Household Food Security Survey Research Articles

Household food insecurity is associated with greater autonomic dysfunction testing score in Latinos with type 2 diabetes.

We examined household food insecurity (HFI) and autonomic nervous system (ANS) function in a subset of low-income Latinos with type 2 diabetes with data from a stress management trial. InclusionLatino or Hispanic, Spanish speaking, age less than 18 years, ambulatory status, type 2 diabetes more than 6 months, A1c less than 7.0%. ExclusionPain or dysfunction in hands (e.g., arthritis) precluding handgrip testing; medical or psychiatric instability. HFI was assessed with the 6-item U.S. household food security survey module; with responses to > = 1 question considered HFI. An ANS dysfunction index was calculated from xix autonomic function tests which were scored 0 = normal or 1 = abnormal based on normative cutoffs and then summed. Autonomic function tests were: 1) 24-hour heart rate variability as reflected in standard deviation of the normal-to-normal (SDNN) heart rate acquired with 3-channel, 7-lead ambulatory electrocardiogram (Holter) monitors; 2) difference between the highest diastolic blood pressure (DBP) during sustained handgrip and the average DBP at rest; 3) difference between baseline supine and the minimal BP after standing up; and, from 24-hour urine specimens 4) cortisol, 5) normetanephrine, and, 6) metanephrine. Thirty-five individuals participated, 23 (65.7%) of them were women, age mean = 61.6 (standard deviation = 11.2) years, HbA1c mean = 8.5% (standard deviation = 1.6) and 20 participants (57.1%) used insulin. Twenty-two participants (62.9%) reported HFI and 25 (71.4%) had one or more abnormal ANS measure. Independent t-tests showed that participants with HFI had a higher ANS dysfunction index (mean = 1.5, standard deviation = 0.9) than patients who were food secure (mean = 0.7, standard deviation = 0.8), p = 0.02. Controlling for financial strain did not change significance. Total ANS index was not related to glycemia, insulin use or other socioeconomic indicators. In this sample, HFI was associated with ANS dysfunction. Policies to improve food access and affordability may benefit health outcomes for Latinos with diabetes.

Food Insecurity Among Graduate Students and Postdoctoral Trainees

Food insecurity on college campuses has emerged as an urgent public health priority; however, there has been a lack of studies focused on graduate students or postdoctoral trainees, particularly those enrolled at private academic institutions. To estimate the prevalence of and factors associated with food insecurity among graduate students and postdoctoral trainees at a private academic university in Boston, Massachusetts. In this cross-sectional survey study, a survey on food insecurity was sent to graduate students and postdoctoral trainees at 3 health-focused graduate schools at Harvard University during the end of the spring 2023 academic term (April to June). Participants were studying medicine, dental medicine, or public health. Data analysis was performed from July to September 2023. Sociodemographic characteristics of graduate students and postdoctoral trainees. The primary outcome was food insecurity as assessed using the US Household Food Security Survey Module. Food insecurity also encompassed low and very low food security. Bidirectional stepwise logistic regression models were conducted to estimate the factors associated with food insecurity for graduate students and postdoctoral trainees. The analytic sample included 1745 participants (response rate, 55%): 1287 were graduate students and 458 were postdoctoral trainees. The median age of respondents was 29.0 (IQR, 7.0) years, and more than half (1073 [61.5%]) identified as female. A total of 694 respondents (39.8%) identified as Asian, 625 (35.8%) as White, and 426 (24.4%) as being of other race or ethnicity. The prevalence of food insecurity was 17.4% (224 of 1287) among graduate students and 12.7% (58 of 458) among postdoctoral trainees. Among graduate students, factors associated with food insecurity included being Asian (OR, 1.06 [95% CI, 1.01-1.11]) or of other race or ethnicity (OR, 1.07 [95% CI, 1.02-1.13]), receiving financial aid (OR, 1.09 [95% CI, 1.05-1.13]), and having housing instability (OR, 1.53 [95% CI, 1.45-1.61]). Among postdoctoral trainees, factors associated with food insecurity included receiving Supplemental Nutrition Assistance Program benefits (OR, 1.59 [95% CI, 1.28-1.97]), having housing instability (OR, 1.33 [95% CI, 1.22-1.45]), and not owning a car (OR, 1.11 [95% CI, 1.04-1.18]). In this study, a substantial proportion of graduate students and postdoctoral trainees at a private academic institution experienced food insecurity during the academic year. These findings underscore the need for national and institutional interventions to address the complex, structural factors related to food insecurity in these distinct populations.

