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“New research suggests that adolescents who experience uncertainty about their next meal face an elevated risk of developing Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD, formerly known as NAFLD) compared to their peers from more financially stable households.
Analyzing data from the National Health and Nutrition Examination Survey (NHANES) for children aged 12-18, Dr. Zobair M. Younossi and colleagues from the Beatty Liver and Obesity research program at Inova Health System in Fairfax, Virginia observed a correlation between adolescents with MASLD and those living in low-income households facing food insecurity. These adolescents tended to rely on lower-cost, less balanced food options.
Dr. Younossi explained during a media briefing at The Liver Meeting 2023: American Association for the Study of Liver Diseases (AASLD) that when accounting for demographic and metabolic factors, food insecurity remained significantly associated with NAFLD or MASLD.
The US Department of Agriculture (USDA) defines food insecurity as ‘the limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.’
Approximately 10.2% of children in the US are estimated to experience food insecurity. While it has been established as a risk factor for MASLD in adults, the connection between food insecurity and liver disease in children and adolescents is less extensively documented.
To investigate this potential link, Younossi and colleagues analyzed data from the 2017-2018 NHANES, using the USDA Child Food Security Survey Module. This module comprises eight questions assessing food security levels, ranging from mild concerns about food availability to severe cases of going without food due to financial constraints.
Among the 771 adolescents surveyed, 9.8% reported food insecurity, while 10.8% had MASLD. Almost all (98.9%) of the food-insecure adolescents relied on low-cost food, and 93.2% struggled to access balanced meals. Additionally, 51.5% did not consume enough food.
Food-insecure adolescents were more likely to have MASLD (18.7% vs. 9.9% for food-secure peers) and exhibited higher rates of significant and advanced fibrosis. They were also less likely to be US citizens, more likely to come from lower-income households, and more likely to participate in the Supplemental Nutrition Assistance Program (SNAP).
In models accounting for age, sex, and race, factors independently associated with MASLD included food insecurity (OR: 2.37, P = .0127) and low household income (OR: 2.07, P = .0071). In a multivariable model adjusting for additional demographic factors, the association between food insecurity and MASLD remained significant (OR: 2.43, P = .0168), while low household income lost significance.
At the briefing, Dr. Norah Terrault, president of AASLD, emphasized the importance of public awareness regarding MASLD, highlighting that as many as 1 in 10 children may be affected. She encouraged individuals of all ages to inquire about their liver health during medical visits.”
