Poverty-to-income Ratio Research Articles

Association between dietary calcium and depression among American adults: National health and nutrition examination survey.

There is only limited evidence for an association between calcium (Ca) and depression, and the relationship was inconsistent. Therefore, the aim of this study was to assess the relationship between dietary Ca and the risk of depressive symptoms in individuals over the age of 18 in the US. We extracted 14,971 participants from the US National Health and Nutrition Examination Survey (NHANES) 2007-2016 to probe their associations. Dietary Ca intake was measured through 24 h dietary recall method. Patients with the Patient Health Questionnaire-9 (PHQ-9) ≥ 10 scores were believed to have depressive symptoms. The association between dietary Ca and depressive symptoms was investigated using multivariate logistic regression, sensitivity analysis, and restricted cubic spline regression. In this study, 7.6% (1,144/14,971) of them had depressive symptoms. After adjusting for sex, age, race, poverty to income ratio (PIR), marital status, education, body mass index (BMI), caffeine intake, carbohydrates intake, total energy intake, smoking status, alcohol consumption, physical activity, diabetes, hypertension, severe cardiovascular disease (CVD), cancer, serum vitamin D, serum Ca, and Ca supplement, the adjusted ORs value [95% confidence interval (CI)] of depression for the lowest category (Q1 ≤ 534 mg/day) vs. Q2-Q4 of Ca intake were 0.83 (0.69-0.99), 0.97 (0.65-0.95), and 0.80 (0.63-0.98) with the p for trend (p = 0.014). The relationship between dietary Ca intake and depressive symptoms was linear (non-linear p = 0.148). None of the interactions were significant except among races (p for interaction = 0.001). Association between dietary Ca and the prevalence of depressive symptoms in US adults. And Ca intake was negatively associated with the risk of depressive symptoms. As Ca intake increased, the prevalence of depressive symptoms decreased.

Trends in Overall and Micronutrient-Containing Dietary Supplement Use in US Adults and Children, NHANES 2007–2018

Dietary supplement (DS) use is widespread in the United States and contributes large amounts of micronutrients to users. Most studies have relied on data from 1 assessment method to characterize the prevalence of DS use. Combining multiple methods enhances the ability to capture nutrient exposures from DSs and examine trends over time. The objective of this study was to characterize DS use and examine trends in any DS as well as micronutrient-containing (MN) DS use in a nationally representative sample of the US population (≥1 y) from the 2007-2018 NHANES using a combined approach. NHANES obtains an in-home inventory with a frequency-based dietary supplement and prescription medicine questionnaire (DSMQ), and two 24-h dietary recalls (24HRs). Trends in the prevalence of use and selected types of products used were estimated for the population and by sex, age, race/Hispanic origin, family income [poverty-to-income ratio (PIR)], and household food security (food-secure vs. food-insecure) using the DSMQ or ≥ 1 24HR. Linear trends were tested using orthogonal polynomials (significance set at P<0.05). DS use increased from 50% in 2007 to 56% in 2018 (P=0.001); use of MN products increased from 46% to 49% (P=0.03), and single-nutrient DS (e.g., magnesium, vitamins B-12 and D) use also increased (all P<0.001). In contrast, multivitamin-mineral use decreased (70% to 56%; P<0.001). In adults (≥19 y), any (54% to 61%) and MN (49% to 54%) DS use increased, especially in men, non-Hispanic blacks and Hispanics, and low-income adults (PIR≤130%). In children (1-18 y), any DS use remained stable (∼38%), as did MN use, except for food-insecure children, whose use increased from 24% to 31% over the decade (P=0.03). The prevalence of any and MN DS use increased over time in the United States. This may be partially attributed to increased use of single-nutrient products. Population subgroups differed in their DS use.

Socioeconomic Inequalities Impact the Ability of Pregnant Women and Women of Childbearing Age to Consume Nutrients Needed for Neurodevelopment: An Analysis of NHANES 2007-2018.

