Diets devoid of methionine and choline [methionine choline-defi cient (MCD)] cause hepatic steatosis and infl ammation that mimics nonalcoholic steatohepatitis in human beings ( 1-3 ). MCD feeding reportedly induces hepatic steatosis through a dual process involving enhanced uptake of fatty acids by the liver as well as impaired secretion of hepatic triglyceride (TG) ( 2 ). Stimulation of fatty acid uptake in MCD-fed animals correlates with hepatic upregulation of fatty acid transport proteins. Suppression of hepatic TG secretion is due to the reduced availability of methionine and choline for phospholipid synthesis, which is critical to the formation of TG-rich VLDL particles ( 4, 5 ). Notably, commercial MCD formulas (MP Biomedicals, Harlan Teklad, and Dyets) not only lack methionine and choline but are also enriched in sucrose and fat. These nutrients can themselves stimulate hepatic lipid accumulation ( 6-8 ); thus, they may accentuate the hepatic lipid accumulation caused by methionine and choline deprivation alone.The role of dietary fat as a determinant of liver injury in the MCD model has been the subject of recent investigation. Somewhat unexpectedly, studies have shown that the fat content of the MCD formula can be varied over a wide range (10% to 40% of calories) without any impact on the amount of TG that accumulates in the liver ( 9, 10 ). Even more surprising is that dietary fat does not affect MCDmediated hepatocellular injury based on biochemical or Abstract Methionine-choline-defi cient (MCD) diets cause steatohepatitis in rodents and are used to study the pathophysiology of fatty liver disease in human beings. The most widely used commercial MCD formulas not only lack methionine and choline but also contain excess sucrose and fat. The objective of this study was to determine whether dietary sucrose in the MCD formula plays a role in the pathogenesis of MCD-related liver disease. We prepared two custom MCD formulas, one containing sucrose as the principal carbohydrate and the other substituting sucrose with starch. Mice fed the sucrose-enriched formula developed typical features of MCD-related liver disease, including hepatic steatosis, hepatocellular apoptosis, alanine aminotransferase elevation, lipid peroxidation, and hepatic infl ammation. In contrast, mice fed MCD-starch were signifi cantly protected against liver injury. MCD-sucrose and MCD-starch mice displayed identical diet-related abnormalities in hepatic fatty acid uptake and triglyceride secretion. Hepatic de novo lipogenesis and triglyceride synthesis, however, were 2 times higher in MCD-sucrose mice than MCDstarch mice ( P < 0.01). Hepatic lipid analysis revealed accumulation of excess saturated fatty acids in MCD-sucrose mice that correlated with hepatocellular injury. Overall, the results indicate that dietary sucrose is critical to the pathogenesis of MCD-mediated steatohepatitis. They suggest that saturated fatty acids, which are products of de novo lipogenesis, are mediators of hepatic toxicity in this model of liver disease. ...