Food insecurity, household income associated with risk of NAFLD in adolescents

James Pike, Ph.D

Credit: LinkedIn

Food insecurity and low household income increase the risk of non-alcoholic fatty liver disease (NAFLD) in adolescents, according to recent study findings.

Presented at The Liver Meeting 2023 of the American Association for the Study of Liver Diseases (AASLD) by Dr. James Pike, senior biostatistician at Inova Health System, the data show that food-insecure adolescents living in lower-income households are at greater risk of NAFLD than their higher-income counterparts.1

The most common chronic liver disease in the United States, NAFLD affects about 25% of adults and 5%-10% of adolescents. Food insecurity is known to be associated with obesity, hypertension, diabetes and other cardiometabolic risks, widely regarded as key predictors of NAFLD, although little is known about the direct relationship between food insecurity and NAFLD. People who develop NAFLD in childhood are more likely to have NASH and related complications or liver disease as adults, so understanding the role of nutritional insecurity in adolescent NAFLD is of great interest.2,3

To examine the relationship between food insecurity and NAFLD among US adolescents, researchers collected data on patients aged 12-18 years from the 2017-2018 National Health and Nutrition Examination Survey (NHANES) and compared it with food insecurity, household income versus the federal poverty level and the development of NAFLD.1

The researchers assessed food insecurity using the US Department of Agriculture (USDA) Child Food Security Research Module. Adolescents with 2 or more affirmative responses were classified as food insecure according to USDA guidelines. Low household income is defined as household income <138% federal poverty level.1

A total of 771 adolescents were included in the 2017-2018 NHANES. Among these participants, the mean age was 14.7 years, 52.5% were male, and 50.9% were white. Food insecurity was reported among 9.8% of this group, and 10.8% had NAFLD. The researchers indicated that among the cohort, 22.5% of patients had obesity, 45.4% had central obesity, 1.0% had diabetes, 20.9% had prediabetes; 4.5% had hypertension, 41.6% had hyperlipidemia, and 17.3% had high C-reactive.1

After analysis, 98.9% of adolescents who are considered food insecure rely on cheap food. In addition, 93.2% could not get a balanced diet and 51.5% did not eat enough food.1

Food-insecure adolescents had higher rates of NAFLD (18.7%) and advanced fibrosis (2.8%) than their food-secure counterparts (9.9% and 0.3%, respectively). The researchers noted that adolescents reporting food insecurity were less likely to be US citizens compared to food secure adolescents (88.8% vs. 95.6%) and were more likely to participate in SNAP ( 62.4% vs. 25.1%), have a lower household income (70.4%) % vs. 25.7%) and live in a household where the head of the household has a lower level of education ( 29.2% vs. 17.0%). However, there were no significant differences in metabolic diseases according to food insecurity.1

In a model adjusted for demographic factors, metabolic diseases, and SNAP participation, food insecurity (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.07-6.41), obesity (OR, 15.56; 95% CI, 7.71-31.50), and hypertension (OR, 4.93; 95% CI, 2.67-9.14 ) were independently associated with NAFLD. An additional multivariate model showed that food insecure adolescents living in a lower income household had a greater risk of NAFLD (OR, 4.79; 95% CI, 1.44-15.86) compared with adolescents , living in higher income households.1

“Food insecurity and low household income lead to risk of NAFLD in adolescents,” the researchers concluded.1


  1. Paik, JM, et al. 176: FOOD INSECURITY AND HOUSEHOLD INCOME SIGNIFICANTLY INCREASE THE RISK OF NAFLD AMONG ADOLESCENT CHILDREN IN THE UNITED STATES. Paper presented at: The Liver Meeting. Boston, Massachusetts. 10 – 14 November 2023
  2. American Liver Foundation. Definition and prevalence of NASH. Nonalcoholic steatohepatitis (NASH). November 1, 2023. Accessed November 12, 2023.
  3. National Institute of Diabetes and Digestive and Kidney Diseases. Definition and facts about NAFLD and NASH in children. December 1, 2021. Accessed November 12, 2023.

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