Several studies have found strong correlation of metabolic syndrome with gastroesophageal reflux disease (GERD)

Wu P, Ma L, Dai GX et al. The association of metabolic syndrome with reflux esophagitis: a case‐control study. Neurogastro Motil. November 2011;23(11):989-994. Available at

Mohammadi M, Ramezani Jolfaie N, Alipour R, Zarrati M. Is Metabolic Syndrome Considered to Be a Risk Factor for Gastroesophageal Reflux Disease (Non-Erosive or Erosive Esophagitis)?: A Systematic Review of the Evidence. Iran Red Crescent Med J. 2016;18(11):e30363. Published 2016 Aug 8. doi:10.5812/ircmj.30363. Available at

Ierardi E, Rosania R, Zotti M, Principe S, Laonigro G, Giorgio F, Francesco V, Panella C. Metabolic syndrome and gastro-esophageal reflux: A link towards a growing interest in developed countries. World J Gastrointest Pathophysiol 2010; 1(3): 91-96. DOI: URL:

Hirata A, Kishida K, Nakatsuji H. et al. High prevalence of gastroesophageal reflux symptoms in type 2 diabetics with hypoadiponectinemia and metabolic syndrome. Nutr Metab (Lond) 2012;9:4. Available at

Hsieh YH, Wu MF, Yang PY et al. What is the impact of metabolic syndrome and its components on reflux esophagitis? A cross-sectional study. BMC Gastroenterol 2019;19:33. Available at

Nomura M, Tashiro N, Watanabe T et al. Association of Symptoms of Gastroesophageal Reflux with Metabolic Syndrome Parameters in Patients with Endocrine Disease. International Scholarly Research Notices. vol. 2014, Article ID 863206, 6 pages, 2014. Available at

Kallel L, Bibani N, Fekih M et al. Metabolic syndrome is associated with gastroesophageal reflux disease based on a 24-hour ambulatory pH monitoring. Dis Esophagus. 2011 Apr;24(3):153-9. doi: 10.1111/j.1442-2050.2010.01118.x. Available at

Niigaki M, Adachi K, Hirakawa K et al. Association between metabolic syndrome and prevalence of gastroesophageal reflux disease in a health screening facility in Japan. J Gastroenterol 2013;48:463–472. Available at

Punjabi P, Hira A, Prasad S, Wang X, Chokhavatia S. Review of gastroesophageal reflux disease (GERD) in the diabetic patient. J Diab. September 2015;7(5):599-609. Available at

Chung SJ. Oesophagus Metabolic syndrome and visceral obesity as risk factors for reflux oesophagitis: a cross-sectional case–control study of 7078 Koreans undergoing health check-ups. Gut 2008;57:1360-1365.

Park JH et al. Metabolic syndrome is associated with erosive esophagitis World J Gastroenterol. 2008;14(35):5442–5447. URL:

Lee Y-C. The effect of metabolic risk factors on the natural course of gastro-oesophageal reflux disease Gut 2009;58:174-181. URL:

Gut Microbiota and Diseases

Human intestines are home to more than a trillion microbes, of about 1000 species, weighing more than 2 kgs. These microbes are intricately related to the functions of not only the intestinal tract, but also of every organ in the body, particularly the nervous system, endocrinal system, immune system and several metabolic pathways. Modern diet and lifestyle, and also use of medications, are affecting the quantity, quality and functioning of these microbes. Recent studies have revealed interesting facts about the relationships between gut microbes and human diseases, of the body and the mind.

