Metabolic Dysfunction-associated Liver Disease Associated With Poor Food Access and Geographic hot Spots Among Liver Transplant Candidates
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Metabolic dysfunction-associated liver disease (MASLD) and frailty share metabolic risk factors. We evaluated the relationship between poor food access and the prevalence of MASLD and frailty among patients with cirrhosis being evaluated for LT and visualized the geospatial clustering of MASLD and frailty. METHODS: We conducted a retrospective cross-sectional cohort study of adults at a single center. Poor food access was defined at the census-tract level using U.S. Department of Agriculture Food Access Data as low-income and low-access (LILA) areas, also referred to as food deserts. RESULTS: Two thousand two hundred sixty-six adults were included; the median age was 61 (interquartile range, 54-66), 171 (8%) resided in LILA areas, 29% were Hispanic, and 43% had public insurance. Fifteen percent were frail, and 19% had MASLD. In univariate logistic regression, living in a LILA area was associated with a 50% increased odds of MASLD (odds ratio, 1.50; P = 0.03; 95% confidence interval, 1.03-2.14) but lost statistical significance in multivariate regression. Hotspot analysis of MASLD and frailty revealed a similar geographic distribution of hot and cold spots. Spatial autocorrelation analysis yielded a Moran's I of 0.007 ( P = 0.02) and 0.007 ( P = 0.01) for MASLD and frailty, respectively. Hot spots of both were associated with LILA areas and census tracts with less walkability and higher poverty, social vulnerability, and pollution. CONCLUSIONS: Residing in a LILA area was associated with increased prevalence of MASLD and frailty among patients with cirrhosis. There was significant clustering of MASLD and frailty, suggesting that geographical determinants influence the indication for liver transplantation and the risk of frailty.
Source: Transplantation
Institutions: University of California, San Francisco, Columbia University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Promoting Multidisciplinary Clinical and Translational Science in Aging by Resident Investigators, UCSF Liver Center, The Impact of Frailty on Liver Transplant Outcomes in Older Adults with Hepatocellular Carcinoma, Application of Novel Biomarkers of Renal Health in Cirrhosis Patients to Stratify Risk of Acute Kidney Injury Occurrence and Reversibility, Addressing social adversity to improve outcomes among children undergoing liver transplant: the role for a health advocate on the transplant team
OpenAlex ID: W7165769915