A groundbreaking study unveiled at UEG Week 2025 in Berlin has raised serious concerns about the health impact of both sugar-sweetened beverages (SSBs) and their low- or non-sugar-sweetened counterparts (LNSSBs), revealing a significant association with metabolic dysfunction-associated steatotic liver disease (MASLD).
A summarised overview of the study is as follows.
- Participants: 123,788 individuals from the UK Biobank, all free of liver disease at baseline.
- Method: Beverage intake was tracked using repeated 24-hour dietary questionnaires.
- Duration: Median follow-up of 10.3 years.
Researchers found that daily consumption of more than 250g of either beverage type was linked to a markedly increased risk of developing MASLD:
- LNSSBs: 60% higher risk (HR: 1.599)
- SSBs: 50% higher risk (HR: 1.469)
Additionally, LNSSBs were associated with a higher risk of liver-related mortality, while both beverage types correlated with increased liver fat content.
Understanding MASLD
Previously known as non-alcoholic fatty liver disease (NAFLD), MASLD is characterised by fat buildup in the liver, which can lead to inflammation, pain, fatigue, and appetite loss.
It is now recognised as the most prevalent chronic liver disease globally, affecting over 30% of the population and contributing to rising liver-related deaths.
Rethinking ‘Diet’ drinks
Lead researcher Lihe Liu challenged the widespread belief that LNSSBs are a healthier alternative to sugary drinks.
“Even modest intake—like a single can per day—was linked to increased MASLD risk,” Liu noted.
The study suggests that LNSSBs may disrupt gut microbiota, stimulate insulin secretion, and encourage sweet cravings, while SSBs contribute to liver fat through spikes in blood sugar and insulin, weight gain, and elevated uric acid.
Water is safer
Replacing SSBs or LNSSBs with water significantly lowered MASLD risk:
- SSBs: 12.8% reduction
- LNSSBs: 15.2% reduction
However, switching between SSBs and LNSSBs offered no protective benefit. “Water removes the metabolic burden and prevents fat accumulation in the liver,” Liu emphasized.
More research
The research team plans to delve deeper into the biological mechanisms through long-term randomized and genetic studies, focusing on how sugar and sweetener substitutes interact with the gut microbiome and influence liver health.
This study adds a critical layer to the conversation around beverage choices and public health. As MASLD continues to rise globally, the findings urge a reevaluation of what we drink—and how it affects our bodies.
Further information
About the author:
Lihe Liu is a graduate student in the Department of Gastroenterology at the First Affiliated Hospital of Soochow University, Suzhou, China. Her research focuses on metabolic liver diseases and gastroenterology, where she applies data-driven approaches using R and Python to support clinical research.
About UEG:
Founded in 1992, United European Gastroenterology (UEG) is the leading non-profit organisation for excellence in digestive health in Europe and beyond with its headquarters in Vienna. We improve the prevention and care of digestive diseases in Europe through providing top tier education, supporting research and advancing clinical standards.
As Europe’s home and umbrella for multidisciplinary gastroenterology, we unite over 50,000 engaged professionals from national and specialist societies, individual digestive health experts and related scientists from all fields and career stages. Over 30,000 digestive healthcare professionals from around the world have joined the UEG Community as UEG Associates and UEG Young Associates. The UEG Community enables digestive health professionals from around the world to become UEG Associates, thereby connecting, networking, and benefiting from a wide range of free resources and educational activities.
Find out more about UEG’s work by visiting: https://ueg.eu/
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
