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. 2024 Feb:265:113818.
doi: 10.1016/j.jpeds.2023.113818. Epub 2023 Nov 4.

Food Insecurity and Pediatric Nonalcoholic Fatty Liver Disease Severity

Sarah Orkin  1 , Xueheng Zhao  2 , Kenneth D R Setchell  2 , Emily Carr  3 , Ana Catalina Arce-Clachar  1 , Kristin Bramlage  4 , Rong Huang  5 , Lin Fei  6 , Andrew F Beck  7 , Rima Fawaz  8 , Pamela L Valentino  9 , Stavra A Xanthakos  1 , Marialena Mouzaki  10
Affiliations

Food Insecurity and Pediatric Nonalcoholic Fatty Liver Disease Severity

Sarah Orkin et al. J Pediatr. 2024 Feb.

Abstract

Objective: To determine the association between food insecurity and pediatric nonalcoholic fatty liver disease (NAFLD).

Methods: Cross-sectional study of patients < 21 years of age with histologically confirmed NAFLD. The Household Food Security Survey Module was administered to determine food insecurity status. Skin lipidomics were performed to explore pathophysiologic mechanisms.

Results: Seventy-three patients with histologically confirmed NAFLD completed the Household Food Security Survey Module. Of these, the majority were male (81%) and non-Hispanic (53%), with a mean age at biopsy of 13 ± 3 years. Food insecurity was seen in 42% (n = 31). Comparison of features between food insecure and food secure subgroups revealed no differences in sex, ethnicity, BMI z-score, aminotransferases, or histologic severity. However, children experiencing food insecurity presented on average 2 years before their food secure counterparts (12.3 ± 3.0 vs 14.4 ± 3.6 years, P = .015). A subset of 31 patients provided skin samples. Skin lipidomics revealed that food insecurity was associated with down-regulated features from the lipoamino acid class of lipids, previously linked to inflammation and adipocyte differentiation.

Conclusions: Food insecurity is highly prevalent in children with NAFLD and is associated with earlier presentation. Lipidomic analyses suggest a possible pathophysiologic link that warrants further exploration.

Keywords: NAFLD; cutaneous biomarker; fatty liver; food security; lipidomics.

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Conflict of interest statement

Declaration of Competing Interest SO was funded by the NASPGHAN Foundation/ Abbott Nutrition Advanced Fellowship Training in Pediatric Nutrition (2019) and the NIHP30 DK078392 of the Digestive Diseases Research Core Center in Cincinnati. The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1.
Figure 1.
Patient recruitment strategy.
Figure 3.
Figure 3.
Principal component analysis of positive ion features showing clustering of patients into 2 groups. Principal component analysis depicts the profile of skin lipidome in patients with and without FI. There is a distinct cluster of outliers, the majority of which (5/6) have FI. PC1, phosphatidylcholine 1; PC2, phosphatidylcholine 2.
See this image and copyright information in PMC

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