Food Insecurity In Adults Research Articles

Association between adult food insecurity and mortality among adults aged 20-79 years with diabetes: A population-based retrospective cohort study.

There is limited research on the relationship between food insecurity and mortality among individuals with diabetes. This study aims to investigate the impact of food insecurity on all-cause and cause-specific mortality in adults with diabetes. This study included 5749 adults with diabetes from the National Health and Nutrition Examination Survey cycles 2003-2018 and followed up until 31 December 2019. Food insecurity was measured by the Food Security Survey Module. Cox proportional hazard models were employed to estimate hazard ratios (HRs) and 95% confidence intervals for both all-cause mortality and cause-specific mortality. The weighted prevalence of full food security, marginal food security, low food security, and very low food security was 70.8%, 11.0%, 10.4%, and 7.8%, respectively. Food insecurity demonstrated a significant correlation with diminished diet quality and reduced consumption of healthy foods. Over the course of 42,272.0 person-years of follow-up, we documented 1091 deaths, of which 370 were attributed to cardiovascular disease and 180 to cancer. After adjusting for multiple variables, food insecurity scores were significantly and linearly associated with increased all-cause mortality. Comparing to full food security, participants experiencing very low food security had a multivariate-adjusted HR of 1.48 (1.12, 1.95) for all-cause mortality (ptrend = 0.010). Food insecurity was associated with increased all-cause mortality and compromised diet quality, especially in individuals experiencing very low food security. Future strategies may necessitate the monitoring of and interventions for food insecurity among individuals with diabetes.

VISION LOSS AND FOOD INSECURITY IN THE NATIONAL HEALTH AND AGING TRENDS STUDY

Abstract Adults with vision impairment (VI) may be at a greater risk of experiencing food insecurity due to economic hardships and difficulty with daily activities. However, the relationship is not well understood. We examined the cross-sectional associations between VI and food insecurity in older community-dwelling US adults among 2,815 National Health and Aging Trends Study participants. VI was measured on categorical (distance acuity VI [> 20/40], near acuity VI [> 20/40], contrast sensitivity impairment [CSI] [<1.55], and any VI (distance, near, or CSI)) and continuous scales (distance and near acuity [per 0.1 logMAR], and contrast sensitivity [per 0.1 logCS units]). Food insecurity was classified based on functional limitations, lack of social support, and/or financial limitations. Overall, older adults with any VI had higher prevalence rates of food insecurity than adults without VI (4.56% vs. 1.90%). In fully-adjusted models, older adults with any VI had double the odds of food insecurity than their peers (OR=2.13, 95% CI: 1.25–3.62). Although no associations were found when assessing other vision measures categorically, continuous scales showed strong associations; worse distance (OR=5.00, 95% CI: 1.85–13.48) and near acuity (OR=2.56, 95% CI: 1.05–6.21, per 0.1 logMAR), and worse CS (OR=2.57, 95% CI: 1.11–5.94, per 0.1 logCS units) were associated with higher odds of food insecurity. These results suggest that older Americans with VI have a higher likelihood of food insecurity, and highlight a need to examine strategies, such as more disability-inclusive policies impacting food access, to improve accessibility and reduce these inequities.

Food insecurity in adults with severe mental illness living in Northern England: Peer research interview findings.

Food insecurity means that a person does not have access to sufficient nutritious food for normal growth and health. Food insecurity can lead to many health problems such as obesity, heart disease, diabetes, and other long term health conditions. People living with a severe mental illness are more likely to experience food insecurity than people without mental illness. Peer-led in-depth interviews were conducted with adults with severe mental illness from Northern England, during which their experiences of food insecurity and strategies to tackle food insecurity were discussed. Interviews took place between March and December 2022, with interviews being transcribed and analysed using deductive and inductive thematic analysis. Thirteen interviews were conducted, finding that food insecurity in adults with severe mental illness was often a long-standing issue. Unemployment, the cost-of-living crisis and fuel poverty impacted on experiences of food insecurity. Difficulties accessing food banks such as transport, stigma, and the limited selection of available food was also discussed. Strategies to tackle food insecurity centred on making food banks more accessible and improving the quality of available food. Future research should aim to eradicate food insecurity for adults with severe mental illness, as limited research and action focuses on this population group over and above 'mental illness' or 'poor mental health'. Removing barriers to accessing food such as lack of transport, and providing food which is of adequate nutritional quality, should be prioritised, as well as tackling the stigma and accessibility issues surrounding food banks use.

