P0948 - Prevalence of Nonalcoholic Fatty Liver Disease and Fibrosis Among US Adults with Food Insecurity: A 2017-2020 United States National Health and Nutrition Examination Surveys (NHANES) Assessment

Sunday, October 22, 2023

3:30 PM - 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

David S. Kim, MD

Rutgers New Jersey Medical School
Newark, NJ

David S. Kim, MD, Aaron Kahlam, MD, Ayham Khrais, DO, Nikolaos T.. Pyrsopoulos, MD, PhD, MBA
Rutgers New Jersey Medical School, Newark, NJ

Introduction: Prior studies examined the risk of food insecurity on nonalcoholic fatty liver disease (NAFLD) and fibrosis, but population data using novel non-invasive methods remains under characterized. In this study, we described the characteristics of NAFLD and fibrosis in food secure and insecure participants, using vibration-controlled transient elastography (VCTE).

Methods: Cross-sectional analysis of adults in the United States who participated in the 2017–March 2020 pre-pandemic National Health and Nutrition Examination Survey was performed. Participants with excessive alcohol use (≥2 or 1 drinks/day for males and females, respectively) or viral hepatitis were excluded. Food insecurity was defined using the Household Food Security Survey. NAFLD was defined as controlled attenuation parameter (CAP) scores ≥ 263 dB/m. Advanced fibrosis and cirrhosis was defined as liver stiffness measurement (LSM) ≥ 9.6 kPa and ≥ 11.0 kPa, respectively.

Results: Among 6,474 participants, 1,463 (22.6%) were food insecure. Prevalence of NALFD was 53.8% and 44.6% for food insecure and secure respectively (P < 0.001). Compared to food secure participants with NAFLD, food insecure participants with NAFLD had significantly higher age, lower male gender, higher percentage of Hispanic and Black ethnicity, body mass index (BMI), and percentage of current smokers (P < 0.05). Furthermore, food insecure participants with NAFLD had significantly higher platelet count and alanine aminotransferase, compared to food secure participants with NAFLD (P < 0.05). Food insecure and secure participants with NAFLD had similar prevalence of advanced fibrosis.

Discussion: Participants with food insecurity had significantly higher prevalence of NAFLD, but advanced fibrosis was not significantly different between food insecure and secure participants with NAFLD. However, large inequalities exist between food insecure and secure participants with NAFLD, in terms of younger age, female gender, Hispanic or Black ethnicity, and higher BMI. This study highlights important risk factors for NAFLD and fibrosis in food insecure and secure participants.

Table 1. Baseline characteristics
Variables	Food Insecure NAFLD (unweighted n=662, 22.1%)	Food Secure NAFLD (unweighted n=2,193, 77.9%)	P value
Demographic variables
Age, years	44.2 (1.7)	52.9 (1.0)	< 0.001
Male gender	47.8%	57.6%	0.009
Race
Hispanic	34.4%	13.3%	0.001
White	40.9%	68.4%
Black	13.9%	8.2%
Other	10.9%	10.1%
BMI	34.2 (0.7)	32.4 (0.3)	0.017
Current smoking	48.4%	18.8%	0.007
Laboratory variables
Platelet count, 10⁹/L	240.2 (9.1)	228.6 (8.3)	0.002
Aspartate aminotransferase, IU/L	22.8 (2.5)	21.2 (0.6)	0.104
Alanine aminotrasferase, IU/L	25.5 (3.0)	23.6 (1.3)	0.043
Serum albumin, g/dL	3.9 (< 0.1)	4.1 (< 0.1)	0.985
Total bilirubin, mg/dL	0.5 (< 0.1)	0.5 (< 0.1)	0.167
LDL-cholesterol, mg/dL	99.9 (3.4)	107.3 (1.2)	0.514
HbA1c, %	6.0 (0.1)	5.9 (0.1)	0.301
Liver fibrosis
Liver stiffness, kPa	10.6 (1.8)	6.7 (0.4)	0.522
Advanced fibrosis	10.2%	10.0%	0.847
Liver steatosis
Controlled attenuation parameter, dB/m	330.0 (5.0)	327.1 (5.3)	0.056

Table: Variables are expressed as mean (standard error), or %.
NAFLD, nonalcoholic fatty liver disease; BMI, body mass index; LDL, low-density lipoprotein; HbA1c, hemoglobin A1c; kPa, kilopascal;

Disclosures:

David Kim indicated no relevant financial relationships.

Aaron Kahlam indicated no relevant financial relationships.

Ayham Khrais indicated no relevant financial relationships.

Nikolaos Pyrsopoulos: CytoSorbents – Grant/Research Support. Durect – Grant/Research Support. Gilead – Grant/Research Support. Grifols – Grant/Research Support. Mallinckrodt Pharmaceuticals – Consultant. Ocelot Bio – Grant/Research Support. Salix – Grant/Research Support.

David S. Kim, MD, Aaron Kahlam, MD, Ayham Khrais, DO, Nikolaos T.. Pyrsopoulos, MD, PhD, MBA. P0948 - Prevalence of Nonalcoholic Fatty Liver Disease and Fibrosis Among US Adults with Food Insecurity: A 2017-2020 United States National Health and Nutrition Examination Surveys (NHANES) Assessment, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.