Could a common sugar in processed foods be fueling childhood liver disease?

By Dr. Chinta SidharthanReviewed by Susha Cheriyedath, M.Sc.Feb 12 2025

A new study reveals a troubling link between childhood obesity, fructose consumption, and liver disease—but are sugary drinks or hidden processed foods to blame?

Study: Fructose Intake and Unhealthy Eating Habits Are Associated with MASLD in Pediatric Obesity: A Cross-Sectional Pilot Study. Image Credit: Ann in the UK / Shutterstock

In a recent study published in the journal Nutrients, a team of scientists in Italy investigated how fructose intake and unhealthy eating habits contribute to metabolic dysfunction-associated steatotic liver disease (MASLD) in children with obesity. They examined dietary patterns and metabolic markers to assess fructose's impact on youth liver health.

Liver disease and sugar

Fructose, a naturally occurring sugar found in fruits, has become a major dietary concern due to its widespread use in processed foods and sugary beverages. Unlike glucose, fructose is less effective at triggering satiety, leading to increased calorie intake and fat accumulation. Studies have linked excessive fructose consumption to obesity, insulin resistance, and metabolic syndrome. Furthermore, these effects are even more concerning among children due to their long-term health implications.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is a growing concern, especially in pediatric populations. While obesity is a well-known risk factor for MASLD, the specific contribution of fructose remains debated, particularly regarding its dietary sources. Moreover, most research has focused on MASLD in adults or older children, leaving a gap in understanding how fructose affects younger age groups.

About the study

In the present study, the researchers sought to clarify whether fructose consumption, independent of its source, is linked to metabolic dysfunction and liver disease in obese children and adolescents.

A cross-sectional analysis was conducted at the Pediatric Endocrinology Unit of the University of Bari, Italy, between January and December 2023. The study included 41 children and adolescents between the ages of 3 and 16 who had been diagnosed with obesity, defined as a body mass index (BMI) above the 97th percentile for age and sex. The participants were categorized into two groups: preschool children aged 3 to 6 and adolescents between the ages of 12 and 16.

The clinical assessments used in the study included blood pressure, body fat distribution, and anthropometric measurements, such as height, weight, and waist circumference. The researchers used biochemical tests to measure fasting blood glucose, insulin, liver enzymes, lipids, and inflammatory markers. Insulin resistance was calculated using the homeostasis model assessment index.

Additionally, the study also used ultrasound imaging to evaluate liver health and assess hepatic steatosis. The hepatorenal index was used as an objective measure of fat accumulation in the liver, and MASLD was diagnosed based on ultrasound findings and classified into mild (grade 1) or moderate (grade 2) categories.

The study also incorporated assessments of dietary intake, which were obtained through a fructose-specific questionnaire and other food frequency questionnaires widely used in pediatric nutrition studies. Total fructose intake was calculated as a percentage of daily caloric intake, and correlations between fructose intake, dietary habits, and metabolic parameters were examined.

Study findings

The study found that MASLD was present in both preschool children and adolescents with obesity, with 12 out of the 41 participants (29.3%) being diagnosed with the condition. However, adolescents exhibited higher visceral adipose tissue, subcutaneous adipose tissue, and insulin resistance than preschool children.

The fructose intake levels differed between age groups. Preschool children had a higher overall weekly fructose intake than adolescents, but adolescents consumed a greater proportion of their fructose from processed foods rather than fruit. Moreover, those with MASLD had a significantly higher fructose intake, with fruit being a major reported source. However, the researchers suggest that this could be due to misreporting, as processed sugary foods and drinks might have been underreported. MASLD was also associated with higher consumption of foods rich in saturated fats.

The researchers found that liver enzyme levels were elevated in children with MASLD, indicating potential liver damage. High levels of uric acid, a known metabolic byproduct of fructose metabolism, were also observed, suggesting a link between fructose intake—particularly from processed foods—and metabolic dysfunction.

However, the study relied solely on dietary questionnaires, which may not have accurately captured the fructose intake. Additionally, the participants' physical activity levels, which could influence metabolic outcomes, were not assessed. Therefore, the researchers recommended further large-scale studies to explore the long-term effects of fructose consumption on pediatric liver health.

Conclusions

In summary, the findings brought attention to a concerning link between fructose intake, unhealthy dietary habits, and MASLD in children with obesity. The study suggested that reducing fructose consumption, especially from processed foods, may help mitigate liver disease risks. Interestingly, the study did not find a strong link between MASLD and fructose from sugary drinks. However, a high intake of fruit was associated with MASLD, which the researchers believe may be due to misreporting.

The results implied that public health strategies should focus on educating parents and caregivers about healthier food choices. The researchers emphasize that reducing fructose intake alone is not enough—limiting saturated fat consumption is equally important in lowering MASLD risk. Public health strategies should educate families on both factors. Further research is also needed to better understand fructose’s role in pediatric metabolic disorders and develop targeted interventions for at-risk children.