Use of co-production to explore food insecurity in adults with severe mental illness living in Northern England: a mixed-methods study

BackgroundPeople living with severe mental illness experience premature mortality from diet-related preventable illnesses. Yet, little research focuses on food insecurity with adults with severe mental illness. This coproduced study aimed to understand the experiences of adults with severe mental illness and food insecurity and strategies to help. MethodsFollowing a pragmatism philosophical foundation, we undertook a mixed-methods study involving a survey (online and paper versions) and one-to-one semi-structured interviews (online and telephone) during March 7 to Dec 16, 2022. We recruited participants via existing severe mental illness service user groups and social media in Northern England. Eligible participants were adults (≥18 years) self-reporting a diagnosis of severe mental illness. Ethics approval was obtained from Teesside University and the Health Research Authority (Reference: 22/NR/0010; IRAS ID: 306281), with informed consent given. The target sample size, accounting for a typical survey response rate for people with severe mental illness of 10–20%, was 135. A target sample of 20 interviews was agreed to capture a range of views. Food insecurity was defined as the lack of financial resources needed to ensure someone has reliable access to enough food to meet their dietary, nutritional, and social needs. It is sometimes called food poverty. Quantitative data were analysed using descriptive statistics and binary logistic regression and qualitative data using thematic analysis. Findings135 participants completed the survey (mean age 44·67 years [SD 14·1]). Participants were predominantly male (53%, n=72), white (87%, n=117), and from the Yorkshire region (50%, n=68). Overall, prevalence of food insecurity was 50·4% (n=68). Discussion across 13 interviews found food insecurity being a long-rooted experience, including familial and intergenerational experiences of food insecurity: “I grew up… with this insecurity around food” (P002). Recommendations for tackling food insecurity centred on food banks, increasing accessibility, and reducing stigma: “I would like to get more information on where the centres are...” (P006) and “I was referred to, erm, a foodbank … but it's still the stigma that's attached to it.” (P002). InterpretationWe found a higher prevalence of food insecurity in this study than in the general population (being 15%), yet limited research with adults with severe mental illness perpetuates food insecurity intergenerational injustices. Food insecurity should be eliminated. However, in the meanwhile, there should be widespread easy access to food banks offering nutritional foods. Limitations of this research include not reaching target sample size and a lack of ethnic diversity. FundingNational Institute of Health and Care Research (NIHR) Research for Patient Benefit.

Food Insecurity, Memory, and Dementia Among US Adults Aged 50 Years and Older

Despite existing federal programs to increase access to food, food insecurity is common among US older adults. Food insecurity may affect Alzheimer disease and Alzheimer disease-related dementias via multiple mechanisms, yet there is almost no quantitative research evaluating this association. To examine whether food insecurity in older adults is associated with later-life cognitive outcomes. This cohort study of US residents aged 50 years and older from the US Health and Retirement Study was restricted to respondents with food insecurity data in 2013 and cognitive outcome data between calendar years 2014 and 2018. Analyses were conducted from June 1 to September 22, 2023. Food insecurity status in 2013 was assessed using the validated US Department of Agriculture 6-item Household Food Security Module. Respondents were classified as being food secure, low food secure, and very low food secure. Outcomes were dementia probability and memory score (standardized to 1998 units), estimated biennially between 2014 and 2018 using a previously validated algorithm. Generalized estimation equations were fit for dementia risk and linear mixed-effects models for memory score, taking selective attrition into account through inverse probability of censoring weights. The sample consisted of 7012 participants (18 356 person-waves); mean (SD) age was 67.7 (10.0) years, 4131 (58.9%) were women, 1136 (16.2%) were non-Hispanic Black, 4849 (69.2%) were non-Hispanic White, and mean (SD) duration of schooling was 13.0 (3.0) years. Compared with food-secure older adults, experiencing low food security was associated with higher odds of dementia (odds ratio, 1.38; 95% CI, 1.15-1.67) as was experiencing very low food security (odds ratio, 1.37; 95% CI, 1.11-1.59). Low and very low food security was also associated with lower memory levels and faster age-related memory decline. In this cohort study of older US residents, food insecurity was associated with increased dementia risk, poorer memory function, and faster memory decline. Future studies are needed to examine whether addressing food insecurity may benefit brain health.

