Most people assume that low- or no-sugar drinks are a healthier alternative to regular sodas, but new research suggests that might not be the full picture. A large-scale study presented at UEG Week 2025 found that both sugar-sweetened beverages (SSBs) and low- or non-sugar-sweetened beverages (LNSSBs) are linked to an increased risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD), a condition previously known as non-alcoholic fatty liver disease.What Is MASLD?According to the Cleveland Clinic, MASLD—short for metabolic dysfunction-associated steatotic liver disease, is a condition in which extra fat accumulates in the liver. It was previously called nonalcoholic fatty liver disease (NAFLD). Unlike liver damage caused by heavy drinking, MASLD is linked to metabolic risk factors such as obesity, type 2 diabetes, high blood pressure, and high cholesterol. If left untreated, it can progress to more serious liver problems.What The Study FoundResearchers analyzed data from 123,788 participants in the UK Biobank who did not have liver disease at the start of the study. Participants reported their beverage consumption through multiple 24-hour dietary questionnaires, giving researchers insight into how both sugary and “diet” drinks might affect liver health.The results were striking: individuals consuming more than 250 grams per day of either SSBs or LNSSBs faced significantly higher risks of MASLD, about 60% higher for LNSSBs and 50% higher for SSBs. Over a median follow-up of 10.3 years, 1,178 participants were diagnosed with MASLD, and 108 died from liver-related causes. Interestingly, LNSSBs, but not SSBs, showed a notable link to liver-related mortality. Both drink types were also tied to increased liver fat.Understanding MASLD and Its Growing ImpactMASLD occurs when excess fat builds up in the liver, which can eventually lead to inflammation, fatigue, abdominal pain, and loss of appetite. Once considered less common, MASLD has now become the most widespread chronic liver disease globally, affecting more than 30% of the population. It is also emerging as a leading cause of liver-related deaths worldwide.Lead author Lihe Liu emphasized, “SSBs have long been scrutinized, while their ‘diet’ counterparts are often seen as a healthier choice. Our study shows that both types of beverages are widely consumed, yet their effects on liver health have not been fully understood.”Liu added, “Even modest consumption of LNSSBs, like a single can per day, was linked to a higher risk of MASLD. These findings challenge the perception that ‘diet’ drinks are harmless and highlight the need to reconsider their role in our diets, especially as MASLD continues to grow as a public health concern.”Why Both Sugary and Diet Drinks May Harm the LiverThe researchers explained potential mechanisms behind the risks. SSBs, with their high sugar content, can spike blood glucose and insulin, promote weight gain, and increase uric acid levels, all contributing to liver fat accumulation. LNSSBs may affect liver health differently: by altering the gut microbiome, disrupting feelings of fullness, triggering sugar cravings, or even stimulating insulin secretion.Water Remains the Safest ChoiceExperts recommend limiting both sugar-sweetened and artificially sweetened beverages. Replacing either type with water showed a significant reduction in MASLD risk, about 13% for SSBs and 15% for LNSSBs. Simply switching between SSBs and LNSSBs did not reduce risk.The researchers plan to investigate causal mechanisms more deeply with long-term studies, including randomized and genetic trials. They aim to better understand how sugar and its substitutes interact with the gut microbiome and influence liver disease.
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