title: Associations of sugar- and artificially sweetened soda with nonalcoholic fatty liver disease: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease (NAFLD) is the major concern of public health worldwide. The risk of NAFLD in subjects who regularly drink soda is controversial. The aim of this study was to assess the association between consumption of sugar-sweetened soda and NAFLD.
  
  
  METHODS
  A literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception through June 2015. Studies that reported relative risks, odd ratios, or hazard ratios comparing the risk of NAFLD in patients consuming a significant amount of either sugar or artificially sweetened soda vs. those who did not consume soda were included. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.
  
  
  RESULTS
  Seven observational studies were included in our analysis to assess the association between consumption of sugar-sweetened soda and NAFLD. The pooled RR of NAFLD in patients consuming sugar-sweetened soda was 1.53 (95% CI: 1.34-1.75, I(2) = 0). When meta-analysis was limited only to studies with adjusted analysis, the pooled RR of NAFLD was 1.55 (95% CI: 1.36-1.78, I(2) = 0). The data on association between consumption of artificially sweetened soda and NAFLD were limited; one observational study reported no significant increased risk of NAFLD in artificially sweetened soda consumption.
  
  
  CONCLUSIONS
  Our study demonstrates statistically significant association between sugar-sweetened soda consumption and NAFLD. This finding may impact clinical management and primary prevention of NAFLD.
authors.affiliation: From the 1Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY.
authors.forename: K
authors.initials: K
authors.lastname: Wijarnpreecha
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
authors.forename: C
authors.initials: C
authors.lastname: Thongprayoon
authors.affiliation: Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Edmonds
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
authors.forename: W
authors.initials: W
authors.lastname: Cheungpasitporn
mesh_terms: D002253:Carbonated Beverages / Q000009:adverse effects*; D019422:Dietary Sucrose / Q000009:adverse effects*; D006801:Humans; D007333:Insulin Resistance; D064306:Non-Nutritive Sweeteners / Q000009:adverse effects*; D065626:Non-alcoholic Fatty Liver Disease / Q000139:chemically induced* / Q000517:prevention & control; D064887:Observational Studies as Topic; D016017:Odds Ratio; D018570:Risk Assessment
chemical_list: D019422:Dietary Sucrose; D064306:Non-Nutritive Sweeteners