Metabolic Dysfunction-associated Liver Disease Associated With Poor Food Access and Geographic hot Spots Among Liver Transplant Candidates.

IF 4.9 2区医学 Q1 IMMUNOLOGY

Transplantation Pub Date : 2026-10-01 Epub Date: 2026-06-25 DOI:10.1097/TP.0000000000005813

Laila Fozouni, Giuseppe Cullaro, Jennifer C Lai, Sharad I Wadhwani

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引用次数: 0

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.

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肝脏移植候选者中代谢功能障碍相关肝病与食物获取困难和地理热点相关

背景：代谢功能障碍相关肝病（MASLD）和虚弱有共同的代谢危险因素。我们评估了肝硬化LT患者食物获取困难与MASLD患病率和虚弱之间的关系，并可视化了MASLD和虚弱的地理空间聚类。方法：我们在单中心对成人进行了回顾性横断面队列研究。根据美国农业部粮食获取数据，在人口普查区一级将粮食获取困难地区定义为低收入和低获取（LILA）地区，也被称为粮食沙漠。结果：纳入了2,266名成年人；年龄中位数为61岁（四分位间距为54-66岁），171人（8%）居住在LILA地区，29%为西班牙裔，43%有公共保险。15%的人身体虚弱，19%的人患有MASLD。在单因素logistic回归中，生活在LILA地区与MASLD的几率增加50%相关（优势比为1.50;P = 0.03； 95%可信区间为1.03-2.14），但在多因素回归中没有统计学意义。热点分析和脆弱性分析显示热点和冷点的地理分布相似。空间自相关分析结果显示，MASLD和脆性的Moran's I分别为0.007 （P = 0.02）和0.007 （P = 0.01）。两者的热点都与LILA地区和人口普查区有关，这些地区的可步行性较差，贫困程度、社会脆弱性和污染程度较高。结论：在肝硬化患者中，居住在LILA地区与MASLD患病率增加和虚弱相关。MASLD和虚弱有明显的聚集性，表明地理因素影响肝移植的适应症和虚弱的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation 医学-免疫学

CiteScore

8.50

自引率

11.30%

发文量

1906

审稿时长

1 months

期刊介绍： The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation.