NAFLD

Non alcoholic fatty liver disease (NAFLD) is today the most common cause of chronic liver disease, causing steatohepatitis, cirrhosis, hepatic failure and hepatocellular carcinoma. Newer insights into the issue have revealed a  simple truth that it’s the sugars, fruits and grains that are the source of every alcoholic beverage and the actions and metabolism of these sugars, particularly of fructose, have several similarities with those of alcohol. Therefore, prevention and management of NAFLD have got lot to do with restriction of these dietary factors.

Toxic Truth of Sugar: Source

Fructose and nonalcoholic fatty liver disease (NAFLD): the multifaceted aspects of fructose metabolism. [See]

The Toxic Truth: Too much fructose can damage your liver, just like too much alcohol [See]

Sugar is Toxic: The growing scientific evidence, both epidemiological and mechanistic, very clearly shows that excess sugar induces all of the diseases associated with the metabolic syndrome, Robert H. Lustig et al write in Nature. See Lustig RH, Schmidt LA, Brindis CD. Public health: The toxic truth about sugar. Nature. 02 February 2012;482:27–29. doi:10.1038/482027a[Link][Report | Report | Report | Report]

Lim J, Mietus-Snyder M, Valente A et al. The role of fructose in the pathogenesis of NAFLD and the metabolic syndrome. Nat Rev Gastroenterol Hepatol 2010;7:251–264. https://doi.org/10.1038/nrgastro.2010.41

Jegatheesan P, Bandt J-PD. Fructose and NAFLD: The Multifaceted Aspects of Fructose Metabolism. Nutrients 2017;9(3):230. https://doi.org/10.3390/nu9030230. Available at https://www.mdpi.com/2072-6643/9/3/230/htm

Zhang D-M, Jiao R-Q, Kong LD. High Dietary Fructose: Direct or Indirect Dangerous Factors Disturbing Tissue and Organ Functions. Nutrients 2017;9(4):335. https://doi.org/10.3390/nu9040335 Available at https://www.mdpi.com/2072-6643/9/4/335/htm

Vos MB, Lavine JE. Dietary fructose in nonalcoholic fatty liver disease. Hepatology. June 2013;57(6):2525-2531. https://doi.org/10.1002/hep.26299. Available at https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.26299

Duarte S, Stefano JT,  Vanni D, Carrilho F, Oliveira C. Impact of current diet at the risk of non-alcoholic fatty liver disease (NAFLD). Arquivos de Gastroenterologia. 2019;56.  DO – 10.1590/s0004-2803.201900000-67. Available at https://www.researchgate.net/publication/337087437_Impact_of_current_diet_at_the_risk_of_non-alcoholic_fatty_liver_disease_NAFLD/fulltext/5dc9088f299bf1a47b2cc3ed/Impact-of-current-diet-at-the-risk-of-non-alcoholic-fatty-liver-disease-NAFLD.pdf

Prussick RB,  Miele L. Nonalcoholic fatty liver disease in patients with psoriasis: a consequence of systemic inflammatory burden? Br J Dermat. July 2018;179(1):16-29. https://doi.org/10.1111/bjd.16239. Available at https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.16239

Gastaldelli A, Cusi K. From NASH to diabetes and from diabetes to NASH: Mechanisms and treatment options. JHEP Reports. October 2019;1(4):312-328. Available at https://www.sciencedirect.com/science/article/pii/S2589555919300795

Aron-Wisnewsky J, Gaborit B, Dutour A, Clement K. Gut microbiota and non-alcoholic fatty liver disease: new insights. Clinical Microbiology and Infection. 2013;19(4):338-348. https://doi.org/10.1111/1469-0691.12140. Available at https://www.sciencedirect.com/science/article/pii/S1198743X14609800

Mann JP et al. Nonalcoholic Fatty Liver Disease in Children. Semin Liver Dis 2018;38:1–13. Available at https://air.unimi.it/retrieve/handle/2434/606450/1395045/s-0038-1627456.pdf