Adequate consumption of nutrients that support infant neurodevelopment is critical among pregnant women and women of childbearing age. Understanding the potential effects of socioeconomic inequalities on nutrient gaps in these life stages is thus important for informing strategies to mitigate negative health consequences. Usual intake (foods and dietary supplements) of neurodevelopment-related nutrients was determined from 24 h recalls among women of childbearing age and pregnant women (20–44 years) using data from 2007–2018 NHANES. Usual intake was compared across household food security, poverty-to-income ratio (PIR), and household participation in federal food and nutrition assistance programs. Intake of EPA + DHA was universally low with >95% of all women (pregnant and non-pregnant) below the DGA recommendation from foods alone. Women in households that participated in the Supplemental Nutrition Assistance Program had a significantly lower intake of multiple nutrients relative to those who did not participate. For example, 50% had intakes below the estimated average requirement (EAR) for vitamin A (versus 32%), 42% were below the EAR for calcium (versus 33%) and 65% were below the EAR for magnesium (versus 42%). Similar gradients were observed by PIR and household food security, and among pregnant women whereby gaps were more evident in those experiencing socioeconomic inequalities. The use of dietary supplements attenuated shortfalls for most nutrients. These findings highlight a critical need to support the nutritional requirements for women of childbearing age and pregnant women.

Income disparities in mental health: investigating the role of food insecurity by disability status.

To investigate whether food insecurity helps explain the association between income and psychological distress and if its role differs by disability status. Using 2011-2017 National Health Interview Survey cross-sectional data (n 102 543), we conducted linear regression models, fully interacted with disability status, to estimate the association between income-to-poverty ratio (IPR) (<1, 1-<2, 2-<4, ≥4) and psychological distress (Kessler 6 (K6) Scale, range: 0-24). Base models adjusted for socio-demographic factors. We then added food security (secure, low and very low), interacted with disability, and conducted post-estimation adjusted Wald tests. USA. Nationally representative sample of non-institutionalised adults 18 years and older. The association between income and psychological distress was stronger for people with disabilities. Compared to those in the highest income category (IPR ≥4), poor individuals (IPR < 1) with and without disabilities scored 2·10 (95 % CI (1·74, 2·46)) and 0·81 (95 % CI (0·69, 0·93)) points higher on the K6 Scale, respectively. Accounting for food insecurity reduced the estimated income disparity in psychological distress significantly more among individuals with disabilities (0·96 points or 46 %) than without disabilities (0·34 points or 42 %), decreasing the difference in the income disparity between those with and without disabilities by 48 % (0·62 points). Further, food insecurity more strongly predicted psychological distress for individuals with disabilities independent of socio-economic disadvantage. Food insecurity plays a more important role in shaping patterns of psychological distress for people with disabilities, explaining more of the association between income and psychological distress among those with than without disabilities. Improving food security may reduce mental health disparities.

Low Socioeconomic Status Is Associated with a Greater Neural Response to Both Rewards and Losses.

Low socioeconomic status (SES) has been associated with distinct patterns of reward processing, which appear to have adverse implications for health outcomes, well-being, and human capital. However, most studies in this literature have used complex tasks that engage more than reward processing and/or retrospectively studied childhood SES in samples of adults. To clarify how SES relates to the development of reward processing tendencies, we measured income-to-poverty ratio (IPR) in 172 youth who subsequently underwent functional MRI while completing a passive avoidance task to assess neural responses to reward and loss information. Participants were 12-15 years old (mean = 13.94, SD = .52; 65.7% female) from a sample broadly representative of the Chicago area in terms of SES (IPR range = 0.1-34.53; mean = 3.90; SD = 4.15) and racial makeup (40.1% White 30.8% Black; 29.1% Hispanic). To the extent they had lower IPR, children displayed a trend toward worse behavioral performance on the passive avoidance task. Lower IPR also was associated with a greater response in attention brain regions to reward and loss cues and to reward and loss feedback. Lower IPR also was associated with reduced differentiation between reward and loss feedback in the ventromedial prefrontal and parietal cortex. The current data suggest that both increased salience of reward/loss information and reduced discrimination between reward and loss feedback could be factors linking SES with the development of human capital and health outcomes.

How Income Inequality and Race Concentrate Depression in Low-Income Women in the US; 2005-2016.

