title: Sugar-sweetened beverage, diet soda, and fatty liver disease in the Framingham Heart Study cohorts.
abstract: OBJECTIVE
  Non-alcoholic fatty liver disease affects ∼30% of US adults, yet the role of sugar-sweetened beverages and diet soda on these diseases remains unknown. We examined the cross-sectional association between intake of sugar-sweetened beverages or diet soda and fatty liver disease in participants of the Framingham Offspring and Third Generation cohorts.
  
  
  METHODS
  Fatty liver disease was defined using liver attenuation measurements generated from computed tomography in 2634 participants. Alanine transaminase concentration, a crude marker of fatty liver disease, was measured in 5908 participants. Sugar-sweetened beverage and diet soda intake were estimated using a food frequency questionnaire. Participants were categorized as either non-consumers or consumers (3 categories: 1 serving/month to <1 serving/week, 1 serving/week to <1 serving/day, and ⩾1 serving/day) of sugar-sweetened beverages or diet soda.
  
  
  RESULTS
  After adjustment for age, sex, smoking status, Framingham cohort, energy intake, alcohol, dietary fiber, fat (% energy), protein (% energy), diet soda intake, and body mass index, the odds ratios of fatty liver disease were 1, 1.16 (0.88, 1.54), 1.32 (0.93, 1.86), and 1.61 (1.04, 2.49) across sugar-sweetened beverage consumption categories (p trend=0.04). Sugar-sweetened beverage consumption was also positively associated with alanine transaminase levels (p trend=0.007). We observed no significant association between diet soda intake and measures of fatty liver disease.
  
  
  CONCLUSIONS
  In conclusion, we observed that regular sugar-sweetened beverage consumption was associated with greater risk of fatty liver disease, particularly in overweight and obese individuals, whereas diet soda intake was not associated with measures of fatty liver disease.
authors.affiliation: USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, United States.
authors.forename: Jiantao
authors.initials: J
authors.lastname: Ma
authors.affiliation: NHLBI's Framingham Heart Study, Framingham, MA, United States; Harvard Medical School, Boston, MA, United States.
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Fox
authors.affiliation: USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, United States.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Jacques
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, United States.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Speliotes
authors.affiliation: Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Boston, MA, United States.
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.affiliation: USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, United States.
authors.forename: Caren E
authors.initials: CE
authors.lastname: Smith
authors.affiliation: USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, United States.
authors.forename: Edward
authors.initials: E
authors.lastname: Saltzman
authors.affiliation: USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, United States. Electronic address: nicola.mckeown@tufts.edu.
authors.forename: Nicola M
authors.initials: NM
authors.lastname: McKeown
mesh_terms: D000328:Adult; D001628:Beverages / Q000009:adverse effects*; D015992:Body Mass Index; D002241:Carbohydrates / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013549:Sweetening Agents / Q000009:adverse effects*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D002241:Carbohydrates; D013549:Sweetening Agents
keywords: Alanine transaminase; Diet soda; Fatty liver disease; Sugar-sweetened beverages