Duwaerts CC, Maher JJ. Macronutrients and the Adipose-Liver Axis in Obesity and Fatty Liver. Cellular and Molecular Gastroenterology and Hepatology2019;7(4):749-761. Available at https://www.cmghjournal.org/article/S2352-345X(19)30009-8/fulltext

Taskinen M-R, Packard CJ, Borén J. Dietary Fructose and the Metabolic Syndrome. Nutrients 2019;11(9):1987. https://doi.org/10.3390/nu11091987. Available at https://www.mdpi.com/2072-6643/11/9/1987/htm

Akhtar DH, Iqbal U, Vazquez-Montesino LM, Dennis BB, Ahmed A. Pathogenesis of Insulin Resistance and Atherogenic Dyslipidemia in Nonalcoholic Fatty Liver Disease. J Clin Transl Hepatol. 2019;7(4):362. doi: 10.14218/JCTH.2019.00028. Available at https://www.xiahepublishing.com/2310-8819/ArticleFullText.aspx?sid=2&id=10.14218%2FJCTH.2019.00028

Chen Q, Wang T, Li J et al. Effects of Natural Products on Fructose-Induced Nonalcoholic Fatty Liver Disease (NAFLD). Nutrients 2017;9:96.Available at https://www.mdpi.com/2072-6643/9/2/96

Godoy-Matos AF, Silva Júnior WS, Valerio CM. NAFLD as a continuum: from obesity to metabolic syndrome and diabetes. Diabetol Metab Syndr 2020;12:60. https://doi.org/10.1186/s13098-020-00570-y. Available at https://dmsjournal.biomedcentral.com/articles/10.1186/s13098-020-00570-y

El-Agroudy NN et al. Are Lifestyle Therapies Effective for NAFLD Treatment? Trends in Endocrinology & Metabolism 2019;30(10):701-709. Available at https://www.cell.com/trends/endocrinology-metabolism/fulltext/S1043-2760(19)30136-5

Lambertz J, Weiskirchen S, Landert S,  Weiskirchen R. Fructose: A Dietary Sugar in Crosstalk with Microbiota Contributing to the Development and Progression of Non-Alcoholic Liver Disease. Front. Immunol., 19 September 2017. https://doi.org/10.3389/fimmu.2017.01159. Available at https://www.frontiersin.org/articles/10.3389/fimmu.2017.01159/full

Hypertension

Hypertension, termed as ‘essential’ in the literature, is increasing in prevalence and affecting more and more of younger population. Traditionally blamed on high consumption of slats, hypertension is increasingly being seen as a part of metabolic syndrome, associated with hyperuricemia, driven by modern day diet that is rich in sugars such as fructose.

Hypertensive mechanisms of fructose [See]

DiNicolantonio JJ, Lucan SC.The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease. Open Heart 2014;1:e000167. doi: 10.1136/openhrt-2014-000167. Available at https://openheart.bmj.com/content/1/1/e000167

Rosset R, Surowska A, Tappy L. Pathogenesis of Cardiovascular and Metabolic Diseases: Are Fructose-Containing Sugars More Involved Than Other Dietary Calories?. Curr Hypertens Rep 2016;18:44. https://doi.org/10.1007/s11906-016-0652-7. Available at https://link.springer.com/article/10.1007/s11906-016-0652-7

Sugar Consumption Increases Blood Pressure: The recently published INTERMAP study reveals that soft drinks, sweetened fruit juices, and sugar-loaded sports drinks are associated with significant increases in systolic and diastolic blood pressures. [Abstract from Brown IJ, Stamler J, Van Horn L, et al. Sugar-sweetened beverage, sugar intake of individuals and their blood pressure: INTERMAP study. Hypertension Feb 2011. doi: 10.1161/HYPERTENSIONAHA.110.165456 | Report]

