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SUGAR- AND LOW/NON-SUGAR-SWEETENED BEVERAGES AND RISKS OF METABOLIC DYSFUNCTION–ASSOCIATED STEATOTIC LIVER DISEASE AND LIVER-RELATED MORTALITY: A PROSPECTIVE ANALYSIS OF THE UK BIOBANK

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Introduction

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a critical component of multi-system metabolic dysfunction and has emerged as a significant global health issue. A growing body of evidence suggests that intake of sugar and its substitutes is linked to cardiometabolic and kidney diseases. While sugar-sweetened beverages (SSBs) and low- or non-sugar-sweetened beverages (LNSSBs) are widely consumed, their associations with liver health outcomes remain uncertain.

Aims & Methods

In this prospective cohort study of 103,251 UK Biobank participants free of baseline liver disease, we investigated the associations between SSBs and LNSSBs intake and the risk of incident MASLD and liver-related mortality. Beverage consumption was assessed through multiple 24-hour dietary questionnaires. The primary outcome was incident MASLD, and secondary outcomes included liver-related mortality and liver fat content measured by MRI- derived proton density fat fraction. Multivariable Cox regression, linear models, stratified analyses, restricted cubic spline, sensitivity analyses, and beverage substitution analyses were employed.

Results

Over a median 10.3-year follow-up, 949 participants developed MASLD, and 103 died from liver-related causes. Higher intake of LNSSBs (>330 g/day) and SSBs (>330 g/day) were associated with elevated MASLD risk (HR: 1.597 and 1.502, respectively; both p < 0.01). LNSSBs consumption also increased liver-related mortality risk in a dose-dependent manner, while no significant association was observed for SSBs. Both beverages were positively associated with liver fat content. Replacing 330 g/day of either beverage with water significantly reduced MASLD risk by 14.7% (SSBs) and 13.5% (LNSSBs), whereas substitution between LNSSBs and SSBs showed no difference in risk.

Conclusion

High intake of either SSBs or LNSSBs is significantly associated with an increased risk of MASLD, with LNSSBs additionally linked to a higher risk of liver-related mortality. Water substitution may offer benefits. These findings support limiting the intake of both SSBs and LNSSBs as part of comprehensive prevention strategies targeting cardio-renal-liver-metabolic dysfunction.

SUGAR- AND LOW/NON-SUGAR-SWEETENED BEVERAGES AND RISKS OF METABOLIC DYSFUNCTION–ASSOCIATED STEATOTIC LIVER DISEASE AND LIVER-RELATED MORTALITY: A PROSPECTIVE ANALYSIS OF THE UK BIOBANK

Lihe Liu 1, Zhaoyang Zou 1, Guoting Xu 1, JINZHOU ZHU 2, RUI LI 3, Airong Wu 1

1 The First Affiliated Hospital of Soochow University, Suzhou, China

2 The first affiliated hospital of Soochow University, Suzhou, China

3 The First Affiliated Hospital Of Soochow University, Suzhou, China

Event

UEG Week Berlin 2025

Topics

Hepatobiliary

Submission format

Abstract

Session

Lifestyle management and therapy in MASLD

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Predicting HCC in metabolic liver disease

Carolin Schneider 1

1 Rwth Aachen, Med III, Aachen, Germany

Event

UEG Week Berlin 2025

Topics

Hepatobiliary

Session

Rising Stars from Europe and Japan: Metabolic liver diseases

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Novel treatment options in PBC

Ana Lleo 1

1 Humanitas University, Milan, Italy

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Immunology Pancreas

Session

Developments in autoimmune HPB disease

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Upcoming therapies in coeliac disease

Michael Schumann 1

1 Charité Berlin, Berlin, Germany

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Hepatobiliary Immunology Mechanisms & Personalised Medicine Small Intestine & Nutrition

Session

The art of making clinical research precise: What will be new in therapy in 2030?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Future trends in diagnosis and management of coeliac disease

Fabiana Zingone 1

1 University of Padua, Padua, Italy

Event

UEG Week Berlin 2025

Topics

Immunology Small Intestine & Nutrition

Session

Coeliac or non-coeliac enteropathy?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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STANDARD VERSUS DOUBLE DOSE OF HEPATITIS B VACCINE IN INFLAMMATORY BOWEL DISEASE: A RANDOMIZED TRIAL

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Introduction

Response to hepatitis B vaccine (HBV) is variable in inflammatory bowel disease (IBD) patients with seroconversion rates of 34-89%. Strategies suggested to improve the seroconversion rates are double dose, accelerated schedule, or addition of booster dose with variable results. This study compared the standard (20 µg) dose and double (40 µg) dose of HBV vaccination in IBD patients.

Aims & Methods

Patients of IBD were randomized to 1:1 to receive standard or double dose of HBV at 0, 1 and 6 months. Anti-HBs titers were assessed at 1 month after the third dose. Response was defined as an adequate immune response (AIR, anti-HBs titer >10 mIU/mL) and effective immune response (EIR, anti-HBs titer >100 mIU/mL). Total mayo score and Crohn’s disease activity index (CDAI) was used to identify the active disease. IBD medications with immunosuppressive effects were categorized as immunomodulators, corticosteroids, tofacitinib and biologic group. Multivariable logistic regression analysis was done to identify the predictors of AIR and EIR.

Results

Eighty-eight patients of IBD were randomized to receive standard (45, 51.1%) or double (43, 48.9%) dose of HBV. 79 of 88 patients had ulcerative colitis (UC) and 9 had Crohn’s disease (CD). 49 (55.7%) patients had active disease while 39 (44.3%) were in remission. At the end of the study, total 63 (71.61%) patients achieved AIR and 51 (60%) achieved EIR. AIR (88.4 % vs. 55.6 %, p 0.001) and EIR (69.8% vs. 46.7%, p = 0.028) rates were significantly higher with double dose compared to standard dose of HBV. Patients with active IBD had higher AIR (87.5% vs. 44%, p = 0.001) and EIR (70.8% vs. 32%, p = 0.007) rates with double dose of HBV. Patients with IBD in remission also had higher AIR (89.5% vs. 70%) and EIR (78.4% vs. 65%) rates with double dose of HBV, though statistically non-significant.
Multivariable analysis identified the use of double dose of HBV {odds ratio (OR) 10.865, 95% confidence interval (CI): 2.418-48.817} and biologic (OR 0.022, 95% CI: 0.001-0.421) as predictors to achieve AIR. Similarly, double dose of HBV (OR 3.0, 95% CI: 1.087-8.280) and use of biologic (OR 0.074, 95% CI: 0.006-0.931) also predicted the EIR.

Conclusion

Double dose of HBV vaccine demonstrated a superiority over standard dose of vaccine for achieving both AIR and EIR. Use of biologic impaired the response. Double dose of HBV should be used in IBD patients to improve the seroconversion rates.