Rohan, a 34-year-old marketing professional, was surprised by his early-stage fatty liver disease diagnosis. That’s because he said he ate clean, having home-cooked meals on most days while maintaining an active lifestyle and an occasional glass of alcohol at social events. But he had a hidden drinking habit which he had not recognised.

Since cola drinks are a health concern, throughout the week he would have energy drinks, mocktail mixes and packaged fruit juices during work breaks, thinking they were less harmful. Then there was the occasional alcohol over the weekends. This, combined with late-night food consumption and irregular sleep patterns, had stressed his liver. Many of these beverages deliver large amounts of sugar — especially fructose — in a form your liver struggles to handle.

Fructose is processed primarily in the liver. When fructose intake is modest, such as when eating whole fruits, the liver can manage it efficiently. But when large amounts arrive quickly, the liver becomes overloaded and must convert the excess into fat.

Sugary beverages make this process worse because they are absorbed very rapidly. Unlike whole fruits, they contain little or no fibre to slow digestion. Liquid calories also do not create the same feeling of fullness as solid food, making it easy to consume large quantities without realizing it. This leads to rapid spikes in blood sugar and insulin levels. When excess fructose reaches the liver, it activates a fat-producing pathway. If the body does not immediately use this fat for energy, it begins to accumulate inside liver cells. Gradually, this buildup leads to fatty liver.

Most of these drinks contain table sugar, high-fructose corn syrup or fruit juice concentrates. A single can of an energy drink may contain very high amounts of added sugar, sometimes equal to or more than soft drinks. The caffeine content can mask fatigue, encouraging people to drink more than they normally would. This combination of frequent intake and heavy sugar load increases the amount of fructose delivered to the liver, accelerating fat production and metabolic strain.

Packaged fruit juices are widely perceived as healthy because they come from fruit and often carry labels highlighting vitamins and antioxidants. However, processing removes most of the fibre that normally slows sugar absorption. What remains is a concentrated source of natural sugars that enter the bloodstream quickly. Drinking juice can, therefore, deliver the sugar equivalent of multiple fruits within minutes, placing a sudden burden on the liver.

Mocktail mixes create a different kind of risk. Though alcohol-free, many rely on flavoured syrups, sweetened fruit concentrates and added sugars to enhance taste. Because they are associated with celebrations and social occasions, people may consume them in large servings without considering their sugar content. The liver ultimately processes this sugar the same way it would from any sweetened beverage.

Regular intake of sugary drinks can also push the body into insulin resistance. Frequent blood sugar spikes cause repeated insulin release. Over time, cells become less responsive to insulin, forcing the body to produce even more. This hormonal imbalance signals the liver to store additional fat, creating a harmful cycle that raises the risk of fatty liver, obesity, metabolic syndrome and Type 2 diabetes.

The body treats alcohol as a toxin. While the liver works to break down alcohol, its ability to process fats and sugars slows. This creates a metabolic traffic jam: fat that would normally be burned for energy begins to accumulate inside liver cells. At the same time, sugary drinks deliver a surge of fructose, which the liver converts into more fat. The result is a double burden that accelerates fatty liver development.

Besides, people usually accompany their drinks with high-calorie meals late at night, when body metabolism slows down naturally.

Making thoughtful beverage choices can significantly reduce this risk. Choosing whole fruits instead of juices, drinking infused water, opting for unsweetened coconut water or selecting plain tea and coffee can help lower sugar intake while still providing refreshment. Fresh citrus spritzers made with squeezed lemon, lime, or orange, sparkling water and crushed mint give the same refreshing feel without sugar overload. All of these work well for a celebratory mood.

For Rohan, we capped alcohol to once a week before gradually phasing it out. Packaged juices on an empty stomach were replaced with healthier options, and meals were balanced with adequate protein and fibre. He stopped eating late, shifted to earlier dinners and began brief walks after meals.

Within three months, he lost weight and reported higher energy levels. Digestive discomfort reduced, and the fatigue that once followed weekend indulgences disappeared. Follow-up tests showed his liver health had improved as fat accumulation began to reverse. Steady routines helped him regain control of his health.

(Kathuria is a clinical dietician)