A diet rich in fructose and saccharose is a risk factor for the development of nonalcoholic fatty liver disease (NAFLD). Thus, a low free sugar diet could be a therapeutic tool for this population, who often suffer from obesity as well. However, there is a lack of research using this diet. We aimed therefore to analyze the effects of a low free sugar diet on overweight and obese NAFLD patients by assessing lipid profile, glycemic indices, liver enzymes, inflammatory factors, and hepatic steatosis and fibrosis.

Participants with FibroScan-proven NAFLD were randomized to a 12-week dietary intervention (low free sugar diet or usual diet). A general questionnaire, 24-h food recall, and metabolic equivalent of task questionnaire were completed. Anthropometric measurements, lipid profile, glycemic indices, liver enzymes, inflammatory factors, and hepatic steatosis and fibrosis were assessed at the beginning and end.

Forty-three subjects completed the 12-week intervention. Low free sugar diet compared with the usual diet significantly decreased the concentrations of ALT (43.00±27.54 to 27.95±20.77 U/L), TG (172.86±83.04 to 144.19±65.55), TC (155.54±37.55 to 139.86±33.63 mg/dL), FBS (103.95±15.42 to 91.00±14.36 mg/dL), insulin (14.37±5.79 to 8.92±5.43 mU/L), HOMA-IR (3.81±1.80 to 2.06±1.29), hs-CRP (3.80±1.09 to 2.88±0.52 mg/L), TNF-α (4.60±1.54 to 3.41±0.69 pg/mL), NF-kb (3.89±1.34 to 3.35±1.33 ), as well as resulted in reduced fibrosis score and steatosis score, with increased QUICKI (P < 0.05). The differences in AST, GGT, HDL-C and LDL-C were not significant (P > 0.05).

Low free sugar diet in overweight/obese NAFLD patients may reduce hepatic steatosis and fibrosis while improving glycemic indices, decreasing the concentrations of biomarkers of inflammation, TG, and TC levels.