Excessive Screen Time Linked to Higher Liver Steatosis Risk in Adolescents

Excessive screen time is associated with an increased risk of liver steatosis in adolescents, according to findings from a recent study.1

Leveraging data from National Health and Nutrition Examination Surveys (NHANES) 2017-2018 participants 12–17 years of age, the study found ≥ 5 hours of self-reported screen time per day was linked to a greater risk of steatosis. Of note, this association was partially mediated by body mass index (BMI).1

“Excessive screen-time behaviors, prevalent both in developed and developing countries in the past decade, have been linked with a range of adverse health outcomes in children and adolescents,” Shanshan Huang, of the department of infectious disease at The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University in China, and colleagues wrote.1

The most common cause of pediatric chronic liver disease in the United States, metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is estimated to affect 5-10% of children and has become more common in recent decades due to a rise in childhood obesity.2 While excessive screen time has previously been linked to youth obesity, less is known about its potential impact on steatosis risk.1

To assess the association between excessive screen exposure and liver steatosis in adolescents, investigators conducted a cross-sectional analysis of data derived from NHANES 2017-2018 for participants 12-17 years of age with self-reported screen time and available data on BMI and transient elastography.1

All individuals reported their leisure screen time, consisting of daily time spent watching TV and using a computer outside of school over the past 30 days. Time spent watching television and using a computer was combined to evaluate total screen exposure, and subjects with ≥ 5 hours of total daily were considered to have excessive screen time.1

Liver steatosis was identified according to the median controlled attenuation parameter (CAP) by transient elastography. Investigators used a cut-off of 248 dB/m for detecting hepatic steatosis.1

In total, the analysis included 731 adolescent NHANES participants with the necessary data on screen time, BMI, and transient elastography. Among the cohort, 23.2% of individuals were categorized as having hepatic steatosis. The majority (65%) of study participants reported excessive screen time.1

Compared with modest screen time < 5 hours, those who reported excessive screen time were older, had higher BMI, and slightly higher high-sensitivity C-reactive protein. Investigators noted steatosis was more common in adolescents with excessive screen time than in those with screen time < 5 hours (27.0% vs 16.1%; P <.001), additionally calling attention to lower physical activity levels and weighted mean Healthy Eating Index (HEI)-2015 scores among those with excessive screen time.1

After adjusting for covariates related to demographic background, metabolic variables, physical activity, and diet quality, excessive screen time was associated with greater odds of steatosis (odds ratio [OR], 2.10; 95% CI, 1.34–3.29; P = .032). However, in a model additionally adjusted for BMI, the association was attenuated and lost statistical significance (OR, 1.43; 95% CI, 0.90–2.27).1

In causal mediation analysis, the total effect of excessive screen time was 0.089 (95% CI, 0.008–0.156), and the indirect effect of excessive screen time with liver steatosis was significant (0.047; 95% CI, 0.016–0.080). Investigators pointed out the estimated proportion mediated by BMI was 52.9% (P = .036).1

“Recognition of the potential metabolic risks with excessive screen time in adolescents and making interventions incorporating screen-time reduction may improve the current burden of MASLD in youth,” Huang and colleagues concluded.1

References

1. Li S, Jin S, Fang P, et al. Association between excessive screen time and steatotic liver disease in adolescents: Findings from the 2017–2018 National Health and Nutrition Examination Survey. Pediatric Obesity. https://doi.org/10.1111/ijpo.70010

2. National Institute of Diabetes and Digestive and Kidney Diseases. Nonalcoholic Fatty Liver Disease & NASH in Children. December 2021. Accessed March 12, 2025. https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash-children/definition-facts