TOPLINE: 

Very low food security and poverty below 130% of national guidelines were associated with an increased risk for metabolic dysfunction-associated steatotic liver disease (MASLD) among US adults. Among racial and ethnic groups, the association between very low food security and MASLD remained significant in non-Hispanic White individuals.

METHODOLOGY:

• The burden of MASLD is not equally distributed across populations; although racial, ethnic, and socioeconomic disparities in MASLD prevalence and severity have been observed, the mechanisms underlying these disparities are not fully understood.
• Researchers analyzed the data of US adults who participated in the 2017-2020 National Health and Nutrition Examination Survey to examine the links between food insecurity, poverty, and the risks for MASLD and moderate hepatic fibrosis.
• Food insecurity was measured using the US Food Security Survey Module and stratified into full (score, 0), marginal (score, 1-2), low (score, 3-5), and very low (score, 6-10) food security levels. Household income was used to calculate monthly poverty indices, categorized as < 130%, 130%-185%, and > 185% of the US Department of Health and Human Services poverty guidelines.
• MASLD was determined using FibroScan data and was defined as a controlled attenuation parameter (CAP) value ≥ 290 dB/m plus either BMI ≥ 25 (or ≥ 23 for non-Hispanic Asian individuals) or an A1c level ≥ 6.5 or a CAP value > 290 dB/m plus two or more metabolic criteria, including hypertension, prediabetes, large waist circumference, and homeostatic model assessment for insulin resistance score ≥ 2.5.
• Individuals with MASLD were further stratified into those with moderate hepatic fibrosis (liver stiffness measurement [LSM] > 7 kPa) and those without (LSM ≤ 7 kPa).

TAKEAWAY:

• Among 5741 respondents, 33.8% (weighted percentage) had MASLD (mean age, 51.2 years; 54.5% men), including 27.0% with moderate fibrosis.
• Very low vs full food security and a poverty index < 1.30 vs > 1.85 were associated with an increased risk for MASLD (adjusted odds ratio [aOR], 1.61 [95% CI, 1.27-2.03] and 1.29 [95% CI, 1.03-1.62], respectively).
• In race/ethnicity-stratified analyses, very low food security was associated with a higher risk for MASLD among non-Hispanic White individuals (aOR, 1.96; 95% CI, 1.34-2.87), whereas this association was not observed among Hispanic individuals and non-Hispanic Black individuals.
• In individuals with MASLD, food security and poverty were not associated with risk for moderate hepatic fibrosis in the overall population; however, a poverty index of 1.30-1.85 was associated with higher odds of moderate fibrosis in non-Hispanic White individuals (aOR, 1.86; 95% CI, 1.02-3.40). Hispanic individuals with a poverty index of 1.30-1.85 (aOR, 0.48; 95% CI, 0.26-0.87) and non-Hispanic Black individuals with a poverty index < 1.30 (aOR, 0.57; 95% CI, 0.36-0.90) had reduced odds of moderate hepatic fibrosis.

IN PRACTICE:

“[The study] findings underscore the need for targeted screening for food insecurity and socioeconomic risk factors in primary care and hepatology clinics as well as for policies that expand access to nutrition assistance programs and address upstream structural determinants,” the study authors wrote.

SOURCE:

The study was led by Kyle S. Liu, Washington University, St Louis, Missouri. It was published online in Digestive Diseases and Sciences.

LIMITATIONS: 

The study relied on self-reported income and food security data. Unhoused individuals, a group at particularly high risk for food insecurity and poverty, were excluded from the analysis. Patients with incomplete interview, mobile clinic visits, or elastography data were also excluded. The inclusion of an “other race/ethnicity” category combined heterogeneous groups, such as Native American and multiracial individuals, who may have distinct risk factors and exposures. Lipid-lowering and diabetic medications could not be accurately incorporated as they may have been prescribed for indications other than dyslipidemia or diabetes.

DISCLOSURES:

This research was supported in part by grants from the Cancer Prevention & Research Institute of Texas. The authors declared having no competing interests.

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