In Reply Messrs Tang and Gao raise 2 questions regarding our study of dietary sugar in pediatric nonalcoholic fatty liver disease.1 They suggest that the effect observed in our trial may have been solely a function of weight loss. The study was not designed to promote weight loss; participants ate without calorie or macronutrient restriction. In support of the argument for a weight loss effect, Tang and Gao reference practice guidelines that were written primarily for adults with nonalcoholic fatty liver disease and recommend weight loss of 5% to 10% of body weight.2
Schwimmer JB, Ugalde-Nicalo P, Vos MB. Low Free Sugar Diet in Adolescents With Nonalcoholic Fatty Liver Disease—Reply. JAMA. 2019;321(24):2469. doi:10.1001/jama.2019.5153
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