High fructose intake in the form of added sugar is independently associated with higher blood pressure, according to the results of a cross-sectional analysis of data from the National Health and Nutrition Examination Survey [Diana I. Jalal, Gerard Smits, Richard J. Johnson and Michel Chonchol. Increased Fructose Associates with Elevated Blood Pressure. Journal of the American Society of Nephrology. July 1, 2010. doi: 10.1681/ASN.2009111111] [Full text] | Report]

Fructose (Fruits) and High Blood Pressure Abstract of Carlos A. Roncal et al, Am J Nephrol; Reuters Report

Malik VS, Hu FB. Fructose and Cardiometabolic Health. Journal of the American College of Cardiology. 2015;66(14):1615-1624. doi: 10.1016/j.jacc.2015.08.025 Available at https://www.jacc.org/doi/abs/10.1016/j.jacc.2015.08.025

Hieronimus B, Medici V, Bremer AA. Synergistic effects of fructose and glucose on lipoprotein risk factors for cardiovascular disease in young adults. Metabolism. November 2020;112:154356. Available at https://www.sciencedirect.com/science/article/pii/S0026049520302201

Zhang D-M, Jiao R-Q, Kong LD. High Dietary Fructose: Direct or Indirect Dangerous Factors Disturbing Tissue and Organ Functions. Nutrients 2017;9(4):335. https://doi.org/10.3390/nu9040335 Available at https://www.mdpi.com/2072-6643/9/4/335/htm

Salt a key player in resistant hypertension Abstract in Pimenta E et al., Hypertension, 20 July, 2009; Report

Exclusive Breastfeeding helps to Boost IQ, has Favourable Effects on Height, Weight and Blood Pressure: Largest Prospective Study Finds Breastfeeding and Child Cognitive Development: New Evidence From a Large Randomized Trial; Effects of prolonged and exclusive breastfeeding on child height, weight, adiposity, and blood pressure at age 6.5 y: evidence from a large randomized trial; Effects of Prolonged and Exclusive Breastfeeding on Child Behavior and Maternal Adjustment: Evidence From a Large, Randomized Trial; Reports 1; 2; 3

Cut Down Salt Intake: ASH Position Paper – Dietary Approaches to Lower Blood Pressure
Full Text of Lawrence J. Appel, ASH; Medscape Article

Reduction of body fat more important than fitness in lowering blood pressure: Individuals who have a healthy body weight are more likely than those who are physically fit to have lower blood pressure, shows a new study [Chen J, Das S, Barlow CE, Grundy S, Lakoski SG. Fitness, fatness, and systolic blood pressure: data from the Cooper Center Longitudinal Study. Am Heart J. 2010 Jul;160(1):166-70.] [Abstract] | Report]

Cardiovascular Disease

Cardiovascular disease, commonly manifesting as coronary artery disease and heart attacks, cerebrovascular disease and strokes, peripheral vascular disease etc., is considered as a component of metabolic syndrome. Several studies in recent years have shown a clear relationship between consumption of modern foods and development of cardiovascular diseases. Dietary restrictions, therefore, have a very important role to play in the prevention and management of cardiovascular diseases.

Fructose and cardiovascular disease [See]

Rosset R, Surowska A, Tappy L. Pathogenesis of Cardiovascular and Metabolic Diseases: Are Fructose-Containing Sugars More Involved Than Other Dietary Calories?. Curr Hypertens Rep 2016;18:44. https://doi.org/10.1007/s11906-016-0652-7. Available at https://link.springer.com/article/10.1007/s11906-016-0652-7

DiNicolantonio JJ, Lucan SC.The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease. Open Heart 2014;1:e000167. doi: 10.1136/openhrt-2014-000167. Available at https://openheart.bmj.com/content/1/1/e000167

Ancient Egyptians Too Had Atherosclerotic Vascular Disease Abstract of Allam AH et al., JAMA, November 18, 2009;302(19); Medpage Today Report; Phys Org Report

Globalization of Food Patterns and Cardiovascular Disease Risk |
Globalization and the epidemiology of obesity

