Food-secure Adults Research Articles

A systematic review of the association between food insecurity and behaviours related to caries development in adults and children in high-income countries.

To synthesize and appraise the evidence regarding the relationship between food insecurity and behaviours associated with dental caries development in adults and children in high-income countries. A systematic review including observational studies assessing the association between food insecurity and selected dietary (free sugar consumption) and non-dietary factors (tooth brushing frequency; use of fluoridated toothpaste; dental visiting; oral hygiene aids; type of toothbrush used; interdental cleaning frequency and mouthwash use) related to dental caries development in adults and children in high-income countries. Studies specifically looking at food insecurity during the COVID-19 pandemic were excluded. Searches were performed in MEDLINE, Embase, Global Health and Scopus from inception to 25 May 2023. Two authors screened the search results, extracted data and appraised the studies independently and in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale (with modifications for cross-sectional studies). Vote counting and harvest plots provided the basis for evidence synthesis. Searches identified 880 references, which led to the inclusion of 71 studies with a total of 526 860 participants. The majority were cross-sectional studies, conducted in the USA and reported free sugar consumption. Evidence for the association between food insecurity and free sugar intake from 4 cohort studies and 61 cross-sectional studies including 336 585 participants was equivocal, particularly in the sugar-sweetened beverage (SSB) consumption post-hoc subgroup, where 20 out of 46 studies reported higher SSB consumption in food insecure individuals. There was consistent, but limited, evidence for reduced dental visiting in adults experiencing food insecurity compared to food secure adults from 3 cross-sectional studies including 52 173 participants. The relationship between food insecurity and dental visiting in children was less clear (3 cross-sectional studies, 138 102 participants). A single cross-sectional study of 3275 children reported an association between food insecurity and reported failure to toothbrush the previous day. This review did not identify clear associations between food insecurity and behaviours commonly implicated in the development of dental caries that would explain why individuals experiencing food insecurity are more likely to have dental caries than those who have food security. There was some evidence of decreased dental visiting in adults experiencing food insecurity. Common methodological weaknesses across the evidence base related to the selection of participants or control of potentially confounding variables. Consequently, the quality of evidence for all outcomes was downgraded to very low. More research is needed to explore access to oral hygiene products and household environments conducive to habitual oral self-care in food insecure populations.

Increasing food insecurity severity is associated with lower diet quality in Australian adults

Food insecurity, the inadequate or insecure access to food due to financial constraints, is a growing concern in high-income countries like Australia(1). Food insecure adults may have reduced diet quality due to constraints on food purchasing and consumption(2) but further research is needed to understand how the severity of food insecurity impacts diet quality in an Australian setting. This study aimed to examine the relationship between diet quality and increasing severity of household food insecurity using validated measurement tools. A cross-sectional, online survey of Australian adults (aged 18 years+) used the USDA Household Food Security Six-item Short Form to classify respondents as food secure or marginally, moderately, or severely food insecure. The Australian Recommended Food Score (ARFS; score between 0–73) determined diet quality (ARFS total) and sub-scale scores for eight food groups(3), with higher scores indicating higher diet quality. Diet quality score results are further categorised as “needs work” (<33), “getting there” (33-38), “excellent” (39-46) or “outstanding” (47+). Survey-weighted linear regression (adjusted for age, sex, income, education, location, household composition) analyses indicate that 45% of participants were living in households that experienced food insecurity, comprising 7% marginally, 18% moderately and 20% severely food insecure households. The ARFS total survey-weighted mean score for the whole sample (n = 804) was 32.4 (SD = 9.8). As the severity of household food insecurity increased, ARFS scores decreased. Marginally food insecure respondents reported a mean ARFS score three points lower than food-secure adults (B=-2.7; 95%CI [−5.11, −0.34]; p = 0.03), and scores reduced by six points for moderately (B=-5.6; 95%CI [−7.26, −3.90]; p<0.001) and twelve points for severely food insecure respondents (B=-11.5; 95%CI [−13.21, −9.78]; p<0.001). Marginally food insecure respondents had significantly lower vegetable sub-scale scores, moderately food insecure respondents had significantly lower sub-scale scores for all food groups except dairy, severely food insecure respondents had significantly lower scores for all sub-scale scores. Poorer diet quality is evident in adults living with any food insecurity but gets progressively worse as the severity of food insecurity increases. Interventions to reduce food insecurity and increase diet quality are required to prevent adverse nutrition-related health outcomes in food-insecure populations in Australia and beyond.

