title: Higher fructose intake is inversely associated with risk of nonalcoholic fatty liver disease in older Finnish adults.
abstract: BACKGROUND
  High fructose intake has been suggested to be a key factor that induces nonalcoholic fatty liver disease (NAFLD), but the evidence from large epidemiologic studies is lacking.
  
  
  OBJECTIVE
  We examined the cross-sectional association between fructose intake and NAFLD by using the Fatty Liver Index (FLI) and the NAFLD liver fat score.
  
  
  METHODS
  The Helsinki Birth Cohort Study investigated 2003 Finnish men and women born in 1943-1944 in Helsinki who participated in a clinical health examination in the years 2001-2004. Trained study nurses measured weight, height, and waist circumference, and body mass index was calculated. Laboratory staff drew fasting blood for measurements of triglycerides and γ-glutamyl-transferase. The FLI and the NAFLD liver fat score were calculated on the basis of these measurements. Habitual fructose and other dietary intake over the past year were assessed by using validated and standardized 131-item food-frequency questionnaires. Data were analyzed in a cross-sectional manner by using logistic regression modeling with statistical software.
  
  
  RESULTS
  In a model adjusted for age, sex, and energy intake, participants in the highest fructose intake quartile (range: 29.2-88.0 g/d) had lower risk of NAFLD assessed by using the FLI (OR: 0.56; 95% CI: 0.42, 0.75; P-trend < 0.001) and NAFLD liver fat score (OR: 0.72; 95% CI: 0.53, 0.99; P-trend < 0.001) than that of the lowest intake quartile (range: 2.2-15.2 g/d). This association remained after adjustment for educational attainment, smoking, physical activity, and other dietary variables only for the FLI (OR: 0.68; 95% CI: 0.47, 0.84; P-trend < 0.05).
  
  
  CONCLUSIONS
  Our cross-sectional results did not support the current hypothesis that high intake of fructose is associated with a higher prevalence of NAFLD as assessed by using the FLI and NAFLD liver fat score.
authors.affiliation: From the Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (NK, SS, NEK, SM, and JGE); the Departments of Public Health (NK) and General Practice and Primary Health Care (JGE), University of Helsinki, Helsinki, Finland; the Folkhälsan Research Center, Helsinki, Finland (SS and JGE); the Helsinki University Central Hospital, Unit of General Practice, Helsinki, Finland (JGE); and the Vasa Central Hospital, Vasa, Finland (JGE).
authors.forename: Noora
authors.initials: N
authors.lastname: Kanerva
authors.affiliation: From the Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (NK, SS, NEK, SM, and JGE); the Departments of Public Health (NK) and General Practice and Primary Health Care (JGE), University of Helsinki, Helsinki, Finland; the Folkhälsan Research Center, Helsinki, Finland (SS and JGE); the Helsinki University Central Hospital, Unit of General Practice, Helsinki, Finland (JGE); and the Vasa Central Hospital, Vasa, Finland (JGE).
authors.forename: Samuel
authors.initials: S
authors.lastname: Sandboge
authors.affiliation: From the Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (NK, SS, NEK, SM, and JGE); the Departments of Public Health (NK) and General Practice and Primary Health Care (JGE), University of Helsinki, Helsinki, Finland; the Folkhälsan Research Center, Helsinki, Finland (SS and JGE); the Helsinki University Central Hospital, Unit of General Practice, Helsinki, Finland (JGE); and the Vasa Central Hospital, Vasa, Finland (JGE).
authors.forename: Niina E
authors.initials: NE
authors.lastname: Kaartinen
authors.affiliation: From the Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (NK, SS, NEK, SM, and JGE); the Departments of Public Health (NK) and General Practice and Primary Health Care (JGE), University of Helsinki, Helsinki, Finland; the Folkhälsan Research Center, Helsinki, Finland (SS and JGE); the Helsinki University Central Hospital, Unit of General Practice, Helsinki, Finland (JGE); and the Vasa Central Hospital, Vasa, Finland (JGE).
authors.forename: Satu
authors.initials: S
authors.lastname: Männistö
authors.affiliation: From the Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland (NK, SS, NEK, SM, and JGE); the Departments of Public Health (NK) and General Practice and Primary Health Care (JGE), University of Helsinki, Helsinki, Finland; the Folkhälsan Research Center, Helsinki, Finland (SS and JGE); the Helsinki University Central Hospital, Unit of General Practice, Helsinki, Finland (JGE); and the Vasa Central Hospital, Vasa, Finland (JGE).
authors.forename: Johan G
authors.initials: JG
authors.lastname: Eriksson
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D002149:Energy Intake; D005234:Fatty Liver / Q000453:epidemiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005632:Fructose / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D015995:Prevalence; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference; D044465:White People; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D014280:Triglycerides; D005632:Fructose; D005723:gamma-Glutamyltransferase