Risk for death higher in food insecure patients with NAFLD, advanced fibrosis
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Among patients with nonalcoholic fatty liver disease and advanced fibrosis, food insecurity significantly correlated with greater all-cause mortality, according to a presenter at the International Liver Congress.
“Food insecurity is prevalent in the United States in adults with NAFLD and advanced fibrosis,” Ani Kardashian, MD, from the department of preventive medicine, University of Southern California, Los Angeles, said during her presentation. “It is associated with greater risk for death in this population. This study really highlights the importance of us really focusing on upstream social determinants of health and the long-term outcomes of people with NAFLD and advanced liver fibrosis.”
Kardashian and colleagues included in their study 34,134 U.S. adults from the U.S. National Health and Nutrition Examination Survey from 1999-2014. Of these, 4,816 had NAFLD and 1,654 had advanced fibrosis. Investigators used the U.S. Department of Agriculture Food Security Survey Module to measure food insecurity. They also used the National Death Index to determine mortality from all causes through Dec. 31, 2015.
Investigators found food insecurity was present in 28% of patients with NAFLD and 21% of those with advanced fibrosis. Among NAFLD patients, all-cause age-adjusted mortality was 12 per 1,000 person-years (11 if food secure, 15 if food insecure) and 32 per 1,000 person-years among patients with advanced fibrosis(28 if food secure, 50 if food insecure).
Food insecurity independently correlated with higher all-cause mortality among those with NAFLD (HR = 1.46; 95% CI,1.08-1.97) and those with advanced fibrosis (HR = 1.37; 95% CI,1.01-1.86), according to results from multivariate models adjusted for age, race/ethnicity, poverty-income ratio, education level, insurance status, HbA1c, BMI and smoking.
“In both groups, people with food insecurity as expected were more likely to suffer from poverty, have less than a high school education, be publicly insured or have no insurance and they were also more likely to be obese, diabetic and to be non-Hispanic white,” she said.
Because Kardashian and colleagues found a link between food insecurity and poverty–income ratio among patients with advanced fibrosis (P = .015), they further grouped patients by poverty status. There was a correlation between food insecurity and greater mortality among adults with advanced fibrosis and poverty (HR = 2.27;, 95% CI, 1.41-3.66); however, not among patients without poverty (HR = 1.09; 95% CI,0.66-1.59).
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Kardashian A, et al. Abstract: GS-1072. Presented at: The International Liver Congress; June 23-26 (virtual meeting).
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