title: Low-income Supplemental Nutrition Assistance Program participation is related to adiposity and metabolic risk factors.
abstract: BACKGROUND
  The Supplemental Nutrition Assistance Program (SNAP) is the largest federal nutrition assistance program. In recent years, SNAP participation rates increased during times of economic hardship.
  
  
  OBJECTIVE
  We examined whether household SNAP participation was associated with adiposity and metabolic risk factors in a representative sample of low-income US adults.
  
  
  METHODS
  A cross-sectional analysis was performed with the use of data from the 2003-2006 National Health and Nutrition Examination Surveys. The study population was restricted to nonelderly adults whose household incomes fell to or <130% of the federal poverty level. Multinomial logistic and Poisson regression models were fit to examine the associations between SNAP participation and BMI, waist circumference, and metabolic risk factors among 2250 low-income adults.
  
  
  RESULTS
  In the previous 12 mo, 32.8% of adults received household SNAP benefits. SNAP participation was positively associated with obesity [prevalence ratio (PR): 1.58; 95% CI: 1.08, 2.31], waist circumference in men (PR for top compared with bottom quartile: 2.04; 95% CI: 1.15, 3.62; P = 0.02), and waist circumference in women (PR: 2.95; 95% CI: 1.51, 5.77; P = 0.003; P-interaction with sex = 0.11), independent of sociodemographic characteristics. SNAP participation was also related to elevated triglycerides (PR: 1.71; 95% CI: 1.33, 2.20), lower HDL cholesterol (PR: 1.23; 95% CI: 1.08, 1.41), elevated fasting glucose (≥110 mg/dL; PR: 1.63; 95% CI: 1.05, 2.52), and metabolic syndrome (PR: 1.49; 95% CI: 1.13, 1.95). Associations with triglycerides and HDL cholesterol persisted after adjustment for BMI.
  
  
  CONCLUSIONS
  Household SNAP participation was positively associated with BMI, waist circumference, and metabolic risk factors among low-income adults. These associations may be mediated by dietary intake and warrant further investigation.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA. cleung@hsph.harvard.edu
authors.forename: Cindy W
authors.initials: CW
authors.lastname: Leung
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.forename: Eric L
authors.initials: EL
authors.lastname: Ding
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D005522:Food Services / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D009749:Nutrition Surveys; D009765:Obesity / Q000097:blood / Q000453:epidemiology*; D011203:Poverty; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012946:Social Welfare; D014280:Triglycerides / Q000097:blood; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D014280:Triglycerides