage, dyslipidemia, and insulin resistance in rats. PLoS ONE 9:e104220. doi:10.1371/journal.pone.0104220
Alwahsh SM, Xu M, Seyhan HA et al (2014b) Diet high in fructose leads to an overexpression of lipocalin-2 in rat fatty liver. World J Gastroenterol 20:1807–1821. doi:10.3748/wjg.v20.i7.1807
Aron-Wisnewsky J, Gaborit B, Dutour A, Clement K (2013) Gut microbiota and non-alcoholic fatty liver disease: new insights. Clin Microbiol Infect 19:338–348. doi:10.1111/1469-0691.12140
Aroor AR, Habibi J, Ford DA et al (2015) Dipeptidyl peptidase-4 inhibition ameliorates Western diet-induced hepatic steatosis and insulin resistance through hepatic lipid remodeling and modulation of hepatic mitochondrial function. Diabetes 64:1988–2001. doi:10.2337/db14-0804
Assy N, Nasser G, Kamayse I et al (2008) Soft drink consumption linked with fatty liver in the absence of traditional risk factors. Can J Gastroenterol 22:811–816
Azhar A, El-Bassossy HM (2014) Pentoxifylline alleviates cardiac ischemia and dysfunction following experimental angina in insulin resistance. PLoS ONE 9:e98281. doi:10.1371/journal.pone.0098281
Bakoma B, Berké B, Eklu-Gadegbeku K et al (2014) Effect of Bridelia ferruginea Benth (Euphorbiaceae) ethyl acetate and acetone fractions on insulin resistance in fructose drinking mice. J Ethnopharmacol 153:896–899. doi:10.1016/j.jep.2014.03.065
Barker CE, Ali S, O’Boyle G, Kirby JA (2014) Transplantation and inflammation: implications for the modification of chemokine function. Immunology 143:138–145. doi:10.1111/imm.12332
Basaranoglu M, Basaranoglu G, Bugianesi E (2015) Carbohydrate intake and nonalcoholic fatty liver disease: fructose as a weapon of mass destruction. Hepatobiliary Surg Nutr 4:109–116. doi:10.3978/j.issn.2304-3881.2014.11.05
Bellentani S, Scaglioni F, Marino M, Bedogni G (2010) Epidemiology of non-alcoholic fatty liver disease. Dig Dis 28:155–161. doi:10.1159/000282080
Bergheim I, Weber S, Vos M et al (2008) Antibiotics protect against fructose-induced hepatic lipid accumulation in mice: role of endotoxin. J Hepatol 48:983–992. doi:10.1016/j.jhep.2008.01.035
Bettaieb A, Vazquez Prieto MA, Rodriguez Lanzi C et al (2014) (−)-Epicatechin mitigates high-fructose-associated insulin resistance by modulating redox signaling and endoplasmic reticulum stress. Free Radic Biol Med 72:247–256. doi:10.1016/j.freeradbiomed.2014.04.011
Birkenfeld AL, Shulman GI (2014) Nonalcoholic fatty liver disease, hepatic insulin resistance, and type 2 diabetes. Hepatology 59:713–723. doi:10.1002/hep.26672
Boesch C, Elsing C, Wegmüller H et al (1997) Effect of ethanol and fructose on liver metabolism a dynamic 31 phosphorus magnetic resonance spectroscopy study in normal volunteers. Magn Reson Imaging 15:1067–1077
Borkham-Kamphorst E, Drews F, Weiskirchen R (2011) Induction of lipocalin-2 expression in acute and chronic experimental liver injury moderated by pro-inflammatory cytokines interleukin-1β through nuclear factor-κB activation. Liver Int 31:656–665. doi:10.1111/j.1478-3231.2011.02495.x
Bray GA, Popkin BM (2014) Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes? Health be damned! Pour on the sugar. Diabetes Care 37:950–956. doi:10.2337/dc13-2085
Bray GA, Nielsen SJ, Popkin BM (2004) Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 89:537–543
Brown SS, Forrest JA, Roscoe P (1972) A controlled trial of fructose in the treatment of acute alcoholic intoxication. Lancet 2:898–899
Butler AA, St-Onge M-P, Siebert EA et al (2015) Differential responses of plasma adropin concentrations to dietary glucose or fructose consumption in humans. Sci Rep 5:14691. doi:10.1038/srep14691
Carvalhana S, Machado MV, Cortez-Pinto H (2012) Improving dietary patterns in patients with nonalcoholic fatty liver disease. Curr Opin Clin Nutr Metab Care 15:468–473. doi:10.1097/MCO.0b013e3283566614
Cha SH, Wolfgang M, Tokutake Y et al (2008) Differential effects of central fructose and glucose on hypothalamic malonyl-CoA and food intake. Proc Natl Acad Sci USA 105:16871–16875. doi:10.1073/pnas.0809255105
