{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T15:25:46Z","timestamp":1787325946282,"version":"build-2736575974"},"reference-count":44,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Interdisciplinary Guided Network for Investigation, Translation and Equity for the All of Us Research Program","award":["OT2 OD031915"],"award-info":[{"award-number":["OT2 OD031915"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Social determinants of health are implicated in metabolic dysfunction\u2013associated steatotic liver disease (MASLD), yet longitudinal evidence on incident disease is scarce, and whether individual- and community-level determinants act independently remains unclear. The objective of this study was to examine whether individual food insecurity and neighborhood deprivation are independently associated with incident MASLD. Methods: In this retrospective cohort of 40,693 U.S. adults without baseline MASLD in the diverse NIH All of Us Research Program, food insecurity (two-item Hunger Vital Sign) and neighborhood deprivation (validated five-domain composite) were co-primary exposures, with incident MASLD ascertained from validated diagnostic codes. Proportional hazards models were adjusted for demographic, socioeconomic, and metabolic factors, including obesity. Results: Over 116,220 person-years, 1240 (3.0%) participants developed MASLD. Both associations remained significant after adjustment for demographic, socioeconomic, and major metabolic risk factors, including obesity (food insecurity adjusted hazard ratio [aHR] 1.32, 95% CI 1.13\u20131.53; neighborhood deprivation aHR 1.20, 95% CI 1.05\u20131.37). Unadjusted cumulative incidence was highest among participants with both exposures and lowest among those with neither. Findings were consistent across sensitivity analyses; the food-insecurity association remained when neighborhood disadvantage was specified with a census-based index. Conclusions: Food insecurity and neighborhood deprivation were independently associated with higher incidence of MASLD. Nutrition-focused, equity-oriented interventions warrant evaluation to reduce MASLD burden and advance health equity.<\/jats:p>","DOI":"10.3390\/nu18162741","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:20:36Z","timestamp":1787322036000},"page":"2741","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Independent Associations of Food Insecurity and Neighborhood Deprivation: Independent Associations with Incident Metabolic Dysfunction\u2013Associated Steatotic Liver Disease in a Diverse U.S. Cohort"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7222-8328","authenticated-orcid":false,"given":"Yong","family":"Eun","sequence":"first","affiliation":[{"name":"Department of Medicine, NYC Health + Hospitals\/Harlem, New York, NY 10037, USA"},{"name":"Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7096-1767","authenticated-orcid":false,"given":"Marie S.","family":"Thearle","sequence":"additional","affiliation":[{"name":"Department of Medicine, NYC Health + Hospitals\/Harlem, New York, NY 10037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon Hee","family":"Kim","sequence":"additional","affiliation":[{"name":"Independent Researcher, New York, NY 10075, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9739-6966","authenticated-orcid":false,"given":"Rhonda K.","family":"Trousdale","sequence":"additional","affiliation":[{"name":"Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA"},{"name":"Division of Endocrinology, Department of Medicine, NYC Health + Hospitals\/Harlem, New York, NY 10037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1515-2475","authenticated-orcid":false,"given":"Joan","family":"Culpepper-Morgan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA"},{"name":"Division of Gastroenterology, Department of Medicine, NYC Health + Hospitals\/Harlem, New York, NY 10037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1097\/HEP.0000000000000520","article-title":"A multisociety Delphi consensus statement on new fatty liver disease nomenclature","volume":"78","author":"Rinella","year":"2023","journal-title":"Hepatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/S2468-1253(22)00165-0","article-title":"The prevalence and incidence of NAFLD worldwide: A systematic review and meta-analysis","volume":"7","author":"Riazi","year":"2022","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2138","DOI":"10.1136\/gutjnl-2023-330110","article-title":"Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus: An updated systematic review and meta-analysis","volume":"72","author":"Ang","year":"2023","journal-title":"Gut"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"155999","DOI":"10.1016\/j.metabol.2024.155999","article-title":"Global burden of metabolic diseases, 1990\u20132021","volume":"160","author":"Zhang","year":"2024","journal-title":"Metabolism"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"l5367","DOI":"10.1136\/bmj.l5367","article-title":"Non-alcoholic fatty liver disease and risk of incident acute myocardial infarction and stroke: Findings from matched cohort study of 18 million European adults","volume":"367","author":"Alexander","year":"2019","journal-title":"BMJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1056\/NEJMra2412865","article-title":"Metabolic Dysfunction\u2013Associated