Suboptimal Diets Identified Among Adults in Two Rural States During the COVID-19 Pandemic

ABSTRACT Rural communities face unique food and nutrition challenges. Analyzing population-level survey data from 2021 to 2022 in two predominantly rural U.S. states using regression and multiple hypothesis testing procedures, we examined how well diets align with national recommendations and associations between diet, age, food security, and rurality. We found dietary intake of key foods and ingredients to differ significantly from recommendations and overall diet quality to increase with age. Food secure adults had higher diet quality than food insecure adults. Neither dietary intake nor dietary quality differed by degree of rurality. Continued action is needed to address nutrition challenges among underserved populations.

Increasing food insecurity severity is associated with lower diet quality.

Food insecurity may reduce diet quality, but the relationship between food insecurity severity and diet quality is under-researched. This study aimed to examine the relationship between diet quality and severity of household food insecurity. A cross-sectional, online survey used the United States Department of Agriculture Household Food Security Six-item Short Form to classify respondents as food secure or marginally, moderately or severely food insecure. The Australian Recommended Food Score (ARFS; scored 0–73) determined diet quality (ARFS total and sub-scale scores). Survey-weighted linear regression (adjusted for age, sex, income, education, location and household composition) was conducted. Tasmania, Australia. Community-dwelling adults (aged 18 years and over). The mean ARFS total for the sample (n 804, 53 % female, 29 % aged > 65 years) was 32·4 (sd = 9·8). As the severity of household food insecurity increased, ARFS total decreased. Marginally food-insecure respondents reported a mean ARFS score three points lower than food-secure adults (B = –2·7; 95 % CI (–5·11, –0·34); P = 0·03) and reduced by six points for moderately (B = –5·6; 95 % CI (–7·26, –3·90); P < 0·001) and twelve points for severely food-insecure respondents (B = –11·5; 95 % CI (–13·21, –9·78); P < 0·001). Marginally food-insecure respondents had significantly lower vegetable sub-scale scores, moderately food-insecure respondents had significantly lower sub-scale scores for all food groups except dairy and severely food-insecure respondents had significantly lower scores for all sub-scale scores. Poorer diet quality is evident in marginally, moderately and severely food-insecure adults. Interventions to reduce food insecurity and increase diet quality are required to prevent poorer nutrition-related health outcomes in food-insecure populations in Australia.

Environmental-, Climate-, and Health-Related Dietary Motivations Are Associated With Higher Diet Quality in a National Sample of US Adults With Lower Incomes

BackgroundPlant-based diets can have co-benefits for human and planetary health. Associations between environmental, climate, and health concerns and dietary intake in US adults are understudied, particularly in underserved populations. ObjectiveThe study objectives were to assess how dietary choices motivated by the environment, climate, and health vary by sociodemographic characteristics and how they relate to diet quality and intake frequency of different food groups in US adults with lower incomes. DesignThe study design was cross-sectional. Participants/settingA web-based survey was fielded in December 2022 to 1,798 US adults with lower incomes (<250% of federal poverty guidelines). Main outcome measuresEnvironmental-, climate-, and health-related dietary motivations and diet quality and dietary food group intake frequency were assessed. Statistical analysesDifferences in mean dietary outcomes and dietary motivation ratings by sociodemographic characteristics were evaluated using analysis of variance and Kruskal–Wallis tests. Associations between dietary motivations and diet quality scores and dietary intake frequency were examined using generalized linear models adjusted for sociodemographic covariates. ResultsYounger adults, women, nonbinary people, racial and ethnic minoritized groups, and adults experiencing food insecurity reported higher environmental and climate dietary motivations; older adults, higher-income adults, and food-secure adults reported higher health motivations. Agreeing with environmental- (β = 2.28, 95% CI 1.09 to 3.47), climate- (β = 2.15, 95% CI 0.90 to 3.40), and health-related (β = 5.27, 95% CI 3.98 to 6.56) dietary motivations was associated with higher diet quality scores compared with those with neutral rankings. Similarly, agreement with environmental-, climate-, and health-related dietary motivations was associated with higher intake frequency of fish, fruits and vegetables, and plant proteins, but not with red and processed meat intake frequency. Of several climate-mitigation behaviors presented, participants perceived meat reduction as least effective (P < .001). ConclusionsEnvironment, climate, and health were positive motivators of several healthy dietary choices in US adults with lower incomes. Such motivators did not translate to lower intake frequency of red and processed meat.

