Association of food insecurity with metabolic dysfunction-associated steatotic liver disease by sex and race/ethnicity

We examined whether the association between food insecurity and metabolic dysfunction-associated steatotic liver disease (MASLD) differs across different racial/ethnic groups and sex using data from the 2017–March 2020 National Health and Nutrition Examination Survey (NHANES). A total of 5076 participants aged ≥ 20 years who completed transient elastography examination for evaluation of MASLD were included. Logistic regression, odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate the association of food insecurity with MASLD. Adult food insecurity was associated with increased odds of MASLD (low/very low vs. full security: OR = 1.41, 95% CI 1.12–1.77). Although there was no significant interaction between food insecurity and race/ethnicity (p interaction = 0.23), the positive association between food insecurity and MASLD was limited among non-Hispanic Whites. Food insecurity was associated with higher odds of MASLD in women but not men, with an interaction between food insecurity and sex (p interaction = 0.049). Furthermore, mediation analyses suggested that added sugar intake and intake of whole fruits and non-potato vegetables partially mediated the association of food insecurity with MASLD. The partial mediating effects of these foods were observed only among non-Hispanic Whites but not observed in other racial/ethnic groups or across sex. Our results suggest that the positive association between food insecurity and MASLD may be dependent on race/ethnicity and sex. Increased consumption of whole fruits vegetables intake and reduced intake of added sugar may partially reduce the impact of food insecurity on MASLD development.