In this issue of Gastroenterology, Schwarz et al1 report on the “Impact of Dietary Fructose Restriction on Liver Fat, De Novo Lipogenesis and Insulin Kinetics in Children with Obesity.” There are 3 recent developments important to the context and impact of the study. First, nonalcoholic fatty liver disease (NAFLD) is highly prevalent in children and the prevalence seems to be increasing.2 NAFLD in children occurs in a setting of excess weight gain and insulin resistance, and it foretells ongoing metabolic decline including type 2 diabetes3 and future cardiovascular disease.