Beyond Economic Barriers: Conceptualizing Food Insecurity among Resettled Refugees Living in the United States

The US Household Food Security Survey Module (HFSSM) is the most common survey tool to measure food security status at the national level. No previous studies have sought to establish its content validity for measuring food security among resettled refugees living in the US. This paper explores this dimension of the HFSSM through a qualitative grounded study of food management experiences among resettled refugees in Vermont. Analysis of the data revealed that non-financial barriers restricted participants’ food security, especially for recent arrivals. These findings present potential problems of content validity for HFSSM questions, and reveal the importance of considering food security through financial and non-financial domains.

A19 THE IMPACT OF FOOD INSECURITY ON ADHERENCE TO A GLUTEN-FREE DIET IN THE ADULT CELIAC DISEASE POPULATION ATTENDING A DEDICATED CELIAC CLINIC

Abstract Background A strict gluten-free diet (GFD) is currently the only treatment for celiac disease (CeD), but a GFD can be inconvenient and expensive. CeD patients who are food insecure (FI) face threats to GFD adherence, overall health, and quality of life. Aims To evaluate the prevalence of FI in patients with CeD attending a dedicated Adult Celiac Disease Clinic (ACDC) at an academic hospital and to examine the relationship between FI and GFD adherence, quality of life and various gastrointestinal symptoms. Methods Patients were invited to participate in the CeD registry when they attended the ACDC; those who agreed to participate then provided verbal and signed consent. Patients had the option to complete the CeD registry forms in the clinic on an iPad or at home using a card with a QR code and a unique ID to access the online CeD registry. The CeD registry uses REDCap (v. 11.1, 2021, US) and includes six validated questionnaires (Celiac Diet Adherence Test (CDAT), Celiac Disease Quality of Life Questionnaire (CD QoL), Celiac Symptom Index (CSI), Gastrointestinal Symptom Rating Scale (GSRS), Hospital Anxiety and Depression Scale (HADS), and Household Food Security Survey Module (HFSSM)). Continuous data are expressed as mean (SD), and categorical data as proportions of patients. The chi-squared test with Fisher correction and t-test were used to assess differences between groups. Results A total of 653 patients attended the ACDC from November 2, 2022, to September 20, 2023, and 411 patients were invited to participate in this study. Of them, 204 completed the CeD registry. Food insecurity was identified in 16% of CeD patients, of whom 11 (5%) were marginally FI, 16 (8%) were moderately FI, and 7 (3%) were severely FI. Compared to CeD patients who are food secure, a greater proportion of FI CeD patients reported nonadherence to GFD (26/34 vs 70/170; p<0.001), reduced QoL (32/34 vs 98/170; p<0.001), greater anxiety (27/34 vs 84/170; p=0.001) and greater depression (13/34 vs 26/170; p=0.004) compared with normal values. CeD patients with FI also reported lower QoL [61.0(14.9) vs 49.6(16.7); p=0.001] and increased gastrointestinal symptoms [GSRS 37.7(14.7) vs 29.0(12.8); p=0.001] compared with food secure CeD patients. Conclusions Food insecurity is common in patients with CeD and is associated with significantly worse adherence to treatment, symptom control, and quality of life. There is an important need for programs and societal measures to abolish food insecurity and ensure adequate access to treatment for patients with CeD. Funding Agencies TRIANGLE Summer Studentship

Properties of the Household Food Security Survey Module Scale in Young Adults with Diabetes

