2976 Risk of Developing Non-Alcoholic Fatty Liver Disease (NAFLD) With Increased Intake of High Fructose Corn Syrup (HFCS): A Systematic Review

Abstract

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) encompasses the spectrum of fatty liver disease without significant alcohol consumption. The pathogenesis of NAFLD is complex and according to the “multiple parallel hits hypothesis,” a number of different processes may contribute to liver inflammation. High fructose corn syrup (HFCS, a mixture of fructose and glucose monosaccharides) appears to have a major role in inducing fatty liver by both stimulating de novo lipogenesis and blocking β-fatty acid oxidation. We performed a systematic review to demonstrate the association of HFCS in NAFLD. METHODS: Two independent authors performed a thorough literature search of English language studies in PubMed, Embase, Medline, Google Scholar, and Science Citation Index to identify relevant studies between January 2010 to January 2018. Keywords used were “high fructose corn syrup,” “nonalcoholic fatty liver disease,” “nonalcoholic steatohepatitis,” “high fructose diet,” “fatty liver,” “hepatic metabolism,” “hepatic triglycerides,” “hepatic de novo lipogenesis” and “liver enzymes.” Effects of HFCS on changes in liver enzymes, hepatic metabolism, and risk of NAFLD were assessed. The strength of evidence was evaluated by considering precision, the risk of bias and consistency. RESULTS: Based on our search criteria 6 animal studies were identified and 3 were excluded after careful review. 3 animal (rat/mice) studies were included for our final analysis. We found a significant evidence from all three studies that consumption of HFCS diet increased de novo lipogenesis in association with up-regulation of fatty acid synthase, sterol regulatory element binding protein (SREBP)-1c and decreased β-oxidation with down-regulation of Peroxisome proliferator-activated receptor (PPARα) in the liver of rats. In addition, ALT (Alanine Aminotransferase) elevation and increased liver triglycerides content were observed in all the three studies. CONCLUSION: Our systematic review shows that HFCS intake is associated with increased risk of developing NAFLD. However, we need more trials looking at the association between HFCS intake and liver metabolism in the future.