Brussels, 9 October 2025: The International Sweeteners Association (ISA) would like to point to the limitations of the observational study presented at the United European Gastroenterology (UEG) Week 2025 that reported an association between beverages with low/no calorie sweeteners and liver disease.
While observational studies can highlight population-level trends, they cannot establish causation. Importantly, individuals often switch to low/no calorie sweetened beverages due to pre-existing health conditions such as obesity, diabetes, or other metabolic disorders, all of which are known risk factors for liver disease. This phenomenon, known as reverse causation, suggests that the observations made may reflect underlying health issues rather than a direct effect of the low/no calorie sweetened beverages themselves.
Robust evidence from systematic reviews of randomised controlled trials (RCTs), the gold- standard in nutrition science, provides a clearer picture. These studies show that replacing sugar-sweetened beverages with low/no calorie sweetened alternatives can reduce liver fat, body weight, and body fat (McGlynn et al., 2022). This stronger causal evidence does not support the biological plausibility of the harmful associations reported in the study presented at UEG Week 2025.
As part of a balanced diet and healthy lifestyle, low/no calorie sweeteners can be used to further public health objectives on sugar intake reduction and ultimately assist in weight and diabetes management, as well as with dental health.