Fatty liver disease, characterized by abnormal accumulation of fat in the liver, covers a broad spectrum of clinical concerns including a buildup of fibrous tissue, liver cirrhosis, and increased risk of end-stage liver disease. Furthermore, it has been linked to type 2 diabetes and cardiovascular disease.

Dietary factors, not related to excessive alcohol consumption, are associated with fat accumulation in the liver. Referred to as nonalcoholic fatty liver disease, evidence suggests that overconsumption of foods of poor nutritional quality may increase a person’s risk. Because of limited food budgets, people living in food-insecure households tend to rely more heavily on foods of low nutritional quality. Therefore, food insecurity may trigger a complex cycle of poor dietary intake, which may predispose individuals to increased risk of nonalcoholic fatty liver disease.

A new study published in The Journal of Nutrition evaluated the association of food insecurity with nonalcoholic fatty liver disease among low-income adults in the United States. Conducting a cross-sectional study consisting of a nationally representative sample of adults, Ilya Golovaty (University of California San Francisco) and colleagues used the Household Food Security Survey to measure food insecurity. Nonalcoholic fatty liver disease and advanced liver fibrosis were estimated using the US Fatty Liver Index and by the Nonalcoholic fatty liver disease Fibrosis Score, respectively. The association between food insecurity and liver outcomes was assessed, adjusting for sociodemographic factors. 

“The Supplemental Nutrition Assistance Program (formerly known as the Food Stamp Program) is the most important tool in the United States to reduce food insecurity.”

Dr. Craig Gundersen

Of the 2995 participants included in the analysis, approximately 1 in 3 adults lived in food-insecure households. Although adults reporting household food insecurity were significantly younger, more than 1 in 3 were obese, 13% had type 2 diabetes, and 23% had high blood pressure. Among low-income adults, the estimated prevalence of nonalcoholic fatty liver disease and advanced fibrosis was 32% and 5%, respectively. Food insecurity was associated with a higher odds of estimated nonalcoholic fatty liver disease and advanced fibrosis after adjusting for sociodemographic and behavioral factors.

These findings suggest that food insecurity may be a contributor to the burgeoning prevalence of metabolic-related liver disease in the United States. Programs addressing the growing burden of nonalcoholic fatty liver disease should consider strategies that improve food access, quality, and healthy eating habits among low-income adults.  A corresponding editorial by Craig Gundersen also stresses the importance of nonalcoholic fatty liver disease intervention stating that “The Supplemental Nutrition Assistance Program (formerly known as the Food Stamp Program) is the most important tool in the United States to reduce food insecurity. Proposed restrictions in the Supplemental Nutrition Assistance Program may reduce eligibility and, hence, increase the prevalence of food insecurity.”

Reference Golovaty I, Tien C, Price JC, Sheira L, Seligman H, Weiser SD. Food insecurity may be an independent risk factor associated with nonalcoholic fatty liver disease among low-income adults in the United States. The Journal of Nutrition, nxz212, https://doi.org/10.1093/jn/nxz212.

Gundersen C.  Expand SNAP to reduce nonalcoholic fatty liver disease in the United States. The Journal of Nutrition, nxz247, https://doi.org/10.1093/jn/nxz247.

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