Macro partitioning
High intake of high fructose corn syrup (HFCS) from processed foods and beverages promotes de novo lipogenesis, insulin resistance, and liver fibrosis, whereas fructose from whole fruits does not carry the same risk and is safe within a Mediterranean diet.
Avoid sugary drinks and processed foods containing high fructose corn syrup, as they directly contribute to liver fat and fibrosis. You do not need to avoid whole fruits, which are part of a healthy Mediterranean diet. Focus on reducing added sugars to improve liver health.
The intake of HFCS-enriched foods has been linked to epidemics of obesity and cardiometabolic-related diseases, including NAFLD... drinking more than six HFCS-enriched soft drinks/day increases steatosis and promotes fibrosis... globally confirm the safe and healthy use of fruit in the Mediterranean diet, whereas HFCS should be excluded.
Why this rating
Supported by multiple observational studies, FFQs, and mechanistic figures, though some confounding by overall calorie intake is noted.
Source
Diet, weight loss, and liver health in nonalcoholic fatty liver disease: Pathophysiology, evidence, and practice
Giulio Marchesini et al. · Hepatology · 2015
DOI 10.1002/hep.28392
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