Charlton M, Krishnan A, Viker K et al (2011) Fast food diet mouse: novel small animal model of NASH with ballooning, progressive fibrosis, and high physiological fidelity to the human condition. Am J Physiol Gastrointest Liver Physiol 301:G825–G834. doi:10.1152/ajpgi.00145.2011
Chung M, Ma J, Patel K et al (2014) Fructose, high-fructose corn syrup, sucrose, and nonalcoholic fatty liver disease or indexes of liver health: a systematic review and meta-analysis. Am J Clin Nutr 100:833–849. doi:10.3945/ajcn.114.086314
Clayton ZE, Vickers MH, Bernal A et al (2015) Early life exposure to fructose alters maternal, fetal and neonatal hepatic gene expression and leads to sex-dependent changes in lipid metabolism in rat offspring. PLoS ONE 10:e0141962. doi:10.1371/journal.pone.0141962
Conlon BA, Beasley JM, Aebersold K et al (2013) Nutritional management of insulin resistance in nonalcoholic fatty liver disease (NAFLD). Nutrients 5:4093–4114. doi:10.3390/nu5104093
Cortez-Pinto H, Chatham J, Chacko V et al (1999) Alterations in liver ATP homeostasis in human nonalcoholic steatohepatitis a pilot study. JAMA 282:1659–1664
Cox CL, Stanhope KL, Schwarz JM et al (2012) Consumption of fructose—but not glucose-sweetened beverages for 10 weeks increases circulating concentrations of uric acid, retinol binding protein-4, and gamma-glutamyl transferase activity in overweight/obese humans. Nutr Metab 9:68. doi:10.1186/1743-7075-9-68
Crescenzo R, Bianco F, Falcone I et al (2013) Increased hepatic de novo lipogenesis and mitochondrial efficiency in a model of obesity induced by diets rich in fructose. Eur J Nutr 52:537–545. doi:10.1007/s00394-012-0356-y
Dam-Larsen S, Franzmann M, Andersen IB et al (2004) Long term prognosis of fatty liver: risk of chronic liver disease and death. Gut 53:750–755
DeBosch BJ, Chen Z, Saben JL et al (2014) Glucose transporter 8 (GLUT8) mediates fructose-induced de Novo lipogenesis and macrosteatosis. J Biol Chem 289:10989–10998. doi:10.1074/jbc.M113.527002
Di Luccia B, Crescenzo R, Mazzoli A et al (2015) Rescue of fructose-induced metabolic syndrome by antibiotics or faecal transplantation in a rat model of obesity. PLoS ONE 10:e0134893. doi:10.1371/journal.pone.0134893
Downing LE, Heidker RM, Caiozzi GC et al (2015) A grape seed procyanidin extract ameliorates fructose-induced hypertriglyceridemia in rats via enhanced fecal bile acid and cholesterol excretion and inhibition of hepatic lipogenesis. PLoS ONE 10:e0140267. doi:10.1371/journal.pone.0140267
Dupas J, Goanvec C, Feray A et al (2016) Progressive induction of type 2 diabetes: effects of a reality-like fructose enriched diet in young wistar rats. PLoS ONE 11:e0146821. doi:10.1371/journal.pone.0146821
Edmison J, McCullough AJ (2007) Pathogenesis of non-alcoholic steatohepatitis: human data. Clin Liver Dis 11:75–104. doi:10.1016/j.cld.2007.02.011
Ekstedt M, Franzén LE, Mathiesen UL et al (2006) Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology 44:865–873. doi:10.1002/hep.21327
Engstler AJ, Aumiller T, Degen C et al (2015) Insulin resistance alters hepatic ethanol metabolism: studies in mice and children with non-alcoholic fatty liver disease. Gut 65:1564–1571. doi:10.1136/gutjnl-2014-308379
Erlanson-Albertsson C, Lindqvist A (2010) Fructose affects enzymes involved in the synthesis and degradation of hypothalamic endocannabinoids. Regul Pept 161:87–91. doi:10.1016/j.regpep.2010.01.003
Feige JN, Lagouge M, Canto C et al (2008) Specific SIRT1 activation mimics low energy levels and protects against diet-induced metabolic disorders by enhancing fat oxidation. Cell Metab 8:347–358. doi:10.1016/j.cmet.2008.08.017
Fernández-Novell JM, Ramió-Lluch L, Orozco A et al (2014) Glucose and fructose have sugar-specific effects in both liver and skeletal muscle in vivo: a role for liver fructokinase. PLoS ONE 9:e109726. doi:10.1371/journal.pone.0109726
Frank DN, St Amand AL, Feldman RA et al (2007) Molecular-phylogenetic characterization of microbial community imbalances in human inflammatory bowel diseases. Proc Natl Acad Sci USA 104:13780–13785. doi:10.1073/pnas.0706625104
Gebhardt R, Matz-Soja M (2014) Liver zonation: novel aspects of its regulation and its impact on homeostasis. World J Gastroenterol 20:8491–8504. doi:10.3748/wjg.v20.i26.8491
