Food Insecurity and Its Association with the Spectrum of Steatotic Liver Disease and Hepatic Fibrosis

The impact of food insecurity on the subtypes of steatotic liver disease (SLD) under the updated nomenclature remains undefined. We aimed to assess the relationship between food insecurity and metabolic dysfunction-associated SLD (MASLD), alcohol-related liver disease (ALD), and metabolic dysfunction and alcohol-related SLD (MetALD), with a focus on significant fibrosis. Using data from the 2017 to 2023 U.S. National Health and Nutrition Examination Survey, we defined food security as full, marginal, low, or very low. We defined SLD subtypes and significant fibrosis using transient elastography. Food insecurity was independently associated with 37% higher odds of MASLD (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.15 to 1.64). A dose-response relationship was evident, with low/very low food security conferring the highest risk. In contrast, the association between food insecurity and MetALD or ALD was not statistically significant. Food insecurity was linked to increased odds of significant fibrosis (OR, 1.34; 95% CI, 1.09 to 1.64); after adjusting for diabetes and obesity, this association was attenuated but remained statistically significant (OR, 1.22; 95% CI, 1.00 to 1.49; p=0.048). Food insecurity is independently associated with MASLD in the United States but not with MetALD or ALD. Food insecurity is significantly associated with significant hepatic fibrosis.