Kardashian A, et al. - In adults with nonalcoholic fatty liver disease (NAFLD) and advanced fibrosis, food insecurity is shown to be significantly linked with greater all-cause mortality. To enhance health in adults with liver disease, interventions that address food insecurity in this population should be prioritized.

• Food insecurity represents a growing public health challenge in the U.S. and has been associated with NAFLD and advanced fibrosis.

• Using a population-based cohort study of U.S. adults (≥20 years) in the NHANES 1999-2014 with NAFLD and advanced fibrosis, food security was assessed using the Department of Agriculture Food Security Survey Module.

• This analysis involved 34,134 eligible participants (mean age 47 years) including 4,816 with NAFLD and 1,654 with advanced fibrosis; food insecurity was present in 28% and 21%, respectively.

• In multivariable analyses, food insecurity was found to be independently related to higher mortality in those with NAFLD (HR=1.46) and advanced fibrosis (HR=1.37) and greater outpatient healthcare utilization in NAFLD patients (OR=1.32).