ESPE Abstracts

Background: Fructose consumption in children is increasing, as is the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD). Despite the growing evidence supporting the effects of added sugars in the development of metabolic syndrome and related comorbidities, the association between fructose intake and liver diseases remains to be clarified, especially in young people. Our study aim ed to evaluate the role of fructose intake on metabolic and liver dysfunction in a cohort of obese children and adolescents.

Methods: We recruited 41 obese children and adolescents (age range: 2.5-16 years, BMI SDS 1.11-3.99). Patients were assessed for clinical and biochemical parameters including an OGTT. MASLD was assessed with liver ultrasound (US) according to European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGAN) guidelines. All US examinations were performed by a pediatric radiologist using a diagnostic US system GE Healthcare, equipped with a curved-array transducer in the frequency range of 3–5 MHz and linear-array transducer in the frequency range of 12–14 MHz. The US abdominal examinations included computerized calculation of hepatorenal index (HRI), measure of subcutaneous fat (scAT), and visceral adipose tissue (vAT). Dietary intake was evaluated through IDEFICS FFQ, whereas fructose intake with a specific semi-quantitative questionnaire. Weekly fructose and sugar intake were obtained by using the Dietosystem software, correcting data for dietary national databases.

Results: Pubertal subjects had more scAT and vAT, insulin resistance and liver fibrosis parameters than those prepubertal. MASLD was present in 12 out of 41 subjects without differences between age-groups, but they had higher scAT and vAT than those without it, although BMI SDS was comparable. Pubertal subjects had lower weekly fructose intake than prepubertal subjects (P <0.02), however they consumed less fructose from fruits (P <0.04), and more fructose from saccarose or sugars (P <0.04) than younger children. Patients with MASLD had higher intake of fructose alone (141.4±23.3 vs 80.4±12.2 g/week, P <0.01) and from fruits (131.0±21.1 vs 64.0±12.0 g/week, P <0.003) than those without it. Furthermore, total fructose was positively associated with waist/height ratio (r: 0.350, P <0.02), meanwhile elasto-kPA was negatively associated with fructose from fruit (r: -0.538, P <0.01).

Conclusions: fructose intake was associated with MASLD and adipose tissue percentage in pediatric patients with obesity. The source of fructose could influence MASLD characteristics.