For generations, the diet drink has been offered as a concession to modernity — all the pleasure of sweetness, none of the cost. A decade-long study of more than 123,000 British adults, presented in Berlin, now quietly dismantles that bargain: artificially sweetened beverages raise the risk of metabolic liver disease by 60 percent, outpacing even sugary drinks at 50 percent. The finding is less a condemnation of any single ingredient than a reminder that the body keeps its own accounts — and that water, unremarkable as it is, remains the only drink that asks nothing in return.
Diet drinks pose greater liver disease risk than sugary alternatives, study finds
Over 10 years, 1,178 participants developed metabolic liver disease and 108 died from liver-related causes.
Water remains the best choice as it removes the metabolic burden
Mark
So the headline is that diet drinks are worse than sugary drinks for your liver. Is that actually what the study shows?
Mimi
It shows that over ten years, artificially sweetened drinks carried a 60 percent increased risk of liver disease, compared to 50 percent for sugary drinks. So yes, the risk was higher.
Luke
But we should be careful here. This is observational data from a single cohort. We don't know if people drinking diet drinks had other risk factors—weight, alcohol use, metabolic conditions—that weren't fully accounted for. The study controlled for some things, but correlation isn't causation.
Mimi
That's fair. But the mechanism they describe for how diet drinks damage the liver—through microbiome changes and disrupted satiety signals—is plausible based on other research.
Mark
Why would artificially sweetened drinks be worse if they don't have sugar?
Mimi
Because they're not just a sugar substitute. They seem to confuse the body's metabolic signals. You drink something sweet, your body expects calories and glucose, but they don't arrive. That mismatch may trigger insulin anyway, and it changes your gut bacteria in ways that promote fat storage.
Luke
The study doesn't directly measure those mechanisms in individual participants, though. They're inferring the pathway from the outcome.
Mark
And what about the people who actually got sick? What happened to them?
Mimi
Over the decade, 1,178 people developed the disease, and 108 died from liver complications. Most cases were caught early, when there's still no liver damage—just fat accumulation. But some progressed.
Luke
The good news is that progression isn't inevitable. The NHS says lifestyle changes can stop it. And the study found that switching to water reduced risk by over 10 percent.
Mark
So the takeaway is: don't drink either kind of sweetened beverage.
Mimi
Exactly. Water is the safest choice. Both sugary and artificially sweetened drinks carry real metabolic costs.
Luke
And if you're already drinking them regularly, this is a reason to talk to a doctor about your liver health, especially if you have other risk factors.
Il Polso
- A study tracking 123,788 people over ten years found that one daily can of diet drink raises liver disease risk by 60% — higher than the 50% risk from sugary drinks, overturning a cornerstone of health-conscious consumer culture.
- Over the decade, 1,178 participants developed metabolic liver disease and 108 died from liver-related causes, giving statistical weight to what had long been an underexamined risk.
- Diet drinks damage the liver through a distinct and arguably more insidious pathway — disrupting gut microbiota, scrambling satiety signals, and triggering insulin responses despite containing no sugar.
- The condition at stake, MASLD, already affects roughly one in three people globally and can silently progress from fat accumulation to serious liver injury before most people are aware of it.
- Replacing both drink types with water reduced liver disease risk by more than 10%, offering a simple, accessible intervention with measurable protective effect.
For generations, the diet drink has been offered as a concession to modernity — all the pleasure of sweetness, none of the cost. A decade-long study of more than 123,000 British adults, presented in Berlin, now quietly dismantles that bargain: artificially sweetened beverages raise the risk of metabolic liver disease by 60 percent, outpacing even sugary drinks at 50 percent. The finding is less a condemnation of any single ingredient than a reminder that the body keeps its own accounts — and that water, unremarkable as it is, remains the only drink that asks nothing in return.
A decade-long study of more than 123,000 British adults has quietly dismantled one of modern nutrition's most durable assumptions: that diet drinks are the safer choice. Presented at the United European Gastroenterology Week in Berlin, the research found that just one daily can of an artificially sweetened beverage raised the risk of metabolic dysfunction-associated steatotic liver disease — a condition in which fat accumulates in the liver — by 60 percent. Sugar-sweetened drinks, long understood to be harmful, increased that same risk by only 50 percent.