BackgroundThe Household Food Security Survey Module (HFSSM) was not tailored to people with chronic diseases or young adults (YAs). ObjectivesWe aim to evaluate whether the 18-item HFSSM meets assumptions underlying the scale among YAs with diabetes. MethodsData from 1887 YAs with youth-onset type 1 diabetes or type 2 diabetes were used from the SEARCH for Diabetes in Youth Study, 2016–2019, and on 925 who returned for the SEARCH Food Security Cohort Study, 2018–2021, all of whom had completed the HFSSM. Guttman scaling properties (affirmation of preceding less severe items) and Rasch model properties (probability to answer an item based on difficulty level) were assessed. ResultsItems 3 (balanced meals) and 6 (eating less than one should) were affirmed more frequently than expected (nonmonotonic response pattern). At 1.2%–3.5%, item nonresponse was rare among type 1 diabetes but higher among type 2 diabetes (range: 3.1%–10.6%). Items 9 (not eating the whole day) and 3 did not meet the Guttman scaling properties. Rasch modeling revealed that item 3 had the smallest difficulty parameter. INFIT indices suggested that some responses to item 3 did not match the pattern in the rest of the sample. Classifying household food insecurity (HFI) based on items 1 and 2 compared with other 2-item combinations, including item 3, revealed a substantial undercount of HFI ranging from 5% to 8% points. ConclusionsUse of the HFSSM among YAs with diabetes could potentially result in biased HFI reporting and affect estimates of HFI prevalence in this population.

Food security and its association with socioeconomic status and dietary diversity in free living older people in Tehran, Iran

BackgroundFood security is a function of food access and dietary diversity. Older age is a period when adequate and diverse dietary intake is a challenge. This study aimed to investigate the association between food security on the one hand and dietary diversity and socioeconomic factors on the other hand among the free-living older people in the city of Tehran.MethodsIn this cross-sectional study, 583 older people, aged 60–80 years living in Tehran city, were selected through the systematic cluster sampling method. Food security was determined by the United States Household Food Security Survey Module (US-HFSSM (.Socioeconomic status (SES) and two 24-h recalls were obtained. Dietary Diversity Score (DDS) was calculated using the FAO 2010 guideline. Multinomial logistic regression was applied.ResultsThe average age of participants was 67.87 ± 5.86 years. Based on US-HFSSM, 56.9% of older people were food secure; while 25.7%, 14.2% and 3.2% suffered from food insecurity (FI) without hunger, with moderate hunger, and with severe hunger, respectively. There was no association between FI and DDS, even after controlling for confounders. FI with mild hunger was associated with household income (OR = 2.744, 95% CI = 1.100–6.846), while FI with severe hunger was associated with Fars ethnicity (OR = 0.146, 95% CI = 0.051–0.424).ConclusionsOverall, socio-economic status and demographic characteristics were the predictors of FI among older people. The findings can have implication in design and targeting of interventions directed at older people.

Food insecurity and health-related quality of life among a nationally representative sample of older adults: cross-sectional analysis

BackgroundFood insecurity is a significant health issue among older adults and contributes to poorer quality of life and mental health. However, limited evidence is available among older adults. Thus, the study evaluated the associations between food security and multiple outcomes related to health-related quality of life. We examined whether participants’ sex and participation in the federal Supplemental Nutrition Assistance Program (SNAP)/or receiving the Food Stamp program might modify these associations.MethodsCross-sectional analysis of the 2007–2012 National Health and Nutrition Examination Surveys (NHANES). A sample of 3,375 adults aged ≥ 60 years with household incomes ≤ 300% of the federal poverty level (FPBL). Food security was assessed using the 18-item US Household Food Security Survey Module and categorized as food security, marginal food security, and food insecurity. Outcomes were the CDC Health-Related Quality of Life measures (HRQOL-4).ResultsApproximately 8% experienced marginal food security and 12% experienced food insecurity. Over the past month, food insecurity was significantly associated with ≥ 16 days of poor physical health (OR 1.88, 95% CI 1.23, 2.85, P-trend = 0.005), ≥ 16 days of poor mental health (OR 2.22, 95% CI 1.50, 3.28, P-trend < 0.0001), and ≥ 16 days of feeling anxious (OR 3.33, 95% CI 2.30, 4.81, P-trend < 0.0001) after multivariate adjustment. The association between food insecurity and poor physical health was stronger in females (P-interaction = 0.02). There was no evidence for effect modification in any of these associations among those receiving benefits from the federal SNAP/Food Stamp program.ConclusionsFood insecurity was positively associated with multiple adverse health outcomes. Public health programs and policies targeted for older adults are needed to mitigate the extent of food insecurity to promote overall health and well-being.

Household food insecurity is negatively associated with achievement of prenatal intentions to feed only breast milk in the first six months postpartum.