Steatotic Liver Disease","volume":"393","author":"Targher","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1136\/gutjnl-2022-327672","article-title":"Non-alcoholic fatty liver disease and risk of new-onset heart failure: An updated meta-analysis of about 11 million individuals","volume":"72","author":"Mantovani","year":"2022","journal-title":"Gut"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1136\/gutjnl-2020-323082","article-title":"Non-alcoholic fatty liver disease and risk of incident chronic kidney disease: An updated meta-analysis","volume":"71","author":"Mantovani","year":"2022","journal-title":"Gut"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e16218","DOI":"10.1111\/liv.16218","article-title":"MASLD Is Associated with an Increased Long-Term Risk of Atrial Fibrillation: An Updated Systematic Review and Meta-Analysis","volume":"45","author":"Mantovani","year":"2025","journal-title":"Liver Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1136\/gutjnl-2021-324191","article-title":"Non-alcoholic fatty liver disease and increased risk of incident extrahepatic cancers: A meta-analysis of observational cohort studies","volume":"71","author":"Mantovani","year":"2022","journal-title":"Gut"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.ejca.2022.06.051","article-title":"Hepatocellular and extrahepatic cancers in non-alcoholic fatty liver disease: A systematic review and meta-analysis","volume":"173","author":"Thomas","year":"2022","journal-title":"Eur. J. Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1136\/gutjnl-2023-330595","article-title":"MASLD: A systemic metabolic disorder with cardiovascular and malignant complications","volume":"73","author":"Targher","year":"2024","journal-title":"Gut"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.cgh.2017.09.041","article-title":"Racial and Ethnic Disparities in Nonalcoholic Fatty Liver Disease Prevalence, Severity, and Outcomes in the United States: A Systematic Review and Meta-analysis","volume":"16","author":"Rich","year":"2018","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4987","DOI":"10.3748\/wjg.v20.i17.4987","article-title":"NAFLD prevalence differs among hispanic subgroups: The Multi-Ethnic Study of Atherosclerosis","volume":"20","author":"Fleischman","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2301","DOI":"10.1016\/j.cgh.2019.02.007","article-title":"American Ancestry Is a Risk Factor for Suspected Nonalcoholic Fatty Liver Disease in Hispanic\/Latino Adults","volume":"17","author":"Kallwitz","year":"2019","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1111\/apt.17631","article-title":"Effects of social determinants of health on mortality and incident liver-related events and cardiovascular disease in steatotic liver disease","volume":"58","author":"Chen","year":"2023","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.jhep.2024.08.011","article-title":"Association of food insecurity with MASLD prevalence and liver-related mortality","volume":"82","author":"Younossi","year":"2025","journal-title":"J. Hepatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.14309\/ajg.0000000000002749","article-title":"Food Insecurity, Low Household Income, and Low Education Level Increase the Risk of Having Metabolic Dysfunction-Associated Fatty Liver Disease Among Adolescents in the United States","volume":"119","author":"Paik","year":"2024","journal-title":"Am. J. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/S2213-8587(24)00318-8","article-title":"Metabolic dysfunction-associated steatotic liver disease: Heterogeneous pathomechanisms and effectiveness of metabolism-based treatment","volume":"13","author":"Stefan","year":"2025","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Han, A.L. (2020). Association between Non-Alcoholic Fatty Liver Disease and Dietary Habits, Stress, and Health-Related Quality of Life in Korean Adults. Nutrients, 12.","DOI":"10.3390\/nu12061555"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1002\/j.2040-4603.2016.tb00694.x","article-title":"Regulation of the Hypothalamic-Pituitary-Adrenocortical Stress Response","volume":"6","author":"Herman","year":"2016","journal-title":"Compr. Physiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1002\/hep.32207","article-title":"High-quality diet, physical activity, and college education are associated with low risk of NAFLD among the US population","volume":"75","author":"Nephew","year":"2022","journal-title":"Hepatology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1007\/s00394-024-03327-9","article-title":"Association between food insecurity and metabolic dysfunction-associated steatotic liver disease\/significant fibrosis measured by fibroscan","volume":"63","author":"Kim","year":"2024","journal-title":"Eur. J. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2790","DOI":"10.1016\/j.cgh.2021.11.029","article-title":"Food Insecurity is Associated with Mortality Among U.S. Adults With Nonalcoholic Fatty Liver Disease and Advanced Fibrosis","volume":"20","author":"Kardashian","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1016\/j.cgh.2024.10.019","article-title":"Neighborhood Social Determinants of Health Are Associated with Metabolic Dysfunction-associated Steatotic Liver Disease Outcomes","volume":"23","author":"Faulkner","year":"2025","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1097\/MPG.0000000000002527","article-title":"Community Socioeconomic Deprivation and Nonalcoholic Fatty Liver Disease Severity","volume":"70","author":"Orkin","year":"2020","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1016\/j.cgh.2024.08.053","article-title":"Food Swamps and Food Deserts Impact on Metabolic Dysfunction-Associated Steatotic Liver Disease Mortality in US Counties","volume":"23","author":"Paik","year":"2025","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"102775","DOI":"10.1016\/j.healthplace.2022.102775","article-title":"Historical redlining and food environments: A study of 102 urban areas in the United States","volume":"75","author":"Li","year":"2022","journal-title":"Health Place"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1136\/jech-2022-220234","article-title":"Impact of neighbourhood-level social determinants of health on healthcare utilisation and perinatal outcomes in pregnant women with NAFLD cirrhosis: A population-based study in Ontario, Canada","volume":"77","author":"Holdsworth","year":"2023","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1002\/hep4.1831","article-title":"Community Socioeconomic Deprivation Predicts Nonalcoholic Steatohepatitis","volume":"6","author":"Giammarino","year":"2022","journal-title":"Hepatol. Commun."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"(2019). The \u201cAll of Us\u201d Research Program. N. Engl. J. Med., 381, 668\u2013676.","DOI":"10.1056\/NEJMsr1809937"},{"key":"ref_32","unstructured":"(2026, July 21). Food Security in the U.S.\u2014Survey Tools. Economic Research Service, Available online: https:\/\/www.ers.usda.gov\/topics\/food-nutrition-assistance\/food-security-in-the-us\/survey-tools#household."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1542\/peds.2009-3146","article-title":"Development and validity of a 2-item screen to identify families at risk for food insecurity","volume":"126","author":"Hager","year":"2010","journal-title":"Pediatrics"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1017\/S1368980017000180","article-title":"Brief assessment of food insecurity accurately identifies high-risk US adults","volume":"20","author":"Gundersen","year":"2017","journal-title":"Public. Health Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1123\/jpah.7.4.533","article-title":"Evaluating a brief self-report measure of neighborhood environments for physical activity research and surveillance: Physical Activity Neighborhood Environment Scale (PANES)","volume":"7","author":"Sallis","year":"2010","journal-title":"J. Phys. Act. Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"401","DOI":"10.4278\/ajhp.120306-QUAN-127","article-title":"Associations of perceived neighborhood physical and social environments with physical activity and television viewing in African-American men and women","volume":"27","author":"Strong","year":"2013","journal-title":"Am. J. Health Promot."},{"key":"ref_37","first-page":"412","article-title":"Disorder and decay: The concept and measurement of perceived neighborhood disorder","volume":"34","author":"Ross","year":"1999","journal-title":"Urban Aff. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1001\/archinte.158.16.1789","article-title":"The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking","volume":"158","author":"Bush","year":"1998","journal-title":"Arch. Intern. Med."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"WHO Expert Consultation (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 363, 157\u2013163.","DOI":"10.1016\/S0140-6736(03)15268-3"},{"key":"ref_40","unstructured":"World Health Organization (2000). Obesity: Preventing and Managing the Global Epidemic, World Health Organization. Report of a WHO Consultation."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1080\/00365521.2023.2185475","article-title":"Administrative coding for non-alcoholic fatty liver disease is accurate in Swedish patients","volume":"58","author":"Wester","year":"2023","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e000572","DOI":"10.1136\/bmjgast-2020-000572","article-title":"Detecting non-alcoholic fatty liver disease and risk factors in health databases: Accuracy and limitations of the ICD-10-AM","volume":"8","author":"Hayward","year":"2021","journal-title":"BMJ Open Gastroenterol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.annepidem.2018.11.008","article-title":"Material community deprivation and hospital utilization during the first year of life: An urban population-based cohort study","volume":"30","author":"Brokamp","year":"2019","journal-title":"Ann. Epidemiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1016\/j.jhep.2021.06.034","article-title":"Non-alcoholic fatty liver disease in children and young adults is associated with increased long-term mortality","volume":"75","author":"Simon","year":"2021","journal-title":"J. Hepatol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/16\/2741\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:24:40Z","timestamp":1787322280000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/16\/2741"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":44,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["nu18162741"],"URL":"https:\/\/doi.org\/10.3390\/nu18162741","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]}}}