A study on the relationship between food insecurity and periodontitis in Korean adults: the Korea National Health and Nutrition Examination Survey (KNHANES VII) from 2016-2018

A study on the relationship between food insecurity and periodontitis in Korean adults: the Korea National Health and Nutrition Examination Survey (KNHANES VII) from 2016-2018

Household Food Insecurity and Cognition in Youth and Young Adults with Youth-Onset Diabetes.

We evaluated the association of household food insecurity (FI) with cognition in youth and young adults with type 1 diabetes (T1D) or type 2 diabetes (T2D). In this cross-sectional study, age-adjusted scores for composite Fluid Cognition, and sub-domain scores for Receptive Language and Inhibitory Control and Attention, were modeled stratified by diabetes-type using linear regression, with FI in the past year as the predictor, controlling for covariates. Tests for processing speed, inhibitory control/attention, working memory, episodic memory, and cognitive flexibility were administered to measure composite Fluid Cognition score. The NIHT-CB Picture Vocabulary Test was used to assess Crystallized Cognition score and rapid identification of congruent versus noncongruent items were used to assess Inhibitory Control and Attention score. The SEARCH for Diabetes in Youth study, representative of 5 U.S. states. Included 1574 youth and young adults with T1D or T2D, mean age of 21 years, mean diabetes duration of 11 years, 51% non-Hispanic white, and 47% had higher HbA1c levels (>9% HbA1c). Approximately 18% of the 1,240 participants with T1D and 31% of the 334 with T2D experienced FI. The food-insecure group with T1D had a lower composite Fluid Cognition score (β= -2.5, 95% confidence interval (CI)= -4.8, -0.1) and a lower Crystallized Cognition score (β= -3.4, CI= -5.6, -1.3) than food-secure peers. Findings were attenuated to non-significance after adjustment for demographics. Among T2D participants, no associations were observed. In participants with T1D effect modification by glycemic levels were found in the association between FI and composite Fluid Cognition score but adjustment for socioeconomic characteristics attenuated the interaction (p=0.0531). Food-insecure youth and young adults with T1D or T2D did not have different cognition compared to those who were food-secure after adjustment for confounders. Longitudinal research is needed to further understand relations amongst these factors.

Food insecurity and cognitive function in older adults: findings from the longitudinal aging study in India

BackgroundAs we grow older, food insecurity (FI) may have an impact on our cognitive abilities. The study examines the association of FI with the cognitive function of older adults in India.MethodsWe have used the data from the first wave of the Longitudinal Ageing Study of India (LASI), with a sample of 27,032 older adults aged 60 years and older. Bivariate analysis and linear regression models with clusters were applied to show the association. The cognitive performance tests include episodic memory, orientation, arithmetic function, executive function, and object naming.ResultsThe mean cognition was 24.2 (range 0–43), while 36.4%, 2.1%, and 6.4% experienced mild, moderate, and severe FI, respectively. After adjustment for potential confounders, mild (β = −0.18, 95% CI: −0.32, − 0.04) and severe (β = −0.52, 95% CI: −0.82, − 0.22) food insecurity was associated with poor overall cognitive performance. Domain-specific differences in cognition, such as memory, orientation, arithmetic function, executive function, and object naming, were also validated by the level of FI.ConclusionThe finding suggests that FI is associated with a poor level of cognition among older adults, highlighting the need for increasing the coverage and intervention strategies to address FI in India.

Food insecurity in adults with severe mental illness: A systematic review with meta-analysis.

Food insecurity in adults living with Severe Mental Illness (SMI) is an underresearched area worldwide. This systematic review and meta-analysis aimed to identify and collate evidence on food insecurity in adults with SMI, in high- and upper-middle income countries. A comprehensive electronic search was completed up to August 2022. Random effects meta-analysis was undertaken to determine the prevalence and the odds ratio for food insecurity in adults with SMI. Narrative synthesis explored the data further. Sixteen publications were included (13 in the meta-analysis). The prevalence estimate of food insecurity in adults with SMI was 41% (95% CI: 29% to 53%, I2 = 99.9%, n = 13). Adults with SMI were 3.31 (95% CI: 2.03 to 5.41) times more likely to experience food insecurity than comparators without SMI (z = 6.29, p < .001, I2 = 98.9%, n = 6). Food insecurity appears to be a risk factor for developing SMI. This review suggests adults with SMI living in high- or upper-middle income countries are more likely to experience food insecurity than the general population and that this relationship may be inverse. Mental health practitioners should be aware of food insecurity and support individuals with SMI to access sufficient food.

