Emotional eating and metabolic dysfunction-associated steatotic liver disease (MASLD): a pre-registered study in a clinical population

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects 38% of adults globally and has been identified as a significant and increasing contributor to global health and economic burdens. Obesity is significantly associated with MASLD. Eating behaviours may represent an underexplored shared risk factor for these adverse physiological outcomes. Here, we tested a novel mediation model and hypothesised that emotional and uncontrolled eating would be positively associated with liver fibrosis (kilopascals; kPa) and steatosis (controlled attenuation parameter; CAP) via body mass index. 129 UK clinical patients undergoing a fibroscan, completed validated questionnaires on eating behaviours, snack and alcohol consumption. We confirmed an indirect relationship between emotional eating and steatosis mediated by BMI (P=0.002), but not for liver fibrosis (P=0.1). A direct relationship between unhealthy snack consumption and steatosis (P=0.04) was also shown. We failed to show any direct or indirect relationships between uncontrolled eating and either fibrosis or steatosis. In an exploratory analysis, we also used separate logistic regressions to examine whether emotional eating and BMI were predictive of MASLD, alcohol related liver disease (ArLD) and other causes of deranged liver function tests (binary status). MASLD status was significantly positively predicted by both emotional eating (P=0.003) and BMI (P=0.024). By contrast, lower emotional eating scores predicted a higher likelihood that someone would have ArLD (P=0.035) and emotional eating scores were not a significant predictor of other causes of deranged liver function ('other group', P=0.398). Our findings indicate that psychological therapy focusing on emotional eating may represent a fruitful intervention target for MASLD.