Ultra-Processed Food can be a Mediator between Food Security Status and Overweight or Obesity among Adults: A Literature Review

Background: The ultra-processed food (UPF) contributed 20-85% of total daily calories. The consumption of UPF can be triggered by food security status. Many studies revealed that UPF consumption has a direct negative impact on health, mainly in overweight and obesity. Objectives: To review published studies assessing food security, UPF consumption, and overweight or obesity and find the possible links between those three factors. Methods: A literature review of scientific articles about food security, UPF consumption, and overweight or obesity, selected systematically according to the PRISMA Diagram. All articles were gathered through medical search engines, including PubMed, ScienceDirect, and Scopus, from December 2021 to February 2022. The bias risk of each selected paper was assessed using the checklist from The Joanna Briggs Institute (JBI) Critical Appraisal. Peer review and group discussions were performed to assess the quality of all articles gathered as objectively as possible using the STROBE Checklist. A narrative synthesis approach was opted to unify all findings across included studies systematically. Results: Nineteen (19) scientific published papers were filtered. The association between food security status and UPF consumption showed inconsistent findings. However, UPF consumption revealed a consistent association with overweight/obesity, where the higher the UPF intake, the greater odds of being overweight/obese. The relationship between food security status and overweight or obesity tended to have a similar pattern. In high-income countries, the association was negative (the more food insecure, the higher overweight or obesity), while in low- and middle-income countries showed the opposite. The pathway could be: (1) food-insecure adults have higher UPF intake, hence gaining body weight, or (2) food-secure adults have higher UPF intake, hence gaining body weight. Conclusions: UPF consumption is indicated as a potential mediator for food security status and nutritional status (overweight/obesity) through two pathways involving socio-demographic factors, psychological factors, social protections, and food choice motives.

Food Insecurity Moderates Association Between Perceived Fresh Fruit and Vegetable Access and Vegetable Intake in the Rural Southern US

Objective. Assess associations between perceived fresh fruit and vegetable access and obtaining fresh fruit and vegetables from various food sources with meeting national recommendations for fruit and vegetable intakes and BMI, and whether associations differ by food insecurity. Methods. Secondary data analysis of a cross-sectional survey evaluating a health equity initiative among 1,474 respondents in 6 rural Georgia counties. Logistic regressions assessed associations between perceived fresh fruit and vegetable access and fresh fruit and vegetable sources with meeting/not meeting fruit and vegetable recommendations and BMI, and interactions with food insecurity. Results. Respondents who obtained fresh fruit and vegetables at small local grocery stores, farmer’s markets, and community/home gardens had twice the odds of meeting national vegetable recommendations. Food secure adults with greater perceived fresh fruit and vegetable access had 1.5 times the odds of meeting national vegetable recommendations. Conclusions and Implications. Results highlight perceived access inequities for food insecure adults and the importance of food sources for vegetable consumption in the rural South.

Food insecurity and atherosclerotic cardiovascular disease risk in adults with diabetes

ObjectivesAdults with diabetes are at an increased risk of atherosclerotic cardiovascular disease (ASCVD), and food insecurity may be a major and underappreciated risk compounder in this population. We sought to analyze the prevalence of food insecurity and its association with ASCVD in adults with diabetes. MethodsA total of 6424 participants with diabetes were included from the 2019 and 2020 National Health Interview Survey. Food insecurity was determined with a 10-question U.S. Adult Food Security Survey Module, and classified as high, marginal, low, and very low. ASCVD was defined as a self-reported history of coronary artery disease, myocardial infarction, or stroke. ResultsOf the 6424 included participants (weighted: n = 21 690 217), 5 405 543 (24.4%) reported a history of ASCVD and 2 946 061 (13.3%) were identified as food insecure (low or very low food security). Adults with food insecurity were more likely to have ASCVD than adults who were food secure (28.9% vs 23.7%; P = 0.008). In the multivariate analyses adjusted for traditional cardiovascular risk factors, all levels of food insecurity were associated with ASCVD compared with food-secure adults (marginal security: odds ratio [OR]: 1.60; 95% confidence interval [CI], 1.18–2.18]; P = 0.003; low security: OR: 2.09; 95% CI, 1.58–2.74]; P < 0.001; very low security: OR: 1.69; 95% CI, 1.22–2.34]; P = 0.001). The association persisted when adjusted for income, location, education, and insurance status. In adults with diabetes and ASCVD, income was a negative factor for food insecurity (OR: 0.71; 95% CI, 0.62–0.80; P < 0.001), but female sex and smoking were positive factors (OR: 1.90; 95% CI, 1.29–2.80; P = 0.001; and OR: 1.97; 95% CI, 1.23–3.18; P = 0.005; respectively). At younger ages, the prevalence of food insecurity increased, especially in adults with ASCVD. ConclusionsWe showed that 13% of U.S. adults with diabetes are food insecure, which was associated with ASCVD independent of traditional and socioeconomic risk factors. Our findings emphasize the importance of recognizing food insecurity as a driver of ASCVD in adults with diabetes, and encourage future efforts at reducing this disparity.

