A small Italian study tested whether an individual’s preferred daily schedule aligns with hidden liver changes, but found no clear signal.
Chronotype and FibroScan-Derived Liver Markers in Adults with Obesity: Preliminary Evidence from a Cross-Sectional Study. Image Credit: mybox / Shutterstock
A recent study in the journal Nutrients investigated the association between chronotype and FibroScan-derived hepatic steatosis and fibrosis in adults with overweight or obesity.
Circadian Rhythms, Chronotype, and Metabolic Liver Disease
The circadian timing system synchronizes physiological and behavioral rhythms with the external light–dark cycle to maintain metabolic balance. This system regulates energy metabolism, endocrine function, and behaviors related to nutrition and sleep.
Chronotype describes individual preferences for the timing of daily activities and is commonly evaluated using the Morningness–Eveningness Questionnaire (MEQ). Morning types tend to follow earlier schedules, whereas evening types reach peak alertness and performance later in the day. Importantly, evening chronotype is often associated with misalignment between endogenous rhythms and social demands, disrupting sleep, meal timing, and other behaviors relevant to metabolic health.
This misalignment, known as chrono-disruption, is associated with adverse metabolic and cardiovascular outcomes. Evening chronotype may further contribute to increased inflammatory activity in visceral adipose tissue, indicating heightened metabolic dysfunction and cardiometabolic risk.
While circadian dysregulation is recognized as a contributor to metabolic disease, the influence of chronotype on hepatic steatosis and fibrotic progression remains unclear. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is characterized by hepatic fat accumulation in individuals with metabolic risk factors. Steatosis marks the early stage of disease, but progression to steatohepatitis and fibrosis elevates long-term risks, including cirrhosis and hepatocellular carcinoma. Fibrosis, in particular, signifies a more advanced stage of liver disease, carries significant prognostic weight, and is driven by mechanisms such as insulin resistance, oxidative stress, and chronic inflammation.
Emerging evidence links evening chronotype to less favorable liver phenotypes, including a higher probability of fibrosis and increased hepatic fat content. Nevertheless, most studies rely on histology, ultrasonography, or surrogate indices, with limited use of quantitative FibroScan-derived assessments of hepatic steatosis and fibrosis. This methodological gap restricts a comprehensive understanding of the relationship between chronotype and liver disease.
Researchers Examined the Association Between Chronotype and Liver Outcomes
The current exploratory cross-sectional study at the National Institute of Gastroenterology, Italy, investigated whether chronotype, measured by the MEQ, was associated with hepatic steatosis and fibrosis, as assessed by FibroScan, a non-invasive imaging tool that quantifies liver fat and stiffness, in medication-naïve adults with overweight or obesity.
Adults aged 18–65 years with BMI ≥ 25 kg/m² and no ongoing pharmacological treatment were recruited between February 2023 and July 2024. Major exclusions included previously diagnosed diabetes, cardiovascular disease, chronic kidney disease, psychiatric disorders, pregnancy or breastfeeding, alcohol intake above defined thresholds, substance abuse, severe infections, and rare metabolic disorders.
At baseline, data were collected on lifestyle, demographics, anthropometrics, and fasting blood samples. Anthropometric measurements were taken in the morning after overnight fasting. Chronotype was assessed using the Italian 19-item MEQ as a continuous variable. Liver fat and liver stiffness, an indirect marker of fibrosis, were measured non-invasively with FibroScan within one week of enrollment.
Primary and secondary outcomes were hepatic steatosis, assessed by FibroScan-derived controlled attenuation parameter (CAP), and liver stiffness, assessed by liver stiffness measurement (LSM). Both were analyzed for correlation with chronotype.
Chronotype Was Not Significantly Associated With Liver Steatosis or Fibrosis
A total of 119 participants, including 58 men, were analyzed, with a mean age of 41.5 years. Nineteen percent were current smokers. Liver steatosis was present in 62% of participants, and 15% were classified as having fibrosis based on liver stiffness measurement. The average chronotype score was 56.34 MEQ units. Using established MEQ cutoffs, 39% were classified as evening type, 43% as neither type, and 19% as morning type.
The mean CAP value was 290.63 dB/m and the mean LSM was 6.45 kPa. Most participants reported moderate to high levels of physical activity. Obesity was highly prevalent, affecting 116 individuals, and none had a prior diagnosis of cardiovascular disease. Mild elevations in blood pressure were common, and previously undiagnosed type 2 diabetes was present in 9.2% of participants. Baseline metabolic markers showed marked insulin resistance. Vitamin D levels were slightly below normal, with modest increases in total and LDL cholesterol.
Correlation analysis revealed no significant associations between chronotype and either CAP or LSM, suggesting that chronotype was not associated with liver fat or stiffness in this sample. However, there was a positive correlation between CAP and LSM, suggesting a relationship between liver fat and stiffness.
Small inverse correlations were found between chronotype and the thyroid hormones TSH and FT3, while small positive correlations were observed with vitamin D levels and adherence to the Mediterranean diet. These findings should be interpreted with caution due to multiple comparisons and a lack of statistical adjustment.
Additionally, CAP values, reflecting liver fat, showed direct correlations with measures of excess weight such as BMI and waist circumference, as well as with insulin resistance, HbA1c, and liver enzyme levels. LSM was directly correlated with BMI, waist circumference, insulin resistance, and physical activity, although its associations with HbA1c and liver enzyme levels were not statistically significant. These associations do not establish causal relationships, but they indicate that liver fat was associated with greater body weight, insulin resistance, HbA1c, and liver enzyme levels, whereas liver stiffness was principally associated with adiposity and insulin resistance.
Multiple regression analyses, adjusting for sex, age, insulin resistance, BMI, and waist circumference, found no significant association between chronotype and either liver fat or liver stiffness. Logistic regression models also showed no significant link between chronotype and the presence of steatosis or fibrosis. Sensitivity analyses using categorized chronotype showed similarly null findings.
Further Investigation Needed on Chronotype and MASLD Progression
The present study found no statistically significant association between chronotype and FibroScan-derived measures of hepatic steatosis or fibrosis in medication-naïve adults predominantly with obesity. However, the confidence intervals remain compatible with small-to-moderate effects, particularly for fibrosis, so a clinically relevant link cannot be entirely excluded.
Further research involving larger, longitudinal multicenter cohorts, healthy comparison groups, and objective assessments of circadian disruption and chrono-nutrition behaviors is needed to clarify the potential role of chronotype in the development or progression of MASLD. Because chronotype was self-reported and information on sleep, shift work, and meal timing was unavailable, the present findings should be considered hypothesis-generating.
Journal reference:
- Cerabino, N. (2026). Chronotype and FibroScan-Derived Liver Markers in Adults with Obesity: Preliminary Evidence from a Cross-Sectional Study. Nutrients. 18(14), 2342. DOI: 10.3390/nu18142342, https://www.mdpi.com/2072-6643/18/14/2342