Aim: To estimate the association between income and depressive symptoms in adult women, ages 20 years and older. Methods: Data for this study came from the 2005–2016 National Health and Nutrition Examination Survey (NHANES). We measured the presence of depressive symptoms by using a 9-item PHQ (Public Health Questionnaire, PHQ-9) and the Poverty to Income Ratio (PIR) as a proxy for income. We employed Negative Binomial Regression (NBRG) and logistic regression models in a sample of 11,420 women. We adjusted models by age, racial/ethnic groups, marital status, education, health insurance, comorbidity, and utilization of mental health professionals. We calculated the Gini Coefficient (GC) as a measure of income inequality, using PIR. Results: Between 2005 and 2016, 20.1% of low-PIR women suffered from depression (PHQ ≥10) compared with 12.0% of women in medium-PIR and 5.0% in high-PIR. The highest probabilities of being depressed were in Black Non-Hispanics (BNH) and Hispanics (12.0%), and then in White NH (WNH; 9.1%). The results of NBRG have shown that women in medium-PIR (0.90 [CI: 0.84–0.97]) and high-PIR 0.76 (CI: 0.70–0.82) had a lower incidence-rate ratio than women in low-PIR. The logistic regression results showed that income is protective in High-PIR groups (OR = 0.56, CI [0.43–0.73]). Conclusion: Policies to treat depression should prioritize the needs of low-income women of all racial groups and women.

How Income and Income Inequality Drive Depressive Symptoms in U.S. Adults, Does Sex Matter: 2005-2016.

Importance: Depression is one of the leading causes of disability in the United States. Depression prevalence varies by income and sex, but more evidence is needed on the role income inequality may play in these associations. Objective: To examine the association between the Poverty to Income Ratio (PIR)—as a proxy for income—and depressive symptoms in adults ages 20 years and older, and to test how depression was concentrated among PIR. Design: Using the 2005–2016 National Health and Nutrition Examination Survey (NHANES), we employed Negative Binomial Regression (NBRG) in a sample of 24,166 adults. We used a 9-item PHQ (Public Health Questionnaire, PHQ-9) to measure the presence of depressive symptoms as an outcome variable. Additionally, we plotted a concentration curve to explain how depression is distributed among PIR. Results: In comparison with high-income, the low-income population in the study suffered more from greater than or equal to ten on the PHQ-9 by 4.5 and 3.5 times, respectively. The results of NBRG have shown that people with low-PIR (IRR: 1.30, 95% CI: 1.23–1.37) and medium-PIR (IRR: 1.55, 95% CI: 1.46–1.65) have experienced a higher relative risk ratio of having depressive symptoms. Women have a higher IRR (IRR: 1.29, 95% CI: 1.24–1.34) than men. We observed that depression was concentrated among low-PIR men and women, with a higher concentration among women. Conclusion and Relevance: Addressing depression should target low-income populations and populations with higher income inequality.

Associations of Ready-to-Eat Cereal Consumption and Income With Dietary Outcomes: Results From the National Health and Nutrition Examination Survey 2015-2018.

BackgroundReady-to-eat (RTE) cereal has been associated with higher diet quality but it is not known if this association differs by income.ObjectiveTo investigate the association of RTE cereal with dietary outcomes in a US population stratified by income [measured using the poverty-to-income ratio (PIR)].MethodsData from children 2–18 years (n = 5,028) and adults 19 years and older (n = 9,813) with 24-h dietary recalls from the cross-sectional, US nationally-representative 2015–2016 and 2017–2018 National Health and Nutrition Examination Surveys (NHANES) were used in a multivariable linear model that included cereal eating status (based on day 1 24 h dietary recall), PIR category (Low-PIR <1.85; Mid-PIR 1.85–3.50; High-PIR >3.50) and their interaction. PIR is based on the ratio of the family household income to the poverty level set by the US Department of Health and Human Services and higher PIR values indicate higher household income.ResultsFor children, there were positive associations between RTE cereal consumption and nutrient (e.g., iron, calcium, fiber, potassium and vitamin D, p < 0.001) and food group (e.g., whole grain and dairy, p < 0.001) intake and 2015-HEI (p < 0.0001) but no association with PIR or RTE cereal-PIR interaction. For adults, PIR category was positively associated with the intake of nutrients (e.g., fiber, magnesium, potassium, and vitamin C, p < 0.001) as was RTE cereal consumption (e.g., fiber, calcium, vitamin D, potassium, vitamin B12, among others, p < 0.001). Both PIR and RTE cereal were positively associated with whole grain, dairy, and fruit (p < 0.001) and 2015-HEI (p < 0.0001) for adults. We also found a significant interaction between PIR and RTE cereal for adults for iron, phosphorus, B vitamins, and dairy (p < 0.001). RTE cereal contributed to one quarter or more of daily intake, across all age and PIR groups, for several B vitamins, iron, zinc, and whole grains. Added sugar intake was not associated with RTE cereal consumption in either children or adults.ConclusionRTE cereal was associated with improved dietary outcomes, including increased intake of under-consumed nutrients, increased intake of recommended food groups, and higher diet quality, at all income levels. This work can help inform future dietary recommendations.

