食物沼泽和食物荒漠对美国各县代谢功能障碍相关脂肪性肝病死亡率的影响。

Food Swamps and Food Deserts Impact on Metabolic Dysfunction-Associated Steatotic Liver Disease Mortality in US Counties.

作者信息

Paik Annette, Henry Linda, de Avila Leyla, AlQahtani Saleh, Nader Fatema, Paik James M, Younossi Zobair M

机构信息

The Global NASH Council, Washington, DC; Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia.

The Global NASH Council, Washington, DC; Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland.

出版信息

Clin Gastroenterol Hepatol. 2025 May;23(6):997-1007.e5. doi: 10.1016/j.cgh.2024.08.053. Epub 2024 Nov 13.

DOI:10.1016/j.cgh.2024.08.053

PMID:39542386

Abstract

BACKGROUND AND AIMS

Lacking access to quality food may increase the risk of metabolic dysfunction-associated steatotic liver disease (MASLD). We investigated associations between food environment factors (food deserts and food swamps) and MASLD-related mortality across the United States.

METHODS

MASLD-related deaths were obtained from the National Vital Statistics System (2016-2020) and food environment factors from Food Environment Atlas. Food deserts are areas where low-income residents have limited access to affordable and nutritious food due to a scarcity of nearby grocery stores. Food swamps are areas oversaturated with outlets offering limited healthy food options.

RESULTS

Counties in the highest mortality quartile (fourth quartile) compared with the lowest mortality quartile (first quartile) were predominantly located in the South region (78.7% vs 23.5%) and rural areas (76.1% vs 26.6%). These counties also had higher rates of elderly residents (19.4% vs 16.5%), Hispanic residents (13.1% vs 10.5%), household crowding (2.83% vs 2.37%), no broadband Internet subscription (23.9% vs 12.7%), no high school diploma (16.1% vs 9.0%), poverty (30.2% vs 18.5%), unemployment (6.4% vs 4.7%), food deserts (8.7% vs 5.8%), and food swamp ratio (5.69 vs 4.28) (all P values <.001). After adjusting for county sociodemographic and clinical factors and regions, mixed-effects linear regression models showed significant differences in mortality rates (per 100,000) between counties with the highest vs lowest quartiles of food deserts (25.65 vs 12.75, adjusted difference = 3.66 [95% confidence interval, 2.66-4.72]) and food swamps (27.13 vs 20.15 per 100,000, adjusted difference = 3.57 [95% confidence interval, 2.44-4.71]).

CONCLUSIONS

In the United States, addressing sociodemographic and food environment disparities is paramount to reduce MASLD-related mortality.

摘要

背景与目的

缺乏优质食物可能会增加代谢功能障碍相关脂肪性肝病（MASLD）的风险。我们调查了美国食物环境因素（食物荒漠和食物沼泽）与MASLD相关死亡率之间的关联。

方法

MASLD相关死亡数据来自国家生命统计系统（2016 - 2020年），食物环境因素来自食物环境地图集。食物荒漠是指由于附近杂货店稀少，低收入居民获取平价营养食物机会有限的地区。食物沼泽是指提供有限健康食物选择的场所过度饱和的地区。

结果

与最低死亡率四分位数（第一四分位数）相比，最高死亡率四分位数（第四四分位数）的县主要位于南部地区（78.7%对23.5%）和农村地区（76.1%对26.6%）。这些县的老年居民比例（19.4%对16.5%）、西班牙裔居民比例（13.1%对10.5%）、家庭拥挤率（2.83%对2.37%）、无宽带网络订阅率（23.9%对12.7%）、无高中文凭率（16.1%对9.0%）、贫困率（30.2%对18.5%）、失业率（6.4%对4.7%）、食物荒漠率（8.7%对5.8%）以及食物沼泽比例（5.69对4.28）也更高（所有P值<0.001）。在调整了县社会人口统计学和临床因素以及地区因素后，混合效应线性回归模型显示，食物荒漠最高四分位数县与最低四分位数县之间的死亡率（每10万人）存在显著差异（25.65对12.75，调整后差异 = 3.66 [95%置信区间，2.66 - 4.72]），食物沼泽方面也有显著差异（每10万人中27.13对20.15，调整后差异 = 3.57 [95%置信区间，2.44 - 4.71]）。