Previous studies have indicated that sugar-containing beverages, defined in this study as fruit juices, fruit concentrates, soft drinks, and lemonade, increase adiposity in children. However, the effect of sugar-containing beverages on the development of non-alcoholic fatty liver disease (NAFLD) in children is not known.  The purpose of this study was to examine the associations between sugar-containing beverage intake in infancy and liver fat accumulation and NAFLD at 10 years old. This population-based, prospective cohort study (n=1940) was embedded in the Generation R study based in the Netherlands. Infants’ sugar-containing beverage consumption was assessed by a modified food frequency completed by parents/guardians at a mean of 13.6 months. Sugar-containing beverage intake was then converted into servings (150g/serving), and categorized into low (less than 1 serving/day); medium (1-2 servings/day); and high (greater than 2 servings/day) intakes. Liver fat was measured at 10 years of age using MRI by a single-breath-hold, 3-dimensional volume and a special three-point proton density–weighted Dixon technique. NAFLD was defined as liver fat greater than 5%. Results showed that the median sugar-containing beverage intake during infancy was 0.9 servings/day. After adjusting for confounding variables, sugar-containing beverage intake in infancy was neither continuously (SD, 0.03; 95% CI, −0.02, 0.07) nor categorically (p=0.38) associated with a higher liver fat. However, infants having greater than 2 servings of sugar-containing beverages/day had the highest odds of developed NAFLD compared to infants having less than one serving of sugar-containing beverages/day (OR, 3.02; 95% CI, 1.34, 6.83).

Study strengths: Strengths of this study include the large sample size, data gathered during infancy, and a prospective longitudinal study design. Additionally, liver fat measured with MRI at 10 years of age makes this study unique.

Study limitations: The study sample contained a small number of overweight and obese children that might limit the study’s generalizability. Additionally, the food frequency questionnaire, which was used to for assessing sugar-containing beverage intake may be subject to underreporting. This study did not account for lifestyle interventions from infancy onward and should be explored in future research. Finally, this study conducted in the Netherlands, focused on ‘sugar-containing beverages, defined as fruit juices, fruit concentrates, soft drinks, and lemonade; it is not clear if 100% fruit juice was part of this. Due to differences in definitions, it cannot be compared to studies in the United States which primarily focus on sugar-sweetened beverages (i.e., any drink with added sugar).

What this means for your practice: Study results showed that there is relationship between sugar-containing beverage intake during infancy and liver fat at ten years of age. The American Academy of Pediatrics recommends infants drink only breastmilk or formula for the first year of life. Around 6 months of age, water can be introduced in a cup, offering no more than 8 oz/day. The 2020 Dietary Guidelines for Americans recommends zero added sugar for infants and toddlers ages zero-two years old. Additionally, The American Academy of Pediatrics also recommends avoiding sugar-sweetened beverages. For children ages one to three years old, 100% fruit juice should be limited to no more than 4 ounces/day. For children ages four to six, fruit juice consumption should be limited to 4-6 ounces/day.

Original citation:

Geurtsen, M. L., Santos, S., Gaillard, R., Felix, J. F., & Jaddoe, V. W. (2021). Associations Between Intake of Sugar‐Containing Beverages in Infancy With Liver Fat Accumulation at School Age. Hepatology, 73(2), 560-570.

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