Tabriz University of Medical Sciences Health Promotion Perspectives 2228-6497 16 2 2026 08 21 Breakfast Dietary Patterns and Their Associations with Metabolic Indicators and NAFLD Severity: A Cross-Sectional Study Among Iranian Adults 253 263 10.34172/hpp.45534 EN Mehrdad Kianmehr https://orcid.org/0000-0002-1894-3408 Maryam Rafraf https://orcid.org/0000-0002-2593-1253 Alireza Hosseini Mojtaba Kianmehr Roghayeh Molani-Gol Journal Article 10.34172/hpp.45534 2025 11 29 2026 05 18 Introduction: Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic diseases worldwide. This study investigated the relationship between breakfast dietary patterns and some metabolic risk factors, obesity, and disease severity in patients with NAFLD. Methods: This cross-sectional study was conducted on 280 adults with NAFLD. Factor analysis was used to identify the breakfast dietary patterns. Statistical analysis was performed with SPSS 19 software using Linear and Ordinal regression models. Results: Two "healthy" and "unhealthy" breakfast dietary patterns were identified. Significant inverse relationships were seen between the consumption of the healthy breakfast pattern and total cholesterol (TC) and body mass index (BMI) in the adjusted model. There were significant direct relationships between the consumption of the unhealthy breakfast dietary pattern and alanine aminotransferase (ALT), aspartate aminotransferase (AST), BMI, and waist circumference (WC) after adjustment for confounders. Participants in the third tertile of the unhealthy breakfast pattern had significantly higher TC, triglycerides (TG), fasting blood sugar (FBS), ALT, AST levels, and BMI compared to the lowest tertile following confounder adjustment. Moreover, healthy breakfast pattern consumption was associated with lower NAFLD severity (Adjusted OR: 0.998 (95%CI: 0.997-0.999), P=0.029), and unhealthy breakfast pattern consumption was associated with increased severity of NAFLD (Adjusted OR: 1.005 (95%CI: 1.002-1.007), P<0.001). Conclusion: The results suggest that following a healthy breakfast pattern was associated with a better lipid profile and reduced total body adiposity and disease severity, while adherence to an unhealthy breakfast pattern was positively associated with NAFLD risk factors. A healthy breakfast pattern could be considered in the management of NAFLD. Longitudinal or interventional studies are required to establish causality.