Household food insecurity (HFI) has been associated with suboptimal breastfeeding practices. Postpartum factors reported by caregivers include stressful life circumstances and maternal diet quality concerns. It is unknown whether prenatal breast milk feeding intentions, a well-established predictor of breastfeeding outcomes, differ by HFI status. We explored associations between HFI and prenatal intentions to feed any and only breast milk in the first 6 months postpartum, and achievement of these intentions. We utilized data from self-identified biological mothers with children 6-12 months of age who responded to a retrospective, cross-sectional online infant feeding survey conducted in Nova Scotia, Canada. HFI (yes/no) was assessed using the Household Food Security Survey Module. Prenatal intentions to feed any and only breast milk were assessed based on responses to five options for infant milk feeding plans. Achievement of intentions was assessed by breast milk and formula feeding practices in the first 6 months. Multivariable logistic regressions were conducted, adjusting for maternal socio-demographics. Among 459 respondents, 28% reported HFI; 88% intended to feed any breast milk and 77% intended to feed only breast milk, with no difference by HFI status. Of those intending to feed any breast milk, 99% succeeded, precluding further analysis. Among mothers who intended to provide only breast milk, only 51% achieved their intention, with lower odds among those with HFI (aOR 0.54, 95% CI 0.29-0.98). HFI was not associated with intentions for feeding breast milk in the first 6 months postpartum, but mothers with HFI were less likely to achieve their intention to provide only breast milk. Further research is needed to understand the underlying reasons for this and to guide intervention designs to address HFI and help mothers reach their breastfeeding goals.

Factors Affecting Quality of Life in Adolescents Living With Type 2 Diabetes: A Substudy of the Improving Renal Complications in Adolescents With Type 2 Diabetes Through REsearch (iCARE) Cohort

ObjectivesType 2 diabetes (T2D) disproportionately impacts adolescents living in challenging socioeconomic conditions. However, the impacts of T2D on quality of life (QOL) in this context are unknown. Our aim in this study was to evaluate QOL and identify its biological, psychological, and social determinants among adolescents living with and without T2D from similar sociodemographic backgrounds. Relationships between glycemic stability, early complications, and treatments of T2D and QOL were also examined. MethodsNinety-two adolescents with T2D and 59 at-risk controls were included from the Improving Renal Complications in Adolescents With Type 2 Diabetes Through Research (iCARE) cohort. The main outcome was QOL (Pediatric QOL Inventory [PedsQL]). Biological covariates included age, sex, body mass index z score, glycated hemoglobin, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio. Psychological factors included perceived stress (14-item Perceived Stress Scale) and mental distress (6-item Kessler scale). Social factors included food security (Household Food Security Survey Module) and income quintile. Multivariate linear regression analyses were used to identify factors associated with QOL between adolescents with and without T2D, and within the T2D cohort. ResultsMean total QOL scores among adolescents with T2D were lower than in controls (67.0±14.8 vs 71.7±16.2, p=0.04). Age, sex, and percent Indigenous ethnicity were not significantly different between groups. Mean duration of T2D was 2.3±2.0 years. In the multivariate analysis, QOL was not associated with diabetes status, but negative associations were seen between mental distress (β=−1.46, p<0.001) and food insecurity QOL (β=−6.26, p=0.037). No differences were seen between biological factors and QOL in either analysis. ConclusionsSignificant factors associated with decreased QOL in adolescents living with T2D include mental distress and food insecurity, indicating areas for targeted intervention.

The relationship between household food insecurity and overweight or obesity among children and adults in Canada: a population-based, propensity score weighting analysis.

Household food insecurity is independently associated with adverse health outcomes among Canadians, but its association with overweight and obesity is poorly understood partly because of limited attention to confounding. This study assessed the relationship between food insecurity status and overweight/obesity in Canada. Cross-sectional data for individuals aged 2-64 years were drawn from the 2004 and 2015 Canadian Community Health Survey-Nutrition. Overweight/obesity was defined using body mass index calculated with measured height and weight. Food insecurity status was assessed with the 18-item Household Food Security Survey Module. The relationship was examined among preschool children (n=2007), girls (n=5512), boys (n=5507), women (n=8317), and men (n=7279) using propensity score weighted logistic regressions to control for confounding. Relative to their food-secure counterparts, girls in moderately food-insecure households (39.7%vs. 28.5%), boys in severely food-insecure households (54.4%vs. 35.0%), and women in moderately and severely food-insecure households (58.9% and 73.1%vs. 50.7%) had higher overweight/obesity prevalence; men in moderately food-insecure households had a lower prevalence (48.9%vs. 66.3%). With propensity score weighting, no association existed between food insecurity and overweight/obesity among preschool children, girls, boys, or men. For women, moderate (adjusted odds ratio (AOR): 1.61; 95% confidence interval (95%CI): 1.06-2.47) and severe (AOR: 2.33; 95%CI: 1.22-4.44) food insecurity was positively associated with overweight/obesity; the association was strongest for severe food insecurity and obesity (AOR: 3.38; 95%CI: 1.60-7.16). Additional research is needed to better understand the nature of the relationship among women. Problems of food insecurity and overweight/obesity among Canadian children and men should not be conflated in public health interventions.

