For generations, the diet drink has been offered as a quiet compromise — the pleasure of sweetness without the guilt of sugar. A decade-long study of more than 123,000 people in the United Kingdom has now dismantled that bargain, finding that artificially sweetened beverages carry an even greater risk of liver disease than their sugary counterparts. The research, presented in Berlin, arrives at a moment when metabolic liver disease already touches more than a third of humanity, asking us to reconsider not which sweetened drink to choose, but whether the choice itself is the problem.
Diet drinks pose greater liver disease risk than sugary alternatives, study shows
Over the 10-year study period, 1,178 participants developed metabolic dysfunction-associated steatotic liver disease and 108 died from liver-related causes.
Even a single can per day was linked to higher liver disease risk
Mark
So the study is saying diet drinks are actually worse than regular soda? That seems counterintuitive.
Mimi
Yes, at least for liver disease risk. Over ten years, people drinking one can a day of artificially sweetened beverages had a 60 percent increased risk, compared to 50 percent for sugary drinks.
Luke
But I want to be careful here—those are relative risk increases, not absolute risk. We don't know what the baseline risk was. If the baseline is low, a 60 percent increase might still be a small number in real terms.
Mimi
That's fair. What we do know is that 1,178 people out of 123,788 developed the disease over the decade. So the absolute numbers are real, even if the relative percentages need context.
Mark
Why would artificial sweeteners be worse? They have no calories, no sugar.
Mimi
The theory is they work through different mechanisms—they alter gut bacteria, mess with your sense of fullness, and may actually trigger insulin release even though there's no sugar. So your body gets confused.
Luke
But that's the mechanism Liu proposed. We should note that's still being studied. The study shows the association, but the why is still somewhat speculative.
Mark
What about just drinking regular soda then, if it's slightly less risky?
Mimi
The researchers say no—both are harmful. The point isn't to pick the lesser evil. It's to drink water instead.
Luke
And that part of the study is solid. They found that replacing both types of sweetened drinks with water reduced liver disease risk significantly.
Mark
So this changes the whole "diet drink" marketing angle.
Mimi
Completely. For decades, diet drinks have been positioned as the responsible choice for people watching their weight. This study suggests that trade-off doesn't exist for liver health.
Luke
Though we should note this is one study, even if it's a large one. It needs replication. But it's compelling enough that people should probably take it seriously.
Il Polso
- A 60% increased risk of liver disease from just one daily diet drink — higher than the 50% risk from sugary sodas — shatters the foundational assumption that artificial sweeteners are the cautious, responsible alternative.
- Over ten years, 1,178 study participants developed metabolic liver disease and 108 died from liver-related causes, giving statistical weight to what had long been a quiet, symptomless epidemic.
- Two very different biological mechanisms — sugar destabilising blood glucose and promoting fat accumulation, artificial sweeteners disrupting gut microbiota and hijacking hunger signals — converge on the same dangerous destination: fat in the liver.
- Researchers are not urging people to pick the lesser poison but to step away from both, with evidence showing that replacing sweetened beverages of any kind with water meaningfully reduces liver disease risk.
- With MASLD now affecting more than 30% of the global population and advancing without obvious symptoms, this study lands as an urgent call to revisit public health guidance that has long treated diet drinks as a safe harbour.
For generations, the diet drink has been offered as a quiet compromise — the pleasure of sweetness without the guilt of sugar. A decade-long study of more than 123,000 people in the United Kingdom has now dismantled that bargain, finding that artificially sweetened beverages carry an even greater risk of liver disease than their sugary counterparts. The research, presented in Berlin, arrives at a moment when metabolic liver disease already touches more than a third of humanity, asking us to reconsider not which sweetened drink to choose, but whether the choice itself is the problem.
A decade-long study tracking more than 123,000 people across the United Kingdom has overturned one of modern nutrition's most comfortable assumptions: that choosing a diet drink over a sugary one is a meaningful act of self-care. Presented at the United European Gastroenterology Week in Berlin, the research found that consuming just one can daily of an artificially sweetened beverage raised the risk of developing metabolic dysfunction-associated steatotic liver disease — MASLD, a condition in which fat silently accumulates in the liver — by 60 percent. Sugar-sweetened drinks, long cast as the obvious villain, raised that same risk by only 50 percent.
