INTRODUCTION: Screen-based behaviours have brought great changes to our lifestyles over the last 50 years. There is limited data evaluating the effects of such alterations on the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in adolescents. This study sets out to assess possible associations of excessive screen exposure with liver steatosis in a representative sample of US adolescents. METHODS: This cross-sectional analysis used data derived from the National Health and Nutrition Examination Surveys (NHANES) carried out in 2017-2018, including 731 subjects aged 12-17 years. Self-reported screen time (ST, hours/day) outside of school was recorded, including hours watching TV or videos and hours using the computer. Liver steatosis was identified according to the median controlled attenuation parameter (CAP) by transient elastography. RESULTS: Among the participants, 476 (65.0%, 95% CI: 60.7%-69.2%) experienced excessive screen time (EST, daily ST ≥ 5 h). The prevalence of liver steatosis was higher in adolescents with EST versus counterparts with modest ST (ST <
5 h) (27.0% vs. 16.1%, p <
0.001). EST was associated with increased odds of liver steatosis in adolescents after adjusting for covariates related to demographic background, metabolic variables, physical activity and diet quality (OR: 2.10, 95% CI: 1.34-3.29, p = 0.032). Body mass index partially mediated the effect of EST on liver steatosis risk (52.9%, p = 0.036). CONCLUSION: Excessive screen time was associated with increased odds of liver steatosis in adolescents. Strategies to reduce screen time for youth may bring benefits for the management of MASLD.