Giriş M, Doğru-Abbasoğlu S, Kumral A et al (2014) Effect of carnosine alone or combined with α-tocopherol on hepatic steatosis and oxidative stress in fructose-induced insulin-resistant rats. J Physiol Biochem 70:385–395. doi:10.1007/s13105-014-0314-7
Gorden DL, Ivanova PT, Myers DS et al (2011) Increased diacylglycerols characterize hepatic lipid changes in progression of human nonalcoholic fatty liver disease; comparison to a murine model. PLoS ONE 6:e22775. doi:10.1371/journal.pone.0022775
Guimaraes PS, Oliveira MF, Braga JF et al (2014) Increasing angiotensin-(1–7) levels in the brain attenuates metabolic syndrome-related risks in fructose-fed rats. Hypertension 63:1078–1085. doi:10.1161/HYPERTENSIONAHA.113.01847
Guo H, Jin D, Zhang Y et al (2010) Lipocalin-2 deficiency impairs thermogenesis and potentiates diet-induced insulin resistance in mice. Diabetes 59:1376–1385. doi:10.2337/db09-1735
Hirahatake KM, Meissen JK, Fiehn O, Adams SH (2011) Comparative effects of fructose and glucose on lipogenic gene expression and intermediary metabolism in HepG2 liver cells. PLoS ONE 6:e26583. doi:10.1371/journal.pone.0026583
Ishimoto T, Lanaspa MA, Rivard CJ et al (2013) High-fat and high-sucrose (western) diet induces steatohepatitis that is dependent on fructokinase. Hepatology 58:1632–1643. doi:10.1002/hep.26594
Johnson RJ, Nakagawa T, Sanchez-Lozada LG et al (2013) Sugar, uric acid, and the etiology of diabetes and obesity. Diabetes 62:3307–3315. doi:10.2337/db12-1814
Johnston RD, Stephenson MC, Crossland H et al (2013) No difference between high-fructose and high-glucose diets on liver triacylglycerol or biochemistry in healthy overweight men. Gastroenterology 145:1016–1025.e2. doi:10.1053/j.gastro.2013.07.012
Kanuri G, Spruss A, Wagnerberger S et al (2011a) Role of tumor necrosis factor α (TNFα) in the onset of fructose-induced nonalcoholic fatty liver disease in mice. J Nutr Biochem 22:527–534. doi:10.1016/j.jnutbio.2010.04.007
Kanuri G, Spruss A, Wagnerberger S et al (2011b) Fructose-induced steatosis in mice: role of plasminogen activator inhibitor-1, microsomal triglyceride transfer protein and NKT cells. Lab Invest 91:885–895. doi:10.1038/labinvest.2011.44
Kavanagh K, Wylie AT, Tucker KL et al (2013) Dietary fructose induces endotoxemia and hepatic injury in calorically controlled primates. Am J Clin Nutr 98:349–357. doi:10.3945/ajcn.112.057331
Kawasaki T, Igarashi K, Koeda T et al (2009) Rats fed fructose-enriched diets have characteristics of nonalcoholic hepatic steatosis. J Nutr 139:2067–2071. doi:10.3945/jn.109.105858
Kelishadi R, Mansourian M, Heidari-Beni M (2014) Association of fructose consumption and components of metabolic syndrome in human studies: a systematic review and meta-analysis. Nutrition 30:503–510. doi:10.1016/j.nut.2013.08.014
Koliaki C (2013) Hepatic energy metabolism in human diabetes mellitus, obesity and non-alcoholic fatty liver disease. Mol Cell Endocrinol 379:35–42. doi:10.1016/j.mce.2013.06.002
Korieh A, Crouzoulon G (1991) Dietary regulation of fructose metabolism in the intestine and in the liver of the rat. Duration of the effects of a high fructose diet after the return to the standard diet. Arch Int Physiol Biochim Biophys 99:455–460
Lanaspa MA, Cicerchi C, Garcia G et al (2012a) Counteracting roles of AMP deaminase and AMP kinase in the development of fatty liver. PLoS ONE 7:e48801. doi:10.1371/journal.pone.0048801
Lanaspa MA, Sanchez-Lozada LG, Choi YJ et al (2012b) Uric acid induces hepatic steatosis by generation of mitochondrial oxidative stress: Potential role in fructose-dependent and -independent fatty liver. J Biol Chem 287:40732–40744. doi:10.1074/jbc.M112.399899
Lanaspa MA, Ishimoto T, Li N et al (2013) Endogenous fructose production and metabolism in the liver contributes to the development of metabolic syndrome. Nat Commun 4:2434. doi:10.1038/ncomms3434
Latta M, Künstle G, Lucas R et al (2007) ATP-depleting carbohydrates prevent tumor necrosis factor receptor 1-dependent apoptotic and necrotic liver injury in mice. J Pharmacol Exp Ther 321:875–883. doi:10.1124/jpet.107.119958
Lettner A, Roden M (2008) Ectopic fat and insulin resistance. Curr Diab Rep 8:185–191
