Clin Mol Hepatol > Volume 29(4); 2023 > Article
Pratap, More, Phalak, and Deshmukh: Letter regarding “Risk factors in nonalcoholic fatty liver disease”
Dear Editor,
We recently read the review article by Ko et al. [1] titled, “Risk factors in nonalcoholic fatty liver disease”. The article has in depth explained the various risk factors associated with non-alcoholic fatty liver disease (NAFLD) and also highlighted NAFLD associated complications having an increased risk of morbidity and mortality from cardiovascular disease (CVD) and malignancy. The review has also emphasized on increasing trend of prevalence and mortality rate due to NAFLD and the risk factors driving the change.
One of the risk factors mentioned is diet, and in it the authors have mentioned how fructose promotes lipogenesis and impairs oxidation of lipids and produces oxidative stress, all of which contribute to NAFLD. Here I would like to emphasize that fructose is consumed mainly as added sugar in form of sucrose, fruit juices, sugar sweetened beverages etc. As per the World Health Organization (WHO) recommendations, there is an acceptable limit to added sugars for beverages without causing any harm to the body. According to these guidelines, usually upto 10% of the total calorie requirement or less than 25 g/day or 6 tsp of added sugar or 1 sweetened beverage / week has been recommended [2,3].
Here, I would like to highlight the need to circulate the message that fructose needs to be consumed within permissible limit to avoid health hazards including NAFLD.


Authors’ contribution
Drafting of the article: Abhijit Pratap, Pradnya Phalak. Critical revision: Umesh More, Anita Deshmukh.
Conflicts of Interest
The authors have no conflicts to disclose.


non-alcoholic fatty liver disease
cardiovascular disease


1. Ko E, Yoon EL, Jun DW. Risk factors in nonalcoholic fatty liver disease. Clin Mol Hepatol 2023;29(Suppl):S79-S85.
crossref pmid pmc pdf
2. World Health Organization. Guideline: Sugars intake for adults and children. Geneva: World Health Organization, 2015.

3. Huang Y, Chen Z, Chen B, Li J, Yuan X, Li J, et al. Dietary sugar consumption and health: umbrella review. BMJ 2023;381:e071609.
crossref pmid pmc

Editorial Office
The Korean Association for the Study of the Liver
Room A1210, 53 Mapo-daero(MapoTrapalace, Dowha-dong), Mapo-gu, Seoul, 04158, Korea
TEL: +82-2-703-0051   FAX: +82-2-703-0071    E-mail:
Copyright © The Korean Association for the Study of the Liver.         
TODAY : 974
TOTAL : 1939109
Close layer