Sugar-sweetened drinks may boost liver cancer risk

Clinical takeaway: Sugary drinks, not diet alternatives, are tied to liver cancer risk, supporting a focus on cutting added-sugar beverages in counseling.

Both sugary and artificially sweetened drinks have been tied to metabolic conditions that raise liver cancer risk, but whether the drinks themselves carry independent risk has stayed unsettled. A 2023 decision classifying aspartame as a possible carcinogen, on limited liver cancer evidence, sharpened the question. This pooled analysis examined both beverage types across liver cancer overall and its two main subtypes.

Each additional daily sugar-sweetened beverage was linked to a 10% higher risk of hepatocellular carcinoma and a 15% higher risk of intrahepatic cholangiocarcinoma. These subtype results were the most robust, holding up independent of the one outlying cohort that had complicated the overall pooled estimate.

For artificially sweetened drinks, an apparent association vanished after adjustment for body mass index and diabetes, with no link to liver cancer overall or either subtype. Heavier diet-drink consumers started with more metabolic risk, which appeared to explain the early signal.

Investigators pooled individual-level data from 11 prospective cohorts, 10 in the US and one in Europe, covering more than 1.5 million cancer-free adults. Intake came from validated food frequency questionnaires, modeled per additional daily drink. Over a median 17.8 years, 2,811 incident liver cancers accrued, including 1,699 hepatocellular carcinomas and 444 cholangiocarcinomas.

The analysis found no safe cutoff for sugar-sweetened beverages. Risk climbed per daily drink in a roughly linear fashion, so the signal points to less rather than to any particular limit.

"Based on this study and prior research associating SSB (sugar-sweetened beverages) with adverse outcomes, individuals may benefit from reducing their intake of SSB," the authors conclude.

Source: Watling CZ. JAMA Netw Open. 2026 Jun 10. Artificially sweetened and sugar-sweetened beverage intake and risk of liver cancer