Consumption of Sugar-Sweetened Beverages Has a Dose-Dependent Effect on the Risk of Non-Alcoholic Fatty Liver Disease: An Updated Systematic Review and Dose-Response Meta-Analysis
State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau 999078, China
Faculty of Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau 999078, China
Faculty of Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau 999078, China
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
Int. J. Environ. Res. Public Health 2019, 16(12), 2192; https://doi.org/10.3390/ijerph16122192
Received: 18 April 2019 / Revised: 9 June 2019 / Accepted: 19 June 2019 / Published: 21 June 2019
Background: Non-alcoholic fatty liver disease (NAFLD) is a serious health problem, but the dose-response relationship between sugar-sweetened beverages (SSBs) and NAFLD remains uncertain. Methods: A systematic review and dose-response meta-analysis were conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Review Manager 5.3 and Stata 14.0 were used to combine trials and analyze data. The dose-response meta-analysis was performed by non-linear trend regression. Results: Twelve studies recruiting a total of 35,705 participants were included. The results showed that the consumption of SSBs was associated with 1.39-fold increased odds of NAFLD (95% CI: 1.29–1.50, p < 0.00001). The risk of NAFLD rose with an increased consumption of SSBs, while the consumptions of low doses (<1 cup/week), middle doses (1–6 cups/week) and high doses (≥7 cups/week) of SSBs increased the relative risk of NAFLD by 14%, 26% and 53%, respectively (p = 0.01, p < 0.00001, p = 0.03, respectively). Conclusions: This study demonstrates that consumers of SSBs are at significantly increased risk of NAFLD, and the consumption of SSBs has a dose-dependent effect on the risk of NAFLD. The findings of this study strengthen the evidence base for healthy dietary patterns and are meaningful for the primary prevention of NAFLD.