Division of Gastrointestinal and Liver Diseases University of Southern California, Los Angeles, California.
Division of Gastrointestinal and Liver Diseases University of Southern California, Los Angeles, California; Department of Population and Public Health Sciences University of Southern California, Los Angeles, California.
Clin Gastroenterol Hepatol. 2022 Dec;20(12):2790-2799.e4. doi: 10.1016/j.cgh.2021.11.029. Epub 2021 Dec 16.
BACKGROUND & AIMS: Food insecurity is a growing public health challenge in the United States (U.S.) and has been linked to nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis. However, little is known of how food insecurity impacts mortality risk and health care utilization in chronic liver disease.
Using a population-based cohort study of U.S. adults (≥20 years) in the National Health and Nutrition Examination Survey, 1999 to 2014, with NAFLD (estimated by the U.S. Fatty Liver Index) and advanced fibrosis (estimated by the NAFLD fibrosis score, aspartate aminotransferase-to-platelet ratio index, or Fibrosis-4 Index), food security was measured using the Department of Agriculture Food Security Survey Module. The primary outcome was all-cause mortality from National Death Index data and the secondary outcome was health care utilization, defined as ≥2 inpatient and ≥4 outpatient visits, with Cox and logistic regression, respectively, estimating associations between food insecurity and outcomes.
Of 34,134 eligible participants (mean age, 47 years; 51% women; 14% in poverty), 4816 had NAFLD and 1654 had advanced fibrosis, with food insecurity present in 28% and 21%, respectively. All-cause age-adjusted mortality was 12 per 1000 person-years among participants with NAFLD (food-secure, 11; food-insecure, 15) and 32 per 1000 person-years among advanced fibrosis participants (food-secure, 28; food-insecure, 50). In multivariable analyses, food insecurity was independently associated with higher mortality among participants with NAFLD (hazard ratio, 1.46; 95% confidence interval [CI], 1.08-1.97) and advanced fibrosis (hazard ratio, 1.37; 95% CI, 1.01-1.86) and greater outpatient health care utilization in participants with NAFLD (odds ratio, 1.32; 95% CI, 1.05-1.67).
Food insecurity is significantly associated with greater all-cause mortality in adults with NAFLD and advanced fibrosis. Interventions that address food insecurity among adults with liver disease should be prioritized to improve health outcomes in this population.
在美国，食物不安全是一个日益严重的公共卫生挑战，与非酒精性脂肪性肝病（NAFLD）和晚期纤维化有关。然而，人们对食物不安全如何影响慢性肝病患者的死亡风险和医疗保健利用知之甚少。
利用美国国家健康和营养调查 1999 年至 2014 年≥20 岁成年人的基于人群的队列研究，使用美国脂肪性肝病指数估计 NAFLD，使用 NAFLD 纤维化评分、天门冬氨酸氨基转移酶与血小板比值指数或纤维化 4 指数估计晚期纤维化，使用农业部食物安全调查模块测量食物安全性。主要结局是通过国家死亡指数数据获得的全因死亡率，次要结局是医疗保健利用，定义为≥2 次住院和≥4 次门诊就诊，分别使用 Cox 和逻辑回归估计食物不安全与结局之间的关联。
在 34134 名合格参与者中（平均年龄 47 岁；51%为女性；14%处于贫困状态），4816 人患有 NAFLD，1654 人患有晚期纤维化，分别有 28%和 21%的人存在食物不安全。NAFLD 患者的全因年龄调整死亡率为每 1000 人年 12 例（食物安全者 11 例，食物不安全者 15 例），晚期纤维化患者为每 1000 人年 32 例（食物安全者 28 例，食物不安全者 50 例）。多变量分析显示，食物不安全与 NAFLD 患者（危险比，1.46；95%置信区间[CI]，1.08-1.97）和晚期纤维化患者（危险比，1.37；95%CI，1.01-1.86）的死亡率升高独立相关，与 NAFLD 患者的门诊医疗保健利用率增加相关（比值比，1.32；95%CI，1.05-1.67）。
食物不安全与 NAFLD 和晚期纤维化成人的全因死亡率显著相关。应优先考虑针对肝病患者的食物不安全干预措施，以改善该人群的健康结局。
