Globally, the incidence of pediatric cancer is increasing, with approximately 400,000 children and adolescents aged 0 to 19 years diagnosed with cancer worldwide [1]. Significant advancements in diagnosis, treatment, and nursing care have raised the average cure rate to 52% and the 5-year survival rate to 80% for children with cancer [2]. Standard cancer treatments, such as surgery and radiation, cause side effects that impact the physical, psychological, and social functioning of pediatric patients with cancer [3]. Consequently, these patients often experience compromised well-being and a reduced quality of life [3].

Evidence shows that malnutrition, particularly inadequate nutrition, can lead to decreased treatment tolerance, impaired functional capacity, prolonged hospital stays, and substantially reduced quality of life [4]. Malnutrition affects up to 75% of children with cancer, primarily due to low dietary intake and excessive disease-related energy expenditure [5]. Some studies have explored nutritional interventions for pediatric patients with cancer, focusing on hospital-based nutritional support, targeted dietary modifications, and structured exercise regimens [6]. However, these interventions have often yielded unsatisfactory outcomes. The ineffectiveness of many nutritional interventions can be attributed to diminished appetite and inadequate food intake in children [7]. Appetite, as the primary regulator of food intake, is crucial for improving nutrition [8]. Therefore, developing strategies to stimulate appetite and promote food intake is essential to prevent malnutrition and maintain quality of life in pediatric patients with cancer.

Pediatric patients with cancer often experience appetite loss [7], and social media content such as mukbang is increasingly being explored by children to boost their food intake. Mukbang, a globally recognized phenomenon, is an online culinary spectacle that captivates viewers with a fusion of auditory and visual experiences and fosters dynamic, interactive dialogue between the host and the audience [9]. Food-related visual and auditory stimuli have been found to enhance the exploration of various sensory dimensions, including those linked to physical tasting encounters [10,11]. Evidence shows that individuals experience positive emotional changes and report diverse taste sensations when exposed to various mukbang videos [12]. A recent scoping review also emphasized that mukbang may have positive effects on viewers’ appetites, food choices, and psychological well-being [11]. Mukbang watching is a deliberate, self-motivated choice among children to invigorate their appetites, reflecting a growing acceptance of interactive culinary experiences.

However, evidence has also linked problematic mukbang watching to disordered eating behaviors, showing a significant positive correlation [13]. A previous qualitative study further explored the psychological and physiological experiences of youth watching mukbang, finding that while it may alleviate mental health concerns and stimulate appetite, long-term watching might have adverse health effects [14]. Given the uncertainty surrounding the impact of mukbang-watching behavior among pediatric patients with cancer, further research is needed.

Appetite’s transient and subjective nature suggests that cross-sectional methods may be subject to recall biases. An intensive longitudinal approach, tracking appetite and watching habits among pediatric patients with cancer in natural settings, provides more insights than retrospective studies. Therefore, this study aimed to establish evidence for the potential of mukbang as an intervention to enhance nutrition and appetite in children with cancer by exploring its impact on the appetite, nutrition, and quality of life of pediatric patients through an intensive longitudinal study.

The study enrolled 179 eligible participants, with no dropouts during the follow-up period. As shown in Table 1, participants had a mean age of 7.7 (SD 3.7) years, with 60.3% (n=108) being male and 65.4% (n=117) diagnosed with leukemia. Most (n=67, 37.4%) were in their first phase of treatment. At baseline, participants reported an average of 4.1 (SD 4.0) days of appetite loss during their last treatment, and 83.8% (n=150) demonstrated adequate nutritional status. The mean quality of life score was 72.8 (SD 12.5).

Regarding mukbang watching habits, 63.7% (114/179) of participants reported watching mukbang. Among these viewers, 42.1% (48/114) watched once daily per meal, and 50.9% (58/114) watched for less than half an hour. Notably, a high proportion engaged in mukbang watching due to boredom (90/114, 78.9%) and reported an enhanced sense of pleasure while watching (74.6%, 85/114). Further details regarding the demographic and disease-related characteristics of the participants are presented in Table 1.

The results of the LCA demonstrated that a 4-class model best fits the data, as indicated by the fit statistics shown in Table 2. This model provided a better fit than the 5-class model, with an entropy of 0.935, indicating good separation between the classes. The average posterior probabilities for the classes were 0.84 (class 1), 0.88 (class 2), 0.86 (class 3), and 0.87 (class 4), suggesting minimal classification uncertainty. Classes 1 (C1) to 4 (C4) comprised 66 (36.9%), 26 (14.5%), 51 (28.5%), and 36 (20.1%) of the 179 participants, respectively.

Figure 1 illustrates mukbang watching frequency, sorted by the degree of separation between classes. C1 was defined by the absence of mukbang watching among participants at baseline and throughout the follow-up period. For simplicity, the 4 classes were referred to as never (C1), low (C2), medium (C3), and high (C4) frequencies of mukbang watching.

Baseline demographic and disease characteristics of participants across the 4 classes are detailed in Table 3.

