Food Insecurity is Associated with Nonalcoholic Fatty Liver Disease, Cognitive Impairment, and Immune Activation in People Living with HIV

Abstract

Food insecurity (FI) is a socioeconomic condition characterized by inadequate access to enough food and nutrition to sustain health and wellbeing. Food insecurity is a risk factor for chronic and age-related conditions, raising concerns for the aging population of people living with HIV (PLWH), in whom food insecurity is disproportionately prevalent. PLWH are at increased risk of nutrition-related complications and chronic co-morbidities, thus food insecurity may exacerbate adverse health outcomes in this population. This study investigated whether food insecurity was associated with nonalcoholic fatty liver disease (NAFLD), cognitive impairment, and immune activation among socioeconomically disadvantaged adults living with and without HIV. This study was conducted with participants from the Miami Adult Studies on HIV (MASH) Cohort, predominantly comprised of low-income Black and Hispanic middle-aged adults. Food insecurity was measured with the U.S. Household Food Security Survey. Magnetic resonance technology was used to assess liver steatosis and fibrosis. The Mini-Mental State Examination was used to assess cognitive impairment. Biomarkers of monocyte/macrophage (sCD14 and sCD163) and lymphocyte (sCD27) activation were measured from blood samples. Approximately a third of participants experienced food insecurity. Food insecurity modified the effect of BMI on NAFLD, increasing the risk associated with increasing BMI among those who experienced food insecurity. Additionally, food insecurity was independently associated with increased risk for any and advanced liver fibrosis. Baseline food insecurity and its frequency over a 2-year period were associated with cognitive decline, particularly when food insecurity was persistent. The effects of food insecurity on liver disease or cognitive impairment were not significantly different between PLWH and HIV-uninfected participants. Among PLWH, food insecurity was associated with increased sCD14 and sCD27, which also correlated with the severity of food insecurity. The severity of food insecurity also appeared to moderate the relationship between CD4 cell count and sCD163. Food insecurity may contribute to the NAFLD and cognitive decline among low-income U.S. minorities. Although food insecurity did not have greater effects for PLWH compared to those HIV-uninfected, food insecurity may promote immune activation in PLWH, suggesting a biological link between food insecurity and adverse health outcomes. Improving financial security and access to high-quality foods could reduce the high burden of disease in vulnerable populations.