Associations of exposure to secondhand smoke with hypertension risk and blood pressure values in adults

BackgroundThe effects of environmental chemical exposure on blood pressure (BP) have been confirmed, but the association between exposure to secondhand smoke (SHS) and hypertension risk and BP in the general population remains unknown.MethodsCross-sectional associations between SHS exposure and hypertension risk and BP values were evaluated using data for subjects who participated in the National Health and Nutrition Examination Survey (NHANES), 1999–2016. Logistic regression and linear regression were performed after adjusting for age, sex, race, alcohol consumption, poverty-to-income ratio (PIR), body mass index (BMI), estimated glomerular filtration rate, physical activity, diabetes, cardiovascular disease, and NHANES cycle. Restricted cubic spline models were created to display the potential nonlinear association between SHS and BP levels.ResultsHigher risk of hypertension was found at the highest SHS concentrations (OR = 1.13, 95% CI 1.04, 1.24, P for trend = 0.007). Additionally, SHS exposure had a strong positive association with systolic blood pressure (SBP) but was negatively associated with diastolic blood pressure (DBP). Furthermore, the nonlinear model result showed a significant association between SHS and SBP (P = 0.017); however, the nonlinear model result was not significant for SHS or DBP.ConclusionsOur results suggest a potential association between high SHS exposure and the risk of hypertension. Further research is needed to elucidate the underlying mechanisms.

Socioeconomic Disparities in Foods/Beverages and Nutrients Consumed by U.S. Adolescents When Snacking: National Health and Nutrition Examination Survey 2005-2018.

Snacking contributes a significant portion of adolescents’ daily energy intake and is associated with poor overall diet and increased body mass index. Adolescents from low socioeconomic status (SES) households have poorer snacking behaviors than their higher-SES counterparts. However, it is unclear if the types of food/beverages and nutrients consumed during snacking differ by SES among adolescents. Therefore, this study examines SES disparities in the aforementioned snacking characteristics by analyzing the data of 7132 adolescents (12–19 years) from the National Health and Nutrition Examination Survey 2005–2018. Results reveal that adolescents from low-income households (poverty-to-income ratio (PIR) ≤ 1.3) have lower odds of consuming the food/beverage categories “Milk and Dairy” (aOR: 0.74; 95% CI: 0.58-0.95; p = 0.007) and “Fruits” (aOR: 0.62, 95% CI: 0.50–0.78; p = 0.001) as snacks and higher odds of consuming “Beverages” (aOR: 1.45; 95% CI: 1.19-1.76; p = 0.001) compared to those from high-income households (PIR > 3.5). Additionally, adolescents from low- and middle-income (PIR > 1.3–3.5) households consume more added sugar (7.98 and 7.78 g vs. 6.66 g; p = 0.012, p = 0.026) and less fiber (0.78 and 0.77 g vs. 0.84 g; p = 0.044, p = 0.019) from snacks compared to their high-income counterparts. Future research is necessary to understand factors that influence snacking among adolescents, and interventions are needed, especially for adolescents from low-SES communities.

Income Disparities in Snacking Characteristics Among U.S. Adolescents 12 to 19 Years: National Health and Nutrition Examination Survey 2005–2018

