Food insecurity is associated with magnetic resonance–determined nonalcoholic fatty liver and liver fibrosis in low-income, middle-aged adults with and without HIV

Abstract

Background Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in the United States. Food-insecure individuals often depend on low-cost, energy-dense but nutritionally poor foods, resulting in obesity and chronic diseases related to NAFLD. Objectives To determine whether food insecurity is associated with NAFLD in a cohort of HIV and hepatitis C virus (HCV) infected and uninfected adults. Methods We conducted a cross-sectional analysis of low-income, middle-aged adults from the Miami Adult Studies on HIV (MASH) cohort without a history of excessive alcohol consumption. Food security was assessed with the USDA's Household Food Security Survey. MRIs were used to assess liver steatosis and fibrosis. Metabolic parameters were assessed from fasting blood, anthropometrics, and vitals. Results Of the total 603 participants, 32.0% reported food insecurity. The prevalences of NAFLD, fibrosis, and advanced fibrosis were 16.1%, 15.1%, and 4.6%, respectively. For every 5 kg/m2 increase in BMI, the odds of NAFLD increased by a factor of 3.83 (95% CI, 2.37–6.19) in food-insecure participants compared to 1.32 (95% CI, 1.04–1.67) in food-secure participants. Food insecurity was associated with increased odds for any liver fibrosis (OR, 1.65; 95% CI, 1.01–2.72) and advanced liver fibrosis (OR, 2.82; 95% CI, 1.22–6.54), adjusted for confounders. HIV and HCV infections were associated with increased risks for fibrosis, but the relationship between food insecurity and liver fibrosis did not differ between infected and uninfected participants. Conclusions Among low-income, middle-aged adults, food insecurity exacerbated the risk for NAFLD associated with a higher BMI and independently increased the risk for advanced liver fibrosis. People who experience food insecurity, particularly those vulnerable to chronic diseases and viral infections, may be at increased risk for liver-related morbidity and mortality. Improving access to adequate nutrition and preventing obesity among low-income groups may lessen the growing burden of NAFLD and other chronic diseases.

In the midst of plenty: Experiences of food insecurity amongst women living with HIV in Vancouver, Canada

“…Food insecurity in high‐income settings tends to result in becoming overweight or experiencing obesity; however, PLWH who are food insecure may experience issues of both underweight and overweight (Sirotin et al., 2012, 2014; Tamargo et al., 2021). Weight issues were often tied to the inability of food banks to provide nutritious food, and existing research suggests WLWH experience issues with weight maintenance as a result of food insecurity (Eicher‐Miller, 2020; Sirotin et al., 2014; Weiser, Fernandes, et al., 2009).…”

Association between the food security status and dietary patterns with polycystic ovary syndrome (PCOS) in overweight and obese Iranian women: a case-control study

“…According to our result, almost 60% of PCOS women and 30% of non-PCOS women had FI. Around the world, FI is one of the most challenging conditions, especially in women, occurs as a consequence of nonsufficient or restricted availability of safe food resources, which can exert several adverse effects, such as obesity [ 30 , 31 , 54 – 56 ] and reduced physical activity [ 57 ]. Furthermore, obesity itself which can be manifested as high waist circumference can amplify the severity of metabolic disorders, such as PCOS [ 58 – 60 ].…”

“…In addition, food insecurity (FI) is considered as a condition that there is limited or uncertain access to adequate healthy diets, which can cause a broad spectrum of socio-emotional issues, obesity, and chronic disorders [ 30 , 31 ] that may be affected by several socio-economic factors [ 32 ]. It was found that FI itself can contribute to the disturbance of the eating patterns and thereby the dietary intakes [ 33 ].…”

Association Between the Food Security Status and Dietary Patterns With Polycystic Ovary Syndrome (PCOS) in Overweight and Obese Iranian Women: A Case-Control Study

“…According to our result, almost 60% of women with PCOS and 30% of non-PCOS women had FI. Around the world, FI especially in women is one of the most challenging can exert several adverse effects such as obesity [30,31,[53][54][55] and altering physical activity [56]. Furthermore, obesity itself which can be manifested as high waist circumference can amplify the severity of kinds of metabolic disorders such as PCOS [57][58][59].…”

“…In addition, food insecurity (FI) is considered as a condition that there is limited access to an adequate healthy diet which can cause a wide spectrum of socio-emotional issues, obesity, and chronic disorders [30,31] that may be affected by several socio-economic factors [32]. Nowadays, almost 795 million persons suffer from FI around the world [33].…”