Abstract 13184: Relationships Between Food Insecurity and Dietary Quality in Persons With Cardiovascular Disease in NHANES (National Health and Nutrition Examination Survey), 2009-2020

Abstract

Background: Most guidelines recommend a nutrient-rich, heart-healthy diet for management of cardiovascular disease (CVD). Following dietary guidelines may be challenging for individuals experiencing food insecurity, but there is limited knowledge on how food insecurity relates to diet quality in persons with CVD. Hypothesis: We hypothesized that for persons with CVD (hypertension, heart disease, angina, MI, heart failure, or stroke), higher levels of food insecurity would be associated with lower levels of dietary quality. Methods: This was a cross-sectional analysis of 5 cycles of data (2009-2020) from the nationally representative National Health and Nutrition Examination Survey (NHANES). Participants aged > 19 with self-reported CVD were included. Food insecurity was measured using the 10-item Food Security Scale. Dietary intake was measured using 24-hour dietary recall from which individual nutrients were derived. Key nutrients examined as indicators of diet quality included sodium, potassium, polyunsaturated and monounsaturated fats, fiber, and total sugars. Relationships between food insecurity and diet quality were quantified using multivariable linear regression models, incorporating NHANES sample weights and controlling for common sociodemographic confounders. Results: The sample consisted of 17,102 persons (weighted study N = 311,708,767). Half were female (55.48%); most were non-Hispanic White (68.74%) and in middle (45-64 years, 44.82%) or late adulthood (≥65 years, 32.29%). Nearly a quarter (23.9%) were food insecure. With the exception of sodium intake (sodium, mg, β=-156, p=0.02), higher levels of food insecurity were significantly associated with poorer diet quality (potassium, mg: β=-157, p<0.004; polyunsaturated fats, gm: β=-1.81, p<0.003; monounsaturated fats, gm: β= -2.19, p=0.003, fiber, mg: β= -1.08, p=0.003, total sugars, gm: β=13.15; p<0.010). Conclusions: In persons with CVD, higher levels of food insecurity were significantly associated with lower diet quality in key nutrients essential for a heart-healthy diet. This study underscores the importance of considering social determinants of health to support patient and family success in following heart-healthy guidelines.