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Low food security increases risk for advanced fibrosis
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PARIS — Food insecurity correlated with an increased risk for advanced fibrosis, particularly among patients with diabetes, according to a presentation at the International Liver Congress 2018.
According to a presentation by Russell Rosenblatt, MD, from the New York Presbyterian Hospital, food insecurity is the state of being without reliable access to a sufficient quantity of affordable, nutritious food, and instead relying on often in the form of low-cost, energy-dense, nutritionally poor foods.
Food insecurity has been linked to obesity, the metabolic syndrome, and an increased risk for diabetes, Rosenblatt said. Complications related to food insecurity in patients with diabetes include hypoglycemia, poor glucose control, and higher 10-year risk for cardiovascular disease.
“Food insecurity’s risk for diabetes doesn’t stop there,” Rosenblatt told Healio Gastroenterology and Liver Disease. “Food insecurity is a risk factor for diabetes, which is itself is a risk factor for NAFLD and advanced fibrosis.”
Studies have shown that the prevalence of food insecurity has been increasing in both the United States and Europe.
Rosenblatt and colleagues reviewed patient data from 2005 to 2014 from the National Health and Nutrition Examination Survey. The study cohort was a weighted sample representative of over 21 million Americans, of whom 77.2% reported full food security and 6.1% reported very low food security.
Patients who reported very low food security were more likely to be younger (53 vs. 61.9 years; P < .0001), women (57.7% vs. 48%; P = .03), have a higher BMI (35 vs. 32.8 kg/m2; P = .006), have higher HbA1c (7.7% vs. 7.1%; P = .0010), be insulin dependent (29.8% vs. 20.7%; P = .01), and have metabolic syndrome (73% vs. 64%; P = .02).
Multivariate analysis showed that very low food security correlated significantly with an increased risk for advanced fibrosis (OR = 2.9; 95% CI, 1.12-7.49). Other factors associated with an increased risk for advanced fibrosis included female sex (OR = 2.7; 95% CI, 1.42-5.13), BMI higher than 40 kg/m2 (OR = 6.66; 95% CI, 1.66-26.75), and HbA1c higher than 9% (OR = 3.25; 95% CI, 1.31-8.07).
Regarding socioeconomic variables, the researchers found that those with low food security were more likely to be of black or Hispanic ethnicity compared with white individuals (P < .0001), were more likely to be uninsured (P < .0001), and more likely to have an education level below secondary school (P < .0001).
“The impact of food insecurity holds true even when controlling for factors affecting advanced fibrosis and glucose control,” Rosenblatt told Healio Gastroenterology and Liver Disease.
Rosenblatt noted that the study lacked histologic data in the form of diagnosed NAFLD or confirmed fibrosis, but included a large and ethnically diverse sample size and a validated food insecurity survey.
“Food insecurity is increasingly common and nearly triples the risk of advanced fibrosis in those with diabetes and NAFLD,” Rosenblatt said in his presentation. “We recommend that providers screen for food insecurity ... as this can be particularly helpful for our most vulnerable patients at risk of going hungry and who have comorbidities.”
For more information:
Rosenblatt R, et al. PS-060. Presented at: International Liver Congress; Apr. 11-15, 2018; Paris, France.
Disclosure: Healio Gastroenterology and Liver Disease could not confirm financial relationships at time of publication.