Abstract Objectives Adolescents from low-income homes are shown to consume energy-dense snacks. However, less is known about the nutrient composition of snacks and the types of foods/beverages consumed as snacks. The overall aim of this study is to examine income disparities in, 1) nutrients consumed from snacks and 2) food/beverages consumed as snacks, among a nationally representative sample of U.S. adolescents. Methods Adolescents (12–19 years) who participated in the National Health and Nutrition Examination Survey 2005–2018, had reliable Day 1 24-h diet recall data, and reported at least 1 snacking occasion were included in the analyses (n = 7132). Nutrient density (g or mg/100 kcal) of snacks was reported for the following: protein, total fat, saturated fat, carbohydrates, total sugar, added sugar, fiber, sodium. We also reported the proportion of adolescents that consume various foods/beverages as snacks, using What We Eat in America (WWEIA) categories. We examined disparities in the aforementioned snacking characteristics by household poverty-to-income ratio (PIR): low-income (PIR ≤ 1.3), middle-income (PIR &amp;gt; 1.3–3.5), and high-income (PIR &amp;gt; 3.5). Data were analyzed using multiple linear and logistic regression models, adjusting for age, sex, and race/ethnicity. Significance was set at P &amp;lt; 0.05. Results On average, adolescents consumed 185.35 kcal (9.30% of total energy intake) per snacking occasion. For every 100 kcals, adolescent consumed 2.02g protein, 2.87g total fat, 0.99g saturated fat, 17.16g carbohydrates, 10.62g total sugar, 1.69g added sugar, 0.88g fiber, and 120.11mg sodium. Adolescents from low-income homes consumed more energy (9.63%) and added sugar (1.76g) per 100 kcals than those from high-income homes (8.52%, 1.49g, respectively; P&amp;lt; 0.05). The top 3 WWEIA categories of snacks were Snacks &amp; Sweets (e.g., potato chips, cakes and pies; 73.3%), Beverages (51.9%), and Milk &amp; Dairy (25.0%). Compared to adolescents from low-income homes, those from high-income homes were more likely to consume Snacks &amp; Sweets (OR: 1.34, 95% CI: 1.05–1.71), but less likely to consume Beverages (OR: 0.69, 95% CI: 0.57–0.84). Conclusions Among U.S. adolescents, there exist income disparities in both the nutrient density of snacks and the types of foods/beverages consumed as snacks. Funding Sources N/A.

Trends and socioeconomic disparities in all-cause mortality among adults with diagnosed diabetes by race/ethnicity: a population-based cohort study - USA, 1997–2015

ObjectivesBy race/ethnicity and socioeconomic position (SEP), to estimate and examine changes over time in (1) mortality rate, (2) mortality disparities and (3) excess mortality risk attributed to diagnosed diabetes (DM).DesignPopulation-based...

Derivation and validation of a simple nomogram prediction model for all-cause mortality among middle-aged and elderly general population.

A simple clinical model that can predict all-cause mortality in the middle-aged and older adults in general population based on demographics and physical measurement indicators. The aim of this study was to develop a simple nomogram prediction model for all-cause mortality in middle-aged and elderly general population based on demographics and physical measurement indicators. This was a prospective cohort study. We used data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES), which included adults aged ≥40 years with mortality status updated through 31 December 2015. Cox proportional hazards regression, nomogram and least absolute shrinkage and selection operator (LASSO) binomial regression model were performed to evaluate the prediction model in the derivation and validation cohort. A total of 13,026 participants (6,414 men, mean age was 61.59±13.80 years) were included, of which 6,671 (3,263 men) and 6,355 (3,151 men) were included in the derivation cohort and validation cohort, respectively. During an average follow-up period of 129.23±9.62 months, 4,321 died. We developed a 9-item nomogram mode included age, gender, smoking, alcohol intake, diabetes, hypertension, marriage status, education and poverty to income ratio (PIR). The area under the curve (AUC) was 0.842 and had good calibration. Internal validation showed good discrimination of the nomogram model with AUC of 0.849 and good calibration. Application of the LASSO regression model in the validation cohort also revealed good discrimination (AUC =0.854) and good calibration. A time-dependent and optimism-corrected AUC value for the model showed no significant relationship with the change of follow-up time. A simple nomogram model, including age, gender, smoking, alcohol intake, diabetes, hypertension, marriage, education and PIR, could predict all-cause mortality well in middle-aged and elderly general population.

