Food Insecurity May Be an Independent Risk Factor Associated with Nonalcoholic Fatty Liver Disease among Low-Income Adults in the United States
- PMID: 31504710
- PMCID: PMC6946902
- 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
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.
Copyright © American Society for Nutrition 2019.
Figures


Comment in
-
The socioeconomic aspects of nonalcoholic fatty liver disease: food insecurity as a novel risk factor for steatosis and liver fibrosis.Hepatobiliary Surg Nutr. 2020 Aug;9(4):543-545. doi: 10.21037/hbsn.2020.03.03. Hepatobiliary Surg Nutr. 2020. PMID: 32832515 Free PMC article. No abstract available.
Similar articles
-
Food insecurity is associated with magnetic resonance-determined nonalcoholic fatty liver and liver fibrosis in low-income, middle-aged adults with and without HIV.Am J Clin Nutr. 2021 Mar 11;113(3):593-601. doi: 10.1093/ajcn/nqaa362. Am J Clin Nutr. 2021. PMID: 33515016 Free PMC article.
-
Food Insecurity is Associated With Mortality Among U.S. Adults With Nonalcoholic Fatty Liver Disease and Advanced Fibrosis.Clin Gastroenterol Hepatol. 2022 Dec;20(12):2790-2799.e4. doi: 10.1016/j.cgh.2021.11.029. Epub 2021 Dec 16. Clin Gastroenterol Hepatol. 2022. PMID: 34958747
-
Food Insecurity, Low Household Income, and Low Education Level Increase the Risk of Having Metabolic Dysfunction-Associated Fatty Liver Disease Among Adolescents in the United States.Am J Gastroenterol. 2024 Jun 1;119(6):1089-1101. doi: 10.14309/ajg.0000000000002749. Epub 2024 Mar 13. Am J Gastroenterol. 2024. PMID: 38477467
-
Fatty Liver Disease and Food Insecurity: Excess in Scarcity.Curr Nutr Rep. 2023 Sep;12(3):439-444. doi: 10.1007/s13668-023-00478-9. Epub 2023 May 29. Curr Nutr Rep. 2023. PMID: 37247090 Free PMC article. Review.
-
Food insecurity, food assistance and weight status in US youth: new evidence from NHANES 2007-08.Pediatr Obes. 2014 Apr;9(2):155-66. doi: 10.1111/j.2047-6310.2012.00143.x. Epub 2013 Jan 31. Pediatr Obes. 2014. PMID: 23364918 Review.
Cited by
-
Nutritional and Lifestyle Therapy for NAFLD in People with HIV.Nutrients. 2023 Apr 20;15(8):1990. doi: 10.3390/nu15081990. Nutrients. 2023. PMID: 37111209 Free PMC article. Review.
-
Food insecurity is associated with magnetic resonance-determined nonalcoholic fatty liver and liver fibrosis in low-income, middle-aged adults with and without HIV.Am J Clin Nutr. 2021 Mar 11;113(3):593-601. doi: 10.1093/ajcn/nqaa362. Am J Clin Nutr. 2021. PMID: 33515016 Free PMC article.
-
The relationship between low levels of albuminuria and cardiovascular mortality among apparently healthy adults.medRxiv [Preprint]. 2023 Dec 24:2023.12.21.23300378. doi: 10.1101/2023.12.21.23300378. medRxiv. 2023. Update in: Eur J Prev Cardiol. 2024 Dec 4;31(17):2046-2055. doi: 10.1093/eurjpc/zwae189. PMID: 38196576 Free PMC article. Updated. Preprint.
-
Nutrition Literacy Is Not Sufficient to Induce Needed Dietary Changes in Nonalcoholic Fatty Liver Disease.Am J Gastroenterol. 2023 Aug 1;118(8):1381-1387. doi: 10.14309/ajg.0000000000002182. Epub 2023 Jan 13. Am J Gastroenterol. 2023. PMID: 36719072 Free PMC article.
-
Lifestyle Intervention for Patients with Nonalcoholic Fatty Liver Disease: A Randomized Clinical Trial Based on the Theory of Planned Behavior.Biomed Res Int. 2022 Sep 12;2022:3465980. doi: 10.1155/2022/3465980. eCollection 2022. Biomed Res Int. 2022. PMID: 36132088 Free PMC article. Clinical Trial.
References
-
- 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-....
-
- 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.