"The Bitter Truth": Both Sugar and Artificial Sweeteners Increase MASLD Risk - Evidence from the Liver

According to a prospective cohort study from the UK Biobank (n=123,788 / median follow-up of 10.3 years) presented at UEG Week 2025 in Berlin, both sugar-sweetened beverages (SSB) and low/no-sugar sweetened beverages (LNSSB) are associated with an increased risk of metabolic-associated liver disease (MASLD). Consumption of more than 250g per day was linked to approximately a 50% increase in risk for SSB and about a 60% increase for LNSSB. Furthermore, LNSSB was also associated with an increase in liver-related mortality. On the other hand, replacing these beverages with water reduced the risk of MASLD by about 12.8% for SSB and 15.2% for LNSSB. The mechanisms suggested include alterations in gut microbiota, disruption of satiety, enhancement of sweet preference, and stimulation of insulin secretion. The conclusion is clear—**“not sugar to artificial sweeteners, but sweet beverages to water”** is the optimal solution.