A Touch of Salt Can Affect Liver Health
Regularly salting your food not only may impact your type 2 diabetes and cardiovascular disease, new research suggests it’s also linked with higher risks for liver diseases, including metabolic dysfunction-associated steatotic liver disease (MASLD), cirrhosis, and hepatocellular carcinoma. Ironically, this link was stronger among nonsmokers, current alcohol consumers, and those without diabetes or with a lower BMI. Body composition (higher body fat) also raised the risk. 1
Past research has indicated that foods with added salt are linked with negative health outcomes, including type 2 diabetes, cardiovascular disease, and death. Its role in liver conditions was not well researched. 2, 3
A prospective cohort study was conducted with 492,265 subjects (mean age, 56.5 years; 45.3% men) from the UK Biobank without liver diseases or alcohol/drug use disorders at baseline.
Self-reported salt use and frequency of adding salt to foods were classified as never/rarely, sometimes, usually, and always in participants.
MASLD was the main incident outcome, while secondary conditions included cirrhosis and hepatocellular carcinoma, discovered using diagnostic codes through electronic health records.
The link between adding salt to food and the risk of liver-related diseases was evaluated using models adjusted for lifestyle factors, sociodemographic characteristics, history of diseases, and nutritional factors. Linear trends were assessed based on the frequency of adding salt to foods.
An increased risk of incident MASLD was observed with using salt more frequently on food with varying degrees: sometimes, usually, and always compared to never/rarely.
Increased risks for cirrhosis and hepatocellular carcinoma were noted with a higher frequency of adding salt. This was also noted with varying degrees depending on sometimes, usually, and always compared to never/rarely.
The link between adding salt frequency and risk for MASLD was higher in nonsmokers, current alcohol consumers, and those without diabetes or with a lower BMI.
Measures of body fatness, such as BMI, waist-to-hip ratio, body fat mass, and body fat percentage, mediated over 20% of the associations between frequency of adding salt and the risk of incident MASLD. Similar factors were associated with cirrhosis and hepatocellular carcinoma in addition to alcohol intake. 1
Practitioners can help clients reduce salt intake with these tips:
· Teach clients to read labels to evaluate the sodium content of commercial foods.
· Offer tips and tricks for seasoning food without salt.
· Encourage moderation or cessation of alcohol intake.
· Provide low-sodium recipes to clients.
· Encourage strength training to improve body composition.
· Monitor blood pressure and other metabolic parameters linked with salt consumption.
· Offer cooking classes focused on low-sodium diets.
· Discourage intake of added sugar, which also impacts risk for MASLD.
· Provide ideas for low-calorie mocktails.
· Work with other healthcare practitioners to identify patients at risk for MASLD.
Lisa Andrews, MEd, RD, LD
Resources
1. Zhang, S., Huo, Z., Borné, Y. et al. Adding salt to foods and risk of metabolic dysfunction-associated steatotic liver disease and other chronic liver diseases. Eur J Nutr 64, 224 (2025). https://doi.org/10.1007/s00394-025-03745-3
2. Ribeiro NG, Lelis DF, Griep RH, Barreto SM, Molina MDCB, Schmidt MI, Duncan BB, Bensenor I, Lotufo PA, Mill JG, Baldo MP. Salt Intake in Adults with Diabetes and Hypertension: The Longitudinal Study of Adult Health-Brasil Study. Metab Syndr Relat Disord. 2024 Jun;22(5):356-364. doi: 10.1089/met.2023.0304. Epub 2024 Apr 2. PMID: 38563778.
3. Ma H, Wang X, Li X, Heianza Y, Qi L. Adding Salt to Foods and Risk of Cardiovascular Disease. J Am Coll Cardiol. 2022 Dec 6;80(23):2157-2167. doi: 10.1016/j.jacc.2022.09.039. PMID: 36456045.
