Food Insecurity and Chronic Liver and Gastrointestinal Conditions: A Systematic Review of Prevalence and Clinical Outcomes.

BACKGROUND AND AIMS: Food insecurity (FI), limited or uncertain access to enough food, has been linked to poor clinical outcomes. Given that dietary management is central to many gastrointestinal (GI) and hepatologic diseases, these populations may be uniquely vulnerable to the effects of FI. Our primary aim was to determine the prevalence rates of FI among patients with chronic GI and liver conditions within the United States and evaluate reported associations with clinical outcomes. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic search of PubMed, Web of Science, and Embase from inception to July 17, 2025. Eligible studies reported FI prevalence and were conducted in the United States. Clinical and nutritional outcomes were collected as well as risk of bias assessment for each study. RESULTS: Of the 1279 references identified, 25 studies (54,034 participants) meet inclusion criteria. FI prevalence varied widely (5%-45.5%) across disease types, including liver disease (n = 12), inflammatory bowel disease (n = 5), cystic fibrosis (n = 5), and celiac disease (n = 3). Eight studies utilized the gold standard, 18-item US Household Food Security Survey. Of the 17 studies reporting clinical outcomes, 13 found possible associations with FI. Seventeen out of 25 studies met ≥80% of quality criteria. The most commonly unmet criteria across studies related to insufficient control of confounding variables. CONCLUSION: FI is prevalent and clinically significant across a range of chronic GI and hepatologic conditions. Though prevalence estimates vary substantially by disease type and measurement approach, FI may be associated with worse clinical outcomes, dietary nonadherence, and social disadvantage. Routine screening and intervention strategies to address FI may be a critical component to comprehensive GI care.