BOSTON—Food insecurity is a known risk factor for metabolic dysfunction-associated steatotic liver disease in adults, and kids suffer too, with new research presented at The Liver Meeting 2023 showing that adolescents in food insecure environments twice as likely as peers with ample access to high-quality food to have MASLD.
“It is important that physicians and providers pay attention to issues related to health disparities, which can be important drivers of this disease," investigator Zobair Younossi, MD, MPH, told Gastroenterology & Endoscopy News. "Providers at the front line, such as primary care physicians and pediatricianss, can make an impact in addressing factors related to quality of food, exercise and other issues. Additionally, gastroenterologists and hepatologists can reinforce the importance of the environmental factors that can contribute to a progressive course of this liver disease,” stressed Dr. Younossi, the chairman of the Global NASH Council and professor and chairman of the Department of Medicine at Inova Fairfax Medical Campus, in Falls Church, Virginia.
To get a better understanding of the association between food insecurity and adolescents in the U.S., Dr. Younossi, and his co-investigators gathered data from the National Health and Nutrition Examination Survey (NHANES) on adolescents aged 12 to 18 years for 2017. They used the U.S. Department of Agriculture Child Food Security Survey Module that is included in NHANES to assess food insecurity, and transient elastography to define MASLD.
Of the 771 adolescents captured in the NHANES database during that one-year period, approximately 11% had MASLD. Adolescent in food insecure environments had nearly two times the rate of MASLD, about 19% compared with 10% of those in food secure homes.They also had a higher prevalence of advanced fibrosis, at nearly 3% compared with 0.3%. Most of the food insecure kids, 99%, relied on low-cost food, and slightly more than half reported not having enough food.
Although there were no differences in type II diabetes between the food insecure and secure groups, these kids may not have had enough time to overtly demonstrate diseases such as type 2 diabetes, Dr. Younossi said at a press briefing ahead of the meeting. He also noted that food insecurity was more common in girls, and in adolescents aged 15 to 18 years. “This is important, because this is where adulthood would start and where these adolescents will take these diseases into adulthood.”
Adjusting for demographics, metabolic diseases and participation in the Supplemental Nutrition Assistance Program, food insecurity and hypertension were independently associated with MASLD. A multivariable model further showed that food insecure adolescents living in homes with low household incomes had a higher risk of MASLD than those from in homes with higher incomes.
“We believe the association of food insecurity with MASLD is more likely due to ... being unable to purchase high-quality food and instead relying on low-quality food," Dr. Younossi said. "This may lead to a cycle of overconsumption of highly processed and sugar sweetened foods that promote this liver disease.”
He further noted that areas that are food deserts—characterized by lack of access to well-stocked grocery stores —also tend to be activity deserts. “They don’t have parks of playgrounds where kids can be active. So it’s a combination of things. When you look at a data set like this it’s hard to tease them out, but they all go together.”
—Monica J. Smith
