Associations between neighborhood built-environment characteristics and hepatic steatosis: The Multi-Ethnic Study of Atherosclerosis

Objective: To characterize the spatio-temporal association between features of the built environment and subclinical liver disease.

Design: We used data from a large community-based population, the Multi-Ethnic Study of Atherosclerosis (2000-2002, N = 5542) with linked historical residential data that characterized past exposure to alcohol outlets (bars and liquor stores), healthy foods stores, and physical activity facilities (1990-2001). We examined whether and how past residential relate to hepatic steatosis (proxied by liver attenuation measured using computed tomography, with lower attenuation indicating higher hepatic steatosis). Hepatic steatosis is the most common.

Results: We found significant associations between past residential exposure to neighborhood alcohol outlets, healthy food and physical activity resources, and hepatic steatosis. The spatial scale where the association between these features of the built environment and hepatic steatosis operate lies within 3 km (∼2 miles). The average association on liver attenuation per additional bar, liquor, healthy food store, and physical activity facility within a 2-mile buffer, were: -0.06 (95% CI -0.09, -0.03), -0.02 (95% CI -0.04, -0.009), 0.05 (95% CI 0.02, 0.07), 0.02 (95% CI 0.01, 0.04), respectively, in the preceding year of the measurement of hepatic steatosis. Furthermore, the association and spatial scale remains consistent ten years prior to the measurement of hepatic steatosis.

Conclusion: Our results suggest that modifying neighborhood environments (decreasing alcohol outlets and improving access to healthy food and physical activity) may represent an effective population-wide approach to reduce liver-related morbidity.