Li YC, Hsieh CC (2014) Lactoferrin dampens high-fructose corn syrup-induced hepatic manifestations of the metabolic syndrome in a murine model. PLoS ONE 9:e97341. doi:10.1371/journal.pone.0097341
Li M, Reynolds CM, Sloboda DM et al (2013) Effects of taurine supplementation on hepatic markers of inflammation and lipid metabolism in mothers and offspring in the setting of maternal obesity. PLoS ONE 8:e76961. doi:10.1371/journal.pone.0076961
Li J-M, Ge C-X, Xu M-X et al (2015) Betaine recovers hypothalamic neural injury by inhibiting astrogliosis and inflammation in fructose-fed rats. Mol Nutr Food Res 59:189–202. doi:10.1002/mnfr.201400307
Lim JS, Mietus-Snyder M, Valente A et al (2010) The role of fructose in the pathogenesis of NAFLD and the metabolic syndrome. Nat Rev Gastroenterol Hepatol 7:251–264. doi:10.1038/nrgastro.2010.41
Lin HZ, Yang SQ, Chuckaree C et al (2000) Metformin reverses fatty liver disease in obese, leptin-deficient mice. Nat Med 6:998–1003. doi:10.1038/79697
Lindqvist A, Baelemans A, Erlanson-Albertsson C (2008) Effects of sucrose, glucose and fructose on peripheral and central appetite signals. Regul Pept 150:26–32. doi:10.1016/j.regpep.2008.06.008
Liu J, Zhang H, Ji B et al (2014a) A diet formula of Puerariae radix, Lycium barbarum, Crataegus pinnatifida, and Polygonati rhizoma alleviates insulin resistance and hepatic steatosis in CD-1 mice and HepG2 cells. Food Funct 5:1038–1049. doi:10.1039/c3fo60524h
Liu X, Xue R, Ji L et al (2014b) Activation of farnesoid X receptor (FXR) protects against fructose-induced liver steatosis via inflammatory inhibition and ADRP reduction. Biochem Biophys Res Commun 450:117–123. doi:10.1016/j.bbrc.2014.05.072
Lou P-H, Yang G, Huang L et al (2010) Reduced body weight and increased energy expenditure in transgenic mice over-expressing soluble leptin receptor. PLoS ONE 5:e11669. doi:10.1371/journal.pone.0011669
Lustig RH (2010) Fructose: metabolic, hedonic, and societal parallels with ethanol. J Am Diet Assoc 110:1307–1321. doi:10.1016/j.jada.2010.06.008
Mahli A, Thasler WE, Patsenker E et al (2015) Identification of cytochrome CYP2E1 as critical mediator of synergistic effects of alcohol and cellular lipid accumulation in hepatocytes in vitro. Oncotarget 6:41464–41478. doi:10.18632/oncotarget.6203
Makki K, Taront S, Molendi-Coste O et al (2014) Beneficial metabolic effects of rapamycin are associated with enhanced regulatory cells in diet-induced obese mice. PLoS ONE 9:e92684. doi:10.1371/journal.pone.0092684
Malkusz DC, Yenko I, Rotella FM et al (2015) Dopamine receptor signaling in the medial orbital frontal cortex and the acquisition and expression of fructose-conditioned flavor preferences in rats. Brain Res 1596:116–125. doi:10.1016/j.brainres.2014.11.028
Marriott BP, Cole N, Lee E (2009) National estimates of dietary fructose intake increased from 1977 to 2004 in the United States. J Nutr 139:1228S–1235S. doi:10.3945/jn.108.098277
Martius G, Alwahsh SM, Rave-Fränk M et al (2014) Hepatic fat accumulation and regulation of FAT/CD36: an effect of hepatic irradiation. Int J Clin Exp Pathol 7:5379–5392
Mate A, De La Hermosa MA, Barfull A et al (2001) Characterization of d-fructose transport by rat kidney brush-border membrane vesicles: changes in hypertensive rats. Cell Mol Life Sci 58:1961–1967
Matz-Soja M, Rennert C, Schönefeld K et al (2016) Hedgehog signaling is a potent regulator of liver lipid metabolism and reveals a GLI-code associated with steatosis. eLife 5:e13308. doi:10.7554/eLife.13308.001
Michael MD, Kulkarni RN, Postic C et al (2000) Loss of insulin signaling in hepatocytes leads to severe insulin resistance and progressive hepatic dysfunction. Mol Cell 6:87–97
Montonen J, Järvinen R, Knekt P et al (2007) Consumption of sweetened beverages and intakes of fructose and glucose predict type 2 diabetes occurrence. J Nutr 137:1447–1454
Morishita S, Ono T, Fujisaki C et al (2013) Bovine lactoferrin reduces visceral fat and liver triglycerides in ICR mice. J Oleo Sci 62:97–103
Mortensen OH, Larsen LH, Ørstrup LKH et al (2014) Developmental programming by high fructose decreases phosphorylation efficiency in aging offspring brain mitochondria, correlating with enhanced UCP5 expression. J Cereb Blood Flow Metab 34:1205–1211. doi:10.1038/jcbfm.2014.72
