Longitudinal Associations of Diet, Food Insecurity, and Supplemental Nutrition Assistance Program Use with Global Cognitive Performance in Middle-Aged and Older Adults

Abstract

BackgroundDiet quality, food access, and food assistance policies may be key modifiable factors related to cognitive decline. ObjectiveWe aimed to evaluate whether diet quality, food insecurity, and Supplemental Nutrition Assistance Program (SNAP) use are associated with longitudinal changes in cognition among older adults in the United States. MethodsFood intake data from the Health Care and Nutrition Study were linked with longitudinal health information from 5 waves of the Health and Retirement Study (2012–2020). The analytic sample (n = 6968) included community-dwelling United States adults aged ≥51 y without cognitive impairment. Global cognition was measured using a telephone-based cognitive status interview (range: 0–27). Diet quality was measured with the Healthy Eating Index, using participants’ average intake of 13 dietary components. Questions regarding food access and affordability were used to determine food insecurity and use of SNAP benefits. Linear mixed-effects regression models were used to estimate longitudinal associations between diet-related factors and cognitive score changes. ResultsPoorer diets [β: −0.24; 95% confidence interval (CI): −0.33, −0.15], food insecurity (β: −1.08; 95% CI: −1.31, −0.85), and SNAP use (β: −0.57; 95% CI: −0.82, −0.32) were associated with lower baseline cognitive scores. Poorer diets (β: −0.17; 95% CI: −0.29, −0.05) and food insecurity (β: −0.23; 95% CI: −0.47, −0.01) were associated with significantly steeper declines in cognitive scores over time, after 8 and 2 y of follow-up, respectively; however, SNAP use was not significantly associated with the rate of cognitive decline over time. Estimates were qualitatively similar when restricting the sample to participants aged ≥65 y. ConclusionsResults suggest that food access and adherence to healthy diet recommendations may be important elements to maintain cognitive health in aging. SNAP benefits may be insufficient to prevent negative cognitive effects of poor diet and limited access to nutritious foods.