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Ruggiero CF, Luo M, Zack RM, Marriott JP, Lynn C, Taitelbaum D, Palley P, Wallace AM, Wilson N, Odoms-Young A, Fiechtner L. Perceived Discrimination Among Food Pantry Clients in Massachusetts. Prev Chronic Dis 2024; 21:E70. [PMID: 39264857 PMCID: PMC11397217 DOI: 10.5888/pcd21.240009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2024] Open
Abstract
Introduction Food insecurity is defined as inconsistent access to enough food to meet nutritional needs. Discrimination is associated with food insecurity and poor health, especially among racial and ethnic minoritized and sexual or gender minoritized groups. We examined the demographic associations of perceived everyday discrimination and food pantry discrimination in Massachusetts. Methods From December 2021 through February 2022, The Greater Boston Food Bank conducted a cross-sectional, statewide survey of Massachusetts adults. Of the 3,085 respondents, 702 were food pantry clients for whom complete data on food security were available; we analyzed data from this subset of respondents. We used the validated 10-item Everyday Discrimination Scale to measure perceived everyday discrimination and a 10-item modified version of the Everyday Discrimination Scale to measure perceived discrimination at food pantries. Logistic regression adjusted for race and ethnicity, age, gender identity, sexual orientation, having children in the household, annual household income, and household size assessed demographic associations of perceived everyday discrimination and discrimination at food pantries. Results Food pantry clients identifying as LGBTQ+ were more likely than those identifying as non-LGBTQ+ to report perceived everyday discrimination (adjusted odds ratio [AOR] = 2.44; 95% CI, 1.24-4.79). Clients identifying as Hispanic (AOR = 1.83, 95% CI, 1.13-2.96) were more likely than clients identifying as non-Hispanic White to report perceived discrimination at food pantries. Conclusion To equitably reach and serve households with food insecurity, food banks and pantries need to understand experiences of discrimination and unconscious bias to develop programs, policies, and practices to address discrimination and create more inclusive interventions for food assistance.
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Affiliation(s)
- Cara F Ruggiero
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, Boston, Massachusetts
- Now with University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK CB2 0QQ
| | - Man Luo
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, Boston, Massachusetts
| | - Rachel M Zack
- Business and Data Analytics Department, The Greater Boston Food Bank, Boston, Massachusetts
| | - James P Marriott
- Business and Data Analytics Department, The Greater Boston Food Bank, Boston, Massachusetts
| | - Catherine Lynn
- Communcation and Public Affairs, The Greater Boston Food Bank, Boston, Massachusetts
| | - Daniel Taitelbaum
- Business and Data Analytics Department, The Greater Boston Food Bank, Boston, Massachusetts
| | - Paige Palley
- Human Resources and Diversity, Equity, and Inclusion, The Greater Boston Food Bank, Boston, Massachusetts
| | - Aprylle M Wallace
- Human Resources and Diversity, Equity, and Inclusion, The Greater Boston Food Bank, Boston, Massachusetts
| | - Norbert Wilson
- Duke Divinity School, Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Angela Odoms-Young
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, New York
| | - Lauren Fiechtner
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, Boston, Massachusetts
- Division of Pediatric Gastroenterology and Nutrition, Mass General for Children, Boston, Massachusetts
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Ruggiero CF, Trexberg KM, Moore AM, Savage JS. Applying the Family Stress Model to responsive feeding and early obesity prevention. Appetite 2024; 200:107515. [PMID: 38797237 PMCID: PMC11227407 DOI: 10.1016/j.appet.2024.107515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024]
Abstract
Rapid weight gain during infancy and obesity during early childhood may lead to adverse health outcomes during later childhood and into adulthood, especially in families experiencing economic hardship. Families experiencing economic hardship may also experience food insecurity, which can impact child development and responsive feeding, an important target for obesity prevention in early life. The Family Stress Model suggests that stress, particularly economic hardship, can negatively impact parents' mental health, parenting, and quality of family relationships. This review proposes a conceptual model that expands upon the original Family Stress Model by including parent-child dyadic interactions during feeding (i.e., responsive feeding) as well as the coparenting relationship around feeding. Our conceptual model integrates responsive feeding into the Family Stress Model and includes the impact of food insecurity on feeding and child health outcomes. Such models that consider multiple influences on child development have implications for the design of effective interventions to promote healthy growth for entire families. Future directions in this research will empirically test the model and explore early intervention strategies that aim to promote responsive feeding, nutrition security, and health within families. Continuing interdisciplinary research between the fields of nutrition and family development will be key to addressing the complex interplay of family stressors, parent responsiveness, and childhood obesity.
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Affiliation(s)
- Cara F Ruggiero
- Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA, 16802, USA; Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA
| | - Kaitlin M Trexberg
- Department of Human Development and Family Studies, The Pennsylvania State University, 119 Health and Human Development Building, University Park, PA, 16802, USA.
| | - Amy M Moore
- Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA, 16802, USA.
| | - Jennifer S Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA, 16802, USA; Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA.
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Laurentino JSL, Brito RCDS, de Oliveira-Silva RT, Soares A, Pereira TDC, de Lima EM, dos Santos ABMV, Palmeira PDA. Association between food insecurity and chronic noncommunicable diseases in Brazil: a systematic review. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27:e240041. [PMID: 39140578 PMCID: PMC11323874 DOI: 10.1590/1980-549720240041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/18/2024] [Accepted: 05/07/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE To analyze the association of food insecurity (FI) with chronic noncommunicable diseases (NCDs) in the Brazilian context. METHODS The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). The searches were conducted in LILACS and PubMed databases (September/2022). Observational studies carried out in the Brazilian population published since 2003 were included, in which: (1) the association of FI with NCDs was analyzed; and (2) the Brazilian Food Insecurity Scale was used. Studies on pregnant women and those that associated FI with cancer, sexually transmitted infections, and musculoskeletal and respiratory diseases were excluded. The studies were subjected to methodological quality assessment. RESULTS A total of 27 cross-sectional studies were included; nine used secondary data from national surveys, and the others used primary data. An association between FI and overweight and obesity in different age groups was verified in the studies. CONCLUSION The included articles did not produce evidence on other NCDs of interest to health in Brazil such as diabetes and high blood pressure. However, they corroborate the already-known relationship between obesity and FI. Studies on the topic, with a longitudinal design, should be encouraged.
