Study: Avoiding Added Sugars May Protect Kids From Fatty Liver Disease

child eating sugary cereal

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Key Takeaways

  • Nonalcoholic fatty liver disease affects 13% of children in the United States.
  • Consuming excessive amounts of added sugar appears to contribute to the development of fatty liver disease, especially in children.
  • While added sugars should be limited, fruit does not need to be avoided because of the additional vitamins, minerals, and fiber that they provide. 

More and more research suggests that limiting added sugars in your child's diet can benefit them in the long run.

According to a recent study review, eating large amounts of added sugars in the form of fructose is linked to the development of fatty liver disease in children.

What Is Fructose?

Fructose is a type of sugar found in fruits, vegetables, and honey. But it is also found in high-fructose corn syrup, which is an artificial sweetener used in sodas, canned fruits, and packaged desserts.

“This study adds to the growing body of evidence that supports limiting added sugar in children's diets,” Sarah Anzlovar, MS, RDN, LDN, a registered dietitian in Boston and owner of Sarah Gold Nutrition, tells Verywell. Anzlovar was not involved in the study. “High sugar consumption continues to be linked to negative health outcomes in both kids and adults, and this study suggests an association between added sugar and non-alcoholic fatty liver disease (NAFLD) in kids.”

What Is Non-Alcoholic Fatty Liver Disease?

Non-alcoholic fatty liver disease (NAFLD) is a condition that results from having extra fat in the liver. In the United States, NAFLD is the most common chronic liver disease in children. Almost 10% of children and teens have the condition.

And while genetics may increase a person’s risk for developing NAFLD, obesity may also play a role. Many cases of NAFLD are not associated with any symptoms until it progresses. Symptoms may include fatigue, yellowing of the skin or eyes (jaundice), and a swollen belly (ascites). Over time, the liver can stop working properly, which can result in a slew of major health issues.

What This Means For You

Higher intake of added sugars is linked to the development of nonalcoholic fatty liver disease in children. Limiting added sugars in a child's diet and introducing some alternative sweeteners can help reduce their risk. Including whole and reduced-fat dairy foods may also be protective against fatty liver disease.

Can Diet Play a Role in Fatty Liver Disease? 

While past data has linked eating too much saturated fat, cholesterol, and sucrose (table sugar made of glucose and fructose) to NAFLD, consuming added sugars may play one of the most important roles.

To evaluate the relationship between sugar intake and NAFLD, researchers reviewed more than 20 studies surrounding the topic. Results were published in December 2020 in the journal Pediatric Obesity

The studies summarized in the review show that too much sugar intake may contribute to NAFLD development in children and teens, and that restriction of those sugars may reduce the effects on the development of fatty liver.  

However, since the sample sizes used in these studies were relatively small—ranging from 15 to 271 subjects—and some studies were not placebo-controlled and randomized, more data is needed to make a definitive connection. 

“It's no secret that Americans consume added sugars in excess,” Lauren Harris-Pincus, MS, RDN, a New Jersey-based registered dietitian and author of The Protein-Packed Breakfast Club, tells Verywell. “According to the American Academy of Pediatrics, on average, kids consume 19 teaspoons of added sugar per day which is over three times the American Heart Association's recommended limit of 6 teaspoons or 25 grams per day.” 

So limiting added sugars in your children and adolescent's diet will not only support their overall health but may also reduce their risk of developing NAFLD. 

How Can You Protect Your Liver?

Among the lifestyle changes you can make to reduce NAFLD risk, limiting the intake of certain sugars appears to be a wise choice based on the current data. 

“The best way to reduce added sugar intake among children is to limit sugary drinks including sodas and fruit drinks as well as high sugar foods like candy and other sweets,” Anzolvar says. She also warns to “watch out for added sugar in many packaged foods like bars, cereals, and snacks. Eating a lot of these foods can also crowd out more nutrient-rich foods that offer health benefits.”

She notes that fruit does not need to be limited, since it contains important vitamins, minerals, and fiber.

Alternative Sweeteners and Food

Harris-Pincus adds that it is sometimes helpful to “incorporate naturally occurring low-calorie sweeteners to help cut high sugar totals.” She shares that allulose is one viable option, as it “has sugar-like taste and 90% fewer calories than sucrose.” Allulose won’t raise blood glucose or insulin levels and is generally well tolerated.

Pincus also highlights other no-calorie sweetener options, like stevia and monk fruit, as viable substitutes for sugar in a diet.

And when considering foods that may reduce your risk of NAFLD, Moises Torres-Gonzalez, PhD, vice president of nutrition research at the National Dairy Council, highlights a recent study published in the Pediatric Journal of Gastroenterology and Nutrition, which found that consumption of whole- and reduced-fat dairy foods were linked to lower levels of fat in the livers of children at risk of Non-Alcoholic Fatty Liver Disease (NAFLD). He says these results provide evidence that eating dairy foods like dairy milk and Greek yogurt may actually be protective against fatty liver disease in children.

The updated Dietary Guidelines for Americans, 2020-2025 dictate that children under the age of two should have zero added sugars in their diet, and intake should be limited beyond the age of 2. Adults should also limit their calories from added sugars to 10% or less. And along with reducing diabetes risk, obesity risk, and cardiovascular disease risk, possibly curbing NAFLD can be one more reason for people to limit this ingredient in their daily diet.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & facts of NAFLD & NASH in children.

  3. Seth A, Orkin S, Yodoshi T, et al. Severe obesity is associated with liver disease severity in pediatric non-alcoholic fatty liver diseasePediatr Obes. 2019;15(2):e12581. doi:10.1111/ijpo. 12581

  4. Parry SA, Hodson L. Influence of dietary macronutrients on liver fat accumulation and metabolism. J Investig Med. 2017;65(8):1102-1115. doi:10.1136/jim-2017-000524

  5. American Academy of Pediatrics. AHA: Limit children’s sugar consumption to 6 teaspoons per day.

  6. Sawh MC, Wallace M, Shapiro E, et al. Dairy fat intake, plasma pentadecanoic acid, and plasma iso-heptadecanoic acid are inversely associated with liver fat in childrenJ Pediatr Gastroenterol Nutr. 2021;72(4):e90-e96. doi:10.1097/MPG.0000000000003040

  7. United States Department of Agriculture. Dietary Guidelines for Americans.