Diet soda intake higher among people with liver disease

To find the connection between diet sodas and MASLD, the present study’s authors analyzed data from the National Health and Nutrition Examination Survey (NHANES)Trusted Source.

The United States’ National Center for Health Statistics sponsors this program to evaluate the health and nutritional conditions of the American population.

Detailed records of diet soda consumption were only available during the 2003–2006 dietary interviews. The study authors examined information on a total of 2,378 participants.

The final study assessment categorized 1,089 people with MASLD and 1,289 with no MASLD.

The NHANES database had no data on liver transient elastography, so the Fatty Liver Index (FLI) was used to determine MASLD status.

Responses to the food frequency questionnaire informed the assessment of diet soda consumption frequency. The answers to the question “How often do you drink diet soft drinks?” included:

  • never
  • rarely
  • sometimes
  • always

The researchers adjusted their results for confounding variables among participants, including:

  • age
  • gender
  • ethnicity
  • smoking status
  • average daily physical activity
  • carbohydrate intake
  • hypertension
  • diabetes

Males made up 54.6% of the MASLD group, and the MASLD group’s diet soft drink intake was dramatically higher than the non-MASLD counterparts’ reported consumption.

Hypertension, hyperlipidemia, and diabetes were also significantly more prevalent among the MASLD population than in the non-MASLD group.

What’s the link between BMI and liver disease?

Dr. Gupta shared: “The inclusion of mediation analysis to explore the potential mediating role of BMI provides insights into the mechanisms underlying the association between diet soft drink consumption and MASLD.”

The study’s authors also tested their hypothesis that BMI may be a mediating factor in MASLD.

After accounting for age, gender, race, dietary factors, and cardiometabolic conditions, the team found that diet soda consumption “was positively associated with the occurrence of MASLD.”

The scientists also noticed a positive correlation between BMI and MASLD.

“It was estimated that 84.7% of the total association between diet soft drink consumption and MASLD was mediated by BMI,” the researchers reported.

More research on diet soda intake and MASLD needed

Dr. Gupta said she was impressed with the study’s large sample size and adjustments for potential demographic, lifestyle, and metabolic syndrome-related confounders.

But she and the study’s authors noted a few drawbacks to the new research.

First, FLI was used instead of the imaging method widely used in clinics. Although FLI has been validated, Dr. Gupta said that it could falsely indicate the presence of fatty liver or fail to detect it.

As the study’s authors mentioned, the cross-sectional design could have made reverse causality possible. In other words, people diagnosed with MASLD may have altered their diet soda intake in response to the diagnosis.

“Using self-reported data is subject to recall bias, [and] the study didn’t use detailed dietary records or biomarkers such as metabolites,” Dr. Gupta said.

She also said that BMI as an obesity marker has its own limitations, as it doesn’t distinguish between muscle and fat mass, or consider fat distribution. Neither does it provide information about metabolic health.

Lastly, this work did not account for genetic variants or sleep patterns, both of which are risk factors for MASLD.

The study’s authors believe that randomized controlled trials (RCTs) will be needed to provide more robust evidence for their findings.