Trends and disparities in prevalence of cardiometabolic diseases by food security status in the United States

BackgroundPrevious studies have demonstrated the association between food security and cardiometabolic diseases (CMDs), yet none have investigated trends in prevalence of CMDs by food security status in the United States (US).MethodsSerial cross-sectional analysis of the US nationally representative data from National Health and Nutrition Examination Survey (1999–2018) was conducted among adults aged 20 years or older. Food security status was defined by the US Household Food Security Survey Module (full, marginal, low, and very low food security). We estimated the age-adjusted prevalence of CMDs including obesity, hypertension, diabetes, and coronary heart disease by food security status. Racial and ethnic disparities in age-adjusted prevalence of CMDs by food security status were also assessed.ResultsA total of 49,738 participants were included in this analysis (weighted mean age 47.3 years; 51.3% women). From 1999 to 2018, the age-adjusted prevalence of CMDs was lower in full food secure group as compared with other groups. For example, trends in hypertension decreased from 49.7% (47.5-51.8%) to 45.9% (43.8-48.0%) (P-trend = 0.002) among the full and from 54.2% (49.9-58.5%) to 49.7% (46.8-52.6%) (P-trend = 0.02) among the marginal but remained stable among the low at 49.7% (47.9-51.6%) and among the very low at 51.1% (48.9-53.3%) (P-interaction = 0.02). Prevalence of diabetes increased from 8.85% (8.15-9.60%) to 12.2% (11.1-13.5%) among the full (P-trend < 0.001), from 16.5% (13.2-20.4%) to 20.9% (18.6-23.5%) (P-trend = 0.045) among the marginal and from 14.6% (11.1-19.0%) to 20.9% (18.8-23.3%) (P-trend = 0.001) among the low but remained stable at 18.8% (17.0-20.9) among the very low (P-trend = 0.35) (P-interaction = 0.03). Racial and ethnic differences in prevalence of CMD by food security status were observed. For example, among individuals with full food secure status, the prevalence of diabetes was 9.08% (95% CI, 8.60-9.59%) for non-Hispanic whites, 17.3% (95% CI, 16.4-18.2%) for non-Hispanic blacks, 16.1% (95% CI, 15.0-17.4%) for Hispanics and 14.9% (95% CI, 13.3-16.7%) for others.Conclusions and relevancePrevalence of CMDs was greatest among those experiencing food insecurity, and food insecurity disproportionately affected racial/ethnic minorities. Disparities in CMD prevalence by food security status persisted or worsened, especially among racial/ethnic minorities.

Household Food Insecurity Is Associated With Physical Activity in Youth and Young Adults With Diabetes: A Cross-Sectional Study.

Physical activity (PA) is essential for optimal diabetes management. Household food insecurity (HFI) may negatively affect diabetes management behaviors. The purpose of this study was to cross-sectionally examine the association between HFI and PA in youth and young adults (YYA) with type 1 (N = 1998) and type 2 (N = 391) diabetes from the SEARCH for Diabetes in Youth Study. HFI was measured with the US Household Food Security Survey Module. PA was measured with the International Physical Activity Questionnaire Short Form. Walking, moderate-intensity PA (excluding walking), vigorous-intensity PA, moderate- to vigorous-intensity PA, and total PA were estimated as minutes per week, while time spent sitting was assessed in minutes per day. All were modeled with median regression. Meeting PA guidelines or not was modeled using logistic regression. YYA with type 1 diabetes who experienced HFI spent more time walking than those who were food secure. YYA with type 2 diabetes who experienced HFI spent more time sitting than those who were food secure. Future research should examine walking for leisure versus other domains of walking in relation to HFI and use objective PA measures to corroborate associations between HFI and PA in YYA with diabetes.