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Affiliation(s)
| | | | | | - Amanda Soares
- Universidade Federal do Rio Grande do Norte, Graduate Program in Public Health – Natal (RN), Brazil
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4
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Ban KF, Hazzard VM, Zickgraf HF, O'Connor SM. Examining measurement invariance of appetitive trait and ARFID symptom measures by food security status. Appetite 2024; 197:107304. [PMID: 38467192 PMCID: PMC11089937 DOI: 10.1016/j.appet.2024.107304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE Measures assessing appetitive traits (i.e., individual differences in the desire to consume food) and disordered eating have generally been developed in predominantly food-secure populations. The current study aims to test measurement invariance (MI) for a measure of appetitive traits and a measure of Avoidant Restrictive Food Intake Disorder (ARFID) symptomology across food security status. METHOD Data from a sample of mothers (n = 634) and two undergraduate samples (n = 945 and n = 442) were used to assess MI for the Adult Eating Behavior Questionnaire (AEBQ), which measures appetitive traits, and the Nine Item ARFID Screen (NIAS), which measures ARFID symptomology. Current food security was assessed using the 18-item USDA Household Food Security Survey Module, which was dichotomized into two groups: 1) the 'food insecure' group included marginal, low, and very low food security and 2) the 'food secure' group included high food security. Overall and multi-group confirmatory factor analyses were conducted separately for each measure in each sample. RESULTS Results demonstrated scalar (i.e., strong) MI for both measures across samples, indicating that these measures performed equivalently across food-secure and food-insecure individuals. CONCLUSION Findings suggest that differences in appetitive traits by food security status observed in prior research are not artifacts of measurement differences, but instead reflect true differences. Additionally, past mixed results regarding the relationship between food insecurity (FI) and ARFID symptomology are not likely driven by measurement error when using the NIAS.
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Affiliation(s)
- Kaoon Francois Ban
- Department of Psychology, Montclair State University, Montclair, NJ, USA
| | - Vivienne M Hazzard
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Hana F Zickgraf
- Department of Psychology, University of South Alabama, Mobile, AL, USA; Research Center, Rogers Behavioral Health, Oconomowoc, WI, USA
| | - Shannon M O'Connor
- Department of Psychology, Montclair State University, Montclair, NJ, USA.
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Almohamad M, Dave JM, Calloway EE, Li R, Sharma S. Relationship between Food Security, Nutrition Security, and Diabetes: The Role of Supplemental Nutrition Assistance Program Participation. Curr Dev Nutr 2024; 8:102153. [PMID: 38693968 PMCID: PMC11061707 DOI: 10.1016/j.cdnut.2024.102153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 05/03/2024] Open
Abstract
Background Inadequate nutrition and poor diet quality are associated with a heightened risk of diabetes. The connection between food insecurity measures and diabetes has been established, with evidence indicating that Supplemental Nutrition Assistance Program (SNAP) participation contributes to reductions in food insecurity. Recently developed nutrition security measures, defined as the ability to acquire healthful foods to prevent diseases, and their association with diabetes and SNAP participation are not yet understood. Objectives This study aimed to assess the relationship between food security and nutrition security in relation to diabetes overall and by SNAP participation and nutrition security as potential modifiers. Methods Secondary data analysis of cross-sectional pilot study data collected from adults in 5 US states (N = 517). Logistic regression mixed models included moderation analysis and clustering effects by state to address site-level confounding. Results Higher nutrition security scores among adults, after adjusting for confounders, were significantly associated with lower odds of diabetes risk (adjusted odds ratio = 0.59; 95% confidence interval: 0.40, 0.87; P value = 0.008). Statistically significant interaction effect of differences according to SNAP participation was observed for nutrition security (Phomogeneity/interaction = 0.021), adjusting for age, gender, race/ethnicity, education, employment, National School Lunch Program, Special Supplemental Nutrition Program for Women, Infants, and Children, food pantry use, household with children, survey mode, and food security. The association between food security and diabetes was not statistically significant overall. However, statistically significant interaction effect of differences according to SNAP participation was observed for food security (Phomogeneity/interaction = 0.047). Further, no interaction effect of differences in nutrition security was found between food security and self-reported diabetes/prediabetes (Phomogeneity/interaction = 0.250). Conclusions This study sheds light on the early exploration of the intricate relationship between nutrition security and diabetes. The findings suggest that a higher nutrition security score, after adjusting for confounders, was significantly associated with lower odds of diabetes risk. Notably, there were statistically significant interaction effects in these associations based on SNAP participation.
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Affiliation(s)
- Maha Almohamad
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
| | - Jayna M Dave
- US Department of Agriculture/ Agricultural Research Service Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Eric E Calloway
- Gretchen Swanson Center for Nutrition, Omaha, NE, United States
| | - Ruosha Li
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
| | - Shreela Sharma
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
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Kim D, Perumpail BJ, Cholankeril G, Ahmed A. Association between food insecurity and metabolic dysfunction-associated steatotic liver disease/significant fibrosis measured by fibroscan. Eur J Nutr 2024; 63:995-1001. [PMID: 38260997 DOI: 10.1007/s00394-024-03327-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE Studies evaluating food insecurity and metabolic dysfunction-associated steatotic liver disease (MASLD) and significant hepatic fibrosis are currently scarce. We evaluated the characteristics of food insecure individuals and whether food insecurity was associated with MASLD and significant hepatic fibrosis in the US population. METHODS In this cross-sectional study from the National Health and Nutrition Examination Survey 2017-2018, 3441 participants with complete data were enrolled. We defined MASLD and significant hepatic fibrosis (≥ F2) by transient elastography in the absence of other causes of liver disease. The detailed questionnaire assessed and categorized food security as high, marginal, low, and very low food security. RESULTS Food-insecure subjects were more likely to be female, younger, more impoverished, non-Hispanic blacks, Hispanics, and less likely to be educated, married, and physically active. Food insecurity increased the odds of the prevalence of MASLD by 42% (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.12-1.78) after adjustment for demographic, lifestyle, and metabolic risk factors. The addition of diabetes and obesity did not change this association (OR: 1.36, 95% CI: 1.03-1.78). The multivariable model showed an independent relationship between food insecurity and significant hepatic fibrosis (OR: 1.40, 95% CI: 1.04-1.88) after adjustment for demographic, lifestyle, and metabolic risk factors, although the association was attenuated and changed insignificantly after adjustment for diabetes and obesity. CONCLUSIONS Food insecurity was associated with higher odds for MASLD. While there is a relationship between food insecurity and significant hepatic fibrosis, this relationship changed insignificantly after adjustment of diabetes and obesity.
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Affiliation(s)
- Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94304, USA.
| | - Brandon J Perumpail
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - George Cholankeril
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Liver Center, Division of Abdominal Transplantation, Michael E DeBakey Department of General Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94304, USA
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Whitehouse CR, Akyirem S, Petoskey C, Huang S, Lendvai D, Batten J, Whittemore R. A Systematic Review of Interventions That Address Food Insecurity for Persons With Prediabetes or Diabetes Using the RE-AIM Framework. Sci Diabetes Self Manag Care 2024; 50:141-166. [PMID: 38545669 DOI: 10.1177/26350106241232649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
PURPOSE The purpose of this study is to systematically review interventions that address food insecurity for persons with prediabetes or type 2 diabetes using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. METHODS Six databases (OVIDMEDLINE, OVIDEMBASE, OVID APA PsycINFO, Web of Science, Cochrane Central Registry of Controlled Trials, and EBSCO CINAHL Complete) were searched through January 2023. Research team members independently performed screening of abstracts and full texts, data abstraction, and risk assessment. RESULTS In all, 3,139 unique citations were identified, and 20 studies met inclusion criteria. Interventions included medically tailored meals/groceries (n = 10) or produce prescriptions/vouchers (n = 10). Reach and effectiveness were the highest reported RE-AIM elements. Interventions reached a high-risk population via food banks, community-based outreach, and federally qualified health centers. A majority of participants identified as female, Black, or Hispanic/Latinx and were living below the federal poverty level. Most studies reported at least 1 diabetes outcome (ie, A1C, hypoglycemia, diabetes distress, diabetes self-management). Seventeen studies reported impact on A1C, with the majority reporting a decrease in A1C and 53% (9/17) of studies demonstrating a decrease over time. Self-management improved in 50% (3/6) of studies that evaluated this outcome. Self-efficacy improved in 40% (2/5) of studies, and improvements were seen in depressive symptoms/diabetes distress (4/7 studies) and quality of life (5/5 studies). Seven studies reported statistically significant improvements in food insecurity. CONCLUSION Food insecurity has been associated with higher risks and adverse clinical outcomes in adults with diabetes. Implementing interventions that address food insecurity among adults with or at risk for diabetes can enhance food security and clinically important diabetes-related outcomes. Additional research dedicated to the sustainability of interventions is needed.