The Diet Quality of Food-Insecure Australian Adults-A Nationally Representative Cross-Sectional Analysis.

Poor diet quality exacerbates risks for acute and chronic conditions. People experiencing food insecurity have an increased likelihood of lower diet quality; however, this has not been investigated in the Australian context. The aim of this cross-sectional study was to examine whether the diet quality of Australian adults differed according to their household food security status. Data were analysed from a nationally representative sample (≥19 years; n = 9115) collected as part of the National Nutrition and Physical Activity Survey 2011-12. Household food security status and socio-demographic and health characteristics were assessed using data from an 18-module health interview. A 24 h dietary recall was used to estimate food and nutrient intakes and to calculate the Dietary Guidelines Index (DGI). DGI is a food-based score (0 to 130) that assesses adherence to the 2013 Australian Dietary Guidelines. Survey-weighted linear regression models, adjusted for age and sex, were used to examine diet quality (total DGI and component scores), and total energy and nutrient intake by food security status. Adults from food-insecure households had a mean total DGI score 3.5 points lower (95% CI −5.57, −1.46) than food-secure adults (p = 0.001). Adults from households experiencing food insecurity, when compared to those who were food-secure, had several lower DGI component scores including for dietary variety (1.6 vs. 2.3, p = 0.009), fruit (3.8 vs. 5.0, p = 0.001) and vegetables (3.7 vs. 4.4, p = 0.010). Adults from food-insecure households consumed on average more carbohydrates (45.6 vs. 43.3, p = 0.004) and total sugar (21.8 vs. 19.0, p = 0.003) as a percentage of daily energy and less protein (18.5 vs. 17.2, p = 0.004), mono-unsaturated fats (11.2 vs. 11.8, p = 0.026) as a percentage of daily energy, and fibre (20.1 vs. 23.0, p = 0.003), than food-secure adults. Sub-optimal diet may be one of the contributing factors to, or outcomes of, poorer health in food-insecure populations. Food security interventions are required to better address nutrition in food-insecure households and should be tailored to the health and socio-demographic characteristics of this population.

Food Insecurity and Depression among US Adults: NHANES 2005-2016.

A growing body of evidence suggests that food insecurity is associated with adverse mental health outcomes such as depression and anxiety. In this study, the relationship between food insecurity and depression was examined using data from the 2005–2016 National Health and Nutrition Examination Survey (NHANES). Food insecurity was assessed with the 18-item United States Food Security Survey Module with zero affirmative responses indicating high food security, 1 or 2 affirmative responses indicating marginal food security, and ≥3 affirmative responses indicating food insecurity. Depression was assessed with the Patient Health Questionnaire-9 with scores ≥10 indicating depression. Data were analyzed from 28,448 adult participants aged 20 or older. Food insecurity was present in 19.2% of the sample population (n = 5452). Food security status was significantly associated with gender, race, education level, marital status, smoking status, and BMI (Rao-Scott chi-square, p < 0.05). Fully food secure and very low food security adults experienced depression at a rate of 5.1% and 25.8%, respectively (Rao-Scott chi-square, p < 0.0001). Participants with very low food security had a significantly greater odds of depression than food secure adults, OR = 3.50 (95% CI: 2.98, 4.12). These findings suggest that food insecurity is a significant risk factors for depression in US adults over 20 years of age. To address this issue in our citizenry, police initiatives and public health interventions addressing both food access and mental health should be prioritized.

