When the Beverage Is Sweet, How Does the Liver Feel?

Dong Xi, Rohit Kohli

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Purpose of Review: The purpose of this paper is to both review the available data and also highlight the gaps in knowledge, regarding the link between pediatric NASH and different types of sweeteners including caloric sweeteners (CS) and non-caloric sweeteners (NCS). Recent Findings: Studies have demonstrated that patients with NASH generally have had an unhealthy diet, characterized by on overconsumption of carbohydrates especially fructose. Mechanistically, a high-fructose diet reduces hepatic lipid oxidation, increases proinflammatory response, increases intestinal permeability, and decreases microbiome diversity. Consumption and availability of NCS has therefore been increasing dramatically. Most NCS are not considered to be metabolized in the body and therefore thought to be safe for consumption. It was reported that pharmacological properties of rebaudioside, a type of NCS, as a potential hepatoprotector are through anti-inflammatory and antifibrotic mechanisms, associated with enhancing glucose-induced insulin secretion and inducing the difference of microbiome diversity. Summary: Diet is an important factor in the pathogenesis of NAFLD and popular dietary patterns are contributing to the increased replacement of natural sweeteners with NCS. Screening for NAFLD by pediatricians and counseling on the avoidance of sugar-sweetened beverages are recommended. We feel that the various NCS available to the consumer today merit further investigation and may potentially have hitherto unknown effects on hepatic metabolic function.

Original languageEnglish (US)
Pages (from-to)458-465
Number of pages8
JournalCurrent Treatment Options in Pediatrics
Issue number4
StatePublished - Dec 1 2019


  • Caloric sweeteners
  • Microbiome
  • Non-caloric sweeteners
  • Nonalcoholic steatohepatitis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


Dive into the research topics of 'When the Beverage Is Sweet, How Does the Liver Feel?'. Together they form a unique fingerprint.

Cite this