Food Insecurity and Poverty Are Associated with Increased Risk for MASLD Among US Adults

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing and disproportionately affects minority populations in the U.S. Racial and ethnic minority groups experience higher rates of food insecurity and poverty. We examined the associations between food insecurity, poverty, and risks of MASLD and moderate fibrosis overall and across racial and ethnic groups.

We used the 2017-2020 National Health and Nutrition Examination Survey data. The inclusion criteria for the current study were being aged ≥ 20 years, being interviewed at home and in a mobile examination center, having undergone Fibroscan, and having available data for food security, poverty ratio, and ethnicity questionnaire components. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using weighted multivariate logistic regression models.

Of the 5741 respondents, 1966 (33.8 weighted %) had MASLD, including 525 (27.0%) with moderate fibrosis. Very low (Adjusted OR [AOR] 1.61; 95% CI 1.27-2.03) food security and poverty index < 1.30 (AOR 1.29; 95% CI 1.03-1.62) were statistically significantly associated with increased risk for MASLD. When stratified by race/ethnicity, the association between very low food security and MASLD only remained statistically significant in non-Hispanic white (NHWs; AOR 1.96; 95% CI 1.34-2.87) individuals. Poverty was not statistically significantly associated with MASLD in analyses stratified by race/ethnicity.

Food insecurity and poverty were associated with MASLD risk. When stratified by race/ethnicity, food insecurity remained associated with MASLD only in the NHW population. Further studies and tailored interventions are needed to address food insecurity and poverty and the impact on liver disease.