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Studies have associated food insecurity with MASLD in adults, but there are few studies of pediatric MASLD, particularly in high\u2010risk populations. We assessed the impact of household food insecurity at 4\u2009years of age on MASLD in Latinx children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using a prospective cohort design, Latina mothers were recruited during pregnancy and followed with their children until early to mid\u2010childhood. Our primary exposure was household food insecurity at 4\u2009years of age measured using the validated US Household Food Security Food Module. Our primary outcome, MASLD, was defined as alanine transaminase (ALT) \u226595th% for age\/gender plus body mass index (BMI) \u226585% at time of ALT measurement (assessed between ages 5\u201312). We used multivariable logistic regression models to test for independent associations between household food insecurity and pediatric MASLD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 136 children, 28.7% reported household food insecurity at 4\u2009years of age and 27.2% had MASLD in early to middle childhood. Approximately 49% of children with MASLD and 21% of children without MASLD were food insecure (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Exposure to household food insecurity at age 4 was independently associated with a 3.7\u2010fold higher odds of MASLD later in childhood (95% CI: 1.5\u20139.0, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Exposure to household food insecurity at 4\u2009years of age was associated with increased risk for MASLD later in childhood. Further studies are needed to explore mechanism(s) and impact of reducing food insecurity on risk for MASLD.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijpo.13109","type":"journal-article","created":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T02:28:25Z","timestamp":1709864905000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Food insecurity is a risk factor for metabolic dysfunction\u2010associated steatotic liver disease in Latinx children"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8155-1346","authenticated-orcid":false,"given":"Sarah L.","family":"Maxwell","sequence":"first","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer 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