Florida International University, Miami, FL, USA.
University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Am J Clin Nutr. 2021 Mar 11;113(3):593-601. doi: 10.1093/ajcn/nqaa362.
Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in the United States. Food-insecure individuals often depend on low-cost, energy-dense but nutritionally poor foods, resulting in obesity and chronic diseases related to NAFLD.
To determine whether food insecurity is associated with NAFLD in a cohort of HIV and hepatitis C virus (HCV) infected and uninfected adults.
We conducted a cross-sectional analysis of low-income, middle-aged adults from the Miami Adult Studies on HIV (MASH) cohort without a history of excessive alcohol consumption. Food security was assessed with the USDA's Household Food Security Survey. MRIs were used to assess liver steatosis and fibrosis. Metabolic parameters were assessed from fasting blood, anthropometrics, and vitals.
Of the total 603 participants, 32.0% reported food insecurity. The prevalences of NAFLD, fibrosis, and advanced fibrosis were 16.1%, 15.1%, and 4.6%, respectively. For every 5 kg/m2 increase in BMI, the odds of NAFLD increased by a factor of 3.83 (95% CI, 2.37-6.19) in food-insecure participants compared to 1.32 (95% CI, 1.04-1.67) in food-secure participants. Food insecurity was associated with increased odds for any liver fibrosis (OR, 1.65; 95% CI, 1.01-2.72) and advanced liver fibrosis (OR, 2.82; 95% CI, 1.22-6.54), adjusted for confounders. HIV and HCV infections were associated with increased risks for fibrosis, but the relationship between food insecurity and liver fibrosis did not differ between infected and uninfected participants.
Among low-income, middle-aged adults, food insecurity exacerbated the risk for NAFLD associated with a higher BMI and independently increased the risk for advanced liver fibrosis. People who experience food insecurity, particularly those vulnerable to chronic diseases and viral infections, may be at increased risk for liver-related morbidity and mortality. Improving access to adequate nutrition and preventing obesity among low-income groups may lessen the growing burden of NAFLD and other chronic diseases.
非酒精性脂肪性肝病（NAFLD）是美国最常见的肝脏疾病。食物不安全的个体通常依赖于低成本、高能量但营养差的食物，导致肥胖和与 NAFLD 相关的慢性疾病。
在一组 HIV 和丙型肝炎病毒（HCV）感染和未感染的成年人中，确定食物不安全是否与 NAFLD 相关。
我们对来自迈阿密成人 HIV 研究（MASH）队列的低收入中年成年人进行了横断面分析，这些成年人没有过量饮酒史。食物安全状况采用美国农业部的家庭食物安全调查进行评估。MRI 用于评估肝脂肪变性和纤维化。代谢参数来自空腹血液、人体测量学和生命体征。
在总共 603 名参与者中，32.0%报告食物不安全。NAFLD、纤维化和晚期纤维化的患病率分别为 16.1%、15.1%和 4.6%。与食物安全参与者相比，BMI 每增加 5kg/m2，NAFLD 的几率增加 3.83 倍（95%CI，2.37-6.19），而食物不安全参与者为 1.32 倍（95%CI，1.04-1.67）。与食物安全参与者相比，食物不安全与任何程度的肝纤维化（OR，1.65；95%CI，1.01-2.72）和晚期肝纤维化（OR，2.82；95%CI，1.22-6.54）的几率增加相关，调整混杂因素后。HIV 和 HCV 感染与纤维化的风险增加相关，但食物不安全与肝纤维化之间的关系在感染和未感染参与者之间没有差异。
在低收入中年成年人中，食物不安全加剧了与 BMI 较高相关的 NAFLD 风险，并独立增加了晚期肝纤维化的风险。经历食物不安全的人，特别是那些易患慢性疾病和病毒感染的人，可能面临更高的肝脏相关发病率和死亡率。改善低收入人群获得充足营养的机会并预防肥胖，可能会减轻日益增长的 NAFLD 和其他慢性疾病的负担。