The study followed 123,788 participants who began the research free of liver disease, monitoring their drinking habits through repeated dietary questionnaires over ten years. By the end, 1,178 had developed MASLD and 108 had died from liver-related causes. The condition, which now affects more than 30 percent of people worldwide, typically progresses without obvious symptoms, making findings like these all the more consequential.
Led by Lihe Liu of Soochow University in China, the research identified distinct but equally damaging biological pathways for each type of drink. Sugary beverages spike blood glucose and insulin, promote weight gain, and raise uric acid levels — all roads leading to liver fat. Artificially sweetened drinks work differently, disrupting gut microbiota, blunting the body's natural fullness signals, intensifying sweet cravings, and potentially triggering insulin responses despite containing no sugar at all. Different mechanisms, the same harmful destination.
The study's conclusion is not that one drink is marginally worse than the other, but that the choice between them is a false one. Replacing both with water was shown to significantly reduce liver disease risk. As Liu put it plainly: the safest approach is to limit both. In a world where diet drinks have long been marketed as the sensible middle ground, that message demands a serious reckoning.
A decade-long study of more than 123,000 people in the UK has upended a widely held assumption about diet drinks: that swapping sugary sodas for artificially sweetened alternatives is a sensible health trade-off. The research, presented at the United European Gastroenterology Week in Berlin, found the opposite. Consuming just one can daily of a drink sweetened with artificial ingredients increased the risk of developing metabolic dysfunction-associated steatotic liver disease—a condition in which fat accumulates in the liver—by 60 percent. Sugar-sweetened beverages, by contrast, raised that risk by 50 percent.
Metabolic dysfunction-associated steatotic liver disease, or MASLD, now affects more than 30 percent of people worldwide. It is a silent condition, often progressing without obvious symptoms, and it has emerged as a significant public health concern. The study tracked 123,788 participants who had no liver disease at the outset, monitoring their beverage consumption through repeated 24-hour dietary questionnaires over ten years. During that period, 1,178 of them developed MASLD. Another 108 died from causes related to liver disease.
Lihe Liu, a graduate student in the gastroenterology department at the First Affiliated Hospital of Soochow University in Suzhou, China, led the research. He noted that the findings directly challenge the common perception that diet drinks represent a safer choice. "Even a single can per day of artificially sweetened drink was linked to a higher risk of liver disease," Liu said. The research suggests that both categories of beverage—the sugary and the artificially sweetened—carry distinct but serious risks to liver health, each through different biological pathways.
Sugar-sweetened beverages damage the liver primarily through metabolic stress. High sugar content triggers rapid spikes in blood glucose and insulin levels, promotes weight gain, and increases uric acid—all of which contribute to the accumulation of fat in liver cells. Artificially sweetened drinks, meanwhile, appear to harm the liver through a different mechanism. These beverages alter the composition of the gut microbiome, disrupt the body's natural signals of fullness, intensify cravings for sweet foods, and may even trigger insulin secretion despite containing no sugar themselves. Both pathways, it seems, lead to the same outcome: fat building up where it should not.
The study's authors emphasized that the safest approach is not to choose between two bad options but to abandon both. Replacing sugar-sweetened and artificially sweetened beverages with water significantly reduced the risk of developing liver disease. Liu stressed this point plainly: "The safest approach is to limit both sugar-sweetened and artificially sweetened drinks." The research does not suggest that one type of drink is merely slightly worse than the other; it indicates that both carry measurable harm, and that the conventional wisdom—diet drinks as the responsible choice—requires serious reconsideration, particularly as MASLD continues to spread as a global health burden.
Citazioni salienti
Even a single can per day of artificially sweetened drink was linked to a higher risk of liver disease— Lihe Liu, lead researcher
The safest approach is to limit both sugar-sweetened and artificially sweetened drinks— Lihe Liu
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