Food Insecurity Predicts Magnitude of Early BMI Change in a Pediatric Weight Management Intervention.

The aim of this study was to estimate the prevalence of food insecurity among children with overweight/obesity presenting for weight management treatment and examine whether food insecurity predicts early change in body mass index (BMI), expressed as a percentage of the 95th percentile (%BMIp95). Children (N = 69; ages 3-18 years) presenting to a hospital-based pediatric weight management intervention and 1 parent/guardian per child (N = 69) were included. At the first appointment, parents/guardians completed the US Household Food Security Survey Module: Six-item Short Form and a demographics questionnaire. Height and weight of the children were measured at the first and third appointments to calculate %BMIp95. Among participating families, 29.0% reported experiencing food insecurity. Controlling for the ratio of income to poverty, 11.4% of the variance in %BMIp95 change from the first to third appointments was accounted for by food insecurity, ▵F (1, 66) = 8.46, p = 0.01. Children with greater food insecurity demonstrated a smaller magnitude of %BMIp95 decrease, representing a small-to-medium effect size within the context of the regression model (f2 = 0.13). A high proportion of families with children receiving weight management treatment reported experiencing food insecurity in comparison with US households with children. There may be unique characteristics of food insecurity, as opposed to household income alone, that explain the smaller magnitude of BMI decrease observed early in treatment. Future research should explore complex associations among food insecurity, income, BMI, and race over time.

Association between food insecurity status, campus food initiative use and diet quality in Australian university students.

University students may experience food insecurity due to financial constraints, reducing the quality of their diet. This study aimed to identify students at higher risk of food insecurity, their engagement with on-campus food initiatives and evaluate the relationship between food insecurity and a validated index of diet quality. A cross-sectional online survey used the six-item Household Food Security Survey Module to assess food insecurity. Total diet quality and subscale scores for eight food groups were measured using the Australian Recommended Food Score (range 0-73). Univariate and multivariate regression identified groups at risk of food insecurity, their engagement with campus food initiatives and relationship with diet quality scores. Of student respondents (n = 197), over half (54%) experienced food insecurity (14% mild, 23% moderate and 18% severe food insecurity). Male students and students not living with parents were at significantly higher risk. Food-insecure students were significantly more likely to use the campus food pantry (odds ratio = 2.3 [95% confidence interval = 1.286-4.142]; p = 0.005) but not a campus community garden. The mean diet quality score was 32.9 (standard deviation = 8.9). Food-insecure students reported a mean diet quality score over three points lower than food-secure respondents (B = -3.5 [95% confidence interval = -6.0 to -1.0]; p = 0.006), with significantly lower fruit and vegetable subscale scores. Results suggest a high occurrence of food insecurity and poor dietary quality in university students. Despite high levels of engagement with the campus food pantry, the poor diet quality of food-insecure students suggests an urgent need for greater university-led interventions to improve students' dietary intake.

Self-Reported Food Security in Adolescents with Type 1 Diabetes: Association with Hemoglobin A1c and Mental Health Symptoms Independent of Household Food Security

BackgroundTypically, child exposure to food insecurity is assessed by caregiver reports of household food security. Child report has the potential for greater accuracy because it pertains only to the child whose experiences may differ from caregiver reports. ObjectiveWe assessed if adolescent-reported food insecurity was associated with levels of hemoglobin A1c (HbA1c), acute diabetes-related complications, depressive symptoms, and disordered eating behaviors in adolescents with type 1 diabetes, independently from household food security. MethodsIn a cross-sectional analysis of the multicenter SEARCH for Diabetes in Youth Cohort Study (phase 4, 2016–2019) including 601 adolescents aged 10–17 y with type 1 diabetes and their caregivers, household food security, and adolescent-reported food security were assessed using the 18-item Household Food Security Survey Module and the 6-item Child Food Security Assessment questionnaire. Age-stratified (10–13 and 14–17) regression models were performed to estimate independent associations, adjusting for sociodemographics, clinical factors, and household food security. ResultsFood insecurity was reported by 13.1% (n = 79) of adolescents and 15.6% (n = 94) of caregivers. Among adolescent–caregiver dyads, 82.5% (n = 496) of reports were concordant and 17.5% (n = 105) discordant, Cohen’s κ= 0.3. Adolescent-reported food insecurity was not independently associated with HbA1c, diabetic ketoacidosis, and severe hypoglycemia, including in age-stratified analyses. Adolescent-reported food insecurity was independently associated with elevated odds of depressive symptoms [odds ratio (OR): 3.6; 95% confidence interval (CI): 1.3, 10.3] and disordered eating behaviors (OR: 2.5, 95% CI: 1.4, 4.6) compared with adolescents reporting food security; these associations remained in both age groups for disordered eating behaviors and in the older group for depressive symptoms. ConclusionsAdolescents with type 1 diabetes may experience food insecurity differently than caregivers. Adolescent-reported food insecurity was independently associated with depressive symptoms and disordered eating behaviors and thus may be an important attribute to assess in addition to household food security in adolescents with type 1 diabetes.

