title: Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999-2002.
abstract: BACKGROUND
  Food insecurity refers to limited or uncertain access to food resulting from inadequate financial resources. There is a clear association between food insecurity and obesity among women, but little is known about the relationship between food insecurity and type 2 diabetes.
  
  
  OBJECTIVE
  To evaluate whether there is an independent association between food insecurity and diabetes.
  
  
  METHODS
  Cross-sectional analysis of the nationally representative, population-based National Health and Nutrition Examination Survey (1999-2002 waves).
  
  
  METHODS
  Four thousand four hundred twenty-three adults > 20 years of age with household incomes < or = 300% of the federal poverty level.
  
  
  METHODS
  We categorized respondents as food secure, mildly food insecure, or severely food insecure using a well-validated food insecurity scale. Diabetes was determined by self-report or a fasting serum glucose > or = 126 mg/dl.
  
  
  RESULTS
  Diabetes prevalence in the food secure, mildly food insecure, and severely food insecure categories was 11.7%, 10.0%, and 16.1%. After adjusting for sociodemographic factors and physical activity level, participants with severe food insecurity were more likely to have diabetes than those without food insecurity (adjusted odds ratio [AOR] 2.1, 95% CI 1.1-4.0, p = .02). This association persisted after further adjusting for body mass index (AOR 2.2, 95% CI 1.2-3.9, p = .01).
  
  
  CONCLUSIONS
  Food insecurity may act as a risk factor for diabetes. Among adults with food insecurity, increased consumption of inexpensive food alternatives, which are often calorically dense and nutritionally poor, may play a role in this relationship. Future work should address how primary care clinicians can most effectively assist patients with food insecurity to make healthy dietary changes.
authors: Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA. hseligman@medsfgh.ucsf.edu
authors: Hilary K
authors: HK
authors: Seligman
authors: Andrew B
authors: AB
authors: Bindman
authors: Eric
authors: E
authors: Vittinghoff
authors: Alka M
authors: AM
authors: Kanaya
authors: Margot B
authors: MB
authors: Kushel
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000523:psychology*; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D005502:Food / Q000191:economics*; D006306:Health Surveys; D006801:Humans; D006815:Hunger; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D009765:Obesity / Q000191:economics* / Q000523:psychology; D011203:Poverty / Q000191:economics / Q000523:psychology*; D014481:United States