title: Food insecurity is associated with chronic disease among low-income NHANES participants.
abstract: Food insecurity refers to the inability to afford enough food for an active, healthy life. Numerous studies have shown associations between food insecurity and adverse health outcomes among children. Studies of the health effects of food insecurity among adults are more limited and generally focus on the association between food insecurity and self-reported disease. We therefore examined the association between food insecurity and clinical evidence of diet-sensitive chronic disease, including hypertension, hyperlipidemia, and diabetes. Our population-based sample included 5094 poor adults aged 18-65 y participating in the NHANES (1999-2004 waves). We estimated the association between food insecurity (assessed by the Food Security Survey Module) and self-reported or laboratory/examination evidence of diet-sensitive chronic disease using Poisson regression. We adjusted the models to account for differences in age, gender, race, educational attainment, and income. Food insecurity was associated with self-reported hypertension [adjusted relative risk (ARR) 1.20; 95% CI, 1.04-1.38] and hyperlipidemia (ARR 1.30; 95% CI, 1.09-1.55), but not diabetes (ARR 1.19; 95% CI, 0.89-1.58). Food insecurity was associated with laboratory or examination evidence of hypertension (ARR 1.21; 95% CI, 1.04-1.41) and diabetes (ARR 1.48; 95% CI, 0.94-2.32). The association with laboratory evidence of diabetes did not reach significance in the fully adjusted model unless we used a stricter definition of food insecurity (ARR 2.42; 95% CI, 1.44-4.08). These data show that food insecurity is associated with cardiovascular risk factors. Health policy discussions should focus increased attention on ability to afford high-quality foods for adults with or at risk for chronic disease.
authors.affiliation: Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA 94143, USA.
authors.forename: Hilary K
authors.initials: HK
authors.lastname: Seligman
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Laraia
authors.forename: Margot B
authors.initials: MB
authors.lastname: Kushel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics / Q000209:etiology; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000191:economics / Q000209:etiology*; D004032:Diet / Q000191:economics*; D005260:Female; D005523:Food Supply / Q000191:economics*; D006801:Humans; D006949:Hyperlipidemias / Q000191:economics / Q000209:etiology*; D006973:Hypertension / Q000191:economics / Q000209:etiology*; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000191:economics; D009749:Nutrition Surveys; D016017:Odds Ratio; D016012:Poisson Distribution; D011203:Poverty; D012307:Risk Factors; D014481:United States; D055815:Young Adult