Food Insecurity, Low Household Income, and Low Education Level Increase the Risk of Having Metabolic Dysfunction Associated Fatty Liver Disease (MASLD) Among Adolescents in the United States

Background: In the U.S., 10.2% households (HHs) report child food insecurity. We assessed associations between MASLD and food insecurity among the adolescents in the U.S. Methods: Cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) 2017-2018. Food insecurity was assessed by the U.S. Department of Agriculture Child Food Security Survey Module. MASLD was defined by transient elastography (TE). Results: Among 771 adolescents (aged 12-18) [mean age 14.7 years; 52.5% male; 50.9% White, 12.7% Black, 24.4% Hispanic, and 12.1% other], 9.8% reported food insecurity; MASLD prevalence 10.12% (95% CI: 7.13-13.20%) affecting 4.27 million adolescents; NAFLD prevalence of 10.77% (95% CI: 7.76-13.78) affecting 4.52 million adolescents. There was near perfect concordance between MASLD and NAFLD [Cohen’s kappa coefficient of 0.971 (95% CI: 0.946-0.996). The prevalence of MASLD was greater among food-insecure adolescents vs. food-secure ones (17.4% vs. 9.4%) and adolescents living with a low HH income vs. a higher HH income (15.0% vs. 7.2%) and living with a head of HH with a lower education level vs. a higher education level (18.0% vs. 8.2%) (p<.05).The fully adjusted model showed that compared to adolescents living in a higher HH income, food-insecure adolescents living in low income HH had a 3-fold greater risk (OR=3.25, 1.31-8.08) of having MASLD, while food-secure adolescents living in low income HH had no increased risk (OR=1.58, 0.85-2.93, p=0.139). The fully adjusted odds of having MASLD was elevated by +163% with the presence of HTN (OR=2.63, 1.02-6.78), +241% with being Hispanic (OR=3.41, 1.36-8.56) and +138% with being male (OR=2.38, 1.20-4.75). Additionally, a 1-unit increase in BMI was associated with 25% increase in the odds of having MASLD (OR=1.25, 1.17-1.33) among U.S. adolescents. Conclusion: Food insecurity is associated with MASLD among U.S. low-income adolescents especially Hispanic males with obesity and hypertension. Policies addressing inequities are needed.