Women with food insecurity, low BMI more likely to have hepatic steatosis
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Key takeaways:
- Women with food insecurity and a BMI less than 25 kg/m2 had higher odds of hepatic steatosis.
- A BMI greater than 25 kg/m2 was associated with lower odds of hepatic steatosis
BOSTON — Women who experience food insecurity and have a BMI less than 25 kg/m2 had higher odds of hepatic steatosis compared with overweight women or those with obesity, regardless of HIV status, according to research at The Liver Meeting.
“Food insecurity, a key social determinant of health, is a risk factor for hepatic steatosis in the general population,” Ani Kardashian, MD, an assistant professor of medicine in the division of gastroenterology and liver diseases at Keck School of Medicine at the University of Southern California, and colleagues wrote. “In people living with HIV, food insecurity is associated with worse HIV-related morbidity and metabolic parameters, including obesity and diabetes. However, little is known about the impact of food insecurity on the risk of hepatic steatosis among women with and at risk for HIV infection.”
Using the 2013-2018 MACS/WIHS combined cohort study, Kardashian and colleagues conducted a cross-sectional analysis of women aged 35 to 60 years who did not have viral hepatitis. They also used data from the U.S. Household Food Security Survey Module to assess and categorize participants as having high, marginal, low or very low food security.
Researchers included 1,533 women (mean age, 50 years; mean BMI, 31 kg/m2), of whom 1,064 were HIV positive. Most women were Black (76%), while 14% were white and 10% were other; 14% identified as Hispanic. In addition, 10% were classified as heavy drinkers and 20% reported experiencing food insecurity.
According to results, patients with food insecurity were more likely to be white (18% vs. 14%), heavy drinkers (13% vs. 9%) and have a lower BMI (mean, 29 kg/m2 vs. 31 kg/m2). Researchers also found that food insecurity was linked to lower odds of hepatic steatosis (OR = 0.6; 95% CI, 0.2-1).
Kardashian and colleagues determined that there was a significant interaction between food insecurity level and BMI. They also found that with each 1-unit increase in BMI, the odds for hepatic steatosis were greater by 14% (95% CI, 12-16) in the high food security group, 10% (95% CI, 6-15 in the marginal food security group, 8% (95% CI, 0.3-16) in the low food security group and 5% (95% CI, –1 to 11) in the very low food security group.
Of note, researchers identified an association between food insecurity and greater odds of hepatic steatosis in women with a BMI below 25 kg/m2 and lower hepatic steatosis in women with a BMI of at least 25 kg/m2.
“Our findings suggest that food insecurity, in the presence of other factors that might lower BMI, such as chronic inflammatory processes, could worsen hepatic steatosis whereas food insecurity may attenuate the effect of higher BMI on hepatic steatosis,” Kardashian and colleagues wrote. “This study lays the groundwork for future efforts exploring potential mechanistic pathways.”
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Kardashian A, et al. The association of food insecurity with hepatic steatosis varies by BMI among women living with and without HIV infection. Presented at: The Liver Meeting; Nov. 10-14, 2023; Boston (hybrid meeting).
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