Gut microbiota and possible molecular pathways linked to cardiovascular and cardiometabolic diseases [See]

Tang WHW, Kitai T, Hazen SL. Gut Microbiota in Cardiovascular Health and Disease. Circulation Research. 2017;120:1183–1196. Available at

Tang WHW, Li DY, Hazen SL. Dietary metabolism, the gut microbiome, and heart failure. Nat Rev Cardiol 2019;16:137–154. Available at

Gérard C, Vidal H. Impact of Gut Microbiota on Host Glycemic Control. Front. Endocrinol. 30 January 2019 | Available at

Thakur AK, Shakya A, Husain GM, Emerald M, Kumar V. Gut-Microbiota and Mental Health: Current and Future Perspectives. J Pharmacol Clin Toxicol 2014;2(1):1016. Available at

Fan Y, Pedersen O. Gut microbiota in human metabolic health and disease. Nat Rev Microbiol (2020). Available at

Ussar S, Fujisaka S, Kahn R. Interactions between host genetics and gut microbiome in diabetes and metabolic syndrome. Molecular Metabolism. September 2016;5(9):795-803. Available at

Herrema H, Niess JH. Intestinal microbial metabolites in human metabolism and type 2 diabetes. Diabetologia 2020;63:2533–2547. Available at

Anhê FF, Barra NG, Schertzer JD. Glucose alters the symbiotic relationships between gut microbiota and host physiology. Am J Phys End Met. 21 Jan 2020. Available at

Scheithauer TPM, Rampanelli E, Nieuwdorp M, Vallance BA, Verchere CB, van Raalte DH, Herrema H. Gut Microbiota as a Trigger for Metabolic Inflammation in Obesity and Type 2 Diabetes. Frontiers in Immunology. 2020;11;2546.
DOI:10.3389/fimmu.2020.571731. Available at

Niccolai E, Boem F, Russo E, Amedei A. The Gut–Brain Axis in the Neuropsychological Disease Model of Obesity: A Classical Movie Revised by the Emerging Director “Microbiome”. Nutrients 2019;11(1):156. Available at

Sohail MU, Althani A, Anwar H, Rizzi R, Marei HE. Role of the Gastrointestinal Tract Microbiome in the Pathophysiology of Diabetes Mellitus. Journal of Diabetes Research. Volume 2017 |Article ID 9631435 | Available at

Borrellia A, Bonellia P, Tuccillo M et al. Role of gut microbiota and oxidative stress in the progression of non-alcoholic fatty liver disease to hepatocarcinoma: Current and innovative therapeutic approaches. Redox Biology. May 2018;15:467-479. Available at

Wiest R, Albillos A, Trauner M, Bajaj JS, Jalan R. Targeting the gut-liver axis in liver disease. J Hepatol. November 01, 2017;67(5):1084-1103 DOI: Available at

He Ff, Li Ym. Role of gut microbiota in the development of insulin resistance and the mechanism underlying polycystic ovary syndrome: a review. J Ovarian Res 2020;13:73. Available at

Sleep Apnoea

Obstructive sleep apnoea is closely linked to metabolic syndrome and its components such as obesity and cardiovascular disease. Weight reduction and dietary restrictions play a major role in reversing OSA.

The bidirectional relationship between obstructive sleep apnea and metabolic disease. [See]

Framnes SN, Arble DM. The Bidirectional Relationship Between Obstructive Sleep Apnea and Metabolic Disease. Front. Endocrinol. 06 August 2018 | Available at

Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Obstructive Sleep ApneaA Cardiometabolic Risk in Obesity and the Metabolic Syndrome. Journal of the American College of Cardiology 2013;62(7):569–76. Available at

Kostoglou-Athanassiou I, Athanassiou P. Metabolic syndrome and sleep apnea. Hippokratia. 2008;12(2):81-86.Available at

Castaneda A, Jauregui-Maldonado E, Ratnani I, Varon J, Surani S. Correlation between metabolic syndrome and sleep apnea. World J Diabetes. 2018;9(4):66-71. doi:10.4239/wjd.v9.i4.66 Available at

Calvin AD, Albuquerque FN, Lopez-Jimenez F, Somers VK. Obstructive sleep apnea, inflammation, and the metabolic syndrome. Metab Syndr Relat Disord. 2009;7(4):271-278. doi:10.1089/met.2008.0093. Available at

Lam JCM, Ip MSM. Obstructive Sleep Apnea and the Metabolic Syndrome. Expert Rev Resp Med. 2009;3(2):177-186. Available at