52-OR: The Burden of Food Insecurity on Quality of Life in Adults with Diabetes

Food insecurity, or the lack of consistent access to enough food for an active, healthy life, is associated with worse glycemic control and higher mortality in adults with diabetes. However, little is known regarding the burden of food insecurity on health-related quality of life, a global measure that captures physical and mental health over time. Using two years of national data collected through the Medical Expenditure Panel Survey (2016-2017) , we investigated the relationship between food insecurity and physical health related (PCS) and mental health related (MCS) quality of life in adults with diabetes. Ten questions asked about running out of food, affording balanced meals, skipping meals, and losing weight due to not eating. Adults scoring 3 or more were considered food insecure. Unadjusted and adjusted linear regression weighted to represent the US adult population was run with PCS and MCS treated as separate continuous outcomes. Food insecure adults with diabetes reported significantly lower physical and mental health related quality of life (PCS 42.2 vs. 35.9; MCS 51.5 vs. 42.7) . After adjusting for demographics, insurance coverage, and comorbidities, food insecure adults with diabetes maintained significantly lower scores compared to food secure adults with diabetes (PCS: -3.43, 95%CI -4.63,-2.25; MCS: -5.37, 95%CI -6.68,-4.06) . This drop in PCS scores of 3.4 and MCS of 5.4 was similar to or larger than differences between those with comorbidities known to significantly impact quality of life, such as stroke (decrease of 2.6 in PCS and 0.5 in MCS) , joint pain (decrease of 4.5 in PCS and 2.4 in MCS) , and heart disease (decrease of 2.0 in PCS and 3.8 in MCS) . Results highlight the significant burden of food insecurity on both physical and mental health related quality of life in adults with diabetes. Interventions are needed that integrate clinical and social factors impacting health-related quality of life to ensure overall well-being in adults with diabetes. Disclosure R.J.Walker: None. A.Thorgerson: None. E.Mosley-johnson: None. L.E.Egede: None. Funding American Diabetes Association (1-19-JDF-075) ; National Institute for Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker) , National Institute of Diabetes and Digestive Kidney Disease (K24DK093699, R01DK118038, R01DK120861, PI: Egede)

Food Insecurity Is Associated with Short and Long Sleep Duration and Circadian Misalignment Among US Adults in the 2017–18 National Health and Nutrition Examination Survey

ObjectivesFood insecurity is a leading public health issue associated with negative health consequences. Poor sleep and circadian misalignment, the discrepancy between the natural circadian rhythm and the cycle imposed by the social clock, may contribute to these health problems. This study examined relationships between food insecurity and sleep and circadian characteristics, including sleep duration and circadian misalignment, characterized by social jetlag and later midpoint of sleep (MPS), in a nationally representative sample of adults.MethodsData were from the 2017–18 National Health and Nutrition Examination Survey (NHANES), which included 5410 adults ≥18 years old with household food security and usual weekday and weekend sleep and wake times. Self-reported sleep measures were used to calculate MPS (median sleep and wake time) and social jetlag (difference between weekend and weekday MPS). MPS and social jetlag were classified into 3 categories based on the 25th and 75th percentiles. Self-reported sleep duration was classified as short (<7 hours), adequate (7–9 hours), and long (>9 hours). Multinominal logistic regression models were conducted between household food security and sleep variables, adjusting for sociodemographic characteristics and accounting for complex survey weights.ResultsIn the analytic sample, 14.3% had low and 8.9% had very low food security. The average MPS was 2:46 AM ± 2.1 hours on weekdays and 3:34 AM ± 1.8 hours on weekends. The average sleep duration was 7.6 hours on weekdays and 8.3 hours on weekends. Greater food insecurity was associated with higher social jetlag in a dose-response manner (p-trend = 0.01). Compared to food-secure adults, adults with very low food security had later weekday MPS (OR 1.37, 95% CI 1.10–1.72) and weekend MPS (OR 1.55, 95% CI 1.24–1.95). In contrast, low food security was related to early weekday MPS (OR 1.23, 95% CI 1.00–1.50). Low and very low food security were each associated with short weekday (OR 1.34, 95% CI 1.08–1.66 and OR 1.22, 95% CI 1.03–1.45) and weekend (OR 1.39, 95% CI 1.11–1.75 and OR 1.42, 95% CI 1.17–1.73) sleep duration. Low and very low food security were also related to long weekday sleep duration.ConclusionsGreater severity of food insecurity was related to multiple markers of circadian misalignment and with short and excessive sleep duration.Funding SourcesUniversity of Michigan.

