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The aim of this cross-sectional study was to analyze the possible relationships of sleep with liver health and whether this interplay is related to body adiposity distribution in children and adolescents. Anthropometric, clinical, and biochemical measurements were performed in children and adolescents (2\u201318 years old) with overweight\/obesity (<jats:italic>n<\/jats:italic>\u2009=\u2009854). Body fat distribution was clinically assessed, and several hepatic markers, including hepatic steatosis index, were calculated. Sleep time mediation (hours\/day) in the relationship between the hepatic steatosis index and body fat distribution was investigated. Differences among diverse fatty liver disease scores were found between children with overweight or obesity (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Linear regression models showed associations between hepatic steatosis index and lifestyle markers (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Hepatic steatosis index was higher (about\u2009+\u200915%) in children with obesity compared to overweight (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Pear-shaped body fat distribution may seemingly play a more detrimental role on liver fat deposition. The association between sleep time and hepatic steatosis index was dependent on body mass index <jats:italic>z<\/jats:italic>-score. Post hoc analyses showed that 39% of the relationship of body fat distribution on hepatic steatosis index may be explained by sleep time.<\/jats:p><jats:p><jats:italic>\u00a0 Conclusion<\/jats:italic>: An association of sleep time in the relationship between body fat distribution and hepatic steatosis index was observed in children and adolescents with overweight\/obesity, which can be relevant in the prevention and treatment of excessive adiposity between 2 and 18 years old. Clinical trial: NCT04805762. <\/jats:p><jats:p>\u00a0 \u00a0<jats:italic>Import<\/jats:italic>: As part of a healthy lifestyle, sleep duration might be a modifiable factor in the management of fatty liver disease in children.\n<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022 Sleep is an influential factor of overweight and obesity in children.<\/jats:italic><jats:italic>\u2022 Excessive adiposity is associated with liver status in children and adolescents.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022 Sleep time plays a role in the relationship between body fat distribution and liver disease.<\/jats:italic><jats:italic>\u2022 Monitoring sleep pattern may be beneficial in the treatment of hepatic steatosis in children with excessive body weight.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-023-05332-2","type":"journal-article","created":{"date-parts":[[2023,11,25]],"date-time":"2023-11-25T03:01:32Z","timestamp":1700881292000},"page":"779-789","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sleep duration is associated with liver steatosis in children depending on body adiposity"],"prefix":"10.1007","volume":"183","author":[{"given":"Bego\u00f1a","family":"de Cuevillas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Lubrecht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Navas-Carretero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Vreugdenhil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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