At baseline, appetite and quality of life significantly differed among the 4 classes, while no significant baseline differences were observed in nutritional status. Longitudinal analysis (Table S1 in Multimedia Appendix 3) indicated that while participants across all 4 classes numerically improved in quality of life compared to baseline, the extent of this improvement varied across classes, highlighting heterogeneity in the observed changes. Meanwhile, overall nutritional status among the 4 classes exhibited a decreasing trend.

As shown in Table 4, compared to the baseline, there were significant differences among the 4 classes in appetite and nutritional status at the end of treatment (all Ps<.001). The adjusted appetite GEE model indicated significant effects of time × class in both the medium class (β=0.08, 95% CI 0.02‐0.13; P=.006) and the high class (β=0.10, 95% CI 0.04‐0.17; P=.003). Both the medium class (β=19.18, 95% CI 7.84‐30.53; P=.001) and the high class (β=13.63, 95% CI 1.15‐26.12; P=.03) showed a significantly higher quality of life compared to the never classes. However, a significant decline in quality of life was also observed in the low class (β=−7.58, 95% CI −14.78 to −0.37; P=.04) and the medium class (β=−14.00, 95% CI −22.06 to −5.94; P=.001). Changes in appetite, quality of life, and adequate nutrition at baseline (T₀) and during follow-up (T₁-T_end) in the 4 classes, based on unadjusted GEE models, are shown in Table S2 in Multimedia Appendix 3.

As shown in Table S3 in Multimedia Appendix 3, the sensitivity analysis stratified by baseline appetite yielded results consistent with those of the main analysis. Regarding appetite, the adjusted GEE model indicated significant interaction effects in both the medium (β=.07, 95% CI 0.01‐0.13; P=.03) and high baseline appetite subgroups (β=.16, 95% CI 0.05‐0.28; P=.005). For quality of life, the medium baseline appetite subgroup showed significant class differences (medium: β=19.18, 95% CI 7.84‐30.53, P=.001; high: β=13.63, 95% CI 1.15‐26.12, P=.03) and significant interaction effects (low: β=−7.58, 95% CI −14.78 to −0.37, P=.04; medium: β=−14.00, 95% CI −22.06 to −5.94, P=.001). In contrast, the high baseline appetite subgroup only exhibited a significant decline over time (β=−8.72, 95% CI −16.73 to −0.71; P=.03).

This study explored the associations between mukbang watching and appetite, nutrition, and quality of life in pediatric patients with cancer using an intensive longitudinal design. These results may provide preliminary evidence for appetite-related symptom management in pediatric patients with cancer.

Reflecting on a broader trend, our study found that most pediatric patients (63.7%) engaged in mukbang, aligning with recent national data showing that 61.8% and 65.1% of junior and senior high school students in China actively use short video platforms, and 72.1% and 77% engage with social media, respectively [29]. In our research, a prevalent pattern of mukbang engagement was observed among pediatric patients, with 89.5% tuning in weekly and 49.1% spending over 30 minutes per session. This trend closely echoes the data of Tayla et al [19], which revealed a committed viewer base, with 34.0% engaging daily for a comparable duration. This trend likely arises from the limited entertainment options and prolonged treatment times experienced by hospitalized children, leading them to seek media that meets their social and companionship needs.

Furthermore, our findings highlighted a notable preference for watching mukbang content while eating, with a considerable proportion of pediatric patients (44.7%) engaging in this behavior—a rate significantly higher than the specific content-based engagement reported in a previous general pediatric study [30]. The combination of video watching with mealtime was notably more common among children with cancer compared to their healthy peers [30]. Guardians often permit pediatric patients with cancer to eat while watching videos as a practical strategy to help mitigate treatment-related issues such as nausea and appetite loss. This approach aligns with broader evidence suggesting that mukbang can enhance mood and provide sensory stimulation [11], potentially serving as a digital tool to overcome clinical barriers to eating.

This study found that appetite in pediatric patients with cancer declined throughout treatment, with significant variations at different times, matching the results of an earlier study [31]. In contrast, the findings also showed that frequent mukbang watching helped mitigate this decline over time. Notably, a graded association was observed, in which higher frequencies of mukbang watching were associated with greater appetite maintenance. This indicates that consistent mukbang watching may be a contributing factor in the stabilization of appetite trajectories. Interestingly, despite the video-watching habits of some participants in the Never class, their appetite levels did not show a positive trend compared to those in other classes actively watching mukbang. The auditory and visual stimuli in mukbang, including the chewing and swallowing sounds and the appealing display of delicious dishes, stimulate the brain to evoke a desire to eat [11]. Frequent exposure to food content on social media can alter eating habits driven by visual attraction [32]. Hunger may activate brain areas, such as the prefrontal and orbitofrontal cortices and the amygdala, when watching food images, sparking intense cravings [33]. Evidence indicates that auditory cues in videos can enhance the perceived flavor of food, which in turn may stimulate the viewer’s appetite [34]. Mukbang creates an enticing ambiance that stimulates appetite.

