Abstract
Purpose
Studies evaluating food insecurity and metabolic dysfunction-associated steatotic liver disease (MASLD) and significant hepatic fibrosis are currently scarce. We evaluated the characteristics of food insecure individuals and whether food insecurity was associated with MASLD and significant hepatic fibrosis in the US population.
Methods
In this cross-sectional study from the National Health and Nutrition Examination Survey 2017–2018, 3441 participants with complete data were enrolled. We defined MASLD and significant hepatic fibrosis (≥ F2) by transient elastography in the absence of other causes of liver disease. The detailed questionnaire assessed and categorized food security as high, marginal, low, and very low food security.
Results
Food-insecure subjects were more likely to be female, younger, more impoverished, non-Hispanic blacks, Hispanics, and less likely to be educated, married, and physically active. Food insecurity increased the odds of the prevalence of MASLD by 42% (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.12–1.78) after adjustment for demographic, lifestyle, and metabolic risk factors. The addition of diabetes and obesity did not change this association (OR: 1.36, 95% CI: 1.03–1.78). The multivariable model showed an independent relationship between food insecurity and significant hepatic fibrosis (OR: 1.40, 95% CI: 1.04–1.88) after adjustment for demographic, lifestyle, and metabolic risk factors, although the association was attenuated and changed insignificantly after adjustment for diabetes and obesity.
Conclusions
Food insecurity was associated with higher odds for MASLD. While there is a relationship between food insecurity and significant hepatic fibrosis, this relationship changed insignificantly after adjustment of diabetes and obesity.
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Data availability
The National Health and Nutrition Examination Survey dataset are publicly available at the National Center for Health Statistics of the Center for Disease Control and Prevention (https://www.cdc.gov/nchs/nhanes/).
Abbreviations
- MASLD:
-
Metabolic dysfunction-associated steatotic liver disease
- NHANES:
-
National Health and Nutrition Examination Survey
- CAP:
-
Controlled attenuation parameter
- CI:
-
Confidence interval
- OR:
-
Odds ratio
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DK: was involved in study concept and design, acquisition of data, analysis, and interpretation of data, drafting of the manuscript, approval of the final draft manuscript, and study supervision. BJP and GC: were involved in the study concept and design, interpretation of data, critical revision of the manuscript for important intellectual content, and approval of the final draft manuscript. AA: was involved in study concept and design, analysis, and interpretation of data, critical revision of the manuscript for important intellectual content, approval of the final draft manuscript, and study supervision.
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The National Center for Health Statistics review board approved the National Health and Nutrition Examination Survey.
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The National Center for Health Statistics obtained informed consent from all participants.
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Kim, D., Perumpail, B.J., Cholankeril, G. et al. Association between food insecurity and metabolic dysfunction-associated steatotic liver disease/significant fibrosis measured by fibroscan. Eur J Nutr 63, 995–1001 (2024). https://doi.org/10.1007/s00394-024-03327-9
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DOI: https://doi.org/10.1007/s00394-024-03327-9