Title: Food insecurity and pediatric nonalcoholic fatty liver disease severity
Source: The Journal of Pediatrics 2023, Nov 4. [E-publication]
Date of publication: November 2023
Publication type: Article
Abstract: Objective: To determine the association between food insecurity and pediatric nonalcoholic fatty liver disease (NAFLD).
Methods: Cross-sectional study of patients < 21 years of age with histologically confirmed NAFLD. The Household Food Security Survey Module was administered to determine food insecurity status. Skin lipidomics were performed to explore pathophysiologic mechanisms.
Results: Seventy-three patients with histologically confirmed NAFLD completed the Household Food Security Survey Module. Of these, the majority were male (81%) and non-Hispanic (53%), with a mean age at biopsy of 13±3 years. Food insecurity was seen in 42% (n=31). Comparison of features between food insecure and food secure subgroups revealed no differences in sex, ethnicity, BMI z-score, aminotransferases, or histologic severity. However, children experiencing food insecurity presented on average two years before their food secure counterparts (12.3 ± 3.0 vs. 14.4 ± 3.6 years, p = 0.015). A subset of 31 patients provided skin samples. Skin lipidomics revealed that food insecurity was associated with down-regulated features from the lipoamino acid class of lipids, previously linked to inflammation and adipocyte differentiation.
Conclusions: Food insecurity is highly prevalent in children with NAFLD and is associated with earlier presentation. Lipidomic analyses suggest a possible pathophysiologic link that warrants further exploration.