The association of food insecurity with non-alcoholic fatty liver disease (NAFLD) in a sample of Iranian adults: a path analysis of a cross-sectional survey

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Abstract

Objectives

The present study aims to examine the hypothetical model of the relationship between food insecurity and Non-alcoholic fatty liver disease (NAFLD) in a sample of Iranian adults.

Methods

In this cross-sectional study, 275 subjects (18–70 years old) who met the inclusion criteria were recruited. Fatty liver was diagnosed by abdominal ultrasonography, and eligible patients underwent liver fibro scan assessment to determine fibrosis and steatosis. Food insecurity was assessed using the validated six-item Short Questionnaire of Household Food Security Scale (SQHFSS). Data were analyzed using SPSS 24.0 and IBM SPSS Amos 24.0.

Results

Among 275 subjects (44.37 ± 11.67 years old, 51.6% male) included in the analysis, 23.6% were food insecure. Food insecurity, general and abdominal obesity were associated with an increased risk of NAFLD, even after multiple adjustments (OR: 2.95, 95% CI: 1.02, 8.57; OR: 3.27, 95% CI: 1.50, 7.11; and OR: 3.81, 95% CI: 1.55, 9.32, respectively). According to the primary hypothesis, food insecurity and NAFLD were fitted into a model (χ ²/df = 1.36, GFI = 0.982, AGFI = 0.952, CFI = 0.954, IFI = 0.959, SRMR = 0.040, RMSEA = 0.037); accordingly, food insecurity and obesity (general and abdominal) directly affected NAFLD (β = 0.12, P = 0.03; β = 0.13, P = 0.02; β = 0.31, P < 0.001, respectively).

Conclusion

Food insecurity was a predictor of, and directly associated with, NAFLD. Social determinants should be considered in the pathogenesis of NAFLD, although the possible underlying biological mechanisms in this association are yet to be determined.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-024-06923-4.

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Most cited references 43

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Estimating wealth effects without expenditure data—or tears: An application to educational enrollments in states of India

Deon Filmer, Lant H. Pritchett (2001)

Using data from India, we estimate the relationship between household wealth and children’s school enrollment. We proxy wealth by constructing a linear index from asset ownership indicators, using principal-components analysis to derive weights. In Indian data this index is robust to the assets included, and produces internally coherent results. State-level results correspond well to independent data on per capita output and poverty. To validate the method and to show that the asset index predicts enrollments as accurately as expenditures, or more so, we use data sets from Indonesia, Pakistan, and Nepal that contain information on both expenditures and assets. The results show large, variable wealth gaps in children’s enrollment across Indian states. On average a “rich” child is 31 percentage points more likely to be enrolled than a “poor” child, but this gap varies from only 4.6 percentage points in Kerala to 38.2 in Uttar Pradesh and 42.6 in Bihar.

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Cause, Pathogenesis, and Treatment of Nonalcoholic Steatohepatitis

Dan L Longo, Anna M Diehl, Christopher Day (2017)

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Metabolic risk factors and incident advanced liver disease in non-alcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis of population-based observational studies

Helen Jarvis, Dawn Craig, Robert Barker … (2020)