Intuitive eating and dietary intake

Intuitive eating has been associated with positive health benefits, yet the research investigating intuitive eating with dietary intake is minimal, inconsistent, and may differ by sex and food security status. The purpose of this study is to identify relationships between intuitive eating and dietary intake in adults living in the US and explore differences by sex and food insecurity status. We recruited 308 adults 18 years and older living in the US to complete an online survey including demographic data, intuitive eating, a diet screener questionnaire, and food insecurity status. We used structural equation modeling to analyze relationships between intuitive eating subscales, calcium, whole grains, added sugars, vegetables, and fruits. Then, we explored differences by sex and food security status. Unconditional permission to eat was associated with a higher intake of added sugar, while body-food choice congruence was associated with a lower intake of added sugar and calcium, and a higher intake of vegetables and whole grains. Eating for physical rather than emotional reasons was associated with a higher intake of calcium and vegetables. Intuitive eating differed by sex and food security status. While intuitive eating is not consistently related to the intake of more nutritious foods, eating for physical rather than emotional reasons and body-food choice congruence may promote diet quality in a community sample. Men and food secure adults scored higher in intuitive eating suggesting tailored intuitive eating interventions may be essential to increase effectiveness.

Shielding children from food insecurity and its association with mental health and well-being in Canadian households.

Adults in food-insecure households will often sacrifice their own nutritional needs so that children are fed first. This shielding may protect children from malnutrition, but its links to mental health and well-being have not been closely examined. The aim of this study is to explore these links. We used data from three cycles of the Canadian Community Health Survey (n = 28,871 youth, 74,416 adults) to identify shielded children (those who reported not being food insecure but lived in food-insecure households). Using Poisson regression, we examined youth and adult mental health and well-being (mood disorder, anxiety disorder, fair/poor mental health, fair/poor health, and low life satisfaction) in shielding households compared to food-secure households and food-insecure households where children were not shielded. About one in six (15.3%) households with children was food insecure. One third of these (6.3%) included children who were shielded from experiencing food insecurity. Shielded youth did not differ significantly from food-secure youth in three of the five outcomes examined. However, unshielded youth, compared to food-secure youth, showed increased risks of every health outcome we investigated. Adults in food-insecure households also reported worse mental health than food-secure adults but better mental health if children were shielded. Shielding is associated with reduced risk of common psychiatric outcomes and poor mental health in youth and adults, possibly because it is associated with milder forms of food insecurity. The inability to protect children from having inadequate access to food may compound the psychological strain of food insecurity on mental health and well-being among adults.

Food Insecurity Is Associated with Depression, Anxiety, and Stress: Evidence from the Early Days of the COVID-19 Pandemic in the United States.

Purpose: To understand associations between food insecurity and depression, anxiety, and stress during the COVID-19 pandemic among low-income adults in the United States.Methods: During March 19–24, 2020, we fielded a national, web-based survey (53% response rate) among low-income adults (<250% of the federal poverty line) in the United States (N=1,476). Food security status was measured using the 18-question USDA Household Food Security Module. Multivariable-adjusted logistic regression models examined the association between food insecurity and psychological distress outcomes and COVID-19-specific worries. Qualitative data from an open-response question were also analyzed.Results: More than one-third of low-income adults screened positive for depression (33%), anxiety (39%), and high stress (39%). Greater food insecurity was associated with a dose–response relationship with all psychological distress outcomes (all outcomes p-trend <0.001) and COVID-19-specific worries (all outcomes p-trend <0.001). Compared to food-secure adults, adults with very low food security were more likely to screen positive for depression (odds ratio [OR] 7.72; 95% confidence interval [CI]: 5.52–10.80), anxiety (OR 6.19; 95% CI: 4.51–8.51), and high perceived stress (OR 10.91; 95% CI: 7.78–15.30). Very low food security was also associated with increased worries about the effect of COVID-19 on one's health (OR 2.56; 95% CI: 1.90–3.45), income (OR 5.18; 95% CI: 3.78–7.06), and ability to feed one's family (OR 9.24; 95% CI: 6.61–12.92).Conclusions: The COVID-19 pandemic is negatively associated with the mental health of low-income adults in the United States, with disproportionate associations among adults experiencing food insecurity. These disparities have the potential to increase mental health disparities over the long term.