Bonsignore MR, Borel A-R, Machan E, Grunstein R. Sleep apnoea and metabolic dysfunction. European Respiratory Review 2013;22: 353-364. DOI: 10.1183/09059180.00003413. Available at

Singh SK, Tentu AK, Singh S, Singh N, Dash C, Singh V, Laxmivandana R, Warrier R. Association of metabolic syndrome in obstructive sleep apnea patients: An experience from zonal tertiary care hospital in Eastern India. Indian J Respir Care [serial online] 2020 [cited 2020 Nov 18];9:71-6. Available from:

Obstructive Sleep Apnea May Be Improved With Low-Energy Diet: A single-center, prospective, observational follow-up study has found that a very low-energy diet leads to improvements in moderate to severe obstructive sleep apnea in obese men, with benefits maintained at 1 year and proportional to weight loss and baseline severity. [Full text | Report]

Food and Kidneys

Recent evidence suggests that fructose and modern diet contribute significantly to the development and worsening of chronic kidney disease.

Fructose and Chronic Kidney Disease [See]

Kretowicz M, Johnson RJ, Ishimoto T, Nakagawa T, Manitius J. The Impact of Fructose on Renal Function and Blood Pressure. International Journal of Nephrology. 2011, Article ID 315879, 5 pages. Available at

Johnson RJ, Sanchez-Lozada LG, Nakagawa T. The Effect of Fructose on Renal Biology and Disease. JASN. December 2010;21(12):2036-2039. DOI: Available at

Bratoeva K, Stoyanov GS, Merdzhanova A, Radanova M. Manifestations of Renal Impairment in Fructose-induced Metabolic Syndrome. Cureus. 2017;9(11):e1826. Published 2017 Nov 7. doi:10.7759/cureus.1826. Available at

Metabolic Syndrome Increases Risk of Kidney Disease: MetS and its components are associated with the development of eGFR <60 ml/min per 1.73 m2 and microalbuminuria or overt proteinuria, a meta analysis shows. [Thomas G et al. Metabolic Syndrome and Kidney Disease: A Systematic Review and Meta-analysis. CJASN August 2011 CJN.02180311. Abstract]

Gout Linked to Increased Risk for Diabetes, Renal Disease [See]

Western Style Diets Linked to Kidney Dysfunction: According to a study published in the American Journal of Kidney Diseases, Western diet is associated with a greater likelihood of the development of microalbuminuria (excretion of small amounts of albumin to the urine) and rapid decrease in kidney function, whereas diets similar to the Dietary Approach to Stop Hypertension (DASH) diet may be protective against rapid decline of estimated glomerular filtration rate (eGFR). [Abstract from American Journal of Kidney Diseases February 2011;57(2):245-254 | Report]

Metabolic syndrome increases kidney stone risk: Data from 34,895 individuals who underwent general health screening tests has revealed that kidney stones were 25% more likely to be found in subjects with metabolic syndrome than in those without it and that kidney stones were 47% more likely to be found in subjects with hypertension than in those without it. [In Gab Jeong et al. Association Between Metabolic Syndrome and the Presence of Kidney Stones in a Screened Population. AJKD. Article in press. Abstract]

Low Carbohydrate Diet May Reverse Kidney Failure in People With Diabetes: Researchers from Mount Sinai School of Medicine have for the first time determined that a specialized high-fat, low carbohydrate diet may reverse impaired kidney function in people with Type 1 and Type 2 diabetes. [Poplawski MM, Mastaitis JW, Isoda F, Grosjean F, Zheng F, et al. Reversal of Diabetic Nephropathy by a Ketogenic Diet. PLoS ONE 2011;6(4):e18604. doi:10.1371/journal.pone.0018604 Full Text | Older Study | Report | Report]

Food and Cancers

Close links between metabolic syndrome, hyperinsulinemia, insulin like growth factor and development and progression of several cancers are being unravelled. It is now clear that modern diet and life style are fueling the cancer epidemic.

