A systematic review and meta-analysis by Chiu et al found that fructose does not cause non-alcoholic fatty liver disease (NAFLD).
In the study, researchers examined data from 13 controlled feeding trials to determine the effect of fructose on markers for NAFLD, including seven trials in which there was equal exchange of glucose for fructose. The researchers concluded that, “preliminary systematic review and meta-analysis does not support a NAFLD-inducing effect of fructose in isocaloric exchange for other carbohydrates at levels of exposure that are well above that found in Western diets.”
Researchers did find that in trials where fructose was consumed at excessive levels, intake was associated with two markers of NAFLD. However, intake levels in these trials were well above what is typically consumed by the average person, and the increased risk was likely from the excess calories, not fructose itself.