Association of Food Insecurity with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Systematic Review

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), has emerged as one of the most prevalent chronic liver conditions worldwide. Emerging evidence suggests that food insecurity may contribute to the development and progression of MASLD through mechanisms such as poor nutrition, chronic stress, and limited access to healthcare. Individuals facing food insecurity are more likely to consume diets high in saturated fats and sugars, which promote hepatic fat accumulation and metabolic dysfunction. This systematic review aims to investigate the association between food insecurity and MASLD, identify vulnerable populations, and explore the biological and social pathways linking these conditions. Understanding this relationship is critical for designing targeted interventions that address both liver health and social determinants of disease. This systematic review was conducted through a comprehensive search of major scientific databases, including PubMed, Scopus, Web of Science, and Google Scholar. Keywords used in the search included combinations of "Food insecurity," "Metabolic dysfunction-associated steatotic liver disease (MASLD)," "Non-alcoholic fatty liver disease (NAFLD)," "Diet quality," "Nutrition and liver disease," and "Socioeconomic status." The search covered publications from ۲۰۱۵ to ۲۰۲۵. After applying inclusion and exclusion criteria—such as study type, target population (adults aged ۱۸ and above), studies examining the relationship between food insecurity and MASLD or NAFLD, and full-text availability—۴۰ articles were selected for final analysis. Among these, ۱۵ studies directly addressed the impact of food insecurity on MASLD and were examined in depth. This article aims to provide a comprehensive overview of food insecurity and MASLD by reviewing evidence on prevalence, contributing dietary/lifestyle factors, biological and social mechanisms, health outcomes, and potential interventions. The central research question is: "How does food insecurity influence the development, progression, and outcomes of MASLD across different populations?" Mechanisms linking food insecurity to MASLD include poor dietary quality promoting hepatic fat accumulation, insulin resistance, and chronic systemic inflammation; micronutrient deficiencies impairing liver function; chronic psychological stress elevating cortisol and exacerbating liver damage; limited access to healthcare delaying diagnosis and treatment; and sedentary lifestyle with central obesity increasing risk factors. Challenges include diversity in study design, inconsistent diagnostic criteria, geographic concentration in high-income countries, and lack of longitudinal data. Recommendations highlight the importance of long-term cohort studies with standardized tools, inclusion of diverse populations, exploration of biological mechanisms, and intervention-based trials supported by mobile health technologies. This review underscores the strong link between food insecurity and MASLD, emphasizing the need for addressing nutritional access and social determinants to reduce disease burden and promote equitable liver health.

کلیدواژه ها:

Metabolic dysfunction-associated steatotic liver disease (MASLD) ، Food insecurity ، Diet quality ، Nutritional disparities