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Accepted manuscript

Added sugar intake and its forms and sources in relation to risk of non-alcoholic fatty liver disease: results from the TCLSIH cohort study

Published online by Cambridge University Press:  26 September 2022

Shunming Zhang
Affiliation:
Nutrition and Radiation Epidemiology Research Center, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China. Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China. Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Huiping Li
Affiliation:
Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China.
Ge Meng
Affiliation:
Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China. Department of Toxicology and Sanitary Chemistry, School of Public Health, Tianjin Medical University, Tianjin, China.
Qing Zhang
Affiliation:
Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China.
Li Liu
Affiliation:
Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China.
Hongmei Wu
Affiliation:
Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China.
Yeqing Gu
Affiliation:
Nutrition and Radiation Epidemiology Research Center, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
Tingjing Zhang
Affiliation:
Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China.
Xuena Wang
Affiliation:
Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China.
Juanjuan Zhang
Affiliation:
Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China.
Jun Dong
Affiliation:
Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China.
Xiaoxi Zheng
Affiliation:
Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China.
Zhixia Cao
Affiliation:
Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China.
Xu Zhang
Affiliation:
Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China.
Xinrong Dong
Affiliation:
Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China.
Shaomei Sun
Affiliation:
Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China.
Xing Wang
Affiliation:
Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China.
Ming Zhou
Affiliation:
Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China.
Qiyu Jia
Affiliation:
Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China.
Kun Song
Affiliation:
Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China.
Yan Borné
Affiliation:
Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Emily Sonestedt
Affiliation:
Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Lu Qi*
Affiliation:
Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Kaijun Niu*
Affiliation:
Nutrition and Radiation Epidemiology Research Center, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China. Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China. Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China. Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China. Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China.
*
*Correspondence and Reprint Addressed to: Prof. Kaijun Niu, Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China; Tel: +86-22-83336613; E-mail: nkj0809@gmail.com Or Prof. Lu Qi, Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA 70112, USA; Tel: 504-988-7259; E-mail: lqi1@tulane.edu
*Correspondence and Reprint Addressed to: Prof. Kaijun Niu, Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin 300070, China; Tel: +86-22-83336613; E-mail: nkj0809@gmail.com Or Prof. Lu Qi, Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA 70112, USA; Tel: 504-988-7259; E-mail: lqi1@tulane.edu
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Abstract

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It has been suggested that added sugar intake is associated with non-alcoholic fatty liver disease (NAFLD). However, previous studies only focused on sugar-sweetened beverages; the evidence for associations with total added sugars and their sources is scarce. This study aimed to examine the associations of total added sugars, their physical forms (liquid vs. solid), and food sources with risk of NAFLD among adults in Tianjin, China. We used data from 15,538 participants, free of NAFLD, other liver diseases, cardiovascular disease, cancer, or diabetes at baseline (2013-2018 years). Added sugar intake was estimated from a validated 100-item food frequency questionnaire. NAFLD was diagnosed by ultrasonography after exclusion of other causes of liver diseases. Multivariable Cox proportional hazards models were fitted to calculate hazards ratios (HRs) and corresponding 95% confidence intervals (CIs) for NAFLD risk with added sugar intake. During a median follow-up of 4.2 years, 3,476 incident NAFLD cases were documented. After adjusting for age, sex, body mass index and its change from baseline to follow-up, lifestyle factors, personal and family medical history, and overall diet quality, the multivariable HRs (95% CIs) of NAFLD risk were 1.18 (1.06, 1.32) for total added sugars, 1.20 (1.08, 1.33) for liquid added sugars, and 0.96 (0.86, 1.07) for solid added sugars when comparing the highest quartiles of intake with the lowest quartiles of intake. In this prospective cohort of Chinese adults, higher intakes of total added sugars and liquid added sugars, but not solid added sugars, were associated with a higher risk of NAFLD.

Type
Research Article
Copyright
© The Authors 2022
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Added sugar intake and its forms and sources in relation to risk of non-alcoholic fatty liver disease: results from the TCLSIH cohort study
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