1241-P: Examination of Direct and Indirect Pathways between Food Insecurity and ABC’s of Diabetes

Abstract

Background: Food insecurity is associated with health outcomes in adults with diabetes. The goal of this study was to investigate pathways through which food insecurity influences the ABC’s of diabetes (HbA1c, blood pressure, and cholesterol-lipids) in an effort to inform intervention development. Methods: National Health and Nutrition Examination Survey (NHANES) from 2011-2018 was used. Adults who self-reported a health professional telling them they had diabetes were included in the analysis (n=4,058). HbA1c, blood pressure, and cholesterol-lipids were measured by NHANES and analyzed as continuous measures. Food insecurity was scored based on the USDA scale. Preliminary analyses investigated indicators for body composition, anthropometrics, and healthy eating. Structural equation modeling using Stata v17 with standardized estimates was used to investigate direct and indirect relationships for the hypothesized pathway of food insecurity leading to lower healthy eating, higher waist circumference, and ultimately higher HbA1c, blood pressure, and cholesterol-lipids. Results: For the pathway with HbA1c, higher food insecurity was directly associated with lower healthy eating (B=-0.09, p<0.001), higher waist circumference (B=0.03, p<0.03), and higher HbA1c (B=0.09, p<0.001). For the pathway with lipids, higher food insecurity was directly associated with lower healthy eating (B=-0.09, p<0.001), higher waist circumference (B=0.05, p=0.002), and higher lipids (B=0.06, p<0.001). Significant indirect effects also existed for the hypothesized pathway for both HbA1c and lipids. However, significant pathways did not exist for the relationship between food insecurity and blood pressure. Conclusions: Food insecurity appears to exert its effect via healthy eating and anthropometrics. Strategies that optimize dietary intake and lifestyle modification for weight management will be most beneficial in improving ABC’s for food insecure adults with diabetes. Disclosure R.J.Walker: None. R.Amjad: None. L.E.Egede: None. Funding National Institutes of Health (R01DK118038, R01DK120861, R01MD013826)