食物不安全可能是美国低收入成年人非酒精性脂肪性肝病的一个独立相关风险因素。
Food Insecurity May Be an Independent Risk Factor Associated with Nonalcoholic Fatty Liver Disease among Low-Income Adults in the United States.
机构信息
Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
出版信息
J Nutr. 2020 Jan 1;150(1):91-98. doi: 10.1093/jn/nxz212.
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.
背景
非酒精性脂肪性肝病（NAFLD）被视为代谢健康的“晴雨表”，是美国最主要的肝病病因。尽管食物不安全与肥胖症、高血压和糖尿病之间存在已确立的关联，但人们对食物不安全与 NAFLD 之间的关系知之甚少。
目的
我们旨在评估美国低收入成年人中食物不安全与 NAFLD 之间的关系。
方法
我们对 NHANES（2005-2014 年波次）中具有代表性的低收入成年人进行了横断面分析。参与者包括无慢性病毒性肝炎或自述大量饮酒的低收入家庭（≤联邦贫困水平的 200%）成年人。使用家庭粮食安全调查评估食物不安全。我们的主要结局是由美国脂肪肝指数估计的 NAFLD，次要结局是由 NAFLD 纤维化评分估计的晚期纤维化。使用多变量逻辑回归评估食物不安全（定义为低和极低食物安全）与肝脏结局之间的关联，调整了社会人口统计学因素。
结果
在纳入分析的 2627 名成年人中，有 29%（95%CI：26%，32%）存在食物不安全。中位年龄为 43 岁，58%为女性，54%为白人。按粮食安全状况估计的 NAFLD 的加权患病率无显著差异（粮食安全者为 31%，粮食不安全者为 34%，P=0.21）。在多变量模型中，与粮食安全者相比，食物不安全的成年人更可能患有 NAFLD（调整后的 OR：1.38；95%CI：1.08，1.77）和晚期纤维化（调整后的 OR：2.20；95%CI：1.27，3.82）。
结论
食物不安全可能与美国低收入成年人的 NAFLD 和晚期纤维化独立相关。未来的策略应评估改善食物获取、质量和健康饮食习惯是否会降低高危成年人中日益增长的与 NAFLD 相关发病率和死亡率的负担。
Zotero 插件