Perceived Barriers to a Healthy Diet and Factors Associated With Unhealthy Food Consumption in Steatotic Liver Disease.

Background and Aims: Dietary modification is important to steatotic liver disease (SLD) management. We aimed to determine barriers to a healthy diet and factors associated with unhealthy eating in a diverse and socioeconomically disadvantaged population. Methods: For this cross-sectional study, 344 adults with SLD at hepatology clinics of a safety-net health-care system were surveyed between February 2020 and February 2024. Clinical data were collected using electronic medical records. An unhealthy diet score was calculated based on the frequency of unhealthy food consumption, and its median defined the cutoff for unhealthy diet outcome. Logistic regression evaluated the relationship between barriers to healthy eating and unhealthy food categories. Multivariable model adjusting for age, sex, race, obesity, and exercise evaluated factors associated with unhealthy diet score. Results: Participant demographics were median age 53 years, 58% female, and 57% Latino. Majority (60%) were obese and 25% had heavy alcohol use. Common barriers were lack of motivation, cost, and lack of healthy cooking knowledge. Carbohydrates and sugar-sweetened beverages consumption were associated with barriers at multiple levels of influence. Lack of motivation to eat healthy foods and/or exercise was significantly associated with increased consumption of fast foods (odds ratio [OR] 1.79) and fried foods (OR 2.72). On adjusted multivariable analysis, age (per decade, OR 0.69) and any exercise (OR 0.52) was associated with lower unhealthy diet scores (all Conclusion: Promoting a healthier diet is especially important in younger age groups and those with lower physical activity in SLD. Dietary educational interventions and culturally tailored healthy cooking practices is critical to enhancing confidence and motivation for dietary change.