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

  • Pediatric Gastroenterology (SA Saeed and K Sandberg, Section Editors)
  • Published:
Current Treatment Options in Pediatrics Aims and scope Submit manuscript

Abstract

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.

Summary

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.

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Abbreviations

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

CS:

Caloric sweeteners

NCS:

Non-caloric sweeteners

DNL:

De novo lipogenesis

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, MS 78, Los Angeles, CA, USA

    Dong Xi MD & Rohit Kohli MBBS, MS

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  1. Dong Xi MD
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  2. Rohit Kohli MBBS, MS
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Correspondence to Rohit Kohli MBBS, MS.

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Dong Xi declares that he no conflict of interest. Rohit Kohli declares that he no conflict of interest.

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Xi, D., Kohli, R. When the Beverage Is Sweet, How Does the Liver Feel?. Curr Treat Options Peds 5, 458–465 (2019). https://doi.org/10.1007/s40746-019-00177-0

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