Sugar-, Artificially-Sweetened Beverages Both Linked to Increased MASLD Risk

New research is shedding light on a heightened risk of metabolic dysfunction-associated steatotic liver disease (MASLD) with high intake of both sugar-sweetened beverages (SSBs) and low- or non-sugar-sweetened beverages (LNSSBs), additionally highlighting an increased risk of liver-related mortality with high LNSSB consumption.1,2

The research, presented at United European Gastroenterology Week 2025, assessed data for > 100,000 UK Biobank participants and found intake of > 330 g per day of both LNSSBs and SSBs were linked to elevated MASLD risk, supporting the limitation of both beverages as part of a comprehensive prevention strategy targeting both liver disease and cardio-renal-metabolic health.1,2

Emerging research suggests intake of sugar and its substitutes is linked to cardiometabolic and kidney diseases. A 2024 analysis of UK Biobank data determined that consumption of >1 serving per day of sugar-sweetened beverages was associated with higher risk of incident chronic kidney disease, with risk unaffected by substituting sugar-sweetened beverages with artificially sweetened beverages.3

“SSBs have long been under scrutiny, while their ‘diet’ alternatives are often seen as the healthier choice,” lead study author Lihe Liu, a graduate student in the department of gastroenterology at the First Affiliated Hospital of Soochow University in China, said in a statement.2 “Both, however, are widely consumed and their effects on liver health have not been well understood.”

To address this gap in research, investigators conducted a prospective cohort study of 103,251 UK Biobank participants free of baseline liver disease, assessing the associations between SSB and LNSSB intake and the risk of incident MASLD and liver-related mortality.1

They assessed beverage consumption through multiple 24-hour dietary questionnaires. The primary outcome was incident MASLD, and secondary outcomes included liver-related mortality and liver fat content measured by MRI- derived proton density fat fraction.1

During a median 10.3-year follow-up, 949 participants developed MASLD and 103 died from liver-related causes. Investigators noted increased intake of LNSSBs, and SSBs, defined as >330 g/day, were associated with elevated MASLD risk (hazard ratio, 1.597 and 1.502, respectively; both P <.01).1

Further analysis revealed LNSSB consumption increased liver-related mortality risk in a dose-dependent manner. However, no significant association was observed for SSBs.1

Investigators noted both beverages were positively associated with liver fat content. Replacing 330 g/day of either beverage with water significantly reduced MASLD risk by 14.7% (SSBs) and 13.5% (LNSSBs), whereas substitution between LNSSBs and SSBs showed no difference in risk.1

“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,” Liu said.2 “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.”

References

1. 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.

2. UEG. Artificially sweetened and sugary drinks are both associated with an increased risk of liver disease, study finds. October 7, 2025. Accessed October 7, 2025. https://ueg.eu/a/378

3. Heo GY, Koh HB, Park JT, et al. Sweetened Beverage Intake and Incident Chronic Kidney Disease in the UK Biobank Study. JAMA Netw Open. 2024;7(2):e2356885. doi:10.1001/jamanetworkopen.2023.56885