Food insecurity boosts fibrosis odds in HIV with diabetes, lowers MASLD odds in HIV alone
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Key takeaways:
- Food insecurity was linked with lower odds of MASLD in patients with HIV, but greater odds for fibrosis among patients with HIV and diabetes.
- Researchers reported food insecurity among 31% of patients with HIV.
Food insecurity was associated with lower odds of metabolic dysfunction-associated steatotic liver disease among patients with HIV, although the presence of diabetes increased the odds of fibrosis in this population, according to data.
“Food insecurity is an independent risk factor for NAFLD and liver fibrosis and associated with greater all-cause mortality and health care utilization in this population,” Ani Kardashian, MD, assistant professor in the division of gastroenterology and liver disease at Keck School of Medicine at University of Southern California, and colleagues wrote in Clinical Gastroenterology and Hepatology. “Whether the relationship between food insecurity and NAFLD is similar among people with HIV, however, is unknown.”
They continued, “A better understanding of the relationship between food insecurity and NAFLD in people with HIV is essential to designing targeted food assistance programs that benefit people with HIV.”
In a prospective study of 654 adults with HIV at eight U.S. centers, researchers investigated the association between food insecurity and the prevalence of NAFLD, now known as MASLD, and fibrosis. They assessed food insecurity using the Six-Item Short Form U.S. Department of Agriculture Household Food Security Survey and diagnosed MASLD and advanced fibrosis by vibration controlled transient elastography.
According to study results, 53% of patients had MASLD and 6% had advanced fibrosis. Researchers reported food insecurity among 31%, which included 28% with MASLD and 44% with advanced fibrosis. Patients with food insecurity were more likely to be younger (mean age, 52.8 years vs. 53.7 years) and have a BMI of at least 30 (50% vs. 44%), and less likely to have type 2 diabetes (16% vs. 21%) or an undetectable HIV-1 RNA (78% vs. 85%).
Multivariable analysis showed that food insecurity was associated with lower odds of MASLD (OR = 0.57; 95% CI, 0.37-0.88) and “greater but nonsignificant” odds of advanced fibrosis (OR = 1.38; 95% CI, 0.65-2.9).
Researchers also reported a “significant interaction” between food insecurity and diabetes regarding risk for fibrosis, with increased odds of fibrosis among food insecure patients with HIV and diabetes (OR = 3.83; 95% CI, 1.15-12.73) vs. those without diabetes (OR = 1.12; 95% CI, 0.47-2.98).
“Food insecurity is highly prevalent and associated with lower odds of NAFLD in people with HIV but greater odds of liver fibrosis in diabetic people with HIV independent of other social determinants of health, metabolic and lifestyle factors,” Kardashian and colleagues wrote. “Exploration of the mechanistic underpinnings underlying these associations is needed to inform preventive food insecurity interventions that can be effectively integrated into HIV, diabetes and liver disease care.”
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