In a recent exploration featured in BMC Public Health, researchers delved into the intricate relationship between diet soft drink consumption and the onset of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).
Leveraging data from the National Health and Nutrition Examination Surveys (NHANES), the study aimed to shed light on the potential risks posed by artificial sweeteners in these beverages.
MASLD, a burgeoning chronic liver disease on a global scale, has witnessed a concerning rise in incidence rates. In the absence of dedicated pharmaceutical interventions, current preventive measures revolve around diet control and physical exercise, both aimed at reducing body fat to mitigate liver steatosis. However, emerging evidence suggests that certain diets, particularly those including diet soft drinks, may elevate the risk of MASLD.
Contrary to the perception that “zero calorie” diet soft drinks prevent weight gain, studies indicate that excessive consumption can lead to obesity. Compounding this issue, the World Health Organization (WHO) has classified the artificial sweetener aspartame, commonly found in diet soft drinks, as carcinogenic to humans since July 2023.
Preclinical studies have further unveiled a potential link between artificial sweeteners and insulin resistance (IR), as well as glucose intolerance—both implicated in MASLD pathogenesis.
Researchers conducted an extensive analysis using NHANES data from 2003–2006, encompassing 2,378 participants. The study cohort comprised 1,089 individuals with MASLD (FLI ≥60) and 1,289 without MASLD.
Diet soft drink intake was gauged through participants’ responses to frequency-related queries. The researchers categorized responses into “Never,” “Rarely,” “Sometimes,” and “Always,” with covariates including age, sex, race/ethnicity, education, smoking status, physical activity levels, and dietary factors.
The MASLD group exhibited a higher frequency of diet soft drink intake, notably associated with the “always” category. Despite no statistical difference in energy intake, the MASLD population had a significantly higher BMI compared to the non-MASLD group.
Logistic regression models consistently revealed a significant association between frequent diet soft drink consumption and MASLD, even after adjusting for demographic, lifestyle, and metabolic syndrome variables. Subgroup analysis identified a notable interaction between diet soft drink intake and type 2 diabetes (T2D) in MASLD incidence.
Furthermore, the study uncovered that BMI played a crucial mediating role, explaining 84.7% of the association between diet soft drink intake and MASLD. However, the question of whether diet soft drink intake directly leads to weight gain remains an open avenue for future investigation.
This nationally representative study contributes valuable insights, estimating a higher weighted prevalence rate of MASLD associated with excessive diet soft drink intake. The findings underscore the need for nuanced dietary recommendations in the prevention and treatment of MASLD, with a particular emphasis on the potential impact of artificial sweeteners.