The association of ultra‐processed food intake with adolescent metabolic dysfunction‐associated steatotic liver disease in the NHANES

Summary Introduction Metabolic dysfunction‐associated steatotic liver disease (MASLD) has become a major public health concern. A thorough analysis of the link between ultra‐processed food (UPF) intake and MASLD in the adolescent population is lacking. Methods Adolescent participants of the National Health and Nutrition Examination Survey (NHANES) pre‐pandemic cohort were included. Different controlled attenuation parameter (CAP) cut‐offs were used to assess MASLD. The percentage energy intake of UPF, categorized according to the NOVA classification, to total energy intake was taken as the main outcome marker. Structural equation modelling (SEM) was used to better quantify the causal connection between UPF and liver steatosis. Results UPF consumption constituted a median 75% (62–86) of total energy intake. There was no significant correlation between UPF intake and CAP ( ρ = 0.061, p = 0.091). The median proportion UPF intake was not associated with steatosis severity. SEM similarly yielded a weak and non‐significant correlation of 0.078. In participants with MASLD, total energy intake was significantly higher ( p < 0.001) and sugar‐containing beverage (SCB) consumption showed a non‐significant trend towards higher consumption. Conclusions No clinically relevant association between UPF intake and MASLD in adolescents could be demonstrated. Our results nonetheless suggest that total energy intake and consumption of SCBs are important contributors to paediatric obesity and MASLD.