Obesity, metabolic syndrome, and cancer: overview of mechanisms [See]

Hursting SD, Hursting MJ. Growth Signals, Inflammation, and Vascular Perturbations: Mechanistic Links Between Obesity, Metabolic Syndrome, and Cancer. Arteriosclerosis, Thrombosis, and Vascular Biology. 2012;32:1766–1770. Available at

Hauner D, Hauner H. Metabolic Syndrome and Breast Cancer: Is There a Link? Breast Care 2014;9: 277 – 281.

Chen Y, Wen Y-Y, Li Z-R, Luo D-L, Zhang X-H. The molecular mechanisms between metabolic syndrome and breast cancer. Biochemical and Biophysical Research Communications. 2016;471(4):391-395. Available at

Battelli MG, Bortolotti M, Polito L, Bolognesi A. Metabolic syndrome and cancer risk: The role of xanthine oxidoreductase. Redox Biology. 2019;21:101070. Available at

Micucci C,  Valli D, Giulia M, Catalano A. Current perspectives between metabolic syndrome and cancer. Oncotarget. 2015;7. 10.18632/oncotarget.8341. Available at

Vigneri R, Sciacca L, Vigneri P. Rethinking the Relationship between Insulin and Cancer. Trends in Edocrinology and metabolism. August 01, 2020;31(8):551-560. DOI: Available at

Cowey S, Hardy RW. The Metabolic Syndrome: A High-Risk State for Cancer? Am J Patho. November 01, 2006;169(5):1505-1522. DOI: Available at

E. Giovannucci. The Role of Insulin Resistance and Hyperinsulinemia in Cancer Causation. Current Medicinal Chemistry – Immunology, Endocrine & Metabolic Agents 2005;5:53. Available at

Arcidiacono B, Iiritano S, Nocera A et al. Insulin Resistance and Cancer Risk: An Overview of the Pathogenetic Mechanisms. Journal of Diabetes Research. 2012, Article ID 789174, 12 pages. Available at

Rosato V,Bosetti C,Talamini R et al. Metabolic syndrome and the risk of breast cancer in postmenopausal women. Annals of Oncology. December 01, 2011;22(12):2687-2692. DOI: Available at

Liu J, Druta M, Shibata D et al. Metabolic syndrome and colon cancer: Is hyperinsulinemia/insulin receptor-mediated angiogenesis a critical process? Journal of Clinical Oncology. DOI: 10.1200/jco.2011.29.15_suppl.e14004. Available at

Yang X, Wang J. The Role of Metabolic Syndrome in Endometrial Cancer: A Review. Front. Oncol. 08 August 2019 | Available at

Li P, Wang T, Zeng C. et al. Association between metabolic syndrome and prognosis of breast cancer: a meta-analysis of follow-up studies. Diabetol Metab Syndr 2020;12:10. Available at

Veniou E, Sofatzis I, Kalantzis I et al. Metabolic syndrome and Cancer: Do they share common molecular pathways? Forum of Clinical Oncology. 30 Dec 2016. Volume 7: Issue 2. DOI:

Tsujimoto T, Kajio H, Sugiyama T. Association between hyperinsulinemia and increased risk of cancer death in nonobese and obese people: A population‐based observational study. Int J Cancer. July 2017;141(1):102-111. Available at

Uzunlulu M, Telci Caklili O, Oguz A. Association between Metabolic Syndrome and Cancer. Ann Nutr Metab 2016;68:173-179. doi: 10.1159/000443743. Available at

Braun S, Bitton-Worms K, LeRoith D. The Link between the Metabolic Syndrome and Cancer. Int J Biol Sci 2011; 7(7):1003-1015. doi:10.7150/ijbs.7.1003. Available from

Vona‐Davis L, Howard‐McNatt M, Rose DP. Adiposity, type 2 diabetes and the metabolic syndrome in breast cancer. Obesity Reviews. September 2007;8(5):395-408. Available at

Hsu IR, Kim SP, Kabir M, Bergman RN. Metabolic syndrome, hyperinsulinemia, and cancer. The American Journal of Clinical Nutrition. September 2007;86(3):867S–871S. Available at

