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COVID-19-related dietary shifts and their association with hepatic steatosis index (HSI)-based metabolic dysfunction-associated steatotic liver disease (MASLD) risk: a dish-based analysis using Korea National Health and Nutrition Examination Survey (KNHANES) 2018–2023

Year: 2026

Type: article

Abstract: Lifestyle factors, especially diet, are strongly associated with metabolic dysfunction-associated steatotic liver disease (MASLD); thus, the risk of MASLD may have been correlated with COVID-19 pandemic-related dietary behavior changes. Using nationally representative data (KNHANES 2018–2023), this cross-sectional study investigated transient changes in dish-based dietary patterns and their association with hepatic steatosis index (HSI)-based MASLD risk across pre- (2018–2019), during- (2020–2021), and post- (2022–2023) COVID-19 periods. Participants with excessive alcohol intake were excluded from the analysis. Dish-based energy contributions shifted away from traditional rice-based dishes, with increasing proportions from processed grain products, oil-based dishes, and animal-based foods, and decreasing proportions from alcoholic beverages. Additionally, HSI-based MASLD risk increased transiently during the pandemic and subsequently lowered. Interestingly, adjustment for dish-group energy contributions altered the association between study period and HSI, and reductions in energy contributions from rice and alcoholic beverages were associated with higher HSI, suggesting that these dish-based dietary shifts are associated with the higher MASLD risk, while progressive increases in oil-based cooking methods may have further association with any possible favorable dietary trends. The shift away from traditional rice-centered meals unfavorably associated with the MASLD risk, while the post-COVID improvement in HSI was not explained by the observed dietary changes. These findings highlight dish-based dietary intake, particularly oil-based cooking methods, as an important target for post-pandemic MASLD prevention.

Source: BMC Public Health

DOI: 10.1186/s12889-026-29689-9

Authors: Anna Han, Jangho Lee, Jae-Ho Park, Soo-Hyun Park

Institutions: Jeonbuk National University, Korea Food Research Institute

Language: English

Topic: Liver Disease Diagnosis and Treatment

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Zero hunger

Open Access status: gold

Estimated APC paid: $3,290