Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan 1;150(1):91-98.
doi: 10.1093/jn/nxz212.

Food Insecurity May Be an Independent Risk Factor Associated with Nonalcoholic Fatty Liver Disease among Low-Income Adults in the United States

Affiliations

Food Insecurity May Be an Independent Risk Factor Associated with Nonalcoholic Fatty Liver Disease among Low-Income Adults in the United States

Ilya Golovaty et al. J Nutr. .

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD), considered a "barometer" of metabolic health, is the leading cause of liver disease in the United States. Despite established associations between food insecurity and obesity, hypertension, and diabetes, little is known about the relation between food insecurity and NAFLD.

Objective: We sought to evaluate the association of food insecurity with NAFLD among low-income adults in the United States.

Methods: We conducted a cross-sectional analysis of a nationally representative sample of adults from the NHANES (2005-2014 waves). Participants included adults in low-income households (≤200% of the federal poverty level) without chronic viral hepatitis or self-reported heavy alcohol use. Food insecurity was measured using the Household Food Security Survey. Our primary outcome was NAFLD, as estimated by the US Fatty Liver Index, and our secondary outcome was advanced fibrosis, as estimated by the NAFLD fibrosis score. The association between food insecurity (defined as low and very low food security) and hepatic outcomes was assessed using multivariable logistic regression, adjusting for sociodemographic factors.

Results: Among 2627 adults included in the analysis, 29% (95% CI: 26%, 32%) were food insecure. The median age was 43 y, 58% were female, and 54% were white. The weighted estimated prevalence of NAFLD did not differ significantly by food security status (food secure 31% compared with food insecure 34%, P = 0.21). In the multivariable model, food-insecure adults were more likely to have NAFLD (adjusted OR: 1.38; 95% CI: 1.08, 1.77) and advanced fibrosis (adjusted OR: 2.20; 95% CI: 1.27, 3.82) compared with food-secure adults.

Conclusions: Food insecurity may be independently associated with NAFLD and advanced fibrosis among low-income adults in the United States. Future strategies should assess whether improved food access, quality, and healthy eating habits will decrease the growing burden of NAFLD-associated morbidity and mortality among at-risk adults.

Keywords: disparities; food insecurity; nutrition; underserved populations; urban health; vulnerable populations.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Adjusted OR (AOR) of food insecurity with cardiometabolic diseases, nonalcoholic fatty liver disease (NAFLD), and fibrosis among adults in low-income households. Adjusted for age, sex, household income (4 categorical intervals), household size, ethnicity (Mexican, non-Mexican Hispanic, other, white, African American), education (less than high school, high school diploma/GED, greater than high school), and any prior alcohol and smoking history. Includes fasting subsample (n = 2627 fasting examination). Error bars represent 95% CI. The dashed reference line reflects an OR of 1.0 (no difference in food insecurity and outcome).
FIGURE 2
FIGURE 2
Predicted prevalence of cardiometabolic and liver diseases by food security status in adults from low-income households. Adjusted for age, sex, household income (4 categorical intervals), household size, ethnicity (Mexican, non-Mexican Hispanic, other, white, African American), education (less than high school, high school diploma/GED, greater than high school), and any prior alcohol and smoking history. Includes fasting subsample (n = 2627 fasting examination). Each darker shaded bar represents worsening food security status. NAFLD, nonalcoholic fatty liver disease.

Comment in

Similar articles

Cited by

References

    1. US Department of Agriculture ERS Definitions of Food Security. [Internet]. 2016. [cited 2018 Mar]. Available from: https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-....
    1. Gregory C, Coleman-Jensen A. Food insecurity, chronic disease and health among working-age adults. Washington (DC): US Department of Agriculture ERS; 2017. Economic Research Report Number 235.
    1. Seligman HK, Bindman AB, Vittinghoff E, Kanaya AM, Kushel MB. Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999–2002. J Gen Intern Med. 2007;22:1018–23. - PMC - PubMed
    1. Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr. 2010;140:304–10. - PMC - PubMed
    1. Berkowitz SA, Berkowitz TSZ, Meigs JB, Wexler DJ. Trends in food insecurity for adults with cardiometabolic disease in the United States: 2005–2012. PLoS One. 2017;12:e0179172. - PMC - PubMed

Publication types