Background Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease worldwide. Many individuals have risk factors associated with NAFLD, but the majority do not develop advanced liver disease: cirrhosis, hepatic decompensation, or hepatocellular carcinoma. Identifying people at high risk of experiencing these complications is important in order to prevent disease progression. This review synthesises the evidence on metabolic risk factors and their potential to predict liver disease outcomes in the general population at risk of NAFLD or with diagnosed NAFLD. Methods and findings We conducted a systematic review and meta-analysis of population-based cohort studies. Databases (including MEDLINE, EMBASE, the Cochrane Library, and ClinicalTrials.gov) were searched up to 9 January 2020. Studies were included that reported severe liver disease outcomes (defined as liver cirrhosis, complications of cirrhosis, or liver-related death) or advanced fibrosis/non-alcoholic steatohepatitis (NASH) in adult individuals with metabolic risk factors, compared with individuals with no metabolic risk factors. Cohorts selected on the basis of a clinically indicated liver biopsy were excluded to better reflect general population risk. Risk of bias was assessed using the QUIPS tool. The results of similar studies were pooled, and overall estimates of hazard ratio (HR) were obtained using random-effects meta-analyses. Of 7,300 unique citations, 22 studies met the inclusion criteria and were of sufficient quality, with 18 studies contributing data suitable for pooling in 2 random-effects meta-analyses. Type 2 diabetes mellitus (T2DM) was associated with an increased risk of incident severe liver disease events (adjusted HR 2.25, 95% CI 1.83–2.76, p 30 kg/m2) as a prognostic factor, providing data on 19.3 million individuals followed up for a median of 13.8 years (IQR 9.0 to 19.8) experiencing 49,541 liver events. Obesity was associated with a modest increase in risk of incident severe liver disease outcomes (adjusted HR 1.20, 95% CI 1.12–1.28, p < 0.001, I 2 87%). There was also evidence to suggest that lipid abnormalities (low high-density lipoprotein and high triglycerides) and hypertension were both independently associated with incident severe liver disease. Significant study heterogeneity observed in the meta-analyses and possible under-publishing of smaller negative studies are acknowledged to be limitations, as well as the potential effect of competing risks on outcome. Conclusions In this review, we observed that T2DM is associated with a greater than 2-fold increase in the risk of developing severe liver disease. As the incidence of diabetes and obesity continue to rise, using these findings to improve case finding for people at high risk of liver disease will allow for effective management to help address the increasing morbidity and mortality from liver disease. Trial registration PROSPERO CRD42018115459.

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Author and article information

Contributors

Farhad Zamani: farhad@gmail.com

Azam Doustmohammadian:

ORCID: http://orcid.org/0000-0001-6249-2520

mohammadian.az@iums.ac.ir

Journal

Journal ID (nlm-ta): BMC Res Notes

Journal ID (iso-abbrev): BMC Res Notes

Title: BMC Research Notes

Publisher: BioMed Central (London )

ISSN (Electronic): 1756-0500

Publication date (Electronic): 18 September 2024

Publication date PMC-release: 18 September 2024

Publication date Collection: 2024

Volume: 17

Electronic Location Identifier: 272

Affiliations

[1 ]Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, ( https://ror.org/03w04rv71) Tehran, Iran

[2 ]GRID grid.502998.f, ISNI 0000 0004 0550 3395, Noncommunicable Diseases Research Center, , Neyshabur University of Medical Sciences, ; Neyshabur, Iran

[3 ]Department of Epidemiology & Biostatistics, School of Public Health, Neyshabur University of Medical Sciences, ( https://ror.org/01x41eb05) Neyshabur, Iran

[4 ]GRID grid.411600.2, Student Research Committee (National Nutrition and Food Technology Research Institute, Department of Community Nutrition, School of Nutrition Sciences and Food Technology), , Shahid Beheshti University of Medical Sciences, ; Tehran, Iran

[5 ]Liver Transplantation research center, Tehran University of medical sciences, ( https://ror.org/01c4pz451) Tehran, Iran

Author information

Azam Doustmohammadian http://orcid.org/0000-0001-6249-2520

Article

Publisher ID: 6923

DOI: 10.1186/s13104-024-06923-4

PMC ID: 11409597

PubMed ID: 39289733

SO-VID: 0ebc7855-6c44-421b-a942-aaff5aca09ae

License:

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

History

Date received : 6 July 2023

Date accepted : 28 August 2024

Custom metadata

ScienceOpen disciplines: Medicine

Keywords: food insecurity,obesity,non-alcoholic fatty liver disease,path analysis,waist circumference

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ScienceOpen disciplines: Medicine

Keywords: food insecurity, obesity, non-alcoholic fatty liver disease, path analysis, waist circumference

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The association of food insecurity with non-alcoholic fatty liver disease (NAFLD) in a sample of Iranian adults: a path analysis of a cross-sectional survey

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