Fructose intake in patients with non-alcoholic fatty liver disease

Background: Although growing evidence suggests that fructose intake contributes to the development of non-alcoholic fatty liver disease (NAFLD), fructose intake in NAFLD patients has not been documented locally. Objectives: The objectives of this study were to compare fructose intake between NAFLD patients and controls with chronic hepatitis B, and to ascertain whether fructose intake was associated with the presence of NAFLD. Methods: This was a cross-sectional, case-control study. Thirty-four patients diagnosed with NAFLD and 34 controls with chronic hepatitis B participated in this study between 2012 and 2014 in the Singapore General Hospital outpatient setting. Fructose, energy and nutrient intake were assessed by using food frequency questionnaires. Results: NAFLD patients had higher body mass index (28.6 +/- 4.0 vs. 22.5 +/- 3.9 kg/m(2), p<0.001) and waist circumference (100.0 +/- 7.9 vs. 80.2 +/- 11.7 cm, p<0.001) than controls. Cases reported higher intakes of energy (2378 +/- 708 vs. 1796 +/- 398 kcal, p<0.001), protein (109 +/- 37 vs. 84 +/- 25 g, p<0.01), fat (87 +/- 33 vs. 62 +/- 19 g, p<0.001), total carbohydrate (294 +/- 83 vs. 232 +/- 63 g, p<0.001) and fructose (42 +/- 17 vs. 31 +/- 15 g, p<0.05). Logistic regression analysis showed waist circumference (odds ratio: 1.25; 95% confidence interval: 1.11-1.41; p<0.001) and energy intake (odds ratio: 1.002; 95% confidence interval: 1.001-1.004; p<0.05) were significant risk factors for NAFLD. Conclusions: Total calorie, macronutrient and fructose intake in NAFLD patients were significantly higher than in controls. Waist circumference and energy intake were significantly associated with NAFLD. Reducing total calorie intake and adopting healthy eating habits should be emphasized to NAFLD patients to manage their clinical conditions.