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Affiliation(s)
| | | | | | - Shuyuan Huang
- NYU Rory Meyers College of Nursing, New York, New York
| | - Dora Lendvai
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Janene Batten
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, Orange, Connecticut
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Wilbrecht L, Lin WC, Callahan K, Bateson M, Myers K, Ross R. Experimental biology can inform our understanding of food insecurity. J Exp Biol 2024; 227:jeb246215. [PMID: 38449329 PMCID: PMC10949070 DOI: 10.1242/jeb.246215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Food insecurity is a major public health issue. Millions of households worldwide have intermittent and unpredictable access to food and this experience is associated with greater risk for a host of negative health outcomes. While food insecurity is a contemporary concern, we can understand its effects better if we acknowledge that there are ancient biological programs that evolved to respond to the experience of food scarcity and uncertainty, and they may be particularly sensitive to food insecurity during development. Support for this conjecture comes from common findings in several recent animal studies that have modeled insecurity by manipulating predictability of food access in various ways. Using different experimental paradigms in different species, these studies have shown that experience of insecure access to food can lead to changes in weight, motivation and cognition. Some of these studies account for changes in weight through changes in metabolism, while others observe increases in feeding and motivation to work for food. It has been proposed that weight gain is an adaptive response to the experience of food insecurity as 'insurance' in an uncertain future, while changes in motivation and cognition may reflect strategic adjustments in foraging behavior. Animal studies also offer the opportunity to make in-depth controlled studies of mechanisms and behavior. So far, there is evidence that the experience of food insecurity can impact metabolic efficiency, reproductive capacity and dopamine neuron synapses. Further work on behavior, the central and peripheral nervous system, the gut and liver, along with variation in age of exposure, will be needed to better understand the full body impacts of food insecurity at different stages of development.
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Affiliation(s)
- Linda Wilbrecht
- Department of Psychology, University of California, Berkeley, Berkeley, CA 94720-1650, USA
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Wan Chen Lin
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Kathryn Callahan
- Psychiatric Research Institute of Montefiore and Einstein, Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, NY 10461, USA
| | - Melissa Bateson
- Bioscience Institute, University of Newcastle, Newcastle upon Tyne, NE2 4HH, UK
| | - Kevin Myers
- Department of Psychology and Programs in Animal Behavior and Neuroscience, Bucknell University, Lewisburg, PA 17837, USA
| | - Rachel Ross
- Psychiatric Research Institute of Montefiore and Einstein, Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, NY 10461, USA
- Department of Psychiatry, Montefiore Medical Center, Bronx, New York, NY 10467, USA
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Zinga J, van der Pligt P, Lindberg R, Vasilevski V, Lee A, McKay F. Food insecurity screening procedures used in reproductive healthcare settings. Nutr Rev 2023; 82:76-89. [PMID: 37120152 DOI: 10.1093/nutrit/nuad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
CONTEXT Food insecurity is an important determinant of health and should be identified by clinicians during routine reproductive healthcare. The procedures used in reproductive healthcare settings to identify people experiencing food insecurity have not been fully researched. OBJECTIVE The objective of this study was to synthesize evidence from published studies that describe the procedures implemented by clinicians in healthcare settings to identify food insecurity in pregnant women, or women of reproductive age (15 years-49 years). DATA SOURCES Four databases were searched in April 2022 to identify studies that met the eligibility criteria. DATA EXTRACTION Studies that used tools that were both validated or newly developed were considered, as were studies that incorporated food insecurity screening as part of a multidomain screening tool. Two authors completed the screening, data extraction, and quality assessment independently. DATA ANALYSIS There were 1075 studies identified; after screening, 7 studies were included in the narrative synthesis, including studies relating to women who were pregnant or in the postpartum period; none of the included studies related to women in the preconception stage. Four screening tools were identified: 2- and 6-item tools specifically focused on food insecurity, a 58-item multidomain tool incorporating 4 food insecurity items, and a modified version of the 2-item tool. Methods of implementing screening varied across studies. Three described subsequent processes that supported food-insecure patients once identified. CONCLUSION Few published studies have investigated optimal screening tools and their implementation within reproductive healthcare settings to address food insecurity for this priority population group. Further research is required to determine: the optimal tool, preferable screening methods from the perspectives of both patients and clinicians, and potential strategies for implementation in countries outside of the United States. An additional evidence gap remains about referral pathways and appropriate supports for this population once food insecurity is identified. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022319687.
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Affiliation(s)
- Julia Zinga
- are with the School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
- are with the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
- are with the Nutrition and Dietetics Department, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Paige van der Pligt
- are with the School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- are with the Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
- is with the Department of Nutrition, Western Health, Footscray, Victoria, Australia
| | - Rebecca Lindberg
- are with the School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- are with the Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Vidanka Vasilevski
- are with the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
- is with the School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Amelia Lee
- are with the Nutrition and Dietetics Department, Royal Women's Hospital, Parkville, Victoria, Australia
- are with the School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Fiona McKay
- are with the School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
- are with the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
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Ganson KT, Pang N, Testa A, Jackson DB, Nagata JM. Food insecurity is associated with muscle dysmorphia symptomatology among a sample of Canadian adolescents and young adults. Body Image 2023; 47:101628. [PMID: 37738777 DOI: 10.1016/j.bodyim.2023.101628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
Prior research has documented the association between food insecurity and eating disorders, disordered eating behaviors, and body dissatisfaction. No known research has investigated whether food insecurity is associated with muscle dysmorphia symptomatology, which was the aim of this study. Data from 912 adolescents and young adults in Canada were analyzed. Linear regression analyses were used to determine the association between experiencing past year food insecurity and current muscle dysmorphia symptomatology. Among the sample, 15.7% reported experiencing any food insecurity. In regression analyses, food insecurity was significantly associated with greater overall muscle dysmorphia symptomatology and symptoms of Functional Impairment and Appearance Intolerance. Nearly one in five (18.5%) participants who reported food insecurity were at clinical risk for muscle-dysmorphia. Findings add to the growing literature on the adverse correlates of food insecurity and underscore the need for more research and intervention efforts to address the relationship between food insecurity and muscle dysmorphia symptomatology.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
| | - Nelson Pang
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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Hardin-Fanning F, Mensah KA, Sha S. Development and Psychometric Evaluation of a Food Resource Acceptability Questionnaire. West J Nurs Res 2023; 45:1035-1042. [PMID: 37772360 DOI: 10.1177/01939459231204288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
The stigma associated with food assistance is a significant barrier to resolution of food insecurity. Interventions and policies aimed at reducing food insecurity would benefit from the inclusion of strategies aimed at minimizing food assistance stigma. We developed the Food Resource Acceptability Questionnaire (FRAQ), a scale that measures the perceptions of stigma associated with food assistance. Qualitative interviews, modified Delphi technique, and exploratory factor analysis were used to develop and evaluate the 17-item scale. The FRAQ consists of two subscales (stigma and the belief that food is a basic right) to measure the likelihood of individuals perceiving food assistance as socially and culturally acceptable. Cronbach's alphas were 0.85, 0.80, and 0.89 for the Stigma subscale, Food as a Basic Right subscale, and the overall FRAQ, respectively. Additional research is needed to determine the applicability of the FRAQ in diverse populations.
