Childhood food insecurity may play role in ‘booming’ rise of MASLD

In this video, Sarah L. Maxwell, MD, and Janet M. Wojcicki, PhD, MPH, discuss a reported link between food insecurity at age 4 years and an increased risk for metabolic dysfunction-associated steatotic liver disease among Latino children.

“[MASLD is] an important public health issue that’s booming,” Maxwell, a pediatric transplant hepatology fellow at the University of California, San Francisco, told Healio. “In our clinic we’re seeing younger kids present with it and not only MASLD as the initial spectrum of disease, but we’re seeing younger kids present with more severe scar tissue in the liver and with more severe disease at younger ages.”

Published literature has described the link between food insecurity and MASLD in adults, Maxwell said, but this association has not been well-documented in children.

“Fatty liver in adults is in the top two indications for liver transplant,” Wojcicki, professor of pediatrics and epidemiology at UCSF, said, “and children who have fatty liver are going to go on to need liver transplants. There are few medications at this time to treat fatty liver, so the goal is prevention. Our impetus in the study was to try to do something for the Latino population that has a very high rate of a fatty liver disease.”

In a prospective cohort study, researchers recruited nearly 300 pregnant women, primarily of Mexican and Central American descent, and monitored their children until early to mid-childhood, conducting annual dietary assessments beginning at age 2 years.

The primary exposure was household food insecurity at age 4 years, measured via the U.S. Household Food Insecurity Food Module. The primary outcome was MASLD, defined by alanine aminotransferase in at least the 95th percentile for age and gender and BMI in at least the 85th percentile at the time of ALT assessment.

According to Maxwell, exposure to household food insecurity at age 4 years correlated with nearly fourfold increased odds for MASLD later in childhood, specifically around ages 5 to 12 years.

Within the next 5 to 10 years, MASLD may be the leading indication for liver transplant, adding a “huge economic and social cost to this problem,” Wojcicki noted.

“From a policy and legislative perspective, it’s important to ensure there are more resources that are dedicated to providing healthy foods in times of need, particularly to families and young children,” she added.

There is an “impetus to take screening seriously,” Maxwell said, noting the importance of screening children with obesity and food insecurity, as well as providing counseling about exercise, eating plenty of fruits and vegetables, cutting out sweet beverages and keeping weight in an ideal range.

“Hopefully in the future, there will be policies that will allow us as physicians to provide prescribed food as medicine because, ultimately, that will be incredibly helpful for metabolic syndrome and fatty liver disease, and metabolic-related problems like heart disease and diabetes as well,” Maxwell said.

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Sources/Disclosures

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Disclosures:
Maxwell reports receiving support from the NIH Training Grant T32-DK007762. Wojcicki reports receiving support from HHS NIH NIDDK 080825 and 097458 and funding from the Benioff, the Hellman Family Foundation and the Allen Foundation.

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