TOPLINE

Food insecurity and neighborhood deprivation were each independently associated with higher incidence of metabolic dysfunction–associated steatotic liver disease (MASLD) in a diverse US cohort, even after adjusting for obesity and other metabolic factors. The highest cumulative incidence was observed among adults experiencing both forms of disadvantage.

METHODOLOGY

• Researchers conducted a retrospective cohort study using data from the All of Us Research Program, analyzing 40,693 adults free of MASLD at baseline (mean age, 57.6 years; 35.5% men).
• Food insecurity was assessed using a validated two-item screener, and neighborhood deprivation was scored from five validated surveys asking residents about walkability, safety, neighborly trust, and visible physical and social disorder; participants scoring at or above the 75th percentile on at least three of the five domains were classified as neighborhood-deprived.
• The primary outcome was incident MASLD diagnosis identified through standard diagnostic codes in electronic health records.
• Analysis employed multivariable Cox proportional hazards models adjusted for age, sex, race/ethnicity, education, income, insurance status, smoking, obesity, hypertension, type 2 diabetes, and hyperlipidemia.
• The median follow-up was 35 months.

TAKEAWAY

• During the study period, 1240 (3.0%) incident MASLD cases were identified.
• Incidence was higher among food-insecure than food-secure participants (18.6 vs 9.43 per 1000 person-years; unadjusted hazard ratio [HR], 1.98; 95% CI, 1.74-2.26) and higher among neighborhood-deprived than non-deprived participants (14.6 vs 9.76 per 1000 person-years; unadjusted HR, 1.49; 95% CI, 1.31-1.69).
• In adjusted models, food insecurity was independently associated with incident MASLD (adjusted HR, 1.32; 95% CI, 1.13-1.53), as was neighborhood deprivation (adjusted HR, 1.20; 95% CI, 1.05-1.37).
• Unadjusted cumulative incidence rose in a graded fashion across the two exposures — lowest among participants with neither, higher with neighborhood deprivation alone, higher still with food insecurity alone, and highest among those with both.

IN PRACTICE

"[The study] findings identify modifiable nutritional and structural social determinants that warrant attention in clinical screening, community nutrition programs, and health-equity policy," wrote the authors.

SOURCE

The study was led by Yong Eun, New York City Health + Hospitals/Harlem in New York. It was published online on August 21 in Nutrients.

LIMITATIONS

MASLD was identified from diagnostic codes, which remain susceptible to misclassification and underdiagnosis. Both exposures were measured only once, and the brief food insecurity screener captured neither severity nor duration. Even with extensive statistical adjustment, unmeasured factors such as diet quality, physical activity, and healthcare access could explain part of what was observed.

DISCLOSURES

The study was supported by The Interdisciplinary Guided Network for Investigation, Translation and Equity for the All of Us Research Program. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.