Mouzaki M, Comelli EM, Arendt BM et al (2013) Intestinal microbiota in patients with nonalcoholic fatty liver disease. Hepatology 58:120–127. doi:10.1002/hep.26319
Mukai Y, Ozaki H, Serita Y, Sato S (2014) Maternal fructose intake during pregnancy modulates hepatic and hypothalamic AMP-activated protein kinase signalling in a sex-specific manner in offspring. Clin Exp Pharmacol Physiol 41:331–337. doi:10.1111/1440-1681.12225
Nair S, Chacko VP, Arnold C, Diehl AM (2003) Hepatic ATP reserve and efficiency of replenishing: comparison between obese and nonobese normal individuals. Am J Gastroenterol 98:466–470. doi:10.1016/S0002-9270(02)05889-6
Nair S, Diehl AM, Wiseman M et al (2004) Metformin in the treatment of non-alcoholic steatohepatitis: a pilot open label trial. Aliment Pharmacol Ther 20:23–28. doi:10.1111/j.1365-2036.2004.02025.x
Nakagawa T, Hu H, Zharikov S et al (2006) A causal role for uric acid in fructose-induced metabolic syndrome. Am J Physiol Renal Physiol 290:F625–F631. doi:10.1152/ajprenal.00140.2005
Nan Y, Wang R, Fu N (2014) Peroxisome proliferator-activated receptor α, a potential therapeutic target for alcoholic liver disease. World J Gastroenterol 20:8055–8060. doi:10.3748/wjg.v20.i25.8055
Narasimhan A, Chinnaiyan M, Karundevi B (2015) Ferulic acid regulates hepatic GLUT2 gene expression in high fat and fructose-induced type-2 diabetic adult male rat. Eur J Pharmacol 761:391–397. doi:10.1016/j.ejphar.2015.04.043
Niklas J, Bonin A, Mangin S et al (2012) Central energy metabolism remains robust in acute steatotic hepatocytes challenged by a high free fatty acid load. BMB Rep 45:396–401
Okada E, Oida K, Tada H et al (1999) Hyperhomocysteinemia is a risk factor for coronary arteriosclerosis in Japanese patients with type 2 diabetes. Diabetes Care 22:484–490. doi:10.2337/diacare.22.3.484
Onyesom I (2005) Honey-induced stimulation of blood ethanol elimination and its influence on serum triacylglycerol and blood pressure in man. Ann Nutr Metab 49:319–324. doi:10.1159/000087336
Oron-Herman M, Rosenthal T, Sela B-A (2003) Hyperhomocysteinemia as a component of syndrome X. Metabolism 52:1491–1495
Ouyang X, Cirillo P, Sautin Y et al (2008) Fructose consumption as a risk factor for non-alcoholic fatty liver disease. J Hepatol 48:993–999. doi:10.1016/j.jhep.2008.02.011
Page KA, Chan O, Arora J et al (2013) Effects of fructose vs glucose on regional cerebral blood flow in brain regions involved with appetite and reward pathways. JAMA 309:63. doi:10.1001/jama.2012.116975
Pastoret A, Marcos R, Sampayo-Reyes A et al (2013) Inhibition of hepatocyte nuclear factor 1 and 4 alpha (HNF1α and HNF4α) as a mechanism of arsenic carcinogenesis. Arch Toxicol 87:1001–1012. doi:10.1007/s00204-012-0948-6
Pessayre D, Fromenty B (2005) NASH: a mitochondrial disease. J Hepatol 42:928–940. doi:10.1016/j.jhep.2005.03.004
Petrie JL, Patman GL, Sinha I et al (2013) The rate of production of uric acid by hepatocytes is a sensitive index of compromised cell ATP homeostasis. Am J Physiol Endocrinol Metab 305:E1255–E1265. doi:10.1152/ajpendo.00214.2013
Petta S, Marchesini G, Caracausi L et al (2013) Industrial, not fruit fructose intake is associated with the severity of liver fibrosis in genotype 1 chronic hepatitis C patients. J Hepatol 59:1169–1176. doi:10.1016/j.jhep.2013.07.037
Prakash P, Singh V, Jain M et al (2014) Silymarin ameliorates fructose induced insulin resistance syndrome by reducing de novo hepatic lipogenesis in the rat. Eur J Pharmacol 727:15–28. doi:10.1016/j.ejphar.2014.01.038
Pyo Y-H, Lee K-W (2014) Preventive effect of Monascus-fermented products enriched with ubiquinones on type 2 diabetic rats induced by a high-fructose plus high-fat diet. J Med Food 17:826–829. doi:10.1089/jmf.2013.3001
Qu H, Li J, Chen W et al (2014) Differential expression of the melanocortin-4 receptor in male and female C57BL/6J mice. Mol Biol Rep 41:3245–3256. doi:10.1007/s11033-014-3187-5
Raatz SK, Johnson LK, Picklo MJ (2015) Consumption of honey, sucrose, and high-fructose corn syrup produces similar metabolic effects in glucose-tolerant and -intolerant individuals. J Nutr 145:2265–2272. doi:10.3945/jn.115.218016.1