The association between food insecurity and dental caries among U.S. adults: Data from the National Health and Nutrition Examination survey

The purpose of this study was to examine the association between food insecurity and untreated dental caries using a nationally representative sample of US adults. Data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014 on adults aged 18years and older were analysed (n=10723). Primary predictors were overall food security (food-secure/ food-insecure) and household food security (full, marginal, low and very low). The main outcome was any untreated dental caries (none/ ≥ one). Multiple logistic regression analyses were done to estimate the adjusted odds ratio after controlling for confounders. Food-insecure adults were more likely to have untreated dental caries than food-secure adults after adjusting for potential confounders (OR: 1.2; 95% CI: 0.9-1.5). Adults from households with marginal (OR:1.4; 95% CI:1.5-2.2), low (OR:1.3, 95% CI:1.3-2.0) and very low food security (OR:1.3; 95% CI:0.9-1.5) had higher odds of untreated caries than adults from households with full food security. Following age stratification, marginal, low and very low food-secure adults had higher prevalence of untreated dental caries than full food-secure adults across all age groups. Our findings suggest that food-insecure adults had higher odds of untreated dental caries than food-secure adults. These findings highlight the importance of assessing food insecurity as a risk factor for dental caries. Longitudinal cohort studies are recommended to determine causal mechanisms.

Severe food insecurity associated with mortality among lower-income Canadian adults approaching eligibility for public pensions: a population cohort study

BackgroundThe prevalence of food insecurity among adults over 65 in Canada is less than half of that among adults approaching 65, possibly due in part to the public pension universally disbursed from the age of 65. Given research associating food insecurity with higher risk of premature mortality, our objective was to determine the likelihood that food-insecure adults with incomes below the national median would live past 65 to collect the public pension.MethodsWe linked respondents of the Canadian Community Health Survey 2005–15 to the death records from the Canadian Vital Statistics Database 2005–17. We assessed household food insecurity status through a validated 18-item questionnaire for 50,780 adults aged 52–64 at interview and with household income below the national median. We traced their vital status up to the age of 65. We fitted Cox proportional hazard models to compare hazard of all-cause mortality before 65 by food insecurity status while adjusting for individual demographic attributes, baseline health, and household socioeconomic characteristics. We also stratified the sample by income and analyzed the subsamples with income above and below the Low Income Measure separately.ResultsMarginal, moderate, and severe food insecurity were experienced by 4.1, 7.3, and 4.5% of the sampled adults, respectively. The crude mortality rate was 49 per 10,000 person-years for food-secure adults and 86, 98, and 150 per 10,000 person-years for their marginally, moderately, and severely food-insecure counterparts, respectively. For the full sample and low-income subsample, respectively, severe food insecurity was associated with 1.24 (95% CI: 1.06, 1.45) and 1.28 (95% CI: 1.07, 1.52) times higher hazard of dying before 65 relative to food security. No association was found between food insecurity and mortality in the higher-income subsample.ConclusionsSeverely food-insecure adults approaching retirement age were more likely to die before collecting public pensions that might attenuate their food insecurity. Policymakers need to acknowledge the challenges to food security and health faced by working-age adults and provide them with adequate assistance to ensure healthy ageing into retirement.

Socio-demographic characteristics, diet and health among food insecure UK adults: cross-sectional analysis of the International Food Policy Study.

To estimate food insecurity (FI) prevalence among UK adults and investigate associations with socio-demographic characteristics, diet and health. Weighted cross-sectional survey data. FI was measured using the USDA Adult Food Security Survey Module. Data were analysed using adjusted logistic regression models. United Kingdom. 2551 participants (aged 18-64 years); sub-sample (n 1949) used to investigate association between FI and overweight. FI prevalence was 24·3 %. Higher odds of FI were observed among participants who reported that making ends meet was difficult v. easy (OR 19·76, 95 % CI 13·78, 28·34), were full-time students v. non-students (OR 3·23, 95 % CI 2·01, 5·18), had low v. high education (OR 2·30, 95 % CI 1·66, 3·17), were male v. female (OR 1·36, 95 % CI 1·01, 1·83) and reported their ethnicity as mixed (OR 2·32, 95 % CI 1·02, 5·27) and white other (OR 2·04, 95 % CI 1·04, 3·99) v. white British. Odds of FI were higher in participants living with children v. alone, especially in single-parent households (OR 2·10, 95 % CI 1·19, 3·70). Odds of FI decreased per year of increase in age (OR 0·95, 95 % CI 0·94, 0·96) and were lower in participants not looking for work v. full-time employed (OR 0·60, 95 % CI 0·42, 0·87). Food insecure v. food secure adults had lower odds of consuming fruits (OR 0·59, 95 % CI 0·47, 0·74) and vegetables (OR 0·68, 95 % CI 0·54, 0·86) above the median frequency, and higher odds for fruit juice (OR 1·39, 95 % CI 1·10, 1·75). Food insecure v. food secure adults had higher odds of reporting unhealthy diets (OR 1·65, 95 % CI 1·31, 2·10), poor general health, (OR 1·90, 95 % CI 1·50, 2·41), poor mental health (OR 2·10, 95 % CI 1·64, 2·69), high stress (OR 3·15, 95 % CI 2·42, 4·11) and overweight (OR 1·32, 95 % CI 1·00, 1·75). FI prevalence was high and varied by socio-demographic characteristics. FI was associated with poorer diet and health.

