Liver disease prevalence, severity, outcomes and hepatic risk factors (for example, unhealthy diet) are heavily affected by socioeconomic status and food insecurity. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease globally and is likely to co-occur with other liver diseases associated with food insecurity. Though weight reduction and adopting a healthy diet can reverse the course of MASLD, gaps between recommendations and practice transcend individual responsibility and preference. Broader sociocultural determinants of food choices (social nutrition) include food insecurity, community and social norms and the local environment, including commercial pressures that target people experiencing poverty, ethnic minorities and children. Food insecurity is a barrier to a healthy diet, as a low-quality diet is often less expensive than a healthy one. Consequently, food insecurity is an ‘upstream’ risk factor for MASLD, advanced fibrosis and greater all-cause mortality among patients with liver disease. Intervening on food insecurity at four major levels (environment, policy, community and health care) can reduce the burden of liver disease, thereby reducing social and health inequities. In this Review, we report on the current research in the field, the need for implementing proven interventions, and the role liver specialists can have.

肝病的患病率、严重程度、结果和肝脏危险因素（例如不健康饮食）在很大程度上受到社会经济状况和粮食不安全的影响。代谢功能障碍相关的脂肪肝病（MASLD）是全球最常见的肝病，并且可能与其他与粮食不安全相关的肝病同时发生。尽管减轻体重和采取健康饮食可以扭转 MASLD 的进程，但建议和实践之间的差距超越了个人责任和偏好。食物选择（社会营养）的更广泛的社会文化决定因素包括粮食不安全、社区和社会规范以及当地环境，包括针对贫困人口、少数民族和儿童的商业压力。粮食不安全是健康饮食的障碍，因为低质量的饮食通常比健康的饮食便宜。因此，粮食不安全是肝病患者发生 MASLD、晚期纤维化和更高全因死亡率的“上游”风险因素。从四个主要层面（环境、政策、社区和医疗保健）对粮食不安全进行干预可以减轻肝病负担，从而减少社会和健康不平等。在这篇综述中，我们报告了该领域当前的研究、实施行之有效的干预措施的必要性以及肝脏专家可以发挥的作用。