Water Insecurity Indicators Are Associated with Lower Diet and Beverage Quality in a National Survey of Lower-Income United States Adults

BackgroundTap water distrust and avoidance, indicators of water insecurity, are prevalent in marginalized United States populations. As future environmental challenges stress water resources, further understanding of the scope of water insecurity and its impact on diet quality is needed, particularly in vulnerable United States populations. ObjectivesTo evaluate associations between 3 potential indicators of water insecurity—1) perception of tap water safety for drinking, 2) perception of tap water safety for cooking, and 3) tap water avoidance—and dietary quality and beverage intake in lower-income United States adults. MethodsA cross-sectional, web-based survey was fielded to 1798 lower-income (<250% federal poverty guidelines) United States adults. Participants answered questions detailing tap water safety perceptions and avoidance, beverage intake, dietary intake (30-d prime diet quality score), and sociodemographic covariates. Sociodemographic differences in drinking water insecurity measures were evaluated using chi-square and Fisher–Freeman–Halton tests. Associations between water insecurity measures and dietary outcomes were assessed using generalized linear models adjusted for sociodemographic covariates, and effect modification by sociodemographic covariates was assessed. ResultsOver half of the adults surveyed experienced some aspect of water insecurity. Measures of water security differed significantly by sociodemographic covariates (Ps < 0.05), with higher percentages of women and gender-nonconforming persons, minoritized racial and ethnic groups, lower-income groups, and food-insecure adults reporting indicators of water insecurity. Presence of any water insecurity was associated with lower diet quality (β = −1.07; 95% CI: −2.11, −0.03; P = 0.04), lower tap water intake (relative difference [RD] = 0.35; 95% CI: 1.28, 2.12; P < 0.0001), higher bottled water intake (RD = 1.64; 95% CI: 1.28, 2.12; P = 0.0001), and higher sugar-sweetened beverages intake frequency (frequency ratio = 1.13; 95% CI: 1.01, 1.27; P = 0.03). ConclusionsWater insecurity indicators are associated with poorer diet quality and beverage intake in a population of United States adults with lower-incomes. Addressing the intersection of water insecurity, food security, environmental impacts, and nutrition may help to improve the well-being and resiliency of vulnerable populations.

Assessing the Feasibility of Conducting Smoking Cessation Outreach in Food Pantries: A Pilot Intervention Study.

Smoking prevalence is high among US adults with food insecurity. This study examined how food assistance settings, namely food pantries, can serve as a community-based venue to reach food insecure adults who smoke for smoking cessation. Partnering with a local hunger relief organization, we conducted surveys and focus groups of food pantry clients in Greater Cleveland, Ohio, followed by food pantry-based outreach events to connect people who smoke to the Ohio Tobacco Quit Line. The survey included 132 participants who visited a food pantry (M age = 47; 74% women; 39% Black/African American), of whom 35% were using tobacco and 31% were smoking cigarettes. Among those currently smoking (M cigarettes/day = 9), 76% intended to quit in the next 6 months, and 82% had not used nor heard of the quitline. Informed by focus group themes, we conducted a total of 22 outreach events at four pantries. Among those interested in smoking cessation resources from the outreach events (n = 54), 78% were able to be subsequently contacted. Of them, 74% provided consent for quitline referral. The remainder either declined or were unable to participate. While it was feasible to leverage food pantries for smoking cessation outreach, the overall reach was low. Despite high interest in quitting, there was limited effectiveness of outreach efforts without adaptations to each pantry setting and in recognition of the immediate food needs and with challenges related to the COVID-19 pandemic. There remains a critical need to address high rates of smoking among populations experiencing food insecurity. Tobacco cessation services are increasingly recognizing the need to address food insecurity and other social needs that commonly occur in populations who use tobacco at higher rates. This research underscores both the value and the challenges related to leveraging food pantries as a community-based venue for smoking cessation outreach. In addition to improvements in outreach models, long-term investments in structural interventions are also needed to address underlying poverty and socioeconomic disadvantage that ultimately drive disparities in smoking and in food insecurity.