Sulfonylureas and insulin increase the risk of pancreatic cancer: A case–control study of general practice patients in the United Kingdom suggests that the use of antidiabetics such as sulfonylureas and insulin is associated with an increased risk for pancreatic carcinogenesis. Bodmer M, Becker C, Meier C, Jick SS, Meier CR. Use of Antidiabetic Agents and the Risk of Pancreatic Cancer: A Case–Control Analysis. The American Journal of Gastroenterology. 31 January 2012; doi:10.1038/ajg.2011.483[Abstract][Report][Report]

No evidence to link meat consumption and colorectal cancer: A population-based case–control study has found no association between meat consumption and incidence of colorectal cancer [Tabatabaei SM et al. Meat consumption and cooking practices and the risk of colorectal cancer European Journal of Clinical Nutrition 2011;65:668–675; doi:10.1038/ejcn.2011.17]

Sweetened Beverages Increase Pancreatic Cancer Risk Mark A. Pereira et al. in Cancer Epidemiology, Biomarkers & Prevention, February 2010 | Eva S. Schernhammer et al., in Cancer Epidemiology, Biomarkers & Prevention, Sep. 2005 | Report

Higher Blood sugar Increases Cancer Risk Abnormal glucose metabolism, independent of BMI, is associated with an increased risk of cancer overall and at several cancer sites, with stronger associations among women than among men, and for fatal cancer compared to incident cancer Stocks T et al., Blood Glucose and Risk of Incident and Fatal Cancer in the Metabolic Syndrome and Cancer Project (Me-Can): Analysis of Six Prospective Cohorts. PLoS Med 2009;6(12): e1000201 | Report

Elevated Insulin Linked To Increased Breast Cancer Risk Report; More; More

Dietary Patterns and Risk of Mortality From Cardiovascular Disease, Cancer, and All Causes:
See Mediterranean Diet and Incidence of and Mortality From Coronary Heart Disease and Stroke in Women – Circulation, Feb 2009 | A Prospective Cohort of Women; Circulation, 2008;118:230-237 | Dietary Patterns and the Risk of Acute Myocardial Infarction in 52 Countries

Cancers Linked To HRT (Once Promoted For Prevention Of Osteoporosis In Post Menopausal Women)
See Report | One More Report | One More Report | Full Text Article

Lipid Disorders

Abnormalities of serum lipids, such as triglycerides, cholesterol, are components of metabolic syndrome, which is increasingly being seen as related to modern diet, comprising of sugars, especially fructose.

Metabolism of fructose in the intestine and liver that contributes to dyslipidemia [See]

Taskinen M-R, Packard CJ, Borén J. Dietary Fructose and the Metabolic Syndrome. Nutrients 2019;11(9):1987. Available at

Tappy L, Lê K-A. Metabolic Effects of Fructose and the Worldwide Increase in Obesity. Physiological Reviews January 2010;90(1):23-46. Available at

Akhtar DH, Iqbal U, Vazquez-Montesino LM, Dennis BB, Ahmed A. Pathogenesis of Insulin Resistance and Atherogenic Dyslipidemia in Nonalcoholic Fatty Liver Disease. J Clin Transl Hepatol. 2019;7(4):362. doi: 10.14218/JCTH.2019.00028. Available at

Malik VS, Hu FB. Fructose and Cardiometabolic Health. Journal of the American College of Cardiology. 2015;66(14):1615-1624. doi: 10.1016/j.jacc.2015.08.025 Available at

Hieronimus B, Medici V, Bremer AA. Synergistic effects of fructose and glucose on lipoprotein risk factors for cardiovascular disease in young adults. Metabolism. November 2020;112:154356. Available at

Zhang D-M, Jiao R-Q, Kong LD. High Dietary Fructose: Direct or Indirect Dangerous Factors Disturbing Tissue and Organ Functions. Nutrients 2017;9(4):335. Available at

Nuts in Place of carbohydrates Helps Control Blood Sugar and Serum Lipids: Two ounces of nuts daily as a replacement for carbohydrate foods improves both glycemic control and serum lipids in type 2 diabetes.[Jenkins DJA. Nuts as a Replacement for Carbohydrates in the Diabetic Diet. Diabetes Care August 2011;34(8):1706-1711. Full text

Low-Carb and Mediterranean Diets Better than Low-Fat for Weight Loss, Lipid Changes at 2 Years: Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets, offering more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet).
See Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359:229-241 Full text Article


Osteoporosis is increasing in younger population, and links to modern diet and metabolic syndrome are emerging.

