A large UK study has shown that both sugar-sweetened and low- or no-sugar soft drinks increase the risk of metabolic dysfunction-associated steatotic liver disease (MASLD). Consuming more than one can daily was linked to up to 60% higher odds of developing the condition. The findings, presented at UEG Week 2025, challenge the view of diet drinks as a healthier alternative.
Researchers analyzed data from 123,788 adults in the UK Biobank who showed no signs of liver disease at the study's outset. Over a median follow-up of 10.3 years, participants' beverage habits were tracked via repeated 24-hour dietary questionnaires. During this period, 1,178 individuals developed MASLD, and 108 died from liver-related causes.
Those consuming more than 250 grams—roughly one can—per day of low- or no-sugar-sweetened beverages (LNSSBs) faced a 60% increased risk of MASLD (hazard ratio: 1.599), while sugar-sweetened beverages (SSBs) were associated with a 50% rise (HR: 1.469). Both types also correlated with elevated liver fat levels. Notably, LNSSB intake showed a significant link to liver-related mortality, unlike SSBs.
MASLD, formerly known as non-alcoholic fatty liver disease, involves excess fat buildup in the liver, potentially leading to inflammation, abdominal pain, fatigue, and appetite loss. It now affects over 30% of the global population and is emerging as a top cause of liver deaths.
Lead researcher Lihe Liu stated, "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."
Liu added, "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."
Possible mechanisms include SSBs causing blood glucose spikes, insulin surges, weight gain, and uric acid increases, while LNSSBs may disrupt the gut microbiome, impair satiety, boost sweet cravings, and stimulate insulin. Substituting either with water cut MASLD risk by 12.8% for SSBs and 15.2% for LNSSBs, but switching between the two offered no benefit.
Liu recommended, "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 study was presented on October 7, 2025, in Berlin, Germany, with future research planned on causal links via randomized trials focusing on gut microbiome interactions.