食物不安全、家庭收入低和教育程度低会增加美国青少年发生代谢相关脂肪性肝病的风险。

Food Insecurity, Low Household Income, and Low Education Level Increase the Risk of Having Metabolic Dysfunction-Associated Fatty Liver Disease Among Adolescents in the United States.

机构信息

The Global NASH Council, Washington, District of Columbia, USA.

Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA.

出版信息

Am J Gastroenterol. 2024 Jun 1;119(6):1089-1101. doi: 10.14309/ajg.0000000000002749. Epub 2024 Mar 13.

DOI:10.14309/ajg.0000000000002749

PMID:38477467

Abstract

INTRODUCTION

In the United States, 10.2% households (HH) report child food insecurity. We assessed associations between metabolic dysfunction-associated fatty liver disease (MASLD) and food insecurity among the adolescents in the United States.

METHODS

This cross-sectional study was performed using data from the National Health and Nutrition Examination Survey 2017-2018. Food insecurity was assessed by the US Department of Agriculture Child Food Security Survey Module. MASLD was defined by transient elastography.

RESULTS

Among 771 adolescents (aged 12-18 years) (mean age 14.7 years; 52.5% male; 50.9% White, 12.7% Black, 24.4% Hispanic, and 12.1% other), 9.8% reported food insecurity; MASLD prevalence of 10.12% (95% confidence interval [CI] 7.13%-13.20%) affecting 4.27 million adolescents; and nonalcoholic fatty liver disease prevalence of 10.77% (95% CI 7.76-13.78) affecting 4.52 million adolescents. There was near-perfect concordance between MASLD and nonalcoholic fatty liver disease (Cohen's κ coefficient of 0.971, 95% CI 0.946-0.996). The prevalence of MASLD was greater among food-insecure adolescents vs food-secure ones (17.4% vs 9.4%) and adolescents living with a low HH income vs those with a higher HH income (15.0% vs 7.2%) and living with a head of HH with a lower education level vs one with a higher education level (18.0% vs 8.2%) ( P < 0.05). The fully adjusted model showed that compared with adolescents living in a higher HH income, food-insecure adolescents living in low income HH had a 3-fold greater risk (odds ratio [OR] 3.25, 1.31-8.08) of having MASLD, while food-secure adolescents living in low-income HH had no increased risk (OR 1.58, 0.85-2.93, P = 0.139). The fully adjusted odds of having MASLD was elevated by +163% with the presence of HTN (OR 2.63, 1.02-6.78), +241% with being Hispanic (OR 3.41, 1.36-8.56), and +138% with being male (OR 2.38, 1.20-4.75). In addition, a 1-unit increase in BMI was associated with 25% increase in the odds of having MASLD (OR 1.25, 1.17-1.33) among US adolescents.

DISCUSSION

Food insecurity is associated with MASLD among US low-income adolescents especially Hispanic male individuals with obesity and hypertension. Policies addressing inequities are needed.

摘要

简介

在美国，有 10.2%的家庭报告存在儿童食物不安全问题。我们评估了代谢功能相关脂肪性肝病（MASLD）与美国青少年食物不安全之间的关系。

方法

本横断面研究使用了 2017-2018 年全国健康和营养调查的数据。食物不安全情况由美国农业部儿童食品安全调查模块评估。MASLD 通过瞬时弹性成像定义。

结果

在 771 名青少年（年龄 12-18 岁；平均年龄 14.7 岁；52.5%为男性；50.9%为白人，12.7%为黑人，24.4%为西班牙裔，12.1%为其他族裔）中，9.8%报告存在食物不安全问题；MASLD 的患病率为 10.12%（95%置信区间[CI]7.13%-13.20%），影响 4270 万名青少年；非酒精性脂肪性肝病的患病率为 10.77%（95%CI 7.76-13.78），影响 4520 万名青少年。MASLD 和非酒精性脂肪性肝病之间几乎完全一致（Cohen's κ 系数为 0.971，95%CI 0.946-0.996）。与食物安全的青少年相比，食物不安全的青少年 MASLD 的患病率更高（17.4% vs 9.4%），与家庭收入较低的青少年相比，家庭收入较高的青少年 MASLD 的患病率更高（15.0% vs 7.2%），与家中受教育程度较低的户主相比，受教育程度较高的户主 MASLD 的患病率更高（18.0% vs 8.2%）（P < 0.05）。完全调整后的模型显示，与生活在高家庭收入的青少年相比，生活在低收入家庭的食物不安全的青少年患 MASLD 的风险增加了 3 倍（比值比[OR]3.25，1.31-8.08），而食物安全的生活在低收入家庭的青少年没有增加的风险（OR 1.58，0.85-2.93，P = 0.139）。存在高血压时，青少年患 MASLD 的几率增加了 163%（OR 2.63，1.02-6.78），为西班牙裔时增加了 241%（OR 3.41，1.36-8.56），为男性时增加了 138%（OR 2.38，1.20-4.75）。此外，在美国青少年中，BMI 每增加 1 个单位，患 MASLD 的几率就会增加 25%（OR 1.25，1.17-1.33）。