Dietary Patterns and Risk of Mortality From Cardiovascular Disease, Cancer, and All Causes:
See Mediterranean Diet and Incidence of and Mortality From Coronary Heart Disease and Stroke in Women – Circulation, Feb 2009 | A Prospective Cohort of Women; Circulation, 2008;118:230-237 | Dietary Patterns and the Risk of Acute Myocardial Infarction in 52 Countries

Hieronimus B, Medici V, Bremer AA. Synergistic effects of fructose and glucose on lipoprotein risk factors for cardiovascular disease in young adults. Metabolism. November 2020;112:154356. Available at https://www.sciencedirect.com/science/article/pii/S0026049520302201

Malik VS, Hu FB. Fructose and Cardiometabolic Health. Journal of the American College of Cardiology. 2015;66(14):1615-1624. doi: 10.1016/j.jacc.2015.08.025 Available at https://www.jacc.org/doi/abs/10.1016/j.jacc.2015.08.025

Sweetened Beverages Increase Coronary Heart Disease: de Koning L, Malik VS, Kellogg MD, Rimm EB, Willett WC, Hu FB. Sweetened Beverage Consumption, Incident Coronary Heart Disease and Biomarkers of Risk in Men. CIRCULATIONAHA.111.067017 doi: 10.1161/CIRCULATIONAHA.111.067017. [Full Text]

Increasing the ratio of beans to white rice, or limiting the intake of white rice by substituting beans, may lower cardiometabolic risk factors: A new study from Costa Rica, which involved monitoring the diet of almost 2,000 people in an investigation of risk factors for heart disease between 1994 and 2004, has shown that those who regularly traded a helping of white rice for one of beans experienced a 35 per cent reduction in the risk of symptoms that usually lead to diabetes. [Mattei J, Hu FB, Campos H. A higher ratio of beans to white rice is associated with lower cardiometabolic risk factors in Costa Rican adults. Am J Clin Nutr. 2011 Sep;94(3):869-76. Epub 2011 Aug 3. Abstract | Report]

Increased Sodium Increases Cardiovascular Risk: A new, 15-year follow-up study has shown that people with the highest ratio of sodium to potassium in their diet had a significantly increased risk of death from cardiovascular disease compared with those who had the lowest ratio of sodium to potassium intake [Yang Q et al. Sodium and Potassium Intake and Mortality Among US Adults Prospective Data From the Third National Health and Nutrition Examination Survey Arch Intern Med. 2011;171(13):1183-1191. doi:10.1001/archinternmed.2011.257 Abstract | Commentary | Report]

Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease: Modest reductions in dietary salt could substantially reduce cardiovascular events and medical costs and should be a public health target. Reducing dietary salt by 3 g per day is projected to reduce the annual number of new cases of CHD by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000 and would save 194,000 to 392,000 quality-adjusted life-years and $10 billion to $24 billion in health care costs annually. Kirsten Bibbins-Domingo et al., Published in N Engl J Med on Jan 20, 2010 [Full Text]

Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies: High salt intake is associated with significantly increased risk of stroke and total cardiovascular disease Full Text of Pasquale Strazzullo et al., BMJ 2009;339:b4567; Report in medpagetoday.com

High calcium intake as supplements may increase cardiovascular mortality [Mark J Bolland et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 29 July 2010;341:c3691. doi:10.1136/bmj.c3691 Full text | Mark J Bolland et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ. 15 January 2008. doi: 10.1136/bmj.39440.525752.BE Full Text]

Calcium Supplements Increase Vascular Events? See

Chronic exposures to Bisphenol A, widely used in epoxy resins lining food and beverage containers, may lead to diabetes and cardiovascular events.
See Full Text Article in JAMA | Report