Rashid A, Wu T-C, Huang C et al (1999) Mitochondrial proteins that regulate apoptosis and necrosis are induced in mouse fatty liver. Hepatology 29:1131–1138
Rebollo A, Roglans N, Baena M et al (2014) Liquid fructose downregulates Sirt1 expression and activity and impairs the oxidation of fatty acids in rat and human liver cells. Biochim Biophys Acta Mol Cell Biol Lipids 1841:514–524. doi:10.1016/j.bbalip.2014.01.002
Ren L-P, Chan SMH, Zeng X-Y et al (2012) Differing endoplasmic reticulum stress response to excess lipogenesis versus lipid oversupply in relation to hepatic steatosis and insulin resistance. PLoS ONE 7:e30816. doi:10.1371/journal.pone.0030816
Ren D, Zhao Y, Nie Y et al (2014) Chemical composition of Pleurotus eryngii polysaccharides and their inhibitory effects on high-fructose diet-induced insulin resistance and oxidative stress in mice. Food Funct 5:2609–2620. doi:10.1039/c3fo60640f
Renaud HJ, Cui JY, Lu H, Klaassen CD (2014) Effect of diet on expression of genes involved in lipid metabolism, oxidative stress, and inflammation in mouse liver-insights into mechanisms of hepatic steatosis. PLoS ONE 9:e88584. doi:10.1371/journal.pone.0088584
Riby JE, Fujisawa T, Kretchmer N (1993) Fructose absorption. Am J Clin Nutr 58:748S–753S
Ritze Y, Bárdos G, D’Haese JG et al (2014) Effect of high sugar intake on glucose transporter and weight regulating hormones in mice and humans. PLoS ONE 9:e101702. doi:10.1371/journal.pone.0101702
Rivera FP, Medina AM, Bezada S et al (2013) Bovine lactoferrin decreases cholera-toxin-induced intestinal fluid accumulation in mice by ganglioside interaction. PLoS ONE 8:e59253. doi:10.1371/journal.pone.0059253
Rodrigues DF, do Carmo Henriques MC, Oliveira MC et al (2014) Acute intake of a high-fructose diet alters the balance of adipokine concentrations and induces neutrophil influx in the liver. J Nutr Biochem 25:388–394. doi:10.1016/j.jnutbio.2013.11.012
Rokutan M, Yabe D, Komoto I et al (2015) A case of insulinoma with non-alcoholic fatty liver disease: roles of hyperphagia and hyperinsulinemia in pathogenesis of the disease. Endocr J 62:1025–1030. doi:10.1507/endocrj.EJ14-0590
Rorabaugh JM, Stratford JM, Zahniser NR (2014) A relationship between reduced nucleus accumbens shell and enhanced lateral hypothalamic orexin neuronal activation in long-term fructose bingeing behavior. PLoS ONE 9:e95019. doi:10.1371/journal.pone.0095019
Rovenko BM, Perkhulyn NV, Gospodaryov DV et al (2015) High consumption of fructose rather than glucose promotes a diet-induced obese phenotype in Drosophila melanogaster. Comp Biochem Physiol Part A Mol Integr Physiol 180:75–85. doi:10.1016/j.cbpa.2014.11.008
Sakar Y, Nazaret C, Lettéron P et al (2009) Positive regulatory control loop between gut leptin and intestinal GLUT2/GLUT5 transporters links to hepatic metabolic functions in rodents. PLoS ONE 4:e7935. doi:10.1371/journal.pone.0007935
Samuel VT, Liu Z-X, Qu X et al (2004) Mechanism of hepatic insulin resistance in non-alcoholic fatty liver disease. J Biol Chem 279:32345–32353. doi:10.1074/jbc.M313478200
Sapp V, Gaffney L, EauClaire SF, Matthews RP (2014) Fructose leads to hepatic steatosis in zebrafish that is reversed by mTOR inhibition. Hepatology 60:1581–1592. doi:10.1002/hep.27284
Saravanan M, Pandikumar P, Saravanan S et al (2014) Lipolytic and antiadipogenic effects of (3,3-dimethylallyl) halfordinol on 3T3-L1 adipocytes and high fat and fructose diet induced obese C57/BL6J mice. Eur J Pharmacol 740:714–721. doi:10.1016/j.ejphar.2014.06.004
Scholz R, Nohl H (1976) Mechanism of the stimulatory effect of fructose on ethanol oxidation in perfused rat liver. Eur J Biochem 63:449–458
Schwarz J-M, Noworolski SM, Wen MJ et al (2015) Effect of a high-fructose weight-maintaining diet on lipogenesis and liver fat. J Clin Endocrinol Metab 100:2434–2442. doi:10.1210/jc.2014-3678
Sclafani A, Ackroff K (1994) Glucose- and fructose-conditioned flavor preferences in rats: taste versus postingestive conditioning. Physiol Behav 56:399–405
Sharma S, Mells JE, Fu PP et al (2011) GLP-1 analogs reduce hepatocyte steatosis and improve survival by enhancing the unfolded protein response and promoting macroautophagy. PLoS ONE 6:e25269. doi:10.1371/journal.pone.0025269
Shawky NM, Shehatou GSG, Abdel Rahim M et al (2014) Levocetirizine ameliorates high fructose diet-induced insulin resistance, vascular dysfunction and hepatic steatosis in rats. Eur J Pharmacol 740:353–363. doi:10.1016/j.ejphar.2014.07.021
Shi P, Chen B, Chen C et al (2015) Honey reduces blood alcohol concentration but not affects the level of serum MDA and GSH-Px activity in intoxicated male mice models. BMC Complement Altern Med 15:225. doi:10.1186/s12906-015-0766-5
Shulga N, Pastorino JG (2014) Mitoneet mediates TNFα-induced necroptosis promoted by exposure to fructose and ethanol. J Cell Sci 127:896–907. doi:10.1242/jcs.140764
Sloboda DM, Li M, Patel R et al (2014) Early life exposure to fructose and offspring phenotype: implications for long term metabolic homeostasis. J Obes 2014:1–10. doi:10.1155/2014/203474
Soleimani M (2011) Dietary fructose, salt absorption and hypertension in metabolic syndrome: towards a new paradigm. Acta Physiol 201:55–62. doi:10.1111/j.1748-1716.2010.02167.x
Song M, Schuschke DA, Zhou Z et al (2012) High fructose feeding induces copper deficiency in Sprague-Dawley rats: a novel mechanism for obesity related fatty liver. J Hepatol 56:433–440. doi:10.1016/j.surg.2006.10.010.Use
Song M, Chen T, Prough RA et al (2016) Chronic alcohol consumption causes liver injury in high-fructose-fed male mice through enhanced hepatic inflammatory response. Alcohol Clin Exp Res 40:518–528. doi:10.1111/acer.12994
Speicher T, Köhler UA, Choukèr A et al (2012) Fructose protects murine hepatocytes from tumor necrosis factor-induced apoptosis by modulating JNK signaling. J Biol Chem 287:1837–1846. doi:10.1074/jbc.M111.266742
Spruss A, Kanuri G, Wagnerberger S et al (2009) Toll-like receptor 4 is involved in the development of fructose-induced hepatic steatosis in mice. Hepatology 50:1094–1104. doi:10.1002/hep.23122
Spruss A, Kanuri G, Uebel K et al (2011) Role of the inducible nitric oxide synthase in the onset of fructose-induced steatosis in mice. Antioxid Redox Signal 14:2121–2135. doi:10.1089/ars.2010.3263
Spruss A, Henkel J, Kanuri G et al (2012a) Female mice are more susceptible to nonalcoholic fatty liver disease: sex-specific regulation of the hepatic AMP-activated protein kinase-plasminogen activator inhibitor 1 cascade, but not the hepatic endotoxin response. Mol Med 18:1346–1355. doi:10.2119/molmed.2012.00223
Spruss A, Kanuri G, Stahl C et al (2012b) Metformin protects against the development of fructose-induced steatosis in mice: role of the intestinal barrier function. Lab Investig 92:1020–1032. doi:10.1038/labinvest.2012.75
Stanhope KL, Schwarz JM, Keim NL et al (2009) Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest 119:1322–1334. doi:10.1172/JCI37385
Suwannaphet W, Meeprom A, Yibchok-Anun S, Adisakwattana S (2010) Preventive effect of grape seed extract against high-fructose diet-induced insulin resistance and oxidative stress in rats. Food Chem Toxicol 48:1853–1857. doi:10.1016/j.fct.2010.04.021
Tappy L, Egli L, Lecoultre V, Schneider P (2013) Effects of fructose-containing caloric sweeteners on resting energy expenditure and energy efficiency: a review of human trials. Nutr Metab 10:54. doi:10.1186/1743-7075-10-54
Thuy S, Ladurner R, Volynets V et al (2008) Nonalcoholic fatty liver disease in humans is associated with increased plasma endotoxin and plasminogen activator inhibitor 1 concentrations and with fructose intake. J Nutr 138:1452–1455
Tilg H, Moschen AR, Roden M (2016) NAFLD and diabetes mellitus. Nat Rev Gastroenterol Hepatol. doi:10.1038/nrgastro.2016.147
Tiniakos DG, Vos MB, Brunt EM (2010) Nonalcoholic fatty liver disease: pathology and pathogenesis. Annu Rev Pathol 5:145–171. doi:10.1146/annurev-pathol-121808-102132
Tomita K, Tamiya G, Ando S et al (2006) Tumour necrosis factor alpha signalling through activation of Kupffer cells plays an essential role in liver fibrosis of non-alcoholic steatohepatitis in mice. Gut 55:415–424. doi:10.1136/gut.2005.071118
