title: Do U.S. adults living in food insecure households experience poorer cardiovascular health?
Creators: name: Sreedhara, Meera
name: Lopez-Cepero, Andrea
name: Rosal, Milagros C.
name: Lemon, Stephenie C.
Publisher: name: eScholarship@UMMS
Year: 2017

description: Background

Twelve percent of U.S. adults live in food insecure households, putting them at risk for adverse health outcomes. Relationships between food insecurity and cardiovascular disease (CVD) risk factors range from well-established to inconsistent and understudied. Food insecurity has been positively associated with poor glycemic control, tobacco use, and poor diet. The link with unhealthy body mass index (BMI) is only observed among women. Inconsistent evidence of relationships with hypertension and dyslipidemia has been found and literature examining physical activity is sparse. The relationships between food insecurity and overall cardiovascular health metrics have not been studied in a nationally representative sample of U.S. adults.

Objective

To quantify the extent to which food insecurity in U.S. adults is associated with poorer cardiovascular health, as measured by the Life Simple 7 metrics, and to assess gender differences in these associations.

Methods

This was a cross-sectional analysis of 1,446 National Health and Nutrition Examination Survey participants (2011-2012) aged >20 years. The United States Department of Agriculture Adult Food Security Module 10-item questionnaire assessed food insecurity status. Affirmative responses were summed and dichotomized as food secure (responses) or food insecure (>3). An ideal cardiovascular health score was generated from the sum of American Heart Association’s (AHA) Life’s Simple 7 metrics components achieved. The metrics included three health factors (blood glucose, cholesterol, and blood pressure) and four health behaviors (non-smoking, physical activity, healthy BMI, and healthy diet) as measured by laboratory values, anthropometric measures, self-reported questionnaires, and dietary recalls. Multiple linear and logistic regressions determined the associations between food insecurity and overall ideal cardiovascular health, defined as meeting all of the AHA Life Simple 7 metrics, and individual cardiovascular health components, respectively. The interaction between food insecurity and gender and ideal cardiovascular health was tested.

Results

No U.S. adults met all ideal cardiovascular health components. The 15.8% of adults living in food insecure households achieved a lower ideal cardiovascular health score (adjusted β coefficient: -0.27; 95% Confidence Interval (CI): [-0.50 to -0.04]) than adults living in food secure households. Tests for gender interaction were non-significant. In analyses assessing individual cardiovascular health components, only smoking was significant; adults living in food insecure households were half as likely to be non-smokers or recent quitters relative to their food secure counterparts (adjusted Odds Ratio 0.51; 95% CI: [0.31-0.81]).

Conclusion

Adults living in food insecure households achieved a lower ideal cardiovascular health score, which was driven by its association with smoking status. In addition to primary and secondary prevention, primordial prevention and cardiovascular health promotion approaches are necessary to reduce CVD burden. Effective policies and health behavior interventions are prudent, specifically to improve diet quality among all U.S. adults and tobacco cessation within food insecure populations.