Exploring Sociodemographic and Chronic Disease Factors Associated With Chronic, Seasonal, Intramonthly, and Intermittent Presentations of Food Security Instability

BackgroundFood insecurity impacts 13.5 million US households yearly. Although food security instability (FS-I) can have many temporal presentations, these are not measured in the current US Household Food Security Survey Module. ObjectiveExplore sociodemographic and chronic disease correlates of 4 FS-I types (chronic, seasonal, intramonthly, and intermittent) using a 3-item US Household Food Security Survey Module instability supplement. DesignThis study was a secondary analysis of cross-sectional survey pilot data collected to validate the US Household Food Security Survey Module instability supplement. Participants and settingAdults at risk for food insecurity (n = 420) were recruited and answered the survey on their households’ behalf from April to June 2021. The participants were recruited from 7 community organizations from 5 states (California, Florida, Maryland, North Carolina, and Washington). Main outcome measuresThe main outcomes were the odds of having a chronic, seasonal, intramonthly, or intermittent FS-I score ≥1 based on several sociodemographic factors and having ≥1 chronic disease. Statistical analyses performedDifferences among the 4 FS-I types were analyzed using contingency tables and χ2 tests of independence. Then, mixed-effects logistic binary and conditional regressions were run for each FS-I type using clustering by state and odds ratios and 95% CI to interpret results. ResultsThe most common FS-I type experienced by the sample was intramonthly (n = 183 [43%]). Nonchronic food insecurity was most likely to happen during the winter, at the end of the month, or randomly with no certain time frame. FS-I in any form was associated with low income, chronic FS-I was associated with younger age and male sex, seasonal FS-I was associated with having no government-subsidized health insurance and females, intramonthly FS-I was associated with participation in nutrition assistance programs, and intermittent FS-I had lower odds among Hispanic/Latino households. ConclusionsFurther research is needed to explore other FS-I correlates and establish causative relationships; however, these results can be used with clinical judgment for targeted food insecurity screening and treatment.

High Prevalence of Food Insecurity and Related Disparities Among US College and University Students From 2015–2019

ObjectiveWe examined food insecurity prevalence among college students included as part of a large, ongoing, nationally representative survey and examined trends and associations with sociodemographic measures. MethodsData come from the Panel Study of Income Dynamics, a nationally representative longitudinal household panel survey, and include 2,538 college students from 2015–2019. Food security status was assessed using the US Department of Agriculture's 18-item Household Food Security Survey Module. ResultsFrom 2015 to 2019, 11% of college students experienced marginal food security, and 15% experienced food insecurity. Food insecurity was 12% in 2015 and 14% in 2017 and 2019. More Black and Hispanic students experienced food insecurity than White students (21% and 26%, vs 9%, respectively; P <0.001), as did first-generation than non-first-generation students (18% vs 10%; P = 0.01). Conclusions and ImplicationsCollege food insecurity is an urgent public health issue demanding greater response from colleges and universities and state and federal governments.

