title: Children with NAFLD are more sensitive to the adverse metabolic effects of fructose beverages than children without NAFLD.
abstract: BACKGROUND
  Dietary fructose induces unfavorable lipid alterations in animal models and adult studies. Little is known regarding metabolic tolerance of dietary fructose in children.
  
  
  OBJECTIVE
  The aim of the study was to evaluate whether dietary fructose alters plasma lipids in children with nonalcoholic fatty liver disease (NAFLD) and in healthy children.
  
  
  METHODS
  We performed a 2-d, crossover feeding study at the Inpatient Clinical Interaction Site of the Atlanta Clinical and Translational Science Institute at Emory University Hospital.
  
  
  METHODS
  Nine children with NAFLD and 10 matched controls without NAFLD completed the study. We assessed plasma lipid levels over two nonconsecutive, randomly assigned, 24-h periods under isocaloric, isonitrogenous conditions with three macronutrient-balanced, consecutive meals and either: 1) a fructose-sweetened beverage (FB); or 2) a glucose beverage (GB) being consumed with each meal.
  
  
  METHODS
  Differences in plasma glucose, insulin, triglyceride, apolipoprotein B, high-density lipoprotein cholesterol, and nonesterified free fatty acid levels were assessed using mixed models and 24-h incremental areas under the time-concentration curve.
  
  
  RESULTS
  After FB, triglyceride incremental area under the curve was higher vs. after GB both in children with NAFLD (P = 0.011) and those without NAFLD (P = 0.027); however, incremental response to FB was greater in children with NAFLD than those without NAFLD (P = 0.019). For all subjects, high-density lipoprotein cholesterol declined in the postprandial and overnight hours with FB, but not with GB (P = 0.0006). Nonesterified fatty acids were not impacted by sugar but were significantly higher in NAFLD.
  
  
  CONCLUSIONS
  The dyslipidemic effect of dietary fructose occurred in both healthy children and those with NAFLD; however, children with NAFLD demonstrated increased sensitivity to the impact of dietary fructose.
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
authors.forename: Ran
authors.initials: R
authors.lastname: Jin
authors.forename: Ngoc-Anh
authors.initials: NA
authors.lastname: Le
authors.forename: Shuling
authors.initials: S
authors.lastname: Liu
authors.forename: Monica
authors.initials: M
authors.lastname: Farkas Epperson
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Ziegler
authors.forename: Jean A
authors.initials: JA
authors.lastname: Welsh
authors.forename: Dean P
authors.initials: DP
authors.lastname: Jones
authors.forename: Craig J
authors.initials: CJ
authors.lastname: McClain
authors.forename: Miriam B
authors.initials: MB
authors.lastname: Vos
mesh_terms: D000293:Adolescent; D001628:Beverages / Q000009:adverse effects*; D001786:Blood Glucose / Q000032:analysis / Q000187:drug effects; D002648:Child; D018592:Cross-Over Studies; D004040:Dietary Carbohydrates / Q000008:administration & dosage / Q000009:adverse effects; D004198:Disease Susceptibility; D004311:Double-Blind Method; D005234:Fatty Liver / Q000150:complications / Q000378:metabolism*; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007328:Insulin / Q000097:blood; D008055:Lipids / Q000097:blood; D008297:Male; D008659:Metabolic Diseases / Q000097:blood / Q000139:chemically induced* / Q000209:etiology; D065626:Non-alcoholic Fatty Liver Disease; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007328:Insulin; D008055:Lipids; D005632:Fructose