Is fruit juice associated with increased risk of NAFLD?

Nonalcoholic fatty liver disease (NAFLD) is a hepatic condition of metabolic syndrome (MetS), and its prevalence parallels that of obesity and diabetes (Jensen et al., 2018). Recent evidence suggests that diets high in sugar increase the risk for NAFLD. Increased consumption of fructose from sweeteners like high-fructose corn syrup (HFCS) and sucrose have negative consequences on our overall health (Jegatheesan, & De Bandt, 2017). Ingestion of fructose chronically has contributed to multiple health consequences like NAFLD (Jegatheesan, & De Bandt, 2017). Fructose is a sugar naturally occurring in fruits or honey. The relationship between high fructose and the development of NAFLD has been reported in large human cohort studies where intake of high fructose is inversely related with NAFLD. However, these studies observed that there is a huge difference between fructose from natural fruits and fructose from soft drinks. The former has an array of chemical compounds including minerals, vitamins, antioxidants, and polyphenols that potentially block high fructose effects, unlike in HFCS. There is evidence that these substances found in natural fruits actually protect against fructose-induced MetS (Jensen et al., 2018). Intake of natural fruits are not associated with NAFLD according to Jensen et al. (2018). 

Studies on fruit juice, however, have been mixed. A 2018 study found that fruit juices were associated with MetS because they have higher amounts of fructose and are often consumed quickly, leading to higher fructose concentrations and causing higher ATP usage and depletion (Jensen et al., 2018). A 2019 study found fruit juices had significantly more incidences of fat changes in individuals with NAFLD (Cantoral et al., 2019). This study suggests that juifeintake is linked to metabolic alterations that can risk developing NAFLD at a young age. In those classified as NAFLD, the median intake of natural fruit juices was statistically higher in development of liver fat than healthy subjects (Cantoral et al., 2019). Opposingly, a 2017 study evaluated the effects of pomegranate juice (PJ) on the prevention of NAFLD/NASH development in Sprague-Dawley rats (Noori, Jafari, & Hekmatdoost, 2017). They found that the regular consumption of PJ could prevent NAFLD even with other risk factors like obesity, hypercholesterolemia, and high energy, fat and sugar intakes (Noori, Jafari, & Hekmatdoost, 2017).

The jury is still out on fruit juice and whether one can even make a blanket statement about all fruit juices. There is no doubt there is protective power in fruit against illness, Does that carry over to its juice form? More studies are definitely needed to answer that question. 

References

Cantoral, A., Contreras-Manzano, A., Luna-Villa, L., Batis, C., Roldán-Valadez, E. A., Ettinger, A. S., Mercado, A., Peterson, K. E., Téllez-Rojo, M. M., & Rivera, J. A. (2019). Dietary Sources of Fructose and Its Association with Fatty Liver in Mexican Young Adults. Nutrients, 11(3). https://doi.org/10.3390/nu11030522

Jegatheesan, P., & De Bandt, J.-P. (2017). Fructose and NAFLD: The Multifaceted Aspects of Fructose Metabolism. Nutrients, 9(3). https://doi.org/10.3390/nu9030230

Jensen, T., Abdelmalek, M. F., Sullivan, S., Nadeau, K. J., Green, M., Roncal, C., Nakagawa, T., Kuwabara, M., Sato, Y., Kang, D.-H., Tolan, D. R., Sanchez-Lozada, L. G., Rosen, H. R., Lanaspa, M. A., Diehl, A. M., & Johnson, R. J. (2018). Fructose and Sugar: A Major Mediator of Nonalcoholic Fatty Liver Disease. Journal of Hepatology, 68(5), 1063–1075. https://doi.org/10.1016/j.jhep.2018.01.019

Noori, M., Jafari, B., & Hekmatdoost, A. (2017). Pomegranate juice prevents development of non-alcoholic fatty liver disease in rats by attenuating oxidative stress and inflammation. Journal of the Science of Food and Agriculture, 97(8), 2327–2332. https://doi.org/10.1002/jsfa.8042

Tajima, R., Kimura, T., Enomoto, A., Saito, A., Kobayashi, S., Masuda, K., & Iida, K. (2019). No association between fruits or vegetables and non-alcoholic fatty liver disease in middle-aged men and women. Nutrition (Burbank, Los Angeles County, Calif.), 61, 119–124. https://doi.org/10.1016/j.nut.2018.10.016