Reviews:
Cell Stress, Vol. 9, No. 1, pp. 49 - 64; doi: 10.15698/cst2025.06.305
Pathogenic aspects of fructose consumption in metabolic dysfunction-associated steatotic liver disease (MASLD): A narrative review
1 Department of Nutritional Sciences, Molecular Nutritional Science, University of Vienna, Vienna, Austria. 2 Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Keywords: sugar, steatotic liver disease, intestinal barrier, microbiome, gut-liver axis, PAMPs.
Received originally: 17/02/2025 Received in revised form: 26/05/2025
Accepted: 28/05/2025
Published: 24/06/2025
Correspondence:
Ina Bergheim, Ph.D., University of Vienna, Department of Nutritional Sciences, Molecular Nutritional Science, Josef-Holaubek-Platz 2, A-1090 Vienna; Phone: +43-1-4277-54981; Fax: +43-1-4277-9549; ina.bergheim@univie.ac.at
Conflict of interest statement: The authors disclose no conflicts.
Please cite this article as: Katharina Burger, Michael Trauner and Ina Bergheim (2025). Pathogenic aspects of fructose consumption in metabolic dysfunction-associated steatotic liver disease (MASLD): A narrative review. Cell Stress 9: 49-64. doi: 10.15698/cst2025.06.305
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly referred to non-alcoholic fatty liver disease (NAFLD), has become a global health concern with a still increasing prevalence. One of the major contributing factors to its pathogenesis is overnutrition. In recent years, a discussion has been started that not only general overnutrition but also specific dietary patterns like the so-called ‘Western diet’ composed of foods rich in saturated fats, cholesterol, and sugar (especially fructose) but low in fiber and polyunsaturated fats, may contribute to the development of MASLD. Evidence from human (intervention) studies regarding the effects of sugar and especially fructose intake is limited and contradictory with respect to the development of MASLD. Still, some scientific liver societies have incorporated a reduction of sugar-sweetened beverages (SSBs) being rich in fructose in their life-style advice for the treatment of MASLD. Being metabolized independently of insulin, fructose has been proposed to be processed more rapidly than glucose, leading to increased lipogenesis and subsequently to hepatic lipid accumulation. Results of more recent experimental studies suggest that an elevated intake of fructose may also affect gut microbiota composition, alter small intestinal morphology and impair intestinal barrier function subsequently leading to an increased translocation of pathogen-associated molecular patterns (PAMPs) into the portal circulation. In this narrative review we summarize recent findings related to the relationship of fructose intake and MASLD, herein focusing on the gut-liver axis and the discrepancy between studies in humans and model organisms.
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© 2025
Pathogenic aspects of fructose consumption in metabolic dysfunction-associated steatotic liver disease (MASLD): A narrative review by Burger et al. is licensed under a Creative Commons Attribution 4.0 International License.
