Why UCSF researchers say Latino kids are at greater risk for liver disease and transplant

Food insecurity has caused a surge in cases of fatty liver disease among Latino children in the United States, researchers at the University of California reported Friday, but many Latino households can’t afford the nutritional food that can prevent the condition.

Latino children and adults have a higher prevalence of fatty liver disease than white or Black people, the UCSF team said, and the condition is the No. 1 indicator for a liver transplant as an adult.

“We believe screening for (fatty liver disease) should begin earlier than current guidelines recommend, which is age 9-11 years for children with obesity and age 2-9 years for those with severe obesity,” said Dr. Sarah Maxwell, a pediatrician and the lead author on the study. “Food insecurity screening is also important early on, especially for Latinx children who are at higher risk and could be connected to healthier food resources in their communities.”

A healthy, balanced diet is a key element in fending off fatty liver disease, medical experts say, but an April 2023 report from the Public Policy Institute of California showed that about one in 10 California households lacked the resources to meet their food needs.

A disproportionate share of households experiencing food insecurity are Latino — 47% vs. 30% in the population at large, according to PPIC researchers Tess Thorman and Patricia Malagon.

Their colleague Paulette Cha also reported that, despite playing a key role in state and national food supply chains, a largely Latino farmworker population is vulnerable to food insecurity because their immigration status prevents them from accessing all the nutritional assistance programs available to U.S. citizens.

Farmworkers face food insecurity, other challenges

In budget plans, California Gov. Gavin Newsom has pledged that undocumented residents older than 55 will be eligible for food assistance in October 2025.

Marco Lizarraga, director of La Cooperativa Campesina de California, said he was not surprised with the findings of the UCSF research. He has spent decades working with farmworkers, who are mostly undocumented, and seen how diets and diseases are impacted by food insecurity.

Lizarraga said the farmworker population is overwhelmingly poor, housing insecure and have inadequate health services. That combination of factors can lead to less nutritious food options for households.

Around 30% of farmworker households earn income that falls below the poverty line, and 73% earn less than 200% of the federal poverty level, a threshold used in many public assistance programs, according to La Cooperativa.

“They (farmworkers) are really at a disadvantage when it comes to be able to provide a nutritious meal to the kids,” Lizarraga said.

There’s also a lack of education. An estimated 78% of farmworkers do not possess a high school diploma or equivalent.

“When you’re not educated, you’re not going to self-educate yourself into nutrition and what is nutritious,” Lizarraga said.

Tracking fatty liver disease in children

Characterized by a build-up of fat in the liver, this condition can lead over time to such complications as cirrhosis, liver failure, liver cancer, the need for organ transplantation and heart health issues, according to Harvard researchers. Fatty liver disease is officially known as metabolic dysfunction-associated steatotic liver disease, or MASLD.

To reach their findings, UCSF researchers assessed the liver health of 136 Hispanic children in the San Francisco area, some born from 2006-07 and others born 2011-13. Each child received an annual checkup until 2021.

They also measured food insecurity levels for the children at age 4, using the U.S. Household Food Security Food Module, and then screened them for fatty liver disease between ages 5 and 12.

More than a quarter of the children — 29% — suffered from food insecurity at age 4, the researchers found, and a striking 27% of them were diagnosed with fatty liver disease in early to middle childhood.

Children with fatty liver disease were more than twice as likely to live in food-insecure households at age 4 as the children who escaped the condition, the UCSF team said. Food insecurity at age 4 raised the odds of having fatty liver disease by age 12 by nearly four times, they said.

Maxwell said the team based its recommendation for earlier screenings on both the study results and what they were seeing for Latino children in their medical clinic.

“We’ve seen studies in adults associating food insecurity with fatty liver disease and liver fibrosis, but very few studies have looked at children,” said Maxwell, who is completing a pediatric transplant hepatology fellowship at UCSF Benioff Children’s Hospitals.

While researchers don’t conclusively know how food insecurity leads to fatty liver disease, their findings suggest that food-insecure children may have diets of poorer nutritional quality. Think less produce and more sugar-sweetened beverages.

Food insecurity in a household also can cause irregular eating patterns that disrupt metabolism, the researchers noted. Consequently, this could place more stress on the liver and increased inflammation, they said, and the relationship between the liver and microorganisms in the gut could deteriorate.

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