Uzuegbu UE, Onyesom I (2009) Fructose-induced increase in ethanol metabolism and the risk of Syndrome X in man. C R Biol 332:534–538. doi:10.1016/j.crvi.2009.01.007
Vilà L, Rebollo A, Ađalsteisson GS et al (2011) Reduction of liver fructokinase expression and improved hepatic inflammation and metabolism in liquid fructose-fed rats after atorvastatin treatment. Toxicol Appl Pharmacol 251:32–40. doi:10.1016/j.taap.2010.11.011
Volynets V, Spruss A, Kanuri G et al (2010) Protective effect of bile acids on the onset of fructose-induced hepatic steatosis in mice. J Lipid Res 51:3414–3424. doi:10.1194/jlr.M007179
Volynets V, Machann J, Küper MA et al (2013) A moderate weight reduction through dietary intervention decreases hepatic fat content in patients with non-alcoholic fatty liver disease (NAFLD): a pilot study. Eur J Nutr 52:527–535. doi:10.1007/s00394-012-0355-z
Vos MB, Kimmons JE, Gillespie C et al (2008) Dietary fructose consumption among US children and adults: the Third National Health and Nutrition Examination Survey. Medscape J Med 10:160
Weiland T, Klein K, Zimmermann M et al (2012) Selective protection of human liver tissue in TNF-targeting of cancers of the liver by transient depletion of adenosine triphosphate. PLoS ONE 7:e52496. doi:10.1371/journal.pone.0052496
Welsh JA, Sharma AJ, Grellinger L, Vos MB (2011) Consumption of added sugars is decreasing in the United States. Am J Clin Nutr 94:726–734. doi:10.3945/ajcn.111.018366
White JS (2008) Straight talk about high-fructose corn syrup: what it is and what it. Am J Clin Nutr 88:1716S–1721S. doi:10.3945/ajcn.2008.25825B.2
Wigg AJ, Roberts-Thomson IC, Dymock RB et al (2001) The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia, and tumour necrosis factor alpha in the pathogenesis of non-alcoholic steatohepatitis. Gut 48:206–211
Xu M, Alwahsh SM, Ramadori G et al (2013) Upregulation of hepatic melanocortin 4 receptor during rat liver regeneration. J Surg Res. doi:10.1016/j.jss.2013.12.019
Xu T, Zheng L, Xu L et al (2014) Protective effects of dioscin against alcohol-induced liver injury. Arch Toxicol. doi:10.1007/s00204-013-1148-8
Xu M-X, Yu R, Shao L-F et al (2016) Up-regulated fractalkine (FKN) and its receptor CX3CR1 are involved in fructose-induced neuroinflammation: suppression by curcumin. Brain Behav Immun 58:69–81. doi:10.1016/j.bbi.2016.01.001
Yin Q, Ma Y, Hong Y et al (2014) Lycopene attenuates insulin signaling deficits, oxidative stress, neuroinflammation, and cognitive impairment in fructose-drinking insulin resistant rats. Neuropharmacology 86:389–396. doi:10.1016/j.neuropharm.2014.07.020
Yki-Järvinen H (2010) Nutritional modulation of nonalcoholic fatty liver disease and insulin resistance: human data. Curr Opin Clin Nutr Metab Care 13:709–714. doi:10.1097/MCO.0b013e32833f4b34
Zhao Y, Yang X, Ren D et al (2014) Preventive effects of jujube polysaccharides on fructose-induced insulin resistance and dyslipidemia in mice. Food Funct 5:1771. doi:10.1039/C3FO60707K
Zheng J, Xiao X, Zhang Q et al (2015) Maternal and post-weaning high-fat, high-sucrose diet modulates glucose homeostasis and hypothalamic POMC promoter methylation in mouse offspring. Metab Brain Dis 30:1129–1137. doi:10.1007/s11011-015-9678-9
Zhong W, Zhang W, Li Q et al (2015) Pharmacological activation of aldehyde dehydrogenase 2 by Alda-1 reverses alcohol-induced hepatic steatosis and cell death in mice. J Hepatol 62:1375–1381. doi:10.1016/j.jhep.2014.12.022
Acknowledgements
S.M.A. and R.G. conceived, designed, wrote, and approved the final manuscript. The authors thank Dr. John Hallett, MCR Centre for Regenerative Medicine, The University of Edinburgh, UK, for proofreading the paper.
Funding
This study was supported by grants from the Bundesministerium für Forschung und Technologie (BMBF) in the framework of the Systems Biology initiative “Virtual Liver Network” to RG (Grant: 0315735).
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Alwahsh, S.M., Gebhardt, R. Dietary fructose as a risk factor for non-alcoholic fatty liver disease (NAFLD). Arch Toxicol 91, 1545–1563 (2017). https://doi.org/10.1007/s00204-016-1892-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00204-016-1892-7