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Affiliation(s)
- Frances Hardin-Fanning
- School of Nursing, University of Louisville, Louisville, KY, USA
- University of Louisville Research Foundation, Inc., Louisville, KY, USA
| | - Kofi Amoh Mensah
- School of Nursing, University of Louisville, Louisville, KY, USA
| | - Shuying Sha
- School of Nursing, University of Louisville, Louisville, KY, USA
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12
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Anderson B, Lehto E, Hardin-Fanning F, Hirst J, Storm J, Montgomery E, Hussain A, Caperell K. Establishing a Permanent Food Pantry in a Pediatric Emergency Department. Pediatrics 2023; 152:e2023061757. [PMID: 37697954 DOI: 10.1542/peds.2023-061757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 09/13/2023] Open
Abstract
Childhood food insecurity is associated with adverse health outcomes. Food pantries housed within healthcare facilities have the potential to reduce childhood food insecurity. An interdisciplinary team established a permanent food pantry in the pediatric emergency department of a metropolitan children's hospital. Members of the team included attending and resident physicians, nurse practitioners, nurses, patient care technicians, a volunteer coordinator, Prevention and Wellness staff, and environmental services staff. The development process, formative evaluation, and impact of the pantry during the first 15 months of use is described. Families presenting to the emergency department were notified of the food pantry and offered a bag of groceries. Data collected included number of adult and children in the household, age ranges of family members, and whether food was accepted. The food pantry provided aid to 2199 households from January 2021 to April 2022. Recipients of food assistance included 4698 children, 3565 adults, and 140 seniors. In addition, the interdisciplinary approach to the development process elucidated barriers to and facilitators of the project's success, thereby maximizing the food assistance outcome.
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Affiliation(s)
- Brit Anderson
- Norton Children's Medical Group affiliated with the University of Louisville School of Medicine Division of Pediatric Emergency Medicine, Louisville, Kentucky
| | - Elizabeth Lehto
- Norton Children's Medical Group affiliated with the University of Louisville School of Medicine Division of Pediatric Emergency Medicine, Louisville, Kentucky
| | | | - Joelle Hirst
- Norton Children's Hospital, Louisville, Kentucky
| | - Joy Storm
- Norton Children's Hospital, Louisville, Kentucky
| | | | - Amber Hussain
- Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Kerry Caperell
- Norton Children's Medical Group affiliated with the University of Louisville School of Medicine Division of Pediatric Emergency Medicine, Louisville, Kentucky
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13
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Fong JH. Risk Factors for Food Insecurity among Older Adults in India: Study Based on LASI, 2017-2018. Nutrients 2023; 15:3794. [PMID: 37686826 PMCID: PMC10490409 DOI: 10.3390/nu15173794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Food security is linked to the nutritional status and well-being of older adults. India is a rapidly aging nation that ranks highly on the 2022 Global Hunger Index. This paper examines the prevalence and risk factors of food insecurity in India's older population. METHODS We used data from the 2017-2018 Longitudinal Aging Study in India. The sample size was 31,532 adults aged 60 years and above. Food insecurity was measured using a four-item version of the Food Insecurity Experience scale. Multivariable logistic regressions using individual-level weights were implemented to assess the risk factors of food insecurity. RESULTS The prevalence of food insecurity was 10.5% in the weighted sample. Sociodemographic factors were important in explaining food insecurity. Older adults who were male, younger, lowly educated, socially disadvantaged, in rural areas, and outside the Northern region were most vulnerable to food insecurity, controlling for various confounders. Additionally, low economic status, no occupational pension, currently working, social isolation, physical impairment, functional disabilities, poor self-rated health, and arthritis were associated with an increased risk of food insecurity. CONCLUSIONS More active food assistance programs catering to older adults and a better provision of economic and social security are warranted to establish a food-secure environment for rapidly aging India.
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Affiliation(s)
- Joelle H Fong
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore 259771, Singapore
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14
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Osei Bonsu E, Afetor M, Munkaila L, Okwei R, Nachibi SU, Adjei BN, Frimpong E, Arimiyaw AW, Adu C, Peprah P. Association of food insecurity and sleep difficulty among 189,619 school-going adolescents: a study from the global in-school students survey. Front Public Health 2023; 11:1212254. [PMID: 37501946 PMCID: PMC10369053 DOI: 10.3389/fpubh.2023.1212254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction Adolescents' sleep disturbances are associated with chronic and dramatic physical, emotional, and mental development and school performance consequences. Although food insecurity could significantly contribute to these effects, few studies have explored the effect of food insecurity on sleep disturbances among adolescents. The study aimed to examine the relationship between adolescents' food insecurity and sleep disturbance. Methods Data on 189,619 adolescents were drawn from the cross-sectional global adolescent health surveys conducted between 2015 and 2018 in 35 countries and territories. Univariate and multivariable multinomial regression models were fitted to examine the hypothesized associations. Results Overall pooled prevalence of moderate [45.2% (95%CI = 43-47)] and severe [5.8% (95%CI = 5-6)] food insecurity levels were reported. About [52.6% (95%CI = 51-54)] moderate and [8.6% (95%CI = 8-9)] severe worry-induced sleep disturbances were found. Considering the fully adjusted multinomial logistic model, moderate food insecurity was significantly associated with moderate (AOR = 1.70 CI = 1.59-1.81; p < 0.0001) and severe (AOR = 1.63 CI = 1.42-1.87; p < 0.0001) sleep disturbances. Also, adolescents reporting severe levels of food insecurity had moderate (AOR = 1.88 CI = 1.68-2.11; p < 0.0001) and severe (AOR = 4.07 CI = 4.74-6.11; p < 0.0001) sleep disturbances. Females and those aged between 15 and 17 years and 18 or more were at higher risk of moderate and severe sleep disturbances in the context of food insecurity. Conclusion Reducing food insecurity could be an effective policy strategy for enhancing adolescent sleep quality.
