A large-scale investigation has found that people who regularly consume both sugar-sweetened beverages (SSBs) and low- or no-sugar-sweetened beverages (LNSSBs) face a significantly greater likelihood of developing metabolic dysfunction-associated steatotic liver disease (MASLD).1
Presented at UEG Week 2025, the research followed 123,788 adults from the UK Biobank who had no signs of liver disease at the start of the study. Participants’ drink habits were recorded through repeated 24-hour dietary questionnaires, allowing researchers to explore how both SSB and LNSSB consumption related to MASLD, liver fat buildup, and deaths linked to liver disease.
Individuals who drank more than 250 grams of either type of beverage per day had notably higher risks: a 60% increased likelihood of developing MASLD for those consuming LNSSBs (HR: 1.599) and a 50% increase for those drinking SSBs (HR: 1.469). During a median follow-up of 10.3 years, 1,178 participants developed MASLD and 108 died from liver-related causes. Although SSBs were not significantly connected to liver-related mortality, LNSSB consumption was. Both kinds of drinks were also associated with higher levels of liver fat.
MASLD, previously known as non-alcoholic fatty liver disease (NAFLD), occurs when excess fat builds up in the liver. Over time, this can trigger inflammation (hepatitis) and lead to symptoms such as abdominal pain, fatigue, and loss of appetite.2 Now the most common chronic liver condition worldwide, MASLD affects more than 30% of people and is rapidly becoming a leading cause of liver-related deaths.3
Lead researcher Lihe Liu explained, “SSBs have long been under scrutiny, while their ‘diet’ alternatives are often seen as the healthier choice. Both, however, are widely consumed and their effects on liver health have not been well understood.”
“Our study shows that LNSSBs were actually linked to a higher risk of MASLD, even at modest intake levels such as a single can per day. These findings challenge the common perception that these drinks are harmless and highlight the need to reconsider their role in diet and liver health, especially as MASLD emerges as a global health concern.”
Liu also discussed the possible biological reasons behind the findings: “The higher sugar content in SSBs can cause rapid spikes in blood glucose and insulin, promote weight gain and increase uric acid levels, all of which contribute to liver fat accumulation. LNSSBs, on the other hand, may affect liver health by altering the gut microbiome, disrupting the feeling of fullness, driving sweet cravings and even stimulating insulin secretion.”
The authors emphasized that these findings support limiting both SSBs and LNSSBs as part of a comprehensive prevention strategy, targeting not only liver disease but also cardio-renal-metabolic health. Replacing either beverage with water significantly reduced MASLD risk — by 12.8% for SSBs and 15.2% for LNSSBs — while substitution between the two types of beverages offered no risk reduction.
Liu added, “The safest approach is to limit both sugar-sweetened and artificially sweetened drinks. Water remains the best choice as it removes the metabolic burden and prevents fat accumulation in the liver, whilst hydrating the body.”
The researchers now aim to explore causal mechanisms more deeply through long-term, randomized and genetic trials with a focus on how sugar and its substitutes interact with the gut microbiome and influence liver disease.
References:
- Liu, L et al. Sugar- and low/non-sugar-sweetened beverages and risks of metabolic dysfunction-associated steatotic liver disease and liver-related mortality: A prospective analysis of the UK Biobank. Presented at UEG Week 2025; 7 October 2025; Berlin, Germany.
- Girish, V. and John, S. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). (2025). PMID: 31082077
- Younossi, Z. M. et al. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. (2023). Journals. DOI: 10.1097/HEP.0000000000000004