Possible mechanisms for how an overconsumption of sugar may cause osteoporosis. [See]

DiNicolantonio JJ, Mehta V, Zaman SB, O’Keefe JH. Not Salt But Sugar As Aetiological In Osteoporosis: A Review. Mo Med. 2018;115(3):247-252. Available at

Bartl R., Frisch B. (2009) The Metabolic Syndrome – A Major Cause of Osteoporosis in the World Today. In: Osteoporosis. Springer, Berlin, Heidelberg. Available at

Sugimoto T, Sato M, Dehle FC, Brnabic AJM, Weston A, Burge R. Lifestyle-Related Metabolic Disorders, Osteoporosis, and Fracture Risk in Asia: A Systematic Review. Value in Health Regional Issues. May 2016;9:49-56. Available at

Zhou J, Zhang Q, Yuan X, Wang J, Li C, Sheng H, Qu S, Li H. Association between metabolic syndrome and osteoporosis: a meta-analysis. Bone. 2013 Nov;57(1):30-5. doi: 10.1016/j.bone.2013.07.013. Available at

Collins KH, Herzog W, MacDonald GZ, Reimer RA, Rios JL, Smith IC, Zernicke RF, Hart DA. Obesity, Metabolic Syndrome, and Musculoskeletal Disease: Common Inflammatory Pathways Suggest a Central Role for Loss of Muscle Integrity. Frontiers in Physiology. 2018;9:112. DOI=10.3389/fphys.2018.00112. Available at

Yu C-Y, Chen F-P, Chen L-W, Kuo S-F, Chien R-N. Association between metabolic syndrome and bone fracture risk. Medicine. December 2017;96(50):e9180. doi: 10.1097/MD.0000000000009180. Available at

Oliveira MC, Vullings J, van de Loo FAJ. Osteoporosis and osteoarthritis are two sides of the same coin paid for obesity. Nutrition. 2020;70:110486. Available at

Higher Calcium Intake May Not Lower Risk for Fractures and Osteoporosis: A 19 years prospective study of 61 433 women has revealed that highest quintile of calcium intake did not further reduce the risk of fractures of any type, or of osteoporosis, but was associated with a higher rate of hip fracture. [Eva Warensjö et al. Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study. BMJ 2011;342:d1473 doi: 10.1136/bmj.d1473 | Report]

Overweight Kids Risk Weak Bones, Diabetes: Abdominal Fat May Play a Role in Bone Strength Norman K Pollock et al. Lower bone mass in prepubertal overweight children with pre-diabetes Journal of Bone and Mineral Research Jul 2010 Abstract | Report]

Caloric Restriction Delays Disease Onset and Mortality in Rhesus Monkeys Abstract in Science, 10 July, 2009; BBC News; Science News


Polycystic ovary syndrome (PCOS) is the commonest cause of infertility, characterised by excessive ovarian activity, yet non-development of healthy ova. Recent studies have clearly established its association with insulin resistance and other manifestations of metabolic syndrome, such as obesity, NAFLD, impaired glucose tolerance etc. Dietary restrictions can help in reversing PCOS within a few weeks.