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Affiliation(s)
- Emmanuel Osei Bonsu
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Maxwell Afetor
- Department of Health Information, Ho Polyclinic, Ghana Health Service, Accra, Ghana
| | - Lambongang Munkaila
- Department of Agribusiness and Applied Economics, North Dakota State University, Fargo, ND, United States
| | - Reforce Okwei
- Department of Geography, Miami University, Oxford, OH, United States
| | | | - Benjamin Noble Adjei
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eric Frimpong
- Audiology Unit, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abdul Wahid Arimiyaw
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Collins Adu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- Center for Social Research in Health, UNSW, Sydney, NSW, Australia
| | - Prince Peprah
- Social Policy Research Centre, UNSW, Sydney, NSW, Australia
- Centre for Primary Health Care and Equity, UNSW, Sydney, NSW, Australia
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15
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Gomez H, DiTosto JD, Niznik CM, Yee LM. Understanding Food Security as a Social Determinant of Diabetes-Related Health during Pregnancy. Am J Perinatol 2023; 40:825-832. [PMID: 34839467 PMCID: PMC9142759 DOI: 10.1055/s-0041-1740194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Gestational and pregestational diabetes during pregnancy are substantial and growing public health issues. Low-income individuals and individuals who identify as racial and ethnic minorities are disproportionately affected. Food security, which is defined as the degree to which individuals have capacity to access and obtain food, is at the center of nutritional resources and decisions for individuals with diabetes. While increasingly recognized as an important mediator of health disparities in the United States, food insecurity is understudied during pregnancy and specifically among pregnant individuals with diabetes, for whom the impact of food-related resources may be even greater. Previous research has suggested that food insecurity is associated with type 2 diabetes mellitus diagnoses and disease exacerbation in the general adult population. An emerging body of research has suggested that food insecurity during pregnancy is associated with gestational diabetes mellitus diagnoses and adverse diabetes-related outcomes. Additionally, food insecurity during pregnancy may be associated with adverse maternal and neonatal outcomes. Future research and clinical work should aim to further examine these relationships and subsequently develop evidence-based interventions to improve diabetes-related outcomes among pregnant individuals with food insecurity. The purpose of this article is to offer a working definition of food security, briefly review issues of food insecurity and diabetes, summarize research on food insecurity and diabetes-related pregnancy health, and discuss clinical recommendations and areas for future investigation. KEY POINTS: · Research on food insecurity and diabetes-related health is limited.. · The impact of food security on diabetes management and obstetric outcomes is likely significant.. · Future work to evaluate perinatal food security screening is warranted..
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Affiliation(s)
- Helen Gomez
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware
| | - Julia D. DiTosto
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charlotte M. Niznik
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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16
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Alhasan DM, Riley NM, Jackson II WB, Jackson CL. Food insecurity and sleep health by race/ethnicity in the United States. J Nutr Sci 2023; 12:e59. [PMID: 37252683 PMCID: PMC10214135 DOI: 10.1017/jns.2023.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 05/31/2023] Open
Abstract
Food insecurity, poised to increase with burgeoning concerns related to climate change, may influence sleep, yet few studies examined the food security-sleep association among racially/ethnically diverse populations with multiple sleep dimensions. We determined overall and racial/ethnic-specific associations between food security and sleep health. Using National Health Interview Survey data, we categorised food security as very low, low, marginal and high. Sleep duration was categorised as very short, short, recommended and long. Sleep disturbances included trouble falling/staying asleep, insomnia symptoms, waking up feeling unrested and using sleep medication (all ≥3 d/times in the previous week). Adjusting for socio-demographic characteristics and other confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95 % confidence intervals (95 % CIs) for sleep dimensions by food security. Among 177 435 participants, the mean age of 47⋅2 ± 0⋅1 years, 52⋅0 % were women, and 68⋅4 % were non-Hispanic (NH)-White. A higher percent of NH-Black (7⋅9 %) and Hispanic/Latinx (5⋅1 %) lived in very low food security households than NH-White (3⋅1 %) participants. Very low v. high food security was associated with a higher prevalence of very short (PR = 2⋅61 [95 % CI 2⋅44-2⋅80]) sleep duration as well as trouble falling asleep (PR = 2⋅21 [95 % CI 2⋅12-2⋅30]). Very low v. high food security was associated with a higher prevalence of very short sleep duration among Asian (PR = 3⋅64 [95 % CI 2⋅67-4⋅97]) and NH-White (PR = 2⋅73 [95 % CI 2⋅50-2⋅99]) participants compared with NH-Black (PR = 2⋅03 [95 % CI 1⋅80-2⋅31]) and Hispanic/Latinx (PR = 2⋅65 [95 % CI 2⋅30-3⋅07]) participants. Food insecurity was associated with poorer sleep in a racially/ethnically diverse US sample.
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Affiliation(s)
- Dana M. Alhasan
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | - Nyree M. Riley
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | | | - Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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17
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Alawode O, Humble S, Herrick CJ. Food insecurity, SNAP participation and glycemic control in low-income adults with predominantly type 2 diabetes: a cross-sectional analysis using NHANES 2007-2018 data. BMJ Open Diabetes Res Care 2023; 11:e003205. [PMID: 37220963 PMCID: PMC10230897 DOI: 10.1136/bmjdrc-2022-003205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/25/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Diabetes, characterized by elevated blood glucose levels, affects 13% of US adults, 95% of whom have type 2 diabetes (T2D). Social determinants of health (SDoH), such as food insecurity, are integral to glycemic control. The Supplemental Nutrition Assistance Program (SNAP) aims to reduce food insecurity, but it is not clear how this affects glycemic control in T2D. This study investigated the associations between food insecurity and other SDoH and glycemic control and the role of SNAP participation in a national socioeconomically disadvantaged sample. RESEARCH DESIGN AND METHODS Adults with likely T2D and income <185% of the federal poverty level (FPL) were identified using cross-sectional National Health and Nutrition Examination Survey (NHANES) data (2007-2018). Multivariable logistic regression assessed the association between food insecurity, SNAP participation and glycemic control (defined by HbA1c 7.0%-8.5% depending on age and comorbidities). Covariates included demographic factors, clinical comorbidities, diabetes management strategies, and healthcare access and utilization. RESULTS The study population included 2084 individuals (90% >40 years of age, 55% female, 18% non-Hispanic black, 25% Hispanic, 41% SNAP participants, 36% low or very low food security). Food insecurity was not associated with glycemic control in the adjusted model (adjusted OR (aOR) 1.181 (0.877-1.589)), and SNAP participation did not modify the effect of food insecurity on glycemic control. Insulin use, lack of health insurance, and Hispanic or another race and ethnicity were among the strongest associations with poor glycemic control in the adjusted model. CONCLUSIONS For low-income individuals with T2D in the USA, health insurance may be among the most critical predictors of glycemic control. Additionally, SDoH associated with race and ethnicity plays an important role. SNAP participation may not affect glycemic control because of inadequate benefit amounts or lack of incentives for healthy purchases. These findings have implications for community engaged interventions and healthcare and food policy.
