ArticleTransplantation2026
Metabolic Dysfunction-associated Liver Disease Associated With Poor Food Access and Geographic hot Spots Among Liver Transplant Candidates.
Article in Transplantation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMetabolic 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.
methodsWe 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.
resultsTwo 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.
conclusionsResiding 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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