Food Insecurity, Household Income Associated with Risk of NAFLD in Adolescents

James Paik, PhD

Credit: LinkedIn

Food insecurity and low household income increase the risk of nonalcoholic fatty liver disease (NAFLD) risk in adolescents, according to findings from a recent study.

Presented at The Liver Meeting 2023 from the American Association for the Study of Liver Diseases (AASLD) by James Paik, PhD, senior biostatistician at Inova Health System, data showed food-insecure adolescents living in lower-income households were at a greater risk of NAFLD compared to their higher-income counterparts.¹

The most common chronic liver condition in the United States, NAFLD affects an estimated 25% of adults and 5%-10% of adolescents. Food insecurity is known to be associated with obesity, hypertension, diabetes, and other cardiometabolic risks widely considered to be key predictors of NAFLD, although little is known about the direct association between food insecurity and NAFLD. People who develop NAFLD during childhood are more likely to have NASH and related complications or liver disease as adults, so understanding food insecurity’s role in adolescent NAFLD is of great interest.^2,3

To examine the association between food insecurity and NAFLD among adolescents in the US, investigators collected data for patients aged 12-18 years from the 2017-2018 National Health and Nutrition Examination Survey (NHANES) and compared it to food insecurity, household income relative to the federal poverty level, and the development of NAFLD.¹

Investigators assessed food insecurity using the US Department of Agriculture (USDA) Child Food Security Survey Module. Adolescents with 2 or more affirmative responses were classified as having food insecurity according to USDA guidelines. Low household income level was defined as household income <138% federal poverty level.¹

A total of 771 adolescents were included in NHANES 2017-2018. Among these participants, the mean age was 14.7 years, 52.5% were male, and 50.9% were white. Food insecurity was reported among 9.8% of this group, and 10.8% had NAFLD. Investigators pointed out among the cohort, 22.5% of patients had obesity, 45.4% had central obesity, 1.0% had diabetes, 20.9% had pre-diabetes; 4.5% had hypertension, 41.6% had hyperlipidemia, and 17.3% had high C-reactive.¹

Upon analysis, 98.9% of adolescents who were considered food insecure relied on low-cost food. Additionally, 93.2% could not get a balanced meal and 51.5% did not eat enough food.¹

Food-insecure adolescents had greater rates of NAFLD (18.7%) and advanced fibrosis (2.8%) compared to their food-secure counterparts (9.9% and 0.3%, respectively). Investigators noted adolescents reporting food insecurity were less likely to be a US citizen compared to food-secure adolescents (88.8% vs 95.6%) and were more likely to participate in SNAP (62.4% vs 25.1%), have a lower household income (70.4% vs 25.7%), and live in a household where the head of the household has a lower level of education (29.2% vs 17.0%). However, there were no significant differences in metabolic diseases according to food insecurity.¹

In a model adjusted for demographic factors, metabolic diseases, and SNAP participation, food insecurity (Odds ratio [OR], 2.62; 95% confidence interval [CI], 1.07-6.41), obesity (OR, 15.56; 95% CI, 7.71-31.50), and hypertension (OR, 4.93; 95% CI, 2.67-9.14) were independently associated with NAFLD. An additional multivariable model showed food-insecure adolescents living in a lower-income household had a greater risk of NAFLD (OR, 4.79; 95% CI, 1.44-15.86) compared to adolescents living in higher-income households.¹

“Food insufficiency and low household income drive NAFLD risk for adolescents,” concluded investigators.¹

References:

1. Paik, JM, et al. 176: FOOD INSECURITY AND HOUSEHOLD INCOME SUBSTANTIALLY INCREASE THE RISK OF NAFLD AMONG ADOLESCENT CHILDREN IN THE UNITED STATES. Paper presented at: The Liver Meeting. Boston, MA. November 10 - 14, 2023.
2. American Liver Foundation. NASH Definition & Prevalence. Nonalcoholic Steatohepatitis (NASH). November 1, 2023. Accessed November 12, 2023. https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-steatohepatitis-nash/nash-definition-prevalence/
3. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & Facts of NAFLD & NASH in Children. December 1, 2021. Accessed November 12, 2023. https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash-children/definition-facts