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Affiliation(s)
- Oluwatobi Alawode
- Department of Obstetrics and Gynecology, Meharry Medical College, Nashville, Tennessee, USA
| | - Sarah Humble
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Cynthia J Herrick
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
- Department of Medicine, Division of Endocrinology, Metabolism, and Lipid Research, Washington University in St Louis, St Louis, Missouri, USA
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18
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Lin E, Wagner KJ, Trutner Z, Brinkman N, Koenig KM, Bozic KJ, Haynes AB, Jayakumar P. Association of Unmet Social Needs With Level of Capability in People With Persistent Knee Pain. Clin Orthop Relat Res 2023; 481:924-932. [PMID: 36735586 PMCID: PMC10097533 DOI: 10.1097/corr.0000000000002554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/19/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Musculoskeletal providers are increasingly recognizing the importance of social factors and their association with health outcomes as they aim to develop more comprehensive models of care delivery. Such factors may account for some of the unexplained variation between pathophysiology and level of pain intensity and incapability experienced by people with common conditions, such as persistent nontraumatic knee pain secondary to osteoarthritis (OA). Although the association of one's social position (for example, income, employment, or education) with levels of pain and capability are often assessed in OA research, the relationship between aspects of social context (or unmet social needs) and such symptomatic and functional outcomes in persistent knee pain are less clear. QUESTIONS/PURPOSES (1) Are unmet social needs associated with the level of capability in patients experiencing persistently painful nontraumatic knee conditions, accounting for sociodemographic factors? (2) Do unmet health-related social needs correlate with self-reported quality of life? METHODS We performed a prospective, cross-sectional study between January 2021 and August 2021 at a university academic medical center providing comprehensive care for patients with persistent lower extremity joint pain secondary to nontraumatic conditions such as age-related knee OA. A final 125 patients were included (mean age 62 ± 10 years, 65% [81 of 125] women, 47% [59 of 125] identifying as White race, 36% [45 of 125] as Hispanic or Latino, and 48% [60 of 125] with safety-net insurance or Medicaid). We measured patient-reported outcomes of knee capability (Knee injury and Osteoarthritis Outcome Score for Joint Replacement), quality of life (Patient-Reported Outcome Measure Information System [PROMIS] Global Physical Health and PROMIS Global Mental Health), and unmet social needs (Accountable Health Communities Health-Related Social Needs Survey, accounting for insufficiencies related to housing, food, transportation, utilities, and interpersonal violence), as well as demographic factors. RESULTS After controlling for demographic factors such as insurance status, education attained, and household income, we found that reduced knee-specific capability was moderately associated with experiencing unmet social needs (including food insecurity, housing instability, transportation needs, utility needs, or interpersonal safety) (standardized beta regression coefficient [β] = -4.8 [95% confidence interval -7.9 to -1.7]; p = 0.002 and substantially associated with unemployment (β = -13 [95% CI -23 to -3.8]; p = 0.006); better knee-specific capability was substantially associated with having Medicare insurance (β = 12 [95% CI 0.78 to 23]; p = 0.04). After accounting for factors such as insurance status, education attained, and household income, we found that older age was associated with better general mental health (β = 0.20 [95% CI 0.0031 to 0.39]; p = 0.047) and with better physical health (β = 0.004 [95% CI 0.0001 to 0.008]; p = 0.04), but effect sizes were small to negligible, respectively. CONCLUSION There is an association of unmet social needs with level of capability and unemployment in patients with persistent nontraumatic knee pain. This finding signals a need for comprehensive care delivery for patients with persistent knee pain that screens for and responds to potentially modifiable social risk factors, including those based on one's social circumstances and context, to achieve better outcomes. LEVEL OF EVIDENCE Level II, prognostic study.
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Affiliation(s)
- Eugenia Lin
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - K. John Wagner
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Zoe Trutner
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Niels Brinkman
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Karl M. Koenig
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Kevin J. Bozic
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Alex B. Haynes
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Prakash Jayakumar
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
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19
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Hallward L, Nagata JM, Testa A, Jackson DB, Ganson KT. Associations between gender identity, eating disorder psychopathology, and food insecurity among Canadian adolescents and young adults during the COVID-19 pandemic. Eat Behav 2023; 49:101723. [PMID: 37030063 DOI: 10.1016/j.eatbeh.2023.101723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/10/2023]
Abstract
There is a clear association between food insecurity and eating disorder (ED) psychopathology, mainly among samples in the United States and prior to the COVID-19 pandemic. However, Canadians experience food insecurity as well, which may have been heightened by the pandemic and its associated restrictions. The associations between food insecurity and ED psychopathology among Canadians remains underexamined. Therefore, the purpose of this study was to explore associations between food insecurity and ED psychopathology by gender identity among a national sample Canadian adolescents and young adults. Data were collected from 2714 participants aged 16 to 30 years old from across Canada. Participants reported sociodemographic characteristics, ED psychopathology, and food insecurity experienced during the COVID-19 pandemic through an online survey. Descriptive statistics, chi-square tests, ANOVAs, and regression analyses were conducted. Overall, 8.9% of the sample experienced food insecurity, with the highest prevalence among transgender and gender nonconforming individuals. Generally, those with no food insecurity reported the lowest ED psychopathology compared to higher ED psychopathology among those with food insecurity. Several unique differences were observed between cisgender men and cisgender women, while there were no significant associations between food insecurity and ED psychopathology found among transgender and gender nonconforming individuals. Further research is needed to investigate how the relationship between food insecurity and ED psychopathology differs based on gender, and to continue to explore food insecurity experienced beyond the COVID-19 pandemic as food insecurity possesses a considerable health threat to all.
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Affiliation(s)
- Laura Hallward
- School of Kinesiology, Western University, London, ON, Canada.
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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20
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Bidopia T, Carbo AV, Ross RA, Burke NL. Food insecurity and disordered eating behaviors in children and adolescents: A systematic review. Eat Behav 2023; 49:101731. [PMID: 37150094 PMCID: PMC10361576 DOI: 10.1016/j.eatbeh.2023.101731] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/09/2023]
Abstract
This study is the first systematic review to investigate the relationship between food insecurity (FI) and disordered eating behaviors exclusively in children and adolescents. Database searches were conducted in PUBMED, Embase, PsycINFO, ProQuest, and Gale OneFile: Informe Académico using English and Spanish search terms. Studies were included if they were published before August 2022, included youth aged 18 years and below, included either parent- or child-report of food security status, included either parent- or child-report of child disordered eating behaviors, and examined the relationship between food security status and child disordered eating behaviors. Following independent title/abstract and full-text screening, 20 studies were included in the review. There were 13 cross-sectional studies, five longitudinal studies, and two qualitative studies, from the United States (19 studies), and Bangladesh (1 study). Sample sizes ranged from 33 to 6077. Findings generally indicated a relationship between FI and behaviors such as binge eating, loss-of-control eating, eating in the absence of hunger, unhealthy weight control behaviors, and picky eating in children and adolescents, though this association varied depending on the type of disordered eating behavior assessed and FI severity. Results highlight the importance of screening for disordered eating behaviors among youth with FI towards eating disorder prevention and intervention. However, given the limited number of primary research articles examining this relationship in youth, further hypothesis-driven research is needed. In addition, more global representation and additional longitudinal studies are needed to further examine the generalizability and temporality of FI and disordered eating in children and adolescents.