Possible pathophysiological mechanisms of polycystic ovary syndrome [See]

Rocha AL, Oliveira FR, Azevedo RC et al. Recent advances in the understanding and management of polycystic ovary syndrome. F1000Research 2019;8(F1000 Faculty Rev):565 Available at

Spinedi E, Cardinali DP. The Polycystic Ovary Syndrome and the Metabolic Syndrome: A Possible Chronobiotic-Cytoprotective Adjuvant Therapy. International Journal of Endocrinology. 2018, Article ID 1349868, 12 pages, 2018. Available at

Shi B, Feng D, Sagnelli M et al. Fructose levels are elevated in women with polycystic ovary syndrome with obesity and hyperinsulinemia. Human Reproduction. January 2020;35(1):187–194.

Mavropoulos JC, Yancy WS, Hepburn J, Westman EC. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab (Lond). 2005;2:35. Published 2005 Dec 16. doi:10.1186/1743-7075-2-35. Available at

Zhang X, Zheng Y, Guo Y, Lai Z. The Effect of Low Carbohydrate Diet on Polycystic Ovary Syndrome: A Meta-Analysis of Randomized Controlled Trials. Int J Endocrinol. 2019;2019:4386401. Published 2019 Nov 26. doi:10.1155/2019/4386401. Available at


Non alcoholic fatty liver disease (NAFLD) is today the most common cause of chronic liver disease, causing steatohepatitis, cirrhosis, hepatic failure and hepatocellular carcinoma. Newer insights into the issue have revealed a  simple truth that it’s the sugars, fruits and grains that are the source of every alcoholic beverage and the actions and metabolism of these sugars, particularly of fructose, have several similarities with those of alcohol. Therefore, prevention and management of NAFLD have got lot to do with restriction of these dietary factors.

Toxic Truth of Sugar: Source

Fructose and nonalcoholic fatty liver disease (NAFLD): the multifaceted aspects of fructose metabolism. [See]

The Toxic Truth: Too much fructose can damage your liver, just like too much alcohol [See]

Sugar is Toxic: The growing scientific evidence, both epidemiological and mechanistic, very clearly shows that excess sugar induces all of the diseases associated with the metabolic syndrome, Robert H. Lustig et al write in Nature. See Lustig RH, Schmidt LA, Brindis CD. Public health: The toxic truth about sugar. Nature. 02 February 2012;482:27–29. doi:10.1038/482027a[Link][Report | Report | Report | Report]

Lim J, Mietus-Snyder M, Valente A et al. The role of fructose in the pathogenesis of NAFLD and the metabolic syndrome. Nat Rev Gastroenterol Hepatol 2010;7:251–264.

Jegatheesan P, Bandt J-PD. Fructose and NAFLD: The Multifaceted Aspects of Fructose Metabolism. Nutrients 2017;9(3):230. Available at

Zhang D-M, Jiao R-Q, Kong LD. High Dietary Fructose: Direct or Indirect Dangerous Factors Disturbing Tissue and Organ Functions. Nutrients 2017;9(4):335. Available at

Vos MB, Lavine JE. Dietary fructose in nonalcoholic fatty liver disease. Hepatology. June 2013;57(6):2525-2531. Available at

Duarte S, Stefano JT,  Vanni D, Carrilho F, Oliveira C. Impact of current diet at the risk of non-alcoholic fatty liver disease (NAFLD). Arquivos de Gastroenterologia. 2019;56.  DO – 10.1590/s0004-2803.201900000-67. Available at

Prussick RB,  Miele L. Nonalcoholic fatty liver disease in patients with psoriasis: a consequence of systemic inflammatory burden? Br J Dermat. July 2018;179(1):16-29. Available at

Gastaldelli A, Cusi K. From NASH to diabetes and from diabetes to NASH: Mechanisms and treatment options. JHEP Reports. October 2019;1(4):312-328. Available at

Aron-Wisnewsky J, Gaborit B, Dutour A, Clement K. Gut microbiota and non-alcoholic fatty liver disease: new insights. Clinical Microbiology and Infection. 2013;19(4):338-348. Available at

Mann JP et al. Nonalcoholic Fatty Liver Disease in Children. Semin Liver Dis 2018;38:1–13. Available at

Duwaerts CC, Maher JJ. Macronutrients and the Adipose-Liver Axis in Obesity and Fatty Liver. Cellular and Molecular Gastroenterology and Hepatology2019;7(4):749-761. Available at