Household socio-economic determinants of food security in Limpopo Province of South Africa: a cross sectional survey

BackgroundDespite the strong commitment at both national and international levels to eradicate hunger and achieve household food security, by 2030 food insecurity remains a public health problem. South Africa is amongst the countries with the highest rate of income inequality in the world and extremely high levels of absolute poverty. The Gini coefficient in South Africa is estimated at 0.68 Although South Africa may be food secure at a national level, large numbers of households within the country are food insecure approximately 52% of the rural households in Limpopo Province of South Africa were considered severely food insecure. It has been noted that the majority of households in South African informal settlements and rural areas were moderately or severely food insecure due to lack of access to food which was directly related to income. Rural areas have assets that can be explored to support households. The adult population above 18 years in South Africa make up 78% of the 5.9 million population with about 40% living in rural areas, this study explored household food insecurity in adults in rural environments. The current study aimed to explore the socioeconomic and dietary determinants of household food insecurity among the adult population in the Limpopo Province.MethodsA cross-sectional survey design was used, and data were collected using a validated pre-tested questionnaire. The participants were recruited from households in Limpopo province. Multiple linear regression was computed to explore the influence of socioeconomic and dietary practices on food insecurity.ResultsThe study included 699 randomly selected participants of which the majority earned a monthly income ≤ 3000 ZAR, and 31.8% experiencing hunger in the past 30 days at the time of study. The dietary practices of the participants were found to be associated with household food insecurity. The study found that large family size, being female in South Africa, low household income and low rate of regular breakfast intake were significant determinants of household food insecurity (p < 0.05).ConclusionIn summary, most of the households were poor and approximately one-third were food insecure. The implementation of sustainable employment policies, and food-based approaches and targeting rural household food production could significantly reduce food insecurity in the rural area.

Adverse childhood experiences and food insecurity in emerging adulthood: findings from the EAT 2010-2018 study.

Low childhood socioeconomic status (SES) and adverse childhood experiences (ACEs) are associated with poor health outcomes in adulthood. Determining how ACEs may be linked to food insecurity among young people from socioeconomically diverse households can inform health-protective strategies. This study examined if ACEs are associated with food insecurity during the transition to adulthood, and investigated prevalence differences across SES strata. Participants were recruited from 20 secondary schools in Minneapolis-St. Paul, Minnesota. The analytic sample (n1,518) completed classroom surveys in 2009-2010 (mean age14.5 years) and follow-up surveys in 2017-2018 (mean age22.0 years). Past-year food insecurity was reported at both time points and ACEs were reported at follow-up. Logistic regression models were used to estimate emerging adult food insecurity prevalence by ACE exposure; models were stratified by childhood SES (low, middle, high). The adjusted prevalence of food insecurity was 45.3% among emerging adults who reported three or more ACEs compared to 23.6% among those with one or two ACEs, and 15.5% among those with no ACE (P<0.001). All forms of ACEs were related to an elevated prevalence of food insecurity in emerging adulthood. ACE-food insecurity associations were strongest for emerging adults from lower and middle SES households. Among emerging adults from low SES households, childhood experiences of emotional abuse and substance use by a household member were associated with the largest prevalence differences in food insecurity. Findings suggest a need for trauma-informed services within food assistance programs to better serve individuals with a history of ACEs.

Multimorbidity and food insecurity in adults: A systematic review and meta-analysis.

Food insecurity is one of the main factors affecting multimorbidity. Previous studies have shown that food insecurity may lead to multimorbidity due to person's inability to consume nutritious diet. However, considering that multimorbidity may cause work-related disabilities and an unstable income, others support the possible effect that multimorbidity has on food insecurity. The purpose of this systematic review and meta-analysis is to examine the relationship between food insecurity and multimorbidity in adults. A systematic literature review of studies was performed using the PubMed, EBSCO and SCOPUS for all articles including adults ≥ 18-year-old with multimorbidity living in developed countries published from August 5th until December 7th 2022. Meta-analysis was performed considering results from the fully adjusted model. The methodological quality was assessed using the Newcastle-Ottawa Scale adapted for cross-sectional studies. This systematic review was not registered. This research received no specific grant from any funding agency. Four cross-sectional studies involving 45,404 participants were included in order to investigate the possible impact that food insecurity has on multimorbidity. The study findings showed an increased probability of multimorbidity 1.55 (95% CI:1.31-1.79, p<0.001, I2 = 44.1%) among people with food insecurity. Conversely, three of the included studies, involving 81,080 participants concluded that people with multimorbidity, have 2.58 (95% CI: 1.66-3.49, p<0.001, I2 = 89.7%) times higher odds to present food insecurity. This systematic review and meta-analysis provide evidence of a reverse association between food insecurity and multimorbidity. Further cross-sectional studies must be conducted in order to elucidate the association between multimorbidity and food insecurity across age groups and between the two genders.