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Affiliation(s)
- Tatyana Bidopia
- Department of Psychology, Fordham University, 441 East Fordham Road, Dealy Hall, Bronx, NY 10458, USA
| | - Alejandra Vivas Carbo
- Department of Psychiatry, Montefiore Medical Center, 3331 Bainbridge Ave, Bronx, NY 10467, USA
| | - Rachel A Ross
- Department of Psychiatry, Neuroscience and Medicine, Albert Einstein College of Medicine, 1410 Pelham Pkwy S, Bronx, NY 10461, USA
| | - Natasha L Burke
- Department of Psychology, Fordham University, 441 East Fordham Road, Dealy Hall, Bronx, NY 10458, USA.
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21
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Baxter SLK, Koob CE, Hossfeld CML, Griffin SF, Mobley C, Hossfeld LH. Food Insecurity, the Food Environment, and COVID-19 in Rural South Carolina. FAMILY & COMMUNITY HEALTH 2023; 46:128-135. [PMID: 36799946 PMCID: PMC9930688 DOI: 10.1097/fch.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
In this study, we explored the relationship between the food environment and food security among rural adults during the COVID-19 pandemic. Researchers, with assistance from community partners, conducted a cross-sectional survey assessing the impact of COVID-19 on food access, food security, and physical activity in 9 rural South Carolina (SC) counties. This survey was administered to a purposive sample (N = 587) from August 2020 to March 2021. The dependent variable was a binary indicator of food insecurity (past 3 months), in accordance with the USDA Household Food Security Survey Module. Independent variables were sociodemographic characteristics, food environment factors (eg, shopping at grocery stores, partial markets, and farmers' markets), and shopping behaviors during the pandemic. Overall, 31% of respondents were food insecure. Food security status differed by income and household composition. Results indicate that the odds of food insecurity were higher for respondents who shopped frequently at partial markets (adjusted odds ratio [AOR] = 1.61, 95% confidence interval [CI]: 1.01-2.56) and shopped more for food before the pandemic than during the pandemic (AOR = 1.68, 95% CI: 1.07-2.64). Findings underscore the importance of examining the relationship between the food environment and food insecurity during COVID-19 in rural settings.
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Affiliation(s)
- Samuel L. K. Baxter
- Public Health Science, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Baxter, Koob, Hossfeld and Griffin); Sociology, Athropology and Criminal Justice, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Mobley); and Dean of College of Behavioral, Social, and Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Hossfeld)
| | - Caitlin E. Koob
- Public Health Science, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Baxter, Koob, Hossfeld and Griffin); Sociology, Athropology and Criminal Justice, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Mobley); and Dean of College of Behavioral, Social, and Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Hossfeld)
| | - Cassius M. L. Hossfeld
- Public Health Science, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Baxter, Koob, Hossfeld and Griffin); Sociology, Athropology and Criminal Justice, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Mobley); and Dean of College of Behavioral, Social, and Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Hossfeld)
| | - Sarah F. Griffin
- Public Health Science, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Baxter, Koob, Hossfeld and Griffin); Sociology, Athropology and Criminal Justice, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Mobley); and Dean of College of Behavioral, Social, and Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Hossfeld)
| | - Catherine Mobley
- Public Health Science, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Baxter, Koob, Hossfeld and Griffin); Sociology, Athropology and Criminal Justice, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Mobley); and Dean of College of Behavioral, Social, and Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Hossfeld)
| | - Leslie H. Hossfeld
- Public Health Science, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Baxter, Koob, Hossfeld and Griffin); Sociology, Athropology and Criminal Justice, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Mobley); and Dean of College of Behavioral, Social, and Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina (Hossfeld)
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22
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Pengpid S, Peltzer K. Food insecurity and health outcomes among community-dwelling middle-aged and older adults in India. Sci Rep 2023; 13:1136. [PMID: 36670204 PMCID: PMC9859825 DOI: 10.1038/s41598-023-28397-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
The study assessed associations between food insecurity and mental, physical, and behavioural health outcomes in India. The study analysed national cross-sectional population-based data (N = 72,262; ≥ 45 years) from in India in 2017-2018. The overall prevalence of food insecurity was 9.7%. Food insecurity was significantly positively associated with poor mental health [low life satisfaction (AOR: 2.75, 95% CI 2.35-3.23), low self-reported health (AOR: 1.61, 95% CI 1.11-1.42), insomnia symptoms (AOR: 1.64, 95% CI 1.45-1.85), depressive symptoms (AOR: 2.21, 95% CI 1.97-2.48), major depressive disorder (AOR: 2.37, 95% CI 2.03-2.77), Alzheimer's/dementia (AOR: 1.75, 95% CI 1.13-2.69), and poorer cognitive functioning (AOR: 0.68, 95% CI 0.49-0.93)], poor physical health [bone or joint disease (AOR: 1.18, 95% CI 1.04-1.34), angina (AOR: 1.80, 95% CI 1.58-2.06), underweight (AOR: 1.28, 95% CI 1.16-1.40), chronic lung disease (AOR: 1.22, 95% CI 1.03-1.45), and functional disability (AOR: 1.68, 95% CI 1.47-1.92)], and health risk behaviour [tobacco use (AOR: 1.13, 95% CI 1.01-1.25), heavy episodic drinking (AOR: 1.45, 95% CI 1.10-1.91) and physical inactivity (AOR: 1.42, 95% CI 1.21-1.67)]. Furthermore, food insecurity was negatively associated with overweight/obesity (AOR: 0.80, 95% CI 0.73-0.88). Food insecurity was associated with seven poor mental health indicators, five poor physical health conditions, and three health risk behaviours. Programmes and policies that improve food availability may help improve mental and physical health among middle-aged and older adults in India.
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Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand.,Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand. .,Department of Psychology, University of the Free State, Bloemfontein, South Africa. .,Department of Psychology, College of Medical and Health Science, Asia University, Wufeng, Taichung, 41354, Taiwan.
