Frequently Adding Salt to Food May Increase Liver Disease Risk, Study Finds

Frequently adding salt to foods may incur a greater risk of incident metabolic dysfunction-associated steatotic liver disease (MASLD), cirrhosis, and hepatocellular carcinoma (HCC), according to findings from a recent study.1

Leveraging data for nearly 500,000 UK Biobank participants, the study found those who self-reported more frequent use of salt were at an increased risk of developing these liver-related disorders than those who said they less frequently added salt to their food, suggesting that reducing salt/sodium intake could be a promising strategy for public health initiatives to promote liver health.1

“Sodium is an important dietary component and serves many physiological functions such as nutrient absorption and maintaining fluid balance. There has been a growing interest in sodium intake owing to its wide-range healthy relevance,” Lu Qi, MD, PhD, HCA Regents Distinguished Chair and Professor at Tulane University and adjunct professor at Harvard T.H. Chan School of Public Health, and colleagues wrote.1 “Previous studies have indicated the positive associations between salt added to foods and various adverse health outcomes such as type 2 diabetes, CVD, and mortality, yet the role of added salt in liver-related disorders remains underexplored.”

MASLD, which currently affects 30% of the global population, can progress to cirrhosis, hepatocellular carcinoma, and increase the risk of several extrahepatic complications, including cardiovascular disease, type 2 diabetes, chronic kidney disease, and extrahepatic cancers. With only a single pharmacologic treatment option currently approved by the US Food and Drug Administration in the form of Madrigal’s resmetirom (Rezdiffra), prevention and early detection of modifiable risk factors are a high public health priority.1,2

To assess the impact of adding salt to foods on the risks of MASLD, cirrhosis, and HCC, investigators conducted a prospective cohort study of UK Biobank participants who did not have prevalent liver diseases at baseline. Data about the frequency of adding salt to foods were collected by a touchscreen question “Do you add salt to your food? (Do not include salt used in cooking)”, with the response options being “Never/rarely”, “Sometimes”, “Usually”, “Always”, and “Prefer not to answer.”

Incident MASLD was the primary outcome and was defined using International Classification of Disease, Tenth Revision (ICD-10) codes. Secondary outcomes included cirrhosis and HCC, which were also identified based on ICD-10 codes.1

Participants were followed up from the date of completion of the baseline assessment to the date of the outcomes, date of death, or the end of follow-up in December of 2022, whichever came first.1

In total, the study included 492,265 participants with a mean age of 56.5 ± 8.1 years, 45.3% of whom were male. During a median follow-up of 13 years, 7005 incident MASLD cases, 5546 cirrhosis cases, and 413 HCC cases occurred.1

After adjusting for sociodemographic characteristics, lifestyle factors, personal history of diseases, and diet factors, investigators noted the risk of MASLD increased as self-reported salt addition frequency increased (P for trend <.0001):

• Never/rarely (reference): Hazard ratio (HR), 1.00
• Sometimes: HR, 1.08 (95% CI, 1.02-1.14)
• Usually: HR, 1.22 (95% CI, 1.13-1.31)
• Always: HR, 1.40 (95% CI, 1.27-1.53)

Investigators observed similar positive associations for cirrhosis and HCC. The fully adjusted HRs of cirrhosis were 1.00 (reference) for never/rarely, 1.11 (95% CI, 1.04-1.18) for sometimes, 1.09 (95% CI, 1.00-1.18) for usually, and 1.32 (95% CI, 1.18-1.47) for always (P for trend <.0001), while the corresponding HRs of HCC were 1.00 (reference), 1.26 (95% CI, 1.00-1.58), 1.45 (95% CI, 1.10-1.93), and 2.25 (95% CI, 1.60-3.16) (P for trend <.0001).1

Of note, the absolute risks of MASLD, cirrhosis, and HCC increased over time, and participants with a higher frequency of adding salt to foods generally had higher risks. Investigators pointed out the positive associations between the frequency of adding salt to foods with the risk of all 3 liver conditions were partly mediated by adiposity.1

“A higher frequency of adding salt to foods was associated with higher risks of incident MASLD, cirrhosis, and HCC,” investigators concluded.1 “These findings suggest that reducing salt/sodium intake could be a promising strategy for preventing liver-related disorders.”

References

1. Zhang S, Huo Z, Borné Y, et al. Adding salt to foods and risk of metabolic dysfunction-associated steatotic liver disease and other chronic liver diseases. Eur J Nutr. https://doi.org/10.1007/s00394-025-03745-3

2. Brooks A. Resmetirom (Rezdiffra) Receives Historic FDA Approval for Noncirrhotic NASH. HCPLive. March 14, 2024. Accessed June 23, 2025. https://www.hcplive.com/view/resmetirom-rezdiffra-receives-historic-fda-approval-for-noncirrhotic-nash