Association between household food insecurity and mortality in Canada: a population-based retrospective cohort study.

Food insecurity affects 1 in 8 households in Canada, with serious health consequences. We investigated the association between household food insecurity and all-cause and cause-specific mortality. We assessed the food insecurity status of Canadian adults using the Canadian Community Health Survey 2005-2017 and identified premature deaths among the survey respondents using the Canadian Vital Statistics Database 2005-2017. Applying Cox survival analyses to the linked data sets, we compared adults' all-cause and cause-specific mortality hazard by their household food insecurity status. Of the 510 010 adults sampled (3 390 500 person-years), 25 460 died prematurely by 2017. Death rates of food-secure adults and their counterparts experiencing marginal, moderate and severe food insecurity were 736, 752, 834 and 1124 per 100 000 person-years, respectively. The adjusted hazard ratios (HRs) of all-cause premature mortality for marginal, moderate and severe food insecurity were 1.10 (95% confidence interval [CI] 1.03-1.18), 1.11 (95% CI 1.05-1.18) and 1.37 (95% CI 1.27-1.47), respectively. Among adults who died prematurely, those experiencing severe food insecurity died on average 9 years earlier than their food-secure counterparts (age 59.5 v. 68.9 yr). Severe food insecurity was consistently associated with higher mortality across all causes of death except cancers; the association was particularly pronounced for infectious-parasitic diseases (adjusted HR 2.24, 95% CI 1.42-3.55), unintentional injuries (adjusted HR 2.69, 95% CI 2.04-3.56) and suicides (adjusted HR 2.21, 95% CI 1.50-3.24). Canadian adults from food-insecure households were more likely to die prematurely than their food-secure counterparts. Efforts to reduce premature mortality should consider food insecurity as a relevant social determinant.

Food Insecurity May Be an Independent Risk Factor Associated with Nonalcoholic Fatty Liver Disease among Low-Income Adults in the United States

Nonalcoholic fatty liver disease (NAFLD), considered a "barometer" of metabolic health, is the leading cause of liver disease in the United States. Despite established associations between food insecurity and obesity, hypertension, and diabetes, little is known about the relation between food insecurity and NAFLD. We sought to evaluate the association of food insecurity with NAFLD among low-income adults in the United States. We conducted a cross-sectional analysis of a nationally representative sample of adults from the NHANES (2005-2014 waves). Participants included adults in low-income households (≤200% of the federal poverty level) without chronic viral hepatitis or self-reported heavy alcohol use. Food insecurity was measured using the Household Food Security Survey. Our primary outcome was NAFLD, as estimated by the US Fatty Liver Index, and our secondary outcome was advanced fibrosis, as estimated by the NAFLD fibrosis score. The association between food insecurity (defined as low and very low food security) and hepatic outcomes was assessed using multivariable logistic regression, adjusting for sociodemographic factors. Among 2627 adults included in the analysis, 29% (95% CI: 26%, 32%) were food insecure. The median age was 43 y, 58% were female, and 54% were white. The weighted estimated prevalence of NAFLD did not differ significantly by food security status (food secure 31% compared with food insecure 34%, P=0.21). In the multivariable model, food-insecure adults were more likely to have NAFLD (adjusted OR: 1.38; 95% CI: 1.08, 1.77) and advanced fibrosis (adjusted OR: 2.20; 95% CI: 1.27, 3.82) compared with food-secure adults. Food insecurity may be independently associated with NAFLD and advanced fibrosis among low-income adults in the United States. Future strategies should assess whether improved food access, quality, and healthy eating habits will decrease the growing burden of NAFLD-associated morbidity and mortality among at-risk adults.