Background & Aims

Food insecurity is a growing public health challenge in the United States (U.S.) and has been linked to nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis. However, little is known of how food insecurity impacts mortality risk and health care utilization in chronic liver disease.

Methods

Using a population-based cohort study of U.S. adults (≥20 years) in the National Health and Nutrition Examination Survey, 1999 to 2014, with NAFLD (estimated by the U.S. Fatty Liver Index) and advanced fibrosis (estimated by the NAFLD fibrosis score, aspartate aminotransferase-to-platelet ratio index, or Fibrosis-4 Index), food security was measured using the Department of Agriculture Food Security Survey Module. The primary outcome was all-cause mortality from National Death Index data and the secondary outcome was health care utilization, defined as ≥2 inpatient and ≥4 outpatient visits, with Cox and logistic regression, respectively, estimating associations between food insecurity and outcomes.

Results

Of 34,134 eligible participants (mean age, 47 years; 51% women; 14% in poverty), 4816 had NAFLD and 1654 had advanced fibrosis, with food insecurity present in 28% and 21%, respectively. All-cause age-adjusted mortality was 12 per 1000 person-years among participants with NAFLD (food-secure, 11; food-insecure, 15) and 32 per 1000 person-years among advanced fibrosis participants (food-secure, 28; food-insecure, 50). In multivariable analyses, food insecurity was independently associated with higher mortality among participants with NAFLD (hazard ratio, 1.46; 95% confidence interval [CI], 1.08–1.97) and advanced fibrosis (hazard ratio, 1.37; 95% CI, 1.01–1.86) and greater outpatient health care utilization in participants with NAFLD (odds ratio, 1.32; 95% CI, 1.05–1.67).

Conclusions

Food insecurity is significantly associated with greater all-cause mortality in adults with NAFLD and advanced fibrosis. Interventions that address food insecurity among adults with liver disease should be prioritized to improve health outcomes in this population.

中文翻译：

---

食品不安全与美国成人非酒精性脂肪肝和晚期纤维化死亡率有关

背景与目标

食品不安全是美国 (US) 日益严重的公共卫生挑战，并且与非酒精性脂肪性肝病 (NAFLD) 和晚期纤维化有关。然而，人们对粮食不安全如何影响慢性肝病的死亡风险和医疗保健利用知之甚少。

方法

使用 1999 年至 2014 年国家健康和营养检查调查中美国成年人（≥20 岁）的基于人群的队列研究，研究对象为 NAFLD（由美国脂肪肝指数估计）和晚期纤维化（由 NAFLD 纤维化评分估计，天冬氨酸氨基转移酶与血小板比率指数，或 Fibrosis-4 指数），食品安全是使用农业部食品安全调查模块测量的。主要结果是国家死亡指数数据中的全因死亡率，次要结果是医疗保健利用率，定义为≥2 次住院和≥4 次门诊就诊，分别使用 Cox 和逻辑回归估计食品不安全与结果之间的关联。

结果

在 34,134 名符合条件的参与者（平均年龄 47 岁；51% 为女性；14% 贫困）中，4816 人患有 NAFLD，1654 人患有晚期纤维化，粮食不安全分别占 28% 和 21%。NAFLD 参与者的全因年龄调整死亡率为每 1000 人年 12 人（食品安全，11 人；食品不安全，15 人），晚期纤维化参与者的全因年龄调整死亡率为每 1000 人年 32 人（食品安全，28 人；食品-不安全，50）。在多变量分析中，食物不安全与 NAFLD（风险比，1.46；95% 置信区间 [CI]，1.08–1.97）和晚期纤维化（风险比，1.37；95% CI，1.01–1.86）参与者的较高死亡率独立相关) 以及 NAFLD 参与者门诊医疗保健利用率更高（比值比，1.32；95% CI，1.05–1.67）。

结论

在患有 NAFLD 和晚期纤维化的成年人中，粮食不安全与更高的全因死亡率显着相关。应优先采取干预措施解决患有肝病的成年人的粮食不安全问题，以改善该人群的健康状况。