No association between egg consumption and the incidence of cardiovascular disease: A study that examined the association between egg consumption and incidence of CVD in a prospective dynamic Mediterranean cohort of 14 185 university graduates found no association between egg consumption and the incidence of CVD [Zazpe I et al. Egg consumption and risk of cardiovascular disease in the SUN Project. European Journal of Clinical Nutrition 2011;65:676–682; doi:10.1038/ejcn.2011.30]

Baked fish reduces and fried fish increases the risk of heart failure in post menopausal women: A 10-year follow-up of more than 84 000 postmenopausal women, who participated in the Women’s Health Initiative–Observational Study (WHI-OS), has found that eating baked or broiled dark fish such as salmon five times a week may prevent heart failure in older women, whereas having fried fish only once a week may increase this risk. [Belin RJ, Greenland P, Martin L, et al. Fish intake and the risk of incident heart failure: The Women’s Health Initiative. Circ Heart Fail 2011; DOI:10.1161/CIRCHEARTFAILURE.110.960450. | Report]

Diet Soda and Salt Increase the Risk of Stroke: In a new study from the University of Miami’s Miller School of Medicine (Northern Manhattan Study), those who drink diet soda were found to have more than a 60% increase in stroke than those who abstain and those who used more than 4g of sodiun per day had double the risk than those who had less than 1.5g per day. Report | Report | Report]

Migraine sufferers twice as likely to have a heart attack: Both driven by sugars?
Report in Science Daily | Report in Telegraph

Childhood Obesity Alone May Increase Risk of Later Cardiovascular Disease: Being obese by as early as 7 years of age may raise a child’s risk of future heart disease and stroke, even in the absence of other cardiovascular risk factors such as high blood pressure, according to a new study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM). Abstract | Report in Science Daily | Report in Modern Medicine

Improved outcomes associated with metformin therapy in patients with diabetes and heart failure: A two year follow-up study has found that metformin use in ambulatory patients with diabetes and heart failure improves outcome, contrary to what was believed. [David Aguilar et al. Metformin Use and Mortality in Ambulatory Patients with Diabetes and Heart Failure CIRCHEARTFAILURE.110.952556 October 15, 2010. doi: 10.1161/​CIRCHEARTFAILURE.110.952556 Abstract | Report]

Almonds may help reduce risk of type 2 diabetes and heart disease: Studyshows that consuming an almond-enriched diet may help improve insulin sensitivity and decrease LDL-cholesterol levels in those with prediabetes. [Michelle Wien et al. Almond Consumption and Cardiovascular Risk Factors in Adults with Prediabetes. Journal of the American College of Nutrition. 2010;29(3):189-197. Abstract | Report]

Increased Potassium Consumption Cuts Cardiovascular Risk by 20%: The largest meta-analysis examining the impact of potassium intake on cardiovascular outcomes has found that higher dietary consumption of potassium is associated with lower rates of stroke and could also reduce the risk of coronary heart disease and total cardiovasular disease. [Abstract from D’Elia L, Barba G, Cappuccio FP, et al. Potassium intake, stroke and cardiovascular disease. A meta-analysis of prospective studies. J Am Coll Cardiol 2011;57:1210-1219. | Report]

Salt Restriction Reduces Cardiovascular Disease Risk
See Report | One More Report | One More..

Fish oil shows beneficial effects in metabolic syndrome: A review published in The Journal of Nutritional Biochemistry, reports that omega-3 fatty acids may promote metabolic changes in visceral (adipose) tissue, leading to significant improvement in metabolic syndrome. [Abstract from Puglisi MJ, Hasty AH, Saraswathi Y. The role of adipose tissue in mediating the beneficial effects of dietary fish oil. Journal of Nutritional Biochemistry.2011;22(2):101-108. doi: 10. 1016/ j.jnutbio.2010.07.003 | Report]

Eating whole grains, compared to refined grain products, could lower heart disease risk A large cross sectional study among the Framingham Heart Study participants has shown that increasing whole-grain intake is associated with lower visceral adipose tissue (VAT) in adults, whereas higher intakes of refined grains are associated with higher VAT.[See Abstract AJCN, Report]