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Author Notes:

Correspondence: Miriam B. Vos. Email: mvos@emory.edu. Telephone: 404-727-1463. Fax: 404-727-4069.

M.B.V., J.A.W., N.-A.L. designed research.

R.J., J.H., P.S., D.R.M., N.-A.L. conducted research.

N.-A.L. provided essential reagents.

R.J. analyzed data.

R.J., M.B.V., N.-A.L. drafted the paper.

M.B.V. had primary responsibility for final content.

All authors read and approved the final manuscript.

The authors thank all of the patients and their families for generously giving of their time.

This study would not have been possible without the tireless dedication of our research coordinators, Nicholas Raviele, Xiomara Hinson, and Rebecca Cleeton.

We thank LipoScience Inc. for their expertise and technical support in lipoprotein particle measures by NMR.

The authors of the study have no conflicts of interest to declare.


Research Funding:

NIH K23 DK080953(Vos), North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) Foundation Nestle Young Investigator Award (Vos), also supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


  • nonalcoholic fatty liver disease
  • hepatic steatosis
  • fructose
  • sugar
  • cardiovascular risk
  • obesity
  • children and adolescents

Dietary Fructose Reduction Improves Markers of Cardiovascular Disease Risk in Hispanic-American Adolescents with NAFLD


Journal Title:



Volume 6, Number 8


, Pages 3187-3201

Type of Work:

Article | Final Publisher PDF


Nonalcoholic fatty liver disease (NAFLD) is now thought to be the most common liver disease worldwide. Cardiovascular complications are a leading cause of mortality in NAFLD. Fructose, a common nutrient in the westernized diet, has been reported to be associated with increased cardiovascular risk, but its impact on adolescents with NAFLD is not well understood. We designed a 4-week randomized, controlled, double-blinded beverage intervention study. Twenty-four overweight Hispanic-American adolescents who had hepatic fat >8% on imaging and who were regular consumers of sweet beverages were enrolled and randomized to calorie-matched study-provided fructose only or glucose only beverages. After 4 weeks, there was no significant change in hepatic fat or body weight in either group. In the glucose beverage group there was significantly improved adipose insulin sensitivity, high sensitivity C-reactive protein (hs-CRP), and low-density lipoprotein (LDL) oxidation. These findings demonstrate that reduction of fructose improves several important factors related to cardiovascular disease despite a lack of measurable improvement in hepatic steatosis. Reducing dietary fructose may be an effective intervention to blunt atherosclerosis progression among NAFLD patients and should be evaluated in longer term clinical trials.

Copyright information:

© 2014 by the authors; licensee MDPI, Basel, Switzerland.

This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 Unported License ( http://creativecommons.org/licenses/by/3.0/), which permits distribution of derivative works, distribution, public display, and publicly performance, making multiple copies, provided the original work is properly cited. This license requires credit be given to copyright holder and/or author, copyright and license notices be kept intact.

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