Screening for food insecurity in patients with cirrhosis: A pilot study

INTRODUCTION: Data collection on food insecurity and barriers to a healthy diet is not routinely done in hepatology clinics, although the prevalence of food insecurity is likely high. This is a pilot study to estimate the prevalence of food insecurity and characterize food-insecure patients with cirrhosis who receive routine outpatient care. 

METHODS: Prospective survey of outpatients with cirrhosis to screen for food insecurity in the waiting room on the day of their appointment. Responses were linked to electronic medical record data for demographic, comorbidity, and health care utilization data. Descriptive statistics were calculated for patients who were food insecure versus food secure. Univariate and multivariable models were constructed to evaluate the relationships between patient factors and food insecurity. 

RESULTS: Of 150 respondents, 25% (n=38) screened positive for food insecurity. In total, 69% (n=104) reported difficulty making the best food choices for their cirrhosis, 89% (n=34) among the food insecure, and 54% (n=60) among the food secure. Compared with food-secure individuals, those with food insecurity were younger (mean age 58.1 vs. 63.5 y, P=0.02), had lower BMI (mean 27.9 vs. 30.9, P=0.03), and were more likely to be Hispanic (15.8% vs. 4.5%, P=0.05) and Medicaid-insured (28.9% vs. 10.7%, P=0.01). Both groups had similar cirrhosis etiologies, co-morbidities, decompensation events, ED visits, and hospital admissions within the past year. 

CONCLUSION: One in 4 patients screened during a routine outpatient hepatology visit reported food insecurity. Over 69% of patients reported difficulties with making cirrhosis-specific food choices, most of whom did not screen positive for food insecurity. Our findings underscore an urgent need for tailored screening and for interventions that address the unique barriers faced by cirrhosis patients.