The association of fructose and fiber consumption and physical activity with non-alcoholic fatty liver disease in children and adolescents: A cross-sectional study

Abstract Background:Non-alcoholic fatty liver disease (NAFLD) is emerging as the most common liver disease in overweight and obese children. Studies have shown no cure for NAFLD, but some researchers have found that dietary and lifestyle changes can improve this condition. Some evidence focuses on the role of carbohydrates especially fructose in NAFLD. Consuming too much fructose leads to de-novo lipogenesis, which causes insulin resistance, especially in overweight and obese people. A Methods:A total number of participants aged 6 to 13 years were included in this cross-sectional study from 2021 to 2022 and were divided into two groups NAFLD and a control. We assessed dietary intakes using a 147-item food frequency questionnaire (FFQ). Results:The mean age of individuals was 9.2±1.7 and 35% had NAFLD. After multivariable adjustment based on gender, maturity status, body mass index z-score, and total daily energy intake from the diet (OR: 1.0, 95%, CI: 0.35-1.29, P=0.221), and multivariable adjustment based on the gender, maturity status, z-score of body mass index and total daily energy intake from diet, leisure time sports activity, and triglyceride (OR: 0.67, 95%, CI: 0.35-1.29, P=0.221), there was no significant differences between fructose consumption and NAFLD. A significant relation was indicated between legume fiber (P=0.03) and nut fiber (P=0.04) with NAFLD risk. Conclusion: we could not indicate a significant association between fructose intake and NAFLD, however, due to the significant association between insulin resistance and dyslipidemia with NAFLD low intake of fructose-content foods is highly recommended in the young population.