AIDS (London, England) · 2025
The association of food insecurity with hepatic steatosis in women with and without HIV.
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Kardashian Ani, Golovaty Ilya, Xia Fan, Ma Yifei, Weiser Sheri D, Sharma Anjali, Minkoff Howard, French Audrey L, Plankey Michael, Floris-Moore Michelle, Ofotokun Ighovwerha, Fischl Margaret, Konkle-Parker Deborah, Seaberg Eric C, Tien Phyllis C, Price Jennifer C
Аннотация
OBJECTIVE: Food insecurity is a risk factor for metabolic dysfunction-associated steatotic liver disease in the general population. However, little is known about the impact of food insecurity on hepatic steatosis among women with HIV (WWH) and women without HIV (WWOH).
DESIGN: We assessed hepatic steatosis by controlled attenuated parameter (CAP) in decibels/meter (dB/m) and food security status using the U.S. Household Food Security Survey in women without viral hepatitis. Women were categorized as being food secure vs. food insecure.
METHODS: We performed multivariable linear regression analyses to examine the association of food security status with hepatic steatosis.
RESULTS: Among 1473 women (1064 WWH, 409 WWOH), 20% reported food insecurity. Food insecurity was associated with lower CAP after adjustment for age, race-ethnicity, income, alcohol intake, BMI, insulin resistance, and HIV [CAP difference: -8.6 dB/m, 95% confidence interval (95% CI): -16.7 to -0.5, P = 0.037]. Each 5 kg/m 2 BMI increase was associated with an 18.4 dB/m CAP increase (95% CI: 16.4-20.3, P < 0.001); there was no association of HIV serostatus with steatosis. Additionally, there was a significant interaction between food insecurity and BMI: among women experiencing food insecurity, for every 5 kg/m 2 BMI increase, CAP decreased by 6.6 dB/m (95% CI: -12.2 to -1.1, P = 0.02).
CONCLUSION: Food insecurity is prevalent in WWH and, unexpectedly, is associated with less steatosis, in contrast with findings observed in the general population. Additionally, while obesity remains a strong driver of steatosis, food insecurity attenuates the association of BMI with steatosis, particularly at higher BMIs. This study lays the groundwork for future efforts exploring potential mechanistic pathways.
DESIGN: We assessed hepatic steatosis by controlled attenuated parameter (CAP) in decibels/meter (dB/m) and food security status using the U.S. Household Food Security Survey in women without viral hepatitis. Women were categorized as being food secure vs. food insecure.
METHODS: We performed multivariable linear regression analyses to examine the association of food security status with hepatic steatosis.
RESULTS: Among 1473 women (1064 WWH, 409 WWOH), 20% reported food insecurity. Food insecurity was associated with lower CAP after adjustment for age, race-ethnicity, income, alcohol intake, BMI, insulin resistance, and HIV [CAP difference: -8.6 dB/m, 95% confidence interval (95% CI): -16.7 to -0.5, P = 0.037]. Each 5 kg/m 2 BMI increase was associated with an 18.4 dB/m CAP increase (95% CI: 16.4-20.3, P < 0.001); there was no association of HIV serostatus with steatosis. Additionally, there was a significant interaction between food insecurity and BMI: among women experiencing food insecurity, for every 5 kg/m 2 BMI increase, CAP decreased by 6.6 dB/m (95% CI: -12.2 to -1.1, P = 0.02).
CONCLUSION: Food insecurity is prevalent in WWH and, unexpectedly, is associated with less steatosis, in contrast with findings observed in the general population. Additionally, while obesity remains a strong driver of steatosis, food insecurity attenuates the association of BMI with steatosis, particularly at higher BMIs. This study lays the groundwork for future efforts exploring potential mechanistic pathways.