The findings challenge the common perception that artificially sweetened beverages are a safe alternative to sodas and fruit drinks loaded with sugar. Researchers found that drinking either type of beverage daily was tied to a significantly higher risk of MASLD (formerly known as nonalcoholic fatty liver disease) — and that diet versions were tied to a greater risk of dying from liver-related causes.
A Daily Can of Diet Soda Raised Liver-Related Death Risk
The study analyzed data from more than 103,000 participants in the UK Biobank who had no liver disease when they joined. Over an average follow-up of about 10 years, 949 people developed MASLD and 103 died from liver-related causes.
The study’s key findings include:
- People who drank more than 12 ounces of a sugar-sweetened drink (equivalent to a standard can of soda) had a 50 percent higher risk of developing MASLD compared with people who drank less than that.
- Low-sugar or diet drinks were tied to an even higher risk: Drinking more than 12 ounces a day was associated with a 60 percent higher risk of developing MASLD.
- Diet drinks were also linked to a higher risk of dying from liver disease. No such link was found between sugary drinks and liver-related death.
- MRI scans confirmed that both beverage types were associated with greater fat content in the liver.
Researchers estimated that replacing a daily serving of either beverage with water reduced MASLD risk by about 13 to 15 percent. Choosing a diet drink instead of a sugary one offered no benefit.
‘Diet’ Doesn’t Mean Zero-Calorie Soda Is Healthy, Experts Say
The results should prompt a rethink about how people view diet drinks, said lead author Lihe Liu, a graduate student in the gastroenterology department at the First Affiliated Hospital of Soochow University in Suzhou, China, in a press release.
These latest findings suggest that low- or sugar-free sweetened drinks were actually associated with a higher risk of liver disease, even if people only have one can a day, she said.
“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,” said Liu.
Sugary Drinks Increase the Risk of Liver Disease, Obesity, and Type 2 Diabetes
Given what’s currently known about the negative health impacts of too much sugar, it makes sense that sugary drinks would increase the risk of developing MASLD, says Matthew Kappus, MD, a gastroenterologist at Duke University School of Medicine in Durham, North Carolina.
Sugary drinks and sodas can cause rapid spikes in blood glucose and insulin, lead to weight gain, and increase fat deposition in the liver — all factors that contribute to MASLD risk, says Longgang Zhao, PhD, a research fellow at the Yale School of Nursing in New Haven, Connecticut.
In addition to contributing to the risk of MASLD, we are “more than confident” that sugar is directly linked to obesity, heart disease, high cholesterol, and diabetes, says Dr. Kappus, who wasn’t involved in the research. Consuming high amounts of sugar increases the likelihood of developing any of those conditions, he adds.
Evidence suggests that because the body absorbs liquid sugars in soda quickly, these beverages can cause more harm to the liver compared with sugary foods.
Why Would Sugar-Free Diet Drinks Pose a Risk to the Liver?
While non-sugar-sweetened beverages may not contribute directly to fat buildup in the liver, there is concern that they may change our appetite and contribute via other pathways, says A. Sidney Barritt IV, MD, a professor of medicine and director of hepatology at the University of North Carolina in Chapel Hill.
Diet drinks may affect the gut microbiome, confuse your body’s natural hunger and fullness signals, and maintain your cravings for sweet foods — all of which could contribute to problems like metabolic issues and a buildup of fat in the liver, says Dr. Zhao.
Because existing research can’t prove cause-and-effect, it’s not clear what may be increasing the risk, says Kappus, who says he is “suspicious of this class of drinks.”
“[The increased risk] could be due to the chemicals used, but we can’t know whether other factors also exist. For instance, is someone who consumes high amounts of low- or non-sugar-sweetened drinks leading a healthy lifestyle with a well-balanced diet and regular physical activity, for example?” he says.
That’s something that can’t be teased out from this study, says Kappus.
More Than 1 in 4 Adults Have MASLD
Although these findings make sense, the low number of people who ended up developing MASLD and dying from liver disease in this analysis raises questions, says Dr. Barritt, who wasn’t involved in the study.
“In over 100,000 patients over the 10 year follow-up researchers identified about 1,000 incident cases of MASLD and about 100 liver-related deaths,” he says.
That raises some concerns about how the disease was classified, says Barritt. “We know that the prevalence of MASLD is approximately 25 to 30 percent in the adult population and that the incidence is increasing, so these low numbers surprise me,” he says.
Another Reason to Drink More Water
The message from experts is consistent: Limit both sugary and diet drinks.
“No one needs soda. No one needs a sports drink outside of someone expending significant sweat through exertion. Limit yourself to water, coffee, and tea, and hold the sugar and artificial sweeteners,” says Kappus.
Barritt agrees that water is almost always a better choice. “Sugar containing beverages expose us to excessive empty calories and there is some concern that even non-sugar-sweetened beverages may influence our appetite and eating behaviors,” he says.
By passing on sugary and diet drinks, you lower the risk of significant health difficulties later on in your life, says Kappus.
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