Association between chrononutrition patterns and metabolic dysfunction-associated steatotic liver disease in adolescents: a population-based study

May 26, 2026Eating and weight disorders : EWD

Timing of Eating Habits Linked to Fatty Liver Disease in Teenagers

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Abstract

In a study of 2128 participants aged 12 to 19 years, later timing of first food intake is associated with an increased risk of metabolic dysfunction-associated steatotic liver disease (MASLD).

The timing of the first food/beverage intake is linked to a 7% increase in the risk of MASLD for each hour of delay.
An increased risk of MASLD is associated with a later midpoint food intake, showing an 11% increase per hour.
Greater energy intake at dinner correlates with a slight increase in MASLD risk.
A shorter eating window is associated with a reduced risk of MASLD, indicating a potential protective effect.
Chrononutrition patterns are particularly associated with higher MASLD risk in males and Mexican Americans.
HDL cholesterol and non-HDL cholesterol ratios partially mediate the relationship between food intake timing and MASLD risk.

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BACKGROUND: Previous studies have primarily examined the benefits of calorie restriction and fasting for metabolic dysfunction-associated steatotic liver disease (MASLD). However, the impacts of eating timing and frequency on MASLD remain uncertain.

METHODS: This study comprised 2128 participants aged 12 to 19 years, drawn from the National Health and Nutrition Examination Survey (NHANES) data collected during the period 2017 to 2023. Chrononutrition patterns were determined with two 24-h dietary recalls. Logistic regression, accounting for potential confounders, was used to examine the relationship between chrononutrition patterns and MASLD. Subgroup analyses stratified by demographic and clinical variables were used to evaluate their potential impact on the associations observed. Mediation analysis was conducted to assess the indirect effects of metabolic indicators on MASLD risk.

RESULTS: Logistic regression demonstrated that the timing of the first (continuous: OR: 1.07; 95% CI 1.02-1.14) and midpoint (continuous: OR: 1.11; 95% CI 1.00-1.22) food/beverage intake, as well as energy intake at dinner (OR: 1.01; 95% CI 1.00-1.01), were significantly associated with an increased risk of MASLD. Furthermore, the eating window (continuous: OR: 0.95; 95% CI 0.91-0.99) was significantly negatively correlated with the risk of MASLD. Subgroup analyses revealed that the chrononutrition pattern was particularly linked to an elevated risk of MASLD among males and Mexican Americans (P < 0.05). Additionally, HDL-C and NHHR (58.69% and 61.90%, respectively) partially mediated the association between the timing of the first food/beverage intake and MASLD risk.

CONCLUSION: Later timing of the first and midpoint food and beverage intake, as well as greater energy consumption at dinner, are linked to an elevated risk of MASLD. HDL-C and NHHR serve as mediators in these associations, particularly with respect to the timing of the first food or beverage intake.

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Association between chrononutrition patterns and metabolic dysfunction-associated steatotic liver disease in adolescents: a population-based study

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