Association of Niacin Intake, Obesity and Metabolic Dysfunction‐Associated Steatotic Liver Disease in Paediatric Patients: National Health and Nutrition Examination Survey

Introduction This study aims to investigate the association between niacin intake, paediatric obesity and metabolic dysfunction‐associated steatotic liver disease in a diverse, large‐scale population in the United States. Methods This cross‐sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2017–2020, including participants aged 12–19 years. Dietary niacin intake was assessed using two 24‐h dietary recalls, with intake calculated as the average of both recalls. Metabolic Dysfunction‐Associated Steatotic Liver Disease (MASLD) was defined as hepatic steatosis plus at least one metabolic risk factor, including obesity, glucose intolerance, dyslipidemia, hypertriglyceridemia, or hypertension. Hepatic steatosis was identified using hepatic elastography (CAP ≥ 248 dB/m) or self‐reported diagnosis. Participants lacking niacin or anthropometric data were excluded. Results Niacin intake was significantly lower in individuals with MASLD compared to those without (22 mg vs. 24 mg, p = 0.023). After adjusting for age, sex and race/ethnicity, individuals in the highest quartile of niacin intake (Q4) had significantly lower odds of MASLD (OR 0.55, 95% CI: 0.35–0.86) compared to those in the lowest quartile (Q1). Hispanic ethnicity remained an independent risk factor (OR 2.35, p < 0.001). Adolescents with MASLD had significantly higher BMI measures, diastolic blood pressure, liver enzymes and glucose metabolism markers (all p < 0.001). Lipid profiles were also reflective of dyslipidemia, with elevated triglycerides and LDL, and reduced HDL levels (all p < 0.001). Conclusion Adolescents with MASLD demonstrated distinct demographic, metabolic and biochemical profiles, particularly higher rates among Hispanic youth and an association with lower niacin intake.