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Food Insecurity, Low Household Income, and Low Education Level Increase the Risk of Having Metabolic Dysfunction Associated Fatty Liver Disease (MASLD) Among Adolescents in the United States.
American Journal of Gastroenterology 2024 March 14
BACKGROUND: In the U.S., 10.2% households (HHs) report child food insecurity. We assessed associations between MASLD and food insecurity among the adolescents in the U.S.
METHODS: Cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) 2017-2018. Food insecurity was assessed by the U.S. Department of Agriculture Child Food Security Survey Module. MASLD was defined by transient elastography (TE).
RESULTS: Among 771 adolescents (aged 12-18) [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 10.12% (95% CI: 7.13-13.20%) affecting 4.27 million adolescents; NAFLD prevalence of 10.77% (95% CI: 7.76-13.78) affecting 4.52 million adolescents. There was near perfect concordance between MASLD and NAFLD [Cohen's kappa 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. a higher HH income (15.0% vs. 7.2%) and living with a head of HH with a lower education level vs. a higher education level (18.0% vs. 8.2%) (p<.05).The fully adjusted model showed that compared to adolescents living in a higher HH income, food-insecure adolescents living in low income HH had a 3-fold greater risk (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). Additionally, 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 U.S. adolescents.
CONCLUSION: Food insecurity is associated with MASLD among U.S. low-income adolescents especially Hispanic males with obesity and hypertension. Policies addressing inequities are needed.
METHODS: Cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) 2017-2018. Food insecurity was assessed by the U.S. Department of Agriculture Child Food Security Survey Module. MASLD was defined by transient elastography (TE).
RESULTS: Among 771 adolescents (aged 12-18) [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 10.12% (95% CI: 7.13-13.20%) affecting 4.27 million adolescents; NAFLD prevalence of 10.77% (95% CI: 7.76-13.78) affecting 4.52 million adolescents. There was near perfect concordance between MASLD and NAFLD [Cohen's kappa 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. a higher HH income (15.0% vs. 7.2%) and living with a head of HH with a lower education level vs. a higher education level (18.0% vs. 8.2%) (p<.05).The fully adjusted model showed that compared to adolescents living in a higher HH income, food-insecure adolescents living in low income HH had a 3-fold greater risk (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). Additionally, 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 U.S. adolescents.
CONCLUSION: Food insecurity is associated with MASLD among U.S. low-income adolescents especially Hispanic males with obesity and hypertension. Policies addressing inequities are needed.
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