Food insecurity and lipid profile abnormalities are associated with an increased risk of non-alcoholic fatty liver disease (NAFLD): a case-control study

Background: Non-alcoholic fatty liver disease (NAFLD) is an important public health problem and a significant cause of morbidity and mortality. Little is known about the relation between food insecurity and NAFLD. This study aimed to assess the relationship between food insecurity, risk factors associated with food insecurity, and NAFLD prevalence in a sample of Iranian adults.Methods In this age-matched and gender-matched case–control study, 210 subjects were recruited. NAFLD diagnosis was performed by a single expert radiologist using ultrasonography. The demographic and socioeconomic characteristics, anthropometric indices, body composition, along with food insecurity and depression status were assessed. Blood samples were collected to determine the lipid profile parameters. Chi-square, independent samples t-test, and uni-and multi-variate logistic regression tests were used. Data were analysed using SPSS V.23.0.Results The prevalence of food insecurity was 56.8% and 26.1% in cases and controls ( P<0.001 ), respectively. According to final analysis model, food insecurity, depression, number of children≥4, overweight, and obesity were identified as significant independent risk factors for NAFLD. The chance of NAFLD in the food insecure, depressed, overweight, and obese subjects was 2.2 (95%CI:1.12-3.43), 1.9 (95%CI:1.02-3.62), 2.6 (95% CI:1.81-3.92), and 2.9 (95%CI:2.02- 5.34) times higher, respectively. Additionally, a higher waist circumference (men, OR = 2.9, P<0.001 ; women, OR= 2.6, P<0.001 ), an elevated waist-to-hip ratio (men, OR = 2.3, P<0.001 ; women, OR= 2.7, P<0.001 ), an increased waist-to-height ratio (OR = 2.9, P<0.001 ), and a higher body fat percentage (men, OR = 3.0, P<0.001 ; women, OR= 3.3, P<0.001 ) were independently associated with an increased risk of NAFLD. The odds of NAFLD increased by increment in serum triglyceride (TG) levels (OR = 2.6, P<0.001 ) and decreased by increase in serum high-density lipoprotein cholesterol (HDL-C) (OR = 0.34, P<0.001 ). Compared to controls, NAFLD patients were more likely to have higher TG/HDL-C ratio (OR = 3.3, P<0.001 ).Conclusions The prevalence of food insecurity in patients with NAFLD was significantly higher compared to controls. Food insecurity was associated with an increased risk of NAFLD, even after adjusting for potential confounding factors. Additionally, NAFLD was significantly related to some indicators of dyslipidemia.