Ribeiro A, Igual-Perez MJ, Santos Silva E and
Hepatology Communication 2019, 3:1;
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.
- 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
- No information on the methods used for this
review are provided.
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.
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.
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.
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.
- 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.