High daily fructose intake and late-evening fruit consumption are associated with ultrasonographically assessed hepatic steatosis in family medicine outpatients

Although high fructose consumption is known to be associated with metabolic disorders, specific intake thresholds and consumption patterns related to hepatic steatosis have not been fully defined. This study aimed to quantify daily fructose intake and examine its association with ultrasonographically assessed hepatic steatosis, including the potential identification of intake thresholds associated with steatosis. This cross-sectional study included 189 adults (89 men, 100 women). Daily fructose intake was assessed using a seven-day food consumption record. Hepatic steatosis was evaluated and graded by hepatobiliary ultrasonography. Metabolic parameters, including fasting insulin, HOMA-IR, and lipid profiles, were analyzed. Multivariable logistic regression and ROC analyses were performed to assess associations and identify cutoff values. Hepatic steatosis was detected in 63.0% of participants. Individuals with a daily fructose intake > 50 g had significantly higher triglyceride, fasting insulin, and HOMA-IR levels compared with those consuming ≤ 50 g (p < 0.005). Evening or night-time fruit consumption was independently associated with higher odds of hepatic steatosis (OR = 4.12, p = 0.004). ROC analysis identified a threshold value of 51.07 g/day for daily fructose intake. In multivariable analysis, fructose intake above this threshold emerged as a primary factor associated with hepatic steatosis (OR = 14.64, 95% CI: 5.96–35.96; p < 0.001), followed by body mass index and age. The model demonstrated good discriminatory performance (Nagelkerke R² = 0.613; accuracy 84.1%). A daily fructose intake above approximately 51 g/day showed a significant association with hepatic steatosis in this study population. In addition, consumption timing—particularly fruit intake in the late evening—was identified as an important behavioral factor associated with steatosis. These findings highlight the potential relevance of both intake quantity and timing in future dietary recommendations and research on hepatic steatosis.