Fructose-induced hepatic steatosis in non-obese children: A comprehensive review

Background/ObjectivesDietary fructose intake has increased markedly in Western countries, leading to an increase of children with a normal weight suffering from non-alcoholic fatty liver disease. The aim of this study is to examine current knowledge of the association between fructose consumption and hepatic steatosis in non-obese, non-diabetic children and adolescents and raise awareness of a well-known disease in a new cohort of paediatric patients.MethodsThis was a narrative literature review with systematic search elements. A literature search of PubMed, MEDLINE, EMBASE, Cochrane Library and Scopus was conducted with the final search completed on 21 September 2024. Eligible studies were peer-reviewed clinical or translational studies (including relevant animal models) reporting hepatic outcomes in paediatric populations without obesity or diabetes.ResultsThirteen studies met inclusion criteria including experimental (n = 2) and observational (n = 4) studies and reviews (n = 4). Those studies demonstrated that high fructose intake promotes hepatic lipid accumulation via unregulated hepatic fructose metabolism, increased de novo lipogenesis, impaired VLDL secretion, oxidative stress and gut-derived inflammation.ConclusionFructose-associated hepatic steatosis is a clinically relevant phenomenon in children without obesity or metabolic syndrome without symptoms, so paediatricians need to screen their patients for it. This review highlights mechanistic distinctions between fructose and glucose metabolism, discusses the complexity of clinical trials, which explains the current gap in literature, and it underscores the role of misleading health marketing and opaque food labelling in exacerbating this risk. It emphasises the need for targeted preventive strategies and clearer food labelling to reduce hidden fructose exposure in youth.