710-P: Material-Needs Security and Food Insecurity in Adults with Type 2 Diabetes in Lebanon

Food insecurity is known to impair diabetes self-management and clinical outcomes. Little is known about the prevalence and social determinants of food insecurity among people with type 2 diabetes (T2DM) in the Middle East and North Africa (MENA) region. Thus, the aim of this study was to assess food insecurity and its relationship with material needs security in Lebanese adults with T2DM of low socioeconomic status. Subjects with T2DM (n=299) were recruited from primary health care centers in Lebanon; sociodemographic and material need variables were collected using self-reported questionnaires. Food insecurity was assessed using the validated US Household Food Security Survey Module: Six-Item Short Form (USDA, 2012). Around 25% of the sample were food insecure. Compared to the food secure group, there were significantly (p&amp;lt;0.05) more participants who were females (58% vs. 44%), and who had low education level (82% vs. 58%) low income (49% vs. 24%), and no health insurance (65% vs. 49%), compared to the food secure group. Sum of material needs security was lower in the food insecure group (7.8±2.0 vs. 9.4±2.1, p&amp;lt;0.05). Results from the fully adjusted logistic regression model showed that material needs security (OR: 1.26; 95% CI: 1.06-1.49; p&amp;lt;0.007) and higher income (OR: 3.34; 95% CI: 1.39-8.05; p&amp;lt;0.007) were independent predictors of food security. Our study highlights the importance of material needs in achieving food security in T2DM in the MENA region. Further research is needed to explore other social determinants of health in this population and potential pathways/mechanisms to guide programs for effective interventions. Disclosure M.Bassil: None. O.Sukkarieh: None. L.E.Egede: None.

611-P: Direct and Indirect Pathways between Food Insecurity and Glycemic Control in Adults with Diabetes

Background: Extensive research has identified food insecurity as a driver of poor glycemic control in adults with diabetes. The goal of this study was to investigate the direct and indirect relationships between food insecurity and glycemic control, focusing on three possible pathways: body composition, anthropometrics, and healthy eating. Methods: Using national US data collected through the 2011-2018 National Health and Nutrition Examination Survey (NHANES), we created measures for body composition (total fat, total lean, fat mass index, lean mass index), anthropometrics (body mass index, waist circumference) and healthy eating index (food group component scores and overall HEI score). Food insecurity was scored based on the standard USDA scale, glycemic control was continuous HbA1c, and diabetes was based on self-report. Structural equation modeling using Stata v17 was used to investigate direct and indirect relationships in a sample of adults with diabetes. Total lean, waist circumference, and overall HEI score served as indicators for each of the three possible pathways based on preliminary correlations that found these as the strongest relationships for each category. Results: The final model was well fit (RMSEA=0.00, CFI=1.0, pclose 1.0) and showed higher food insecurity was directly associated with higher HbA1c (B=0.09, p&amp;lt;0.001) and indirectly associated through waist circumference and HEI score (B=0.008, p&amp;lt;0.001) in adults with diabetes. Food insecurity was significantly associated with higher waist circumference (B=0.07, p&amp;lt;0.001) and lower healthy eating (B=−0.09, p&amp;lt;0.05). Higher waist circumference (B=0.03, p&amp;lt;0.001) and lower healthy eating (B=−.06, p&amp;lt;0.05) were significantly associated with higher HbA1c. Body composition was not a significant pathway. Conclusions: Waist circumference and overall healthy eating index are significant pathways through which food insecurity is associated with worse glycemic control in adults with diabetes. Disclosure R.J.Walker: None. R.Amjad: None. L.E.Egede: None. Funding National Institutes of Health (R01DK118038, R01DK120861, R01MD013826)

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

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&amp;lt;0.001), higher waist circumference (B=0.03, p&amp;lt;0.03), and higher HbA1c (B=0.09, p&amp;lt;0.001). For the pathway with lipids, higher food insecurity was directly associated with lower healthy eating (B=-0.09, p&amp;lt;0.001), higher waist circumference (B=0.05, p=0.002), and higher lipids (B=0.06, p&amp;lt;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)

Connecting the Dots between Barriers to W.I.C. Access and Adult and Child Food Insecurity: A Survey of Missouri Residents.

