Childhood Fructoholism and Fructoholic Liver Disease


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

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


  • 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.


  • 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.


  • 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.


  • 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.