Associations of Fructose Consumption with Prevalence and Incidence of Metabolic Dysfunction-Associated Steatotic...

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of liver diseases. Fructose intake has been associated with liver fat accumulation, but less is known whether the associations differ based on the source of fructose.

We investigated the cross-sectional and longitudinal associations of intake of total fructose and fructose from different sources with risk of MASLD among middle-aged and older people from Eastern Finland.

The cross-sectional analyses included 666 males and 865 females aged 53-73 y, examined in 1998-2001. The longitudinal analyses included 300 males and 467 females examined again in 2005-2008. Fructose intake was assessed with 4-d food record. Fatty liver index (FLI) was used as a surrogate for liver fat content. MASLD was defined as FLI ≥60 and the presence of ≥1 cardiometabolic risk factors. Analysis of variance and multivariable-adjusted logistic regression were used for analyses.

The mean total fructose intake was 33 g/d (standard deviation 13.4, 7.4% of the total energy intake), with sweeteners (mainly sugar, 34.5% of the total fructose intake), fruits and berries (20.2%), and beverages (18.9%) being the major sources. In the cross-sectional analyses, participants with higher total fructose intake had 43% lower odds for MASLD [95% confidence interval (CI): 10%, 64%] in those in the highest (>39.7 g/d) compared with the lowest (<24.6 g/d) intake quartile (P-trend across quartiles = 0.02). Among the sources of fructose, the strongest inverse associations were observed with fructose from sweeteners. In the longitudinal analyses, total fructose intake was not associated with MASLD. However, fructose from sweeteners again had a strong inverse association with odds for MASLD (78% lower odds in the highest compared with the lowest quartile, 95% CI: 49%, 90%; P-trend < 0.001). Fructose from fruits and berries or from beverages was not associated with MASLD.

In middle-aged and older Finnish adults, higher fructose intake, especially from sweeteners, was associated with lower odds for MASLD.