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.