BACKGROUND: Effective interventions for metabolic liver disease include optimized nutritional intake. It is increasingly clear, however, that many patients with metabolic liver disease lack the resources to execute nutritional advice. Data on the trends of food insecurity are needed to prioritize public health strategies to address the burden of liver disease. METHODS: Cross-sectional analysis of six waves of data from 24,847 adults aged >
20 years from the 2017-2018 National Health and Nutrition Examination Survey. Food security was measured using the US Department of Agriculture's Core Food Security Module. Liver disease was defined as elevated liver enzymes and a risk factor: elevated BMI, diabetes, and/or excess alcohol consumption. Advanced liver disease was estimated using FIB-4 >
2.67.Additional covariates included age, sex, race/ethnicity, education, marital status, poverty-income ratio, alcohol intake, body mass index, diabetes, and participation in the Supplemental Nutrition Assistance Program (SNAP). RESULTS: The overall prevalence of liver disease was 24.6%, ranging from 21.1% (2017-2018) to 28.3% (2015-2016) (P-trend = 0.85). 3.4% of participants had possible advanced liver disease, ranging from 1.9% (2007-2008) to 4.2% (2015-2016)(P-trend = 0.07). Among those with liver disease, the prevalence of food insecurity was 13.6% in 2007-2008, which rose steadily to 21.6% in 2015-2016, before declining to 18.0% in 2017-2018 (P-trend = 0.0004). Food insecurity rose more sharply for adults aged <
50 years (2007-2008: 17.6%, 2015-2016: 28.0%, P-trend = 0.004) compared to adults aged ≥ 50 years (2007-2008: 9.5%, 2015-2016: 16.5%, P-trend <
0.0001). Similarly among those with liver disease, significant predictors of food insecurity included Hispanic ethnicity, low educational attainment, and participating in SNAP. CONCLUSION: Food insecurity is increasingly common among those with liver disease.