Introduction. Metabolic and hepatic alterations in adolescents may be associated with inappropriate eating habits and sedentary lifestyles, requiring effective intervention actions. Objective. To determine the association between metabolic and hepatic alterationswith eating habits and physical activity (PA) levels in adolescents from Punin, Ecuador. Materials and methods. An analytical cross-sectional observational study was conducted on 100 adolescents from Punin, aged 10-19 years, between October 2023 and March 2024. Data on diet, physical activity (PA), and socioeconomic status were collected through surveys, and body mass index (BMI) and biochemical parameters were measured. The statistical association analysis was performed using the chi-square test with a significance level of 0.05, utilizing SPSS Statistics 26. Results. 80% of adolescents presented metabolic or hepatic alterations, with imbalances in glucose, insulin, lipids, and transaminases, such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT). BMI indicated a high proportion of overweight and obesity. Alterations were associated with sedentary lifestyles and unbalanced diets. The consumption offish, dairy, eggs, and nuts showed no significant association with the alterations (p>0.05), while the consumption of fruits, vegetables, and legumes was associated with a lower risk of developing them (p<0.001). Differences in metabolic parameters between diet and PA groups were significant (p<0.05). Conclusions: In Punin, most adolescents exhibited metabolic and hepatic alterations, associated to poor eating habits and low PA levels, highlighting the need for effective interventions. Arch Latinoam Nutr 2024; 74(4): 267-276.