Background. Previous research has explored the impact of W.I.C. on recipients' health, but less is known about the connection between barriers to W.I.C. access and health outcomes. We fill in a gap in the literature by studying the relationship between barriers to Special Supplemental Nutrition Program for Women, Infants, and Children (W.I.C.) access and adult and child food insecurity. Methods. After survey administration, we analyzed a cross-sectional sample of 2244 residents in Missouri who have used W.I.C. or lived in a household with a W.I.C. recipient in the past three years. We ran logistic regression models to understand the relationships among barriers to W.I.C. utilization, adult food insecurity, and child food insecurity. Results. Having special dietary needs (for adults), lacking access to technology, encountering inconvenient clinic hours of operation, and experiencing difficulties taking off work were associated with increased adult food insecurity. Difficulties finding WIC-approved items in the store, technological barriers, inconvenient clinic hours, difficulties taking off work, and finding childcare were associated with increased child food insecurity. Conclusion. Barriers to accessing and utilizing W.I.C. are associated with adult and child food insecurity. However, current policies suggest promising approaches to curbing these barriers.

Association between adult food insecurity and self-reported asthma in the United States: NHANES 2003–2018

Objective Asthma is a chronic disease of the lungs. The development of asthma is related to various risk factors. Food insecurity is a critical social determinant of health, although there is little information on the association between adult food insecurity and asthma. The purpose of this study is to explore the potential correlation in US adults. Methods The study population data were extracted from NHANES 2003–2018. Food insecurity was measured using the USDA FSSM and categorized as full, marginal, low, or very low food security. The assessment of self-reported asthma was determined by self-report questionnaires. The self-reported positive outcomes were that participants had asthma and a history of asthma attacks and asthma-related ER visits in the past year. We developed two multivariate logistic regression models. Stratified analyses were performed by gender and age. Results A total of 38,077 participants were considered in our final analysis. Compared to participants with FFS, the ORs (95% CIs) for asthma were 1.16 (1.00–1.33), 1.42 (1.23–1.64), and 1.56 (1.34–1.80) for participants with MFS, LFS, and VLFS, respectively (Model II). Additionally, after full adjustment, individuals with VLFS had 49% greater risks of asthma attacks (OR = 1.49; 95% CI 1.13–1.97). The ORs (95% CIs) for asthma-related ER visits were 1.59 (1.14–2.23) and 1.98 (1.36–2.87) for participants with LFS and VLFS, respectively (Model II). The positive correlations remained robust when stratified by gender and age. Conclusion Our research showed that food insecurity among US adults was associated with asthma, asthma attacks, and asthma-related ER visits.

Binge eating in patients pursuing bariatric surgery: understanding relationships with food insecurity and adverse childhood experiences.

Positive relationships exist between adult food insecurity and binge eating, and between adverse childhood experiences and binge eating. However, the nature of these relationships remains to be determined. The current study sought to examine the association between binge eating and childhood abuse and/or neglect and household dysfunction and to explore whether the strength of the relationship between adverse childhood experiences and binge eating differs across levels of food insecurity in patients seeking bariatric surgery. University Hospital in the Appalachian region of United States. A total of 366 adults seeking bariatric surgery completed validated questionnaires as a component of a routine psychological evaluation prior to surgery. Only childhood experiences of abuse and/or neglect were positively related to adult binge eating, r(363) = .13, P = .011. Food insecurity moderated the relationship between adverse childhood experiences and binge eating, F(4, 358) = 242.98, P < .001, such that the relationship was stronger for individuals who endorsed the presence of both food insecurity and adverse childhood experiences (M= 15.90; standard deviation [SD] = 8.38), relative to individuals who endorsed the absence of both food insecurity and adverse childhood experiences (M = 11.19; SD = 7.91; Tukey P = .005; d = .58). Food insecurity strengthens the relationship between adverse childhood experiences and adult binge eating. Results suggest that healthcare providers should include assessments of both adverse childhood experiences and food insecurity to identify patients who may be at risk for disordered eating prior to surgery, as these individuals may require additional interventions to address binge eating and related factors.