Taskinen M-R, Packard CJ, Borén J. Dietary Fructose and the Metabolic Syndrome. Nutrients 2019;11(9):1987. Available at

Akhtar DH, Iqbal U, Vazquez-Montesino LM, Dennis BB, Ahmed A. Pathogenesis of Insulin Resistance and Atherogenic Dyslipidemia in Nonalcoholic Fatty Liver Disease. J Clin Transl Hepatol. 2019;7(4):362. doi: 10.14218/JCTH.2019.00028. Available at

Chen Q, Wang T, Li J et al. Effects of Natural Products on Fructose-Induced Nonalcoholic Fatty Liver Disease (NAFLD). Nutrients 2017;9:96.Available at

Godoy-Matos AF, Silva Júnior WS, Valerio CM. NAFLD as a continuum: from obesity to metabolic syndrome and diabetes. Diabetol Metab Syndr 2020;12:60. Available at

El-Agroudy NN et al. Are Lifestyle Therapies Effective for NAFLD Treatment? Trends in Endocrinology & Metabolism 2019;30(10):701-709. Available at

Lambertz J, Weiskirchen S, Landert S,  Weiskirchen R. Fructose: A Dietary Sugar in Crosstalk with Microbiota Contributing to the Development and Progression of Non-Alcoholic Liver Disease. Front. Immunol., 19 September 2017. Available at

High Uric Acid

Elevation of blood Uric acid levels is now considered as the key to the development of metabolic syndrome, particularly cardiovascular disease, hypertension and inflammatory status. In recent years, it is becoming clearer that elevation of uric acid is linked to the consumption of fructose in various food types, and therefore, dietary restriction plays a very important role in regulating serum uric acid and the problems associated with its elevation.

Relationship between high-fructose diet, generation of hyperuricemia and resulting metabolic syndrome [See]
Complex interaction of uric acid, components of metabolic syndrome and cardiovascular disease [See]

Kanbay M, Jensen T, Solak Y, Le M, Roncal-Jimenez C, Rivard C, Lanaspa MA, Nakagawa T, Johnson RJ. Uric acid in metabolic syndrome: From an innocent bystander to a central player. Eur J Intern Med. 2016 Apr;29:3-8. doi: 10.1016/j.ejim.2015.11.026.Available at

Fructose Worsens Gout: Consumption of soft drinks sweetened with sugar and fructose is strongly associated with an increased risk for gout, according to the results of a prospective cohort study reported in the February 1 Online First issue of the BMJ. This was a 12-year follow-up study of 46,393 health professionals without a previous history of gout and the goal was to assess the relationship between consumption of sugar-sweetened soft drinks and fructose and the risk for incident gout. See Sweet Soft Drinks, Fructose Linked to Increased Risk for Gout. Available at

Raina S, Raina RK, Raina SK. Hyperuricemia: A risk factor beyond gout. J Obes Metab Res 2015;2:228-33. Available from:

Jamnik J, Rehman S, Blanco Mejia S, et al. Fructose intake and risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies. BMJ Open. 2016;6(10):e013191. Published 2016 Oct 3. doi:10.1136/bmjopen-2016-013191. Available at

Lecoultre V, Egli L, Theytaz F, Despland C, Schneiter P, Tappy L. Fructose-induced hyperuricemia is associated with a decreased renal uric acid excretion in humans. Diabetes Care. 2013;36(9):e149-e150. doi:10.2337/dc13-0866. Available at

Sayehmiri K, Ahmadi I, Anvari E. Fructose Feeding and Hyperuricemia: a Systematic Review and Meta-Analysis. Clinical Nutrition Research. April 2020;9(2):122. DOI: 10.7762/cnr.2020.9.2.122 Available at

Nakagawa T, Hu H, Zharikov S, et al. A causal role for uric acid in fructose-induced metabolic syndrome. American Journal of Physiology-Renal Physiology. 2006;290(3):F625-F631. Available at