The impact of food insecurity on chronic liver disease: A systematic review of the literature.

backgroundChronic liver disease (CLD) poses a significant healthcare burden, with diet playing a crucial role in its management. Food insecurity, defined as limited or uncertain access to adequate food, may worsen liver disease outcomes due to reliance on nutrient-poor diets. While its association with chronic conditions is well-established, its impact on liver disease remains underexplored. This systematic review synthesizes evidence on the impact of food insecurity on liver disease development, progression, and outcomes, identifying gaps and informing future research and public health strategies.

methodsDatabases including Medline, CINAHL, Embase, and Web of Science were searched comprehensively through April 2025. Studies evaluating food insecurity and liver disease outcomes were included. Data on study design, population, definitions, and findings were extracted. Quality and risk of bias were assessed using the Mixed Methods Appraisal Tool.

resultsOf 17,609 studies identified, 17 met the inclusion criteria, predominantly from the United States. Most studies focused on metabolic dysfunction-associated steatotic liver disease (MASLD). Food insecurity was linked to increased odds of MASLD, advanced fibrosis, and mortality, with higher rates of hepatic steatosis, liver stiffness, and fibrosis progression in both pediatric and adult populations. Food insecurity was measured primarily using the USDA Household Food Security Survey Module, and liver outcomes via noninvasive techniques and biomarkers.

conclusionsFood insecurity is a potentially modifiable risk factor for liver disease progression, emphasizing the need for targeted interventions. Further research should explore food assistance interventions, its impact on diet and implement screening programs in hepatology clinics to inform tailored strategies addressing this critical determinant of liver health.