Poverty Status and Clustering of Cardiometabolic Risk Factors and Metabolic Syndrome among African Americans: Results from the National Health and Nutritional Examination Survey 2001-2006

Background: African Americans (AA) are disproportionally affected by cardiovascular disease as compared to other racial-ethnic groups. Exposure to adverse socioeconomic conditions may partially explain disparities in risk factors and prevalence and cardiovascular diseases for AA. We aim to study the impact of poverty status on metabolic syndrome (MetS) and its components among African Americans. Methods: We used data from the National Health and Nutritional Examination Survey (NHANES) cycles 2001-2006. We defined MetS using the Joint Scientific Definition as the presence of any 3/5 components: elevated blood pressure (BP), elevated triglycerides (TGL), lower high-density lipoprotein cholesterol (LDL), elevated fasting plasma glucose (FPG), and elevated waist circumference (WC). Poverty to income ratio (PIR) was categorized as below poverty (3) groups. We used multivariable survey-weighted logistic regression models to study the impact of poverty status of prevalence of MetS and its components among AA men and women. Results: Overall, the average aggregate prevalence of MetS among AA sample was 22% in our study with prevalence being 25% for women and 18% among men (p 3) (OR = 1.57, 95%CI = 1.00 - 2.46, p = 0.05) with no association observed among men (OR (PIR = 1) = 0.70, 95%CI = 0.43 - 1.19, p = 0.13). Further, similar associations were observed for individual components among women including: elevated waist circumference (OR = 2.04, 95%CI = 1.37, 3.01, p 3). No association of poverty status with MetS and its components were observed among AA men. Clustering of factors identified key groups that define MetS among women included WC. Conclusion: African American women living below poverty have a higher likelihood of having MetS and 4 of 5 individual components. Clustering of these factors differ across men and women and should be further explored as tools for clinical management. Main Points: 1) Metabolic syndrome remains an important public health burden among African Americans and shows disparities by socioeconomic status; 2) Women living below poverty were more likely to have MetS and associated components as compared to women living above poverty; 3) Clustering of components gave us snapshot of factors that should be considered to develop gender specific targeted health interventions for MetS among African Americans.

Opposing Consumption Trends for Sugar-Sweetened Beverages and Plain Drinking Water: Analyses of NHANES 2011-16 Data.

Background: Choosing water in place of sugar-sweetened beverages (SSB) can reduce added sugars while maintaining adequate hydration. The present goal was to examine 2011–16 time trends in SSB vs. water consumption across US population subgroups.Methods: Dietary intake data for 22,716 persons aged >4 years came from two 24-h dietary recalls in successive cycles of the National Health and Examination Survey (NHANES 2011–16). Water intakes (in mL/d) from plain water (tap and bottled) and from beverages (SSB and not-SSB) were the principal outcome variables. Intakes were analyzed by age group, income to poverty ratio (IPR), and race/ethnicity. Time trends by demographics were also examined.Results: SSB and water intakes followed distinct social gradients. Most SSB was consumed by Non-Hispanic Black and lower-income groups. Most tap water was consumed by Non-Hispanic White and higher-income groups. During 2011–16, water from SSB declined from 322 to 262 mL/d (p < 0.005), whereas plain water increased (1,011–1,144 mL/d) (p < 0.05). Groups aged <30 years reduced SSB consumption (p < 0.0001) but it was groups aged >30 years that increased drinking water (p < 0.001). Non-Hispanic White groups reduced SSB and increased tap water consumption. Non-Hispanic Black and lower income groups reduced SSB and increased bottled water, not tap.Conclusion: The opposing time trends in SSB and water consumption were not uniform across age groups or sociodemographic strata. Only the non-Hispanic White population reduced SSB and showed a corresponding increase in tap water. Lower-income and minority groups consumed relatively little plain drinking water from the tap.

Weathering in Detroit: Place, Race, Ethnicity, and Poverty as Conceptually Fluctuating Social Constructs Shaping Variation in Allostatic Load.

US population health inequity remains entrenched, despite mandates to eliminate it. To promote a public health approach of consequence in this domain, stakeholders call for moving from risk-factor epidemiology toward consideration of dynamic local variations in the physiological impacts of structured lived experience. Using a community-based, participatory research approach, we collected and analyzed a unique data set of 239 black, white, and Mexican adults from a stratified, multistage probability sample of three Detroit, Michigan, neighborhoods. We drew venous blood, collected saliva, took anthropometric measurements, and assayed specimens to measure allostatic load (AL), an indicator of stress-mediated biological dysregulation, linking participants' AL scores and survey responses. In a series of nested Poisson models, we regressed AL on socioeconomic, psychosocial, neighborhood, and behavioral stressors to test the hypothesis that race/ethnicity and poverty-to-income ratio (PIR) are conceptually fluctuating variables whose impacts on AL are sensitive to structured lived experience. White and Mexican Detroit participants with PIR < 1 have higher AL than counterparts nationally; black participants in Detroit and nationwide had comparable AL. Within Detroit, disparities by PIR were higher in whites than blacks, with no significant difference by PIR in Mexicans. The size of estimated effects of having PIR < 1 for whites is 58 percentage points greater than that of Mexicans and twice that of blacks. Structurally rooted unobserved heterogeneity bias threatens the validity of independent main effects interpretations of associations between race/ethnicity, socioeconomic characteristics, or place and health. One-size-fits-all analytic or policy models developed from the perspective of the dominant social group insufficiently address the experiences of diverse populations in specific settings and historical moments; nor do they recognize culturally mediated protective resources residents may have developed against material and psychosocial hardship.

