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Liver Disease Diagnosis and Treatment · Journal article
Nutrients · September 9, 2026
Well-designed and adequately powered for the question it asks.
This large retrospective cohort study demonstrates that cumulative unfavorable eating behaviors—skipping breakfast, eating dinner within 2 hours of bedtime, and fast eating—are independently and additively associated with incident MASLD/MetALD in Japanese adults, with a dose-dependent relationship evident across time-dependent and stratified analyses. The association persists even among participants with BMI < 23 kg/m², suggesting that simple dietary behavior assessment during routine examinations may identify individuals at elevated hepatic risk.
Retrospective longitudinal cohort study. 29,889 Japanese adults without MASLD/MetALD at baseline undergoing health examinations at facilities in Japan between May 2015 and March 2026.. Intervention: Unfavorable eating behaviors: skipping breakfast, eating dinner within 2 hours before bedtime, and fast eating, assessed individually and as a cumulative score.. Compared with: Absence of unfavorable eating behaviors; reference category (score = 0) for cumulative analyses.. n = 29,889. Japan (specific centres or regions not stated in source).
Skipping breakfast associated with HR 1.19 (95% CI 1.11–1.27) for incident MASLD/MetALD Eating dinner within 2 h before bedtime associated with HR 1.11 (95% CI 1.05–1.18) Fast eating associated with HR 1.06 (95% CI 1.00–1.13)
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Clinicians performing routine health examinations can use simple assessment of three eating behaviors—breakfast skipping, late dinner timing, and eating speed—to stratify hepatic risk in a dose-dependent manner. This approach appears particularly valuable for identifying at-risk individuals with lower BMI who fall outside traditional obesity definitions.
Large, well-designed retrospective cohort study with 29,889 participants, 4,829 incident events, and 115,088 person-years of follow-up demonstrating dose-dependent associations between cumulative unfavorable eating behaviors and incident liver disease with consistent effect estimates across multiple analytical approaches.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians performing routine health examinations can use simple assessment of three eating behaviors—breakfast skipping, late dinner timing, and eating speed—to stratify hepatic risk in a dose-dependent manner. This approach appears particularly valuable for identifying at-risk individuals with lower BMI who fall outside traditional obesity definitions.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background/Objectives: Unfavorable eating behaviors may be associated with metabolic dysfunction-associated steatotic liver disease (MASLD) or metabolic dysfunction- and alcohol-associated liver disease (MetALD), but longitudinal evidence considering the accumulation and changes in these behaviors remains limited. We investigated the associations of skipping breakfast, eating dinner within 2 h before bedtime, and fast eating, individually and cumulatively, with incident MASLD/MetALD in Japanese adults undergoing repeated health examinations. Methods: This retrospective longitudinal cohort study included 29,889 adults without MASLD/MetALD at baseline who underwent health examinations between May 2015 and March 2026. The endpoint was defined as the development of MASLD or MetALD. An unfavorable eating behavior score ranging from 0 to 3 was calculated from the three behaviors. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Additional analyses incorporated time-dependent eating behaviors and covariates, landmark analyses, and subgroup analyses by sex and body mass index (BMI). Results: During 115,088 person-years of follow-up, 4829 participants reached the endpoint. In the mutually adjusted model, skipping breakfast, eating dinner within 2 h before bedtime, and fast eating were associated with incident combined MASLD/MetALD, with HRs of 1.19 (95% CI 1.11–1.27), 1.11 (1.05–1.18), and 1.06 (1.00–1.13), respectively. Compared with participants reporting no unfavorable eating behaviors, the fully adjusted HRs were 1.12 (1.04–1.20), 1.22 (1.13–1.33), and 1.44 (1.28–1.61) for those reporting 1, 2, and 3 behaviors, respectively. Each additional behavior was associated with an HR of 1.12 (1.08–1.15). The association of the cumulative score remained evident in time-dependent and landmark analyses. The cumulative-score association was stronger among participants with BMI < 23 kg/m2 than among those with BMI ≥ 23 kg/m2 (p for interaction < 0.001), whereas no statistically significant interaction by sex was observed. Conclusions: The accumulation of unfavorable eating behaviors was associated with a progressively higher incidence of MASLD/MetALD. Repeated assessment of simple eating behaviors during routine health examinations may help identify individuals at elevated risk, including those below conventional obesity thresholds.
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