title: Food insecurity is inversely associated with diet quality of lower-income adults.
abstract: Food insecurity acts as a chronic stressor independent of poverty. Food-insecure adults may consume more highly palatable foods as a coping mechanism, leading to poorer diet quality and increased risks of chronic disease over time. Using data from the 1999-2008 National Health and Nutrition Examination Surveys, this study aimed to examine the cross-sectional differences in dietary intake and diet quality by household food security among 8,129 lower-income adults (≤300% of the federal poverty level). Food insecurity was assessed using the 18-item US Household Food Security Survey Module. Dietary intake was assessed from 24-hour recalls and diet quality was measured using the Healthy Eating Index-2005 and the Alternate Healthy Eating Index-2010. Relative mean differences in dietary outcomes by household food security were estimated using linear regression models, adjusting for sociodemographic characteristics. Lower-income food-insecure adults reported higher consumption of some highly palatable foods, including high-fat dairy products (P trend<0.0001) and salty snacks (P trend=0.01) compared with lower-income food-secure adults. Food insecurity was also associated with more sugar-sweetened beverages (P trend=0.003); more red/processed meat (P trend=0.005); more nuts, seeds, and legumes (P trend=0.0006); fewer vegetables (P trend<0.0001); and fewer sweets and bakery desserts (P trend=0.0002). No differences were observed for intakes of total energy and macronutrients. Food insecurity was significantly associated with lower Healthy Eating Index-2005 (P trend<0.0001) and Alternate Healthy Eating Index-2010 scores (P trend<0.0001). Despite no macronutrient differences, food insecurity was associated with characteristics of poor diet quality known to increase chronic disease risk.
authors.forename: Cindy W
authors.initials: CW
authors.lastname: Leung
authors.forename: Elissa S
authors.initials: ES
authors.lastname: Epel
authors.forename: Lorrene D
authors.initials: LD
authors.lastname: Ritchie
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Crawford
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Laraia
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003611:Dairy Products / Q000032:analysis; D004032:Diet; D002149:Energy Intake; D007887:Fabaceae; D005247:Feeding Behavior; D005260:Female; D005523:Food Supply; D005638:Fruit; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009749:Nutrition Surveys; D009754:Nuts; D062410:Snacks; D012959:Socioeconomic Factors; D014675:Vegetables; D055815:Young Adult
keywords: Alternate Healthy Eating Index-2010; Dietary intake; Food insecurity; Healthy Eating Index-2005