Abstract P656: Household Food Insecurity is Adversely Associated With Ideal Cardiovascular Health in US Adults: An Updated Analysis Using the American Heart Association’s New Life’s Essential 8 Measure
Authors: Leung Cindy W , Wolfson Julia A , Rimm Eric B 
Published: March 2023

Introduction:
Food insecurity, a condition of limited household food availability due to insufficient resources, is a critical social determinant of health. Food insecurity increases the risks for poor physical, behavioral, and mental health outcomes. Cardiovascular disease remains the leading cause of mortality in the US, and adults with food insecurity may face a high burden of cardiovascular disease risk. This study aimed to examine the associations between household food security status and ideal cardiovascular health (CVH), defined using the American Heart Association (AHA)’s new Life’s Essential 8 measure. We hypothesized that greater severity of food insecurity will be associated with lower overall cardiovascular health.

Methods:
Data came from 14,619 adults ≥20 years from the 2013-2018 National Health and Nutrition Examination Surveys. Food security was measured using the 18-item Household Food Security Survey Module, and categorized into households with high, marginal, low, and very low food security. Per AHA criteria, ideal CVH was calculated as scores (0-100) indicating the attainment of standards for diet, physical activity, smoking, sleep, body mass index, blood lipids, blood glucose, and blood pressure. Overall CVH was calculated as the unweighted average score across the eight metrics and overall average CVH score ≥80 was considered high CVH. We used linear and logistic regression models to examine the associations between household food security and ideal CVH outcomes, adjusting for sociodemographic characteristics. Complex survey weights were applied to all analyses.

Results:
In the sample, 72.7% of adults had high food security, 10.0% had marginal food security, 10.4% had low food security, and 6.8% had very low food security. The mean overall CVH score was 68.8 (SE 0.3), ranging from 70.2 (SE 0.3) for high food security to 62.7 (SE 1.8) for very low food security. After multivariate adjustment, marginal food security (β= -1.5, 95% CI -2.9, -0.1), low food security (β= -3.0, 95% CI -4.4, -1.7), and very low food security (β= -4.7, 95% CI -6.4, -3.0) were each associated with lower overall CVH scores when compared to high food security (
P-trend<0.0001
). These associations were driven by lower mean scores for diet, tobacco, sleep, BMI, and blood glucose with greater severity of food insecurity (
P-trends<0.05
). Furthermore, low food security (OR 0.57, 95% CI 0.45, 0.74) and very low food security (OR 0.52, 95% CI 0.37, 0.73) were both associated with lower odds of high CVH. Results remained significant in sensitivity analyses restricting the sample to adults with family incomes ≤300% of the federal poverty level.

Discussion:
Household food insecurity was adversely associated with cardiovascular health metrics in a dose-response fashion. Public health interventions and policies should consider a holistic approach to health promotion among populations with food insecurity.