Food insecurity is associated with a higher body mass index and lower albumin levels in patients with congestive heart failure in the All of Us research program

Abstract

Abstract Introduction Congestive Heart Failure (CHF) is an extremely prevalent disorder worldwide with high morbidity and mortality rates. Estimates suggest that approximately 80% of cardiovascular diseases (CVD), including CHF, can be prevented by controlling risk factors and adopting a healthy lifestyle. However, there are substantial barriers to implementing this guidance for many patients, including food insecurity, which is a household-level economic and social condition of limited or uncertain access to adequate food. Food insecurity is also associated with a greater prevalence of overweight and obesity, which plays a role in the pathogenesis of CHF. Purpose Our goal is to examine the difference in body mass index (BMI), nutritional and cardiac-specific markers—specifically albumin, B-type natriuretic peptides (BNP), N-terminal pro-B-type natriuretic peptides (NT-proBNP), and troponin I (TnI)—between patients with CHF who are food secure and patients with CHF who are food insecure. To our knowledge, no prior studies have examined this important relationship in a large population-based sample. Methods We use the All of Us Research Program (AoURP) to analyze a large cohort of 372,380 participants representing the diversity of the US population in terms of ancestry, demographics, socioeconomic status, and other characteristics. Of the 372,380 participants, 12,529 had CHF, of which 1472 answered the two validated screening questions for food insecurity, also known as the "hunger vital sign". We split the CHF participants between a food-secure group (1297 participants) and a food-insecure group (175 participants), where food security is defined as responding "never" to both questions of the "hunger vital sign". Results Our findings indicate that the food insecure participants are younger (p<0.0001), less likely to drink alcohol (p<0.0001), less educated (p<0.0001), and more likely to be black (p<0.0001), female (p<0.0001), and Hispanic (p<0.001). The mean (+-SD) BMI for the food insecure group is 35.0 (+-8.8) kg m-2 compared to 31.3 (+-7.2) kg m-2 for the food secure group (p<0.00001) and the mean (+-SD) albumin level for the food insecure group is 34.2 (+- 2.9) g/L compared to 38.4 (+-4.2) g/L for the food secure group (p<0.0001). The differences in BNP, NT-proBNP, and TnI are not statistically significant. Conclusion Our findings–demographic differences, higher mean BMI, lower albumin levels in CHF patients who are food insecure–indicate the necessity to reevaluate our approach to care for historically underserved patients.