Beyond sensory stimulation, research has linked loss of appetite in children to various lifestyle factors [35], and mukbang could help address this issue in pediatric patients with cancer. Previous evidence shows that emotional factors often drive food cravings, with eating choices and pace sometimes influenced more by emotions than by physical hunger [36]. The engaging and calming content of mukbang eases the strain of treatment for pediatric patients with cancer, improving their mood and stimulating their appetite. This encourages them to return to these videos during periods of emotional distress or reduced appetite. The graded association suggests that frequent engagement with mukbang potentially amplifies the emotional regulation benefits that alleviate treatment-related appetite loss. Evidence indicates that mukbang, as a type of food-focused media, can address food cravings and anxieties in those on restrictive diets, effectively satisfying appetite-related desires [37]. Mukbang fosters a sense of community for pediatric patients, reducing loneliness and enhancing social support. Its interactive nature strengthens viewer connections by simulating shared dining experiences, which can boost appetite and food consumption.

Despite the observed significant interaction effect on appetite trajectories, no significant changes were found in nutritional status over time. A previous study revealed that mukbang watching is associated with increased food intake [12], though this discrepancy may be explained by the clinical context of cancer treatment. During chemotherapy or other intensive therapies, children often experience treatment-related dietary restrictions, gastrointestinal side effects, mucositis, or infection-control dietary limitations [38], which may prevent increased appetite from translating into greater caloric intake. Moreover, appetite represents a subjective motivational state, whereas nutritional status reflects objective physiological outcomes that may require sustained dietary changes over a longer period to demonstrate measurable improvement [39]. In addition, cancer-related metabolic alterations and systemic inflammation may counteract the potential benefits of increased food desire [40]. Future research could integrate structured nutritional management strategies alongside mukbang watching to examine whether enhanced appetite, when supported by appropriate dietary interventions, contributes to measurable improvements in nutritional outcomes.

A significant baseline difference in quality of life was observed across classes, suggesting that initial well-being and mukbang engagement may be associated. After adjusting for baseline quality of life, our study showed that the observed negative interactions in the low and medium classes indicate a greater decline in quality of life compared to the never class. Sensitivity analyses confirmed the longitudinal trends observed in our study. While the medium baseline appetite subgroup followed a pattern similar to the main analysis, the high baseline appetite subgroup exhibited a distinct decline over time. These results indicate that the association between mukbang watching frequency and quality of life varies according to the patient’s baseline appetite. This discrepancy suggests that the physiological and psychological impact of mukbang watching is sensitive to the patient’s baseline appetite, which may be explained by the psychological frustration arising when enhanced appetite meets the physical constraints of treatment [41]. Specifically, the strong desire for food stimulated by mukbang may conflict with patients’ dietary restrictions or gastrointestinal discomfort. This contrast between virtual enjoyment and physical reality may create a psychological gap and a sense of deprivation, thereby hindering rapid gains in overall well-being [42]. Beyond that, repeated exposure to highly rewarding food cues without actual consumption may increase reward prediction error and emotional dysregulation [43]. Mukbang may also function as a passive coping strategy that temporarily alleviates distress but limits engagement in more adaptive coping behaviors. Future research should further explore the long-term impact of mukbang watching on both physiological and psychological outcomes.

This study had certain limitations, including a small sample size and a short tracking period focusing on a single pediatric oncology treatment cycle. The relatively smaller sample size of the high baseline appetite subgroup (n=59) may limit the robustness of our sensitivity analyses. While the single-center design may limit the generalizability of the findings, it allowed for consistent data collection protocols. Furthermore, although we implemented real-time data verification to minimize measurement bias, the subjective nature of the CASQ scale and the involvement of parents may cause reporting bias, as caregivers’ perceptions may not fully reflect the child’s subjective experience. This study also did not explore the relationship between mukbang content and appetite due to the absence of a standard definition for mukbang. Future qualitative follow-up research is recommended to better understand mukbang watching among pediatric patients with cancer.

Despite its limitations, the findings provide preliminary insights for clinical practice and research implications. Our study represents a novel exploration of the associations between mukbang watching and the appetite, nutritional status, and quality of life of pediatric patients with cancer. By using an intensive longitudinal study, we documented the real-time behaviors and appetite of pediatric patients with cancer watching mukbang, offering valuable insights into their evolving needs throughout treatment. These results provide preliminary empirical evidence suggesting that mukbang could be a potential supportive strategy to manage appetite in this vulnerable population.

Our findings show that frequent mukbang watching is associated with better appetite maintenance in pediatric patients with cancer, particularly in the medium and high classes. However, the longitudinal patterns of quality of life were less favorable, with the low and medium classes exhibiting a slower recovery process compared to the never class. Sensitivity analyses revealed that the association between mukbang watching and quality of life varies by baseline appetite. While the medium baseline appetite subgroup showed significant longitudinal differences, the high baseline appetite subgroup was characterized primarily by a significant decline over time. These results indicate that the association between mukbang watching and quality of life is not uniform but is sensitive to the patient’s initial appetite status. Further research is needed to identify the factors that may contribute to these varying associations and to explore whether mukbang can be optimized as a supportive strategy for pediatric patients with cancer.