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A large new analysis suggests that swapping sugary sodas for diet versions may not protect your liver. Researchers found that drinks sweetened with artificial compounds were linked to a higher chance of metabolic dysfunction-associated steatotic liver disease. The findings raise fresh questions about everyday beverage choices and liver health.
Study overview: who was tracked and for how long
Scientists followed nearly 123,800 adults from the United Kingdom over more than a decade. Participants reported their intake of soft drinks between 2009 and 2012, answering how many 250 mL servings they drank the day before. That slim-can measure became the basis for exposure categories.
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The team then monitored medical records to see who developed MASLD, the condition where excess fat builds up in the liver and triggers inflammation.
Key findings: diet drinks and regular soda both raise liver risk
The analysis found that drinking more than a single 250 mL can of diet soda each day was associated with a markedly higher risk of MASLD. Regular sugary soft drinks were also linked to increased risk, but to a slightly lesser degree.
- Diet beverages: More than one slim can daily was tied to about a 60% higher risk of developing MASLD.
- Sugar-sweetened drinks: The same intake level showed roughly a 50% higher risk.
Both drink types were associated with greater liver fat accumulation. Notably, only artificially sweetened beverages were linked to higher rates of liver-related death in this cohort.
How sweet drinks may harm the liver
Researchers discussed several biological pathways that could explain the association. The mechanisms differ between sugar-sweetened and artificially sweetened drinks.
Effects tied to sugary beverages
- Rapid blood glucose and insulin spikes.
- Greater calorie load and weight gain over time.
- Higher uric acid levels, which can worsen metabolic stress.
Possible harms from artificial sweeteners
- Alterations to the gut microbiome that may affect metabolism.
- Interference with satiety signals, prompting more calorie intake.
- Potential stimulation of insulin secretion despite low calories.
These pathways are not mutually exclusive, and individual responses may vary depending on genetics, diet and gut bacteria.
Public health context: how common is MASLD?
MASLD is already widespread. Current estimates put prevalence near 38% among adults. As obesity and diabetes rise, experts predict this could climb above 55% by 2040.
That trajectory makes even modest lifestyle contributors—like daily beverage choices—important for long-term liver health.
Study limits and industry reaction
The research team acknowledged several shortcomings. Consumption data relied on single-day recall and did not identify specific brands or individual artificial sweeteners. The study has not completed peer review.
Industry groups criticized the work. One trade association emphasized the study’s reliance on self-reported intake and called for peer-reviewed clinical trials to guide public messaging.
Practical takeaways and data-driven swaps
- Replacing sweetened drinks with water was associated with a reduced MASLD risk in the analysis.
- Substituting water for sugary soda cut risk by about 12.8%.
- Replacing diet soda with water showed an estimated 15.2% lower risk.
Researchers advise limiting both sugar-sweetened and artificially sweetened beverages and favoring plain water for hydration when possible.
What researchers plan next
The team intends to dig deeper into how sugars and their substitutes interact with gut bacteria and metabolic pathways. Future work aims to identify whether particular sweeteners carry greater risk and how individualized factors shape outcomes.
