Childhood Fructoholism and Fructoholic Liver Disease

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Ribeiro A, Igual-Perez MJ, Santos Silva E and Sokal EM.

Hepatology Communication 2019, 3:1; doi: 0.1002/hep4.1291

Objective

  • To conduct a review to provide evidence of the negative effect of high fructose consumption in childhood on future liver health, with many similarities to alcohol, and to propose strategies for its reduction and to support global health improvement in the pediatric age.

Background

  • Nonalcoholic fatty liver disease (NAFLD) is an emerging entity, becoming the most prevalent pediatric chronic liver disease.
  • Excessive fructose consumption is believed to cause addiction like alcohol and other drugs. As such, the new term “fructoholism” refers to the consumption of a substance (fructose) that can cause psychological and physical damage and become a major public health concern, highlighting the seriousness of the excessive consumption of fructose in the pediatric age.
  • Hepatic fructose metabolization leads to hepatic steatosis and progression to fibrosis through mechanisms comparable to alcoholic liver disease, hence the term “fructoholic liver disease.”

Methods

  • No information on the methods used for this review are provided.

Findings

  • Recent data provide evidence of the heterogeneity of NAFLD progression in the pediatric age.  The whole spectrum of NAFLD can be seen in childhood, from liver steatosis to cirrhosis, to liver failure and HCC. Although rare, rapid progression to cirrhosis and end-stage liver disease can disclose within a few years, and cirrhosis at diagnosis has also been described in childhood.
  • Fructose intake has a dose-dependent correlation with NAFLD development and its progression to fibrosis in children and adolescents.  This leads to a pattern of liver injury comparable to alcohol ingestion.
  • Sugar addiction from the viewpoint of behavior and brain neurochemistry has been shown in animal models, in which feeding comportment during intermittent access to sugar solutions was studied, demonstrating similar addiction-related behaviors caused by drugs of abuse, including bingeing, withdrawal syndrome, cravings, and cross-sensitization.
  • In addition to their similar addictive effect, fructose and ethanol share analogies in liver metabolism. Metabolites from alcohol metabolism are comparable to those resulting of fructose metabolism, which leads to identical toxic cellular response and hepatocyte damage.

Conclusions

  • Fructose has been linked to the rising incidence of obesity, insulin resistance, and NAFLD in the pediatric population. Its metabolism may parallel that of alcohol, with the production of similar subproducts and liver damage.
  • Fructose consumption has increased 300% in the past 20 years, and it may have an addictive effect similar to other drugs. Therefore, banning added sugars from children’s diets should be considered a public health priority.

Points to Consider

  • It is unclear whether the authors conducted a systematic review of the literature, as no details regarding the methods utilized are provided. Without evidence of a thorough and balanced review, any conclusions drawn from this review should done so with caution.
  • Lifestyle interventions remain the first line of treatment for NAFLD. These intervention are comprehensive and include changes to physical activity and sedentary behavior, as well as dietary changes that include an increase in fruit, vegetable and unrefined oils and cereals.
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