Flavonoid Intakes in the US Diet Are Linked to Higher Socioeconomic Status and to Tea Consumption: Analyses of NHANES 2011–16 Data

Many of the health benefits of tea have been attributed to its flavonoid content. Tea consumption in US adults varies by socioeconomic status (SES). The present objective was to explore intakes of total flavonoids and flavonoid subclasses by participant sociodemographics and by patterns of tea consumption. The present analyses were based on 2 d of dietary recalls for 17,506 persons aged >9 y in the 2011-2016 NHANES. The What We Eat in America nutrient composition database was merged with the USDA Expanded Flavonoid database, which included total flavonoids and flavan-3-ols (including catechins), flavanones, flavonols, anthocyanidins, flavones, and isoflavones. Flavonoid intakes were compared by sex, age, race/ethnicity, education, and income-to-poverty ratio (IPR) in univariate analyses. Flavonoid intakes of children and adults were also compared by tea consumption status. Time trends in flavonoid intakes were also examined. Mean total flavonoid intake was 219mg/d, of which flavan-3-ols provided 174mg/d, or 79%. The highest total flavonoid intakes were found in adults aged 51-70y (293mg/d), non-Hispanic whites (251 mg/d) and in groups with college education (251mg/d) and higher income (IPR>3.5: 249mg/d) (P<0.001 for all). The socioeconomic gradient was significant for anthocyanidins, flavonols, and flavones (P<0.001 for all) but not for flavan-3-ols, and persisted across 3 cycles of NHANES. Adult tea consumers had higher intakes of total flavonoids (610mg/d compared with 141mg/d) and flavan-3-ols (542mg/d compared with 97.8mg/d) than did nonconsumers (P<0.001). Time trend analyses showed that both tea consumption and flavonoid intakes were unchanged from 2011 to 2016. Flavonoid intakes in children and adults in the NHANES 2011-16 sample were associated with higher SES and were largely determined by tea consumption. Studies of diet and disease risk need to take sociodemographic gradients and eating and drinking habits into account.

Association of Opioid Use With Cardiometabolic Disease Risk Factors: Evidence From the 2009-2018 National Health and Nutrition Examination Survey.

ObjectiveTo investigate the association between opioid drug use and cardiometabolic risk factors in an adult sample data acquired from the National Health and Nutrition Examination Survey (NHANES).MethodsA retrospective cross-sectional analysis was performed using the data from the NHANES for the period 2009-2018 provided by the Centers for Disease Control and Prevention (CDC), amounting to a total of N = 10,032 eligible participants. The data were analyzed to study the relationship between opioid drug use (dividing into four dichotomy groups: drug use (DU) group, illicit drug use (IDU) group, repeated drug use (RDU) group, and current drug use (CDU) group) and cardiometabolic disease risk factors (CDRF) (i.e., hypertension, abnormal triglyceride levels, low-level of high-density lipoproteins (HDLs), high waist circumference, insulin resistance, serum cotinine levels, higher C-reactive protein, hypercholesterolemia, and increased BMI). The statistical correlation was evaluated using the chi-square analysis, and a p-value of less than 0.05 was considered statistically significant. Alcohol use, age, race, ethnicity, education level, and poverty to income ratio (PIR) were analyzed as covariates. ResultsOverall, our analysis found that males were more likely than females (p ≤ 0.001) to have ever reported using drugs at least once in their lifetime. In fact, males were more likely than females to report ever using cocaine (p = 0.01), heroin (p = 0.01), and marijuana (p = 0.01). Additionally, males were significantly more likely than females to disclose the current use of illicit drugs (p = 0.002), and also tend to have consumed more with at least 12 alcoholic beverages per year (p < 0.001). Overall, we found no association between substance use and having a cluster of three or more CDRF variables for both males and females.ConclusionStudy results highlight the prevalence of gender differences in DU and its reporting. With the rising popularity of illicit drugs, clinicians must be aware of its association with CDRF.