MASLD affects more than 30 percent of people worldwide. It begins quietly, with fat building up in liver tissue, but can progress to serious injury in a subset of cases. Led by Lihe Liu, a gastroenterology graduate student at Soochow University in China, the research team tracked participants from the UK Biobank over ten years using repeated dietary questionnaires. The human toll was concrete: 1,178 people developed MASLD during the study period, and 108 died from liver-related causes.
The two drink types damage the liver through different mechanisms. Sugary drinks spike blood glucose and insulin, promote weight gain, and raise uric acid — all drivers of liver fat. Diet drinks, by contrast, alter the gut microbiome, disrupt the body's fullness signals, intensify sweet cravings, and may provoke insulin secretion despite containing no sugar. In some respects, this makes them more metabolically disruptive than the drinks they were designed to replace.
The study's most actionable finding was also its simplest: when participants replaced both drink types with water, their risk of developing MASLD fell by more than 10 percent. Liu's conclusion was unambiguous — limit both categories, and choose water. For a condition that affects roughly one in three people globally and can be halted or reversed through lifestyle change, that substitution may carry more consequence than it appears.
A decade-long study of more than 123,000 British adults has upended a widely held assumption about diet beverages: that they represent a safer choice than their sugary counterparts. The research, presented at the United European Gastroenterology Week in Berlin, found that drinking just one can daily of an artificially sweetened beverage raised the risk of metabolic dysfunction-associated steatotic liver disease—a condition where fat accumulates in the liver—by 60 percent. Sugar-sweetened drinks, by comparison, increased that same risk by 50 percent.
Metabolic dysfunction-associated steatotic liver disease, or MASLD, affects more than 30 percent of people worldwide. It begins when fat builds up in the liver without causing immediate damage, but in a smaller subset of cases, it progresses to more serious stages of liver injury. The condition has become a growing global health concern, yet the mechanisms by which different beverages contribute to its development have remained poorly understood—until now.
Lihe Liu, a graduate student in gastroenterology at the First Affiliated Hospital of Soochow University in Suzhou, China, led the research team. Over ten years, they tracked 123,788 participants from the UK Biobank who had no liver disease at the study's start. Researchers assessed what people drank using repeated 24-hour dietary questionnaires administered at multiple points across the decade. The results were stark: 1,178 participants developed MASLD during the follow-up period, and 108 died from liver-related causes.
The pathways by which each type of drink damages the liver appear to differ. Sugar-sweetened beverages cause rapid spikes in blood glucose and insulin levels, promote weight gain, and increase uric acid—all factors that drive fat accumulation in liver tissue. Artificially sweetened drinks work through a different mechanism: they alter the composition of the gut microbiome, disrupt the body's signals of fullness, intensify cravings for sweet foods, and may even trigger insulin secretion despite containing no sugar themselves. In some respects, this makes diet drinks more metabolically disruptive than their sugary alternatives.
The findings challenge a perception that has shaped consumer behavior for decades. Diet drinks have long been marketed as a health-conscious option, a way to enjoy familiar beverages without the caloric or glycemic burden of sugar. Liu emphasized that the study "refutes this notion," noting that even a single can per day of artificially sweetened drinks carried measurable risk. The research suggests that both categories of beverage—sugary and artificially sweetened alike—warrant reconsideration in the context of liver health.
There is, however, a clear intervention. When participants replaced both sugary and artificially sweetened drinks with water, their risk of developing MASLD dropped by more than 10 percent. Water carries no metabolic burden, prevents fat from accumulating in liver tissue, and simply hydrates the body. Liu's conclusion was direct: "The safest approach is to limit both sugar-sweetened and artificially sweetened drinks." The NHS notes that MASLD can be halted or reversed through lifestyle changes, meaning that dietary intervention—particularly the substitution of water for sweetened beverages—could prevent progression of a disease that currently affects roughly one in three people globally.
Citazioni salienti
Even a single can per day of artificially sweetened drinks were linked to a higher risk of liver disease— Lihe Liu, lead study author, First Affiliated Hospital of Soochow University
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— Lihe Liu
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