Just One Sugary Drink a Day Could Increase the Risk for Liver Cancer and Chronic Liver Disease

New research suggests that regular consumption of sugary beverages like sodas, energy drinks, and sweetened coffee concoctions isn’t just linked to obesity and type 2 diabetes — it may also increase the likelihood of developing chronic liver disease and liver cancer.
The study, published August 8 in JAMA, included nearly 100,000 postmenopausal women and found that those who drank one or more sugary drinks a day had a higher risk of liver cancer and death due to chronic liver disease compared with women who drank less than one sugar-sweetened drink a week.
This is the first study to report an association between sugar-sweetened beverage intake and chronic liver disease mortality, according to the authors. “If our findings are confirmed, reducing sugar-sweetened beverage consumption might serve as a public health strategy to reduce liver disease burden,” says corresponding author Xuehong Zhang, MBBS, ScD, an associate professor of nutrition at the Harvard T.H. Chan School of Public Health and associate professor of medicine at Brigham and Women’s Hospital, both in Boston.
Added Sugars in Drinks Can Add Up to a Lot of Extra Calories
The average American consumes 22 teaspoons (tsp) of added sugar a day, which translates into about 350 calories, according to the Harvard T.H. Chan School of Public Health. One teaspoon of sugar is equal to 4 grams (g).
The American Heart Association (AHA) recommends that people cut back on added sugar to help reduce the risk of heart disease and obesity by limiting daily intake to about 6 tsp (24 g) of sugar for women and 9 tsp (36 g) of sugar for men.
Here’s a sampling of how much sugar is found in a 12-ounce (oz) serving of some popular drinks, according to the Harvard T.H. Chan School of Public Health:
- Coca-Cola Classic: 41 g (10 tsp)
- Minute Maid Orange Juice: 41 g (10 tsp)
- Gatorade Thirst Quencher, Orange: 22 g (5 tsp)
- Starbucks Frappuccino: 40.5 g (10 tsp)
The Link Between Sugar and Liver Health
According to the authors, consuming sugar-sweetened beverages — thought to be a risk factor for obesity, diabetes, and cardiovascular disease — may drive insulin resistance and inflammation, which are both strongly associated with the initiation of liver cancer and liver health.
To evaluate whether intake of sugar-sweetened beverages or artificially sweetened beverages was associated with higher rates of liver cancer and chronic liver disease mortality, researchers looked at 98,786 postmenopausal women from the Women’s Health Initiative (WHI), which included women between the ages of 50 to 79 years old who enrolled at one of 40 clinical centers in the U.S. between 1993 and 1998.
At the beginning of the study, participants reported their typical consumption of soft drinks or fruit drinks (but not fruit juice). Three years later, they were asked how often they consumed artificially sweetened beverages.
On average, the women were followed for about 20 years, and researchers tracked self-reported liver cancer incidence and death due to chronic liver disease, such as fibrosis, cirrhosis, or chronic hepatitis. These results were further verified by medical records or the National Death Index.
Just One Sugary Drink a Day Significantly Increased Risk for Liver Cancer and Disease
The 6.8 percent of women who consumed one or more sugar-sweetened beverages per day had an 85 percent higher risk of liver cancer and 68 percent higher risk of chronic liver disease mortality compared to those who had fewer than 3 sugar sweetened beverages per month.
Even after controlling for BMI, the estimates remained largely unchanged, indicating that the apparent link between sugar-sweetened beverage consumption and adverse liver outcomes may exist independently of obesity, says Dr. Zhang.
The authors acknowledged a few shortcomings to the study. For one, it assumed subjects accurately reported how often they consumed the drinks. Additionally, the study was observational, meaning the findings don’t prove that the sugary drinks caused increased risk of liver disease.
These findings are interesting, but they should be viewed with some perspective, says Dale Shepard, MD, PhD, a hematologist and medical oncologist at the Cleveland Clinic in Ohio who was not involved in this study.
“The strengths of this study are the large number of people and the duration of observation. The limitations are: the small number of cases of liver cancer (there were only 207 cases of liver cancer in 100,000 people, even though the subjects were followed for 20 years); the lack of inclusion of fruit juices as a sugar-sweetened beverage (only sodas and fruit drinks were included); and the imbalance in the groups,” Dr. Shepard tells Everyday Health. “The group that consumed more sugar-sweetened drinks had a higher body mass index and were less active, which are both risk factors for cancer, including obesity-related cancers like liver cancer,” he adds.
Why Sugary Drinks May Contribute to Chronic Liver Disease and Cancer
Although this study doesn’t prove that the drinks caused the added risks, there are several potential pathways that could be behind the association between sugary beverages and adverse liver outcomes, says Zhang.
- Additional calories from sugary beverages can contribute to being overweight and obese. Being overweight or obese is a strong risk factor for liver diseases. However, adjustments for body mass index did not significantly change the risk in this study.
- Insulin resistance. The higher intake of fructose may also contribute to dyslipidemia, insulin resistance, and adverse changes in the gut microbiome, which can further influence liver health. Sugars in liquid form are rapidly absorbed, which might lead to metabolic conditions and liver problems.
- Chemicals associated with sugar-sweetened drinks. Metabolites, such as taurine and phenylalanine, and other chemical compounds contained in sugar-sweetened beverages, such as caramel color, citric acid, natural flavors, and organic diol, might also contribute to the detrimental effects of sugar-sweetened beverages.
Should People Who Regularly Consume Sugary Drinks Be Concerned About Risk to Their Liver?
Keep in mind, this was a study that looked at risk in postmenopausal women, and so it’s important to realize that this study doesn’t establish an increased risk in the general population, says Shepard.
“The authors showed that there was a statistically significant difference in risk for liver cancer in those drinking one or more sugar-sweetened beverages, compared to those drinking three or less per month — but this is not likely to be clinically significant given the low numbers of cancers,” he says.
“Clinical significance” is another way of saying whether changing something (in this case, sugary drinks) will have a significant effect on someone’s health outcomes.
Water Is the Best Way to Stay Hydrated
“As a physician, I recommend moderation in what patients eat and drink. The range for consumption for this study was one or more sugar-sweetened beverages a day compared to less than three per month. There were not really clinically significant changes between the two groups, and most patients are likely somewhere in the middle,” says Shepard.
Should people drinking sugary drinks switch to artificially sweetened beverages? While this study suggests that sugar-sweetened drinks may increase liver cancer, recently the World Health Organization has suggested that aspartame, an artificial sweetener, is a possible carcinogen with an association with obesity-related cancers. It’s not likely, then, that patients clearly benefit from one over the other, says Shepard.
According to Harvard’s T.H. Chan School of Public Health, the old reliable — water — is the best choice for quenching your thirst, and unsweetened coffee and tea are also healthy choices.
Fruit juice, milk, and diet drinks should be limited or consumed in moderation, and the guidelines for moderate alcohol intake should be followed. Sugar-sweetened drinks like soda, sports drinks, and energy drinks are considered less healthy options.

Becky Upham
Author
Becky Upham has worked throughout the health and wellness world for over 25 years. She's been a race director, a team recruiter for the Leukemia and Lymphoma Society, a salesperson for a major pharmaceutical company, a blogger for Moogfest, a communications manager for Mission Health, a fitness instructor, and a health coach.
Upham majored in English at the University of North Carolina and has a master's in English writing from Hollins University.
Upham enjoys teaching cycling classes, running, reading fiction, and making playlists.