These findings, in conjunction with our recent geospatial work outlining that children from more deprived neighborhoods may be at risk for earlier onset of NAFLD, suggest that pathophysiologic mechanisms may link food insecurity and liver disease severity, such as alteration in cortisol levels and hunger cues resulting from food insecurity that impacts insulin sensitivity and lipolysis from the peripheral tissue (12). This evidence concerns the gene INS and metabolic dysfunction-associated steatotic liver disease.