Food Insecurity and Food Addiction in a Large, National Sample of Lower-Income Adults

BackgroundGrowing research has highlighted associations between food insecurity and eating-related problems. Food addiction is one important, clinically significant pattern of problematic eating, which is related to, but distinct from, eating disorders. To date, there is only one study examining the association between food insecurity and food addiction, to our knowledge. Additional research is needed to understand the complexities of this association. ObjectiveWe examined the association between food insecurity and food addiction in a large, national convenience sample of lower-income adults and potential heterogeneity in this association by age, gender, race, and ethnicity. DesignA cross-sectional, web-based study was conducted among 1780 US adults (≥18 y) with household incomes <250% of the federal poverty guideline. Household food security was assessed using the Household Food Security Survey Module. Food addiction was assessed using the modified Yale Food Addiction Scale (mYFAS), version 2.0. Multivariate logistic regression models examined the associations between food insecurity and food addiction, adjusting for sociodemographic covariates. ResultsThe prevalence of food addiction was 7.3%, and the prevalence of food insecurity was 51%. Compared with adults with food security, adults with food insecurity endorsed each mYFAS symptom with significantly greater frequency, including failure to fulfill major role obligations (20%), continued use despite social or interpersonal problems (18%), and craving or strong desire to use (16%). After adjustment, food insecurity was associated with 3.82-fold higher odds of food addiction (95% CI 2.36, 6.19), with no significant heterogeneity by age, gender, or race and ethnicity. The most problematic foods reported by adults with food insecurity were chips, nondiet soda, chocolate, pizza, and ice cream. ConclusionThese findings provide additional support for the association between food insecurity and food addiction. Mechanistic studies are needed to explore the role of psychosocial factors, eating behaviors, and the food environment in contributing to these associations.

Food Insecurity, Race and Ethnicity, and Cognitive Function Among United States Older Adults

BackgroundCognitive impairment and dementia are severe public health issues in aging populations, which can be exacerbated by insufficient or unhealthy dietary intake. Food (in)security status is linked to cognitive function among older adults, but the relationship is complex and can vary by sociodemographic characteristics. ObjectiveThis article aimed to investigate the association between food insecurity and cognitive function among United States older adults and explore potential variations by race and ethnicity groups. MethodsWe prospectively examined changes in cognitive function and incidence of cognitive impairment alongside the presence of self-reported food insecurity among older adults of different racial and ethnic groups. Data were from the 2012–2018 Health and Retirement Study (HRS) and the 2013 Health Care and Nutrition Study (HCNS), including N = 6,638 United States adults aged 50 years and older. Food insecurity was measured by a self-reported United States Household Food Security Survey Module, and cognitive function was assessed by the modified version of the Telephone Interview for Cognitive Status. ResultsResults showed that 17% of United States older adults reported food insecurity in the 2013 HCNS. Compared with food secure older adults, those reporting food insecurity experienced worsened cognitive functioning over time (B = −0.63, p < .001), and they were more likely to have onset of cognitive impairment (OR= 1.46, p < .001) in the 6-y observation. Compared with non-Hispanic White older adults, being non-Hispanic Black, non-Hispanic Other, or Hispanic was associated with 2.96, 2.09, or 1.26 odds (p < .001) of cognitive impairment (2012–2018), respectively. Older adults of racial and ethnic minority groups also had higher risks of experiencing the double burden of cognitive impairment alongside food insecurity compared with non-Hispanic White older adults. ConclusionFindings underscore racial and ethnic structural disparities in food security and cognitive health in the United States aging population.

Food Insecurity and Pediatric Nonalcoholic Fatty Liver Disease Severity

ObjectiveTo determine the association between food insecurity and pediatric nonalcoholic fatty liver disease (NAFLD). MethodsCross-sectional study of patients < 21 years of age with histologically confirmed NAFLD. The Household Food Security Survey Module was administered to determine food insecurity status. Skin lipidomics were performed to explore pathophysiologic mechanisms. ResultsSeventy-three patients with histologically confirmed NAFLD completed the Household Food Security Survey Module. Of these, the majority were male (81%) and non-Hispanic (53%), with a mean age at biopsy of 13±3 years. Food insecurity was seen in 42% (n=31). Comparison of features between food insecure and food secure subgroups revealed no differences in sex, ethnicity, BMI z-score, aminotransferases, or histologic severity. However, children experiencing food insecurity presented on average two years before their food secure counterparts (12.3 ± 3.0 vs. 14.4 ± 3.6 years, p = 0.015). A subset of 31 patients provided skin samples. Skin lipidomics revealed that food insecurity was associated with down-regulated features from the lipoamino acid class of lipids, previously linked to inflammation and adipocyte differentiation. ConclusionsFood insecurity is highly prevalent in children with NAFLD and is associated with earlier presentation. Lipidomic analyses suggest a possible pathophysiologic link that warrants further exploration.