1546-P: Complex Relationships between Income, Food Insecurity, Dietary Behaviors, and A1C in U.S. Adults with Diagnosed Diabetes: NHANES, 2007-2014

In people with diagnosed diabetes (DM), pathways between income, diet, and glycated hemoglobin levels (A1c) are unclear. Performing mediation analysis using structural equation modeling, we investigated cross-sectional total effects (direct + indirect effects), shown as standardized coefficients in this conceptual model of household poverty-to-income ratio (PIR), household food insecurity (FI), and individual consumer-related dietary behavior [# of meals prepared away from home (#meals) and % of #meals from fast food/pizza place (%FFpizza) in last 7 days] associated with A1c (Figure). Data from 2,343 participants aged ≥21 years with DM in 2007-2014 National Health and Nutrition Examination Survey were used. Among U.S. adults with DM; 43% had PIR&amp;lt;200%, 16% were FI, and 42% and 37%, respectively, reported ≥3 #meals and more than 50% %FFpizza. Greatest absolute magnitude of association was PIR with FI (-0.41), which was more than 1.5 times greater than next largest, PIR with #meals (0.25). Only FI (0.11) and #meals (0.07) had significant total effect with A1c. Though #meals had a positive total effect on %FFpizza, %FFpizza had no significant total effect on A1c. Complex relationships between PIR, FI, #meals, and %FFpizza in adults with DM suggest the need for a better understanding of dietary behaviors that can influence healthier options for better DM management. Disclosure C. Mercado: None. S. Saydah: None. K.M. Bullard: None. K.R. Siegel: None. G. Imperatore: None.

Association of Ready-to-Eat Cereal Consumption with Nutrient and Food Group Intake and Diet Quality by Income Status Among Children, NHANES 2013–2016

Abstract Objectives Ready-to-eat (RTE) cereal is an important source of nutrients and whole grains in the diet of children and is associated with higher diet quality. Socioeconomic status is also strongly associated with nutrient intake and diet quality in the US. The objective of this study was to characterize the association between RTE cereal consumption and nutrient and food group intake and diet quality in US children ages 2 to 18 years stratified by their household income status. Methods Children age 2 to 18 years (N = 5658) in two cycles (2013–2014 and 2015–2016) of the National Health and Nutrition Examination Survey, a US nationally representative cross-sectional study, were categorized as RTE cereal eaters or non-eaters based on one day 24-hour dietary recall. Children were further stratified by their household income status according to the poverty-to-income ratio (PIR), as low-income (PIR ≤ 1.85), mid-income (PIR &amp;gt; 1.85 to &amp;lt;3.50) or high-income (PIR ≥ 3.50). Nutrient intakes, food group intake, and diet quality were compared between RTE cereal eaters and non-eaters in each income category using t-tests. Results More children in the low-income group were RTE cereal eaters (52%) compared to children in the mid-income (24%) and high-income (23%) groups. RTE cereal eaters, compared to non-eaters, in the low-income group had higher intakes of calcium (23% higher), vitamin D (85%), potassium (9%), fiber (12%), iron (71%), magnesium (11%), vitamin A (66%), and vitamin C (21%) (P &amp;lt; 0.05 for all). Conversely, only intakes of vitamin D (59% higher), iron (56%) and vitamin A (39%) were significantly higher in RTE cereal eaters than non-eaters from the high-income group (P &amp;lt; 0.05 for all). Cereal eaters also had higher intake of several key food groups including total dairy, fluid milk, and whole grains in all groups (P &amp;lt; 0.05 for all). Lastly, diet quality was significantly higher among RTE cereal eaters, compared to non-eaters, in the low- and mid-income groups (P &amp;lt; 0.05 for both) but not the high-income group. Conclusions RTE cereal is a popular, affordable food that provides under-consumed nutrients and food groups and is associated with increased diet quality particularly among low-income children. Funding Sources This study was funded by the Bell Institute of Health and Nutrition, General Mills, Inc.