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23
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Zierath R, Claggett B, Hall ME, Correa A, Barber S, Gao Y, Talegawkar S, Ezekwe EI, Tucker K, Diez-Roux AV, Sims M, Shah AM. Measures of Food Inadequacy and Cardiovascular Disease Risk in Black Individuals in the US From the Jackson Heart Study. JAMA Netw Open 2023; 6:e2252055. [PMID: 36689225 PMCID: PMC9871801 DOI: 10.1001/jamanetworkopen.2022.52055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/10/2022] [Indexed: 01/24/2023] Open
Abstract
Importance Food insecurity disproportionately affects Black individuals in the US. Its association with coronary heart disease (CHD), heart failure (HF), and stroke is unclear. Objective To evaluate the associations of economic food insecurity and proximity with unhealthy food options with risk of incident CHD, HF, and stroke and the role of diet quality and stress. Design, Setting, and Participants This cohort study was a time-to-event analysis of 3024 Black adult participants in the Jackson Heart Study (JHS) without prevalent cardiovascular disease (CVD) at visit 1 (2000-2004). Data analysis was conducted from September 1, 2020, to November 30, 2021. Exposures Economic food insecurity, defined as receiving food stamps or self-reported not enough money for groceries, and high frequency of unfavorable food stores (>2.5 unfavorable food stores [fast food restaurants, convenience stores] within 1 mile). Main Outcomes and Measures The main outcomes were incident CVD including incident CHD, stroke, and HF with preserved ejection fraction and with reduced ejection fraction (HFrEF). During a median follow-up of 13.8 (IQR, 12.8-14.6) years, the associations of measures of food inadequacy with incident CVD (CHD, stroke, and HF) were assessed using multivariable Cox proportional hazards regression models. Results Among the 3024 study participants, the mean (SD) age was 54 (12) years, 1987 (66%) were women, 630 (21%) were economically food insecure, and 50% (by definition) had more than 2.5 unfavorable food stores within 1 mile. In analyses adjusted for cardiovascular risk and socioeconomic factors, economic food insecurity was associated with higher risk of incident CHD (hazard ratio [HR], 1.76; 95% CI, 1.06-2.91) and incident HFrEF (HR, 2.07; 95% CI, 1.16-3.70), but not stroke. These associations persisted after further adjustment for diet quality and perceived stress. In addition, economic food insecurity was associated with higher high-sensitivity C-reactive protein and renin concentrations. High frequency of unfavorable food stores was not associated with CHD, HF, or stroke. Conclusions and Relevance The findings of this cohort study suggest that economic food insecurity, but not proximity to unhealthy food options, was associated with risk of incident CHD and HFrEF independent of socioeconomic factors, traditional cardiovascular risk factors, diet quality, perceived stress, and other health behaviors. Economic food insecurity was also associated with markers of inflammation and neurohormonal activation. Economic food insecurity may be a promising potential target for the prevention of CVD.
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Affiliation(s)
- Rani Zierath
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | - Sharrelle Barber
- Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Yan Gao
- University of Mississippi Medical Center, Jackson
| | - Sameera Talegawkar
- Milken Institute of Public Health at the George Washington University, Washington, DC
| | | | - Katherine Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell
| | - Ana V. Diez-Roux
- Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Mario Sims
- University of Mississippi Medical Center, Jackson
| | - Amil M. Shah
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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24
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Maudrie TL, Aulandez KMW, O'Keefe VM, Whitfield FR, Walls ML, Hautala DS. Food Stress and Diabetes-Related Psychosocial Outcomes in American Indian Communities: A Mixed Methods Approach. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:1051-1065. [PMID: 36244877 PMCID: PMC9742178 DOI: 10.1016/j.jneb.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Explore the relationship between diabetes-related psychosocial outcomes and food stress in American Indian communities. DESIGN Convergence model of a mixed methods triangulation study. SETTING Five American Indian reservation communities in the Midwest. PARTICIPANTS One-hundred ninety-two participants were randomly selected from tribal health centers using clinic patient records and were surveyed about diabetes distress, empowerment, and food stress across 4 different time points. Seventeen focus group discussions were conducted and transcribed, and a mix of purposive and convenience sampling was used. PHENOMENON OF INTEREST Psychosocial outcomes associated with (or related to) diabetes and food stress. ANALYSIS Quantitative: Multiple linear regression was performed to explore relationships between food stress and diabetes distress and empowerment. Qualitative: Open coding of data identified portions of the transcripts related to food followed by a deductive approach on the basis of the components of quantitative food stress. RESULTS Food stress in the forms of (1) not having enough money for food and not having enough time for cooking or shopping (P = 0.08) and (2) inadequate food access and being on a special diet (P = 0.032) were associated with increased diabetes distress. Lower diabetes empowerment was associated with not having enough money for food and being on a special diet (P = 0.030). Our qualitative data mirrored quantitative findings that experiencing multiple forms of food stress negatively impacted diabetes psychosocial outcomes and illuminated the cyclical role mental health can play in relationships to food. CONCLUSIONS AND IMPLICATIONS Our findings highlight that experiencing food stress negatively affects diabetes empowerment and diabetes distress. These findings emphasize the importance of improving community food environments and addressing individual food access for diabetes management and prevention initiatives in American Indian communities.
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Affiliation(s)
- Tara L Maudrie
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
| | - Kevalin M W Aulandez
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Victoria M O'Keefe
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | | | - Melissa L Walls
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Dane S Hautala
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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25
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Oldroyd L, Eskandari F, Pratt C, Lake AA. The nutritional quality of food parcels provided by food banks and the effectiveness of food banks at reducing food insecurity in developed countries: a mixed-method systematic review. J Hum Nutr Diet 2022; 35:1202-1229. [PMID: 35112742 PMCID: PMC9790279 DOI: 10.1111/jhn.12994] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/13/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Research indicates that food parcels provided by food banks are nutritionally poor. Food insecurity and the use of food banks are both rising, with detrimental effects on the dietary intake and health of users. This mixed-method systematic review aims to investigate the current nutritional adequacy of pre-packaged food parcels and whether using food banks reduces the food insecurity and improves the dietary intake of their users. METHODS A mixed-method systematic literature review, restricted to articles published from 2015, was conducted using eight electronic databases, four grey literature databases and eight relevant websites. Quantitative findings, investigating the nutritional quality of food parcels and/or their impact on dietary intake or food insecurity, were presented narratively. Qualitative findings reporting the views of food bank users regarding food from food banks underwent thematic synthesis. These independent syntheses were integrated using configurative analysis and presented narratively. RESULTS Of 2189 articles, 11 quantitative and 10 qualitative were included. Food parcels were inconsistent at meeting nutritional requirements and often failed to meet individual needs, including cultural and health preferences. Using food banks improved food security and dietary quality of users, allowing otherwise unachievable access to food. However, food insecurity remained, and is explained by limited food variety, quality and choice. The mixed-method findings support interventions to ensure consistent, adequate nutrition at food banks, including catering for individual needs. CONCLUSIONS Food banks are a lifeline for those severely food insecure. However when used alone, food banks struggle to eliminate the heightened food insecurity of their users. Efforts to improve the nutritional quality of food parcels could improve the experiences and diet-related outcomes of those requiring food banks.
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Affiliation(s)
- Lucy Oldroyd
- Centre for Public Health Research, School of Health & Life SciencesTeesside UniversityMiddlesbroughUK
| | - Fatemeh Eskandari
- Centre for Public Health Research, School of Health & Life SciencesTeesside UniversityMiddlesbroughUK,Fuse, The Centre for Translational Research in Public HealthNewcastleUK
| | - Charlotte Pratt
- Centre for Public Health Research, School of Health & Life SciencesTeesside UniversityMiddlesbroughUK
| | - Amelia A. Lake
- Centre for Public Health Research, School of Health & Life SciencesTeesside UniversityMiddlesbroughUK,Fuse, The Centre for Translational Research in Public HealthNewcastleUK
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26
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Bermúdez-Millán A, Feinn R, Hahn C, Jui SA, Berthold SM, Buckley T, Buxton O, Kong S, Kuoch T, Scully M, Wagner J. SNAP participation moderates the association between household food insecurity and HbA1c among Cambodian Americans with depression. ETHNICITY & HEALTH 2022; 27:1718-1731. [PMID: 34121523 PMCID: PMC8666460 DOI: 10.1080/13557858.2021.1939272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/28/2021] [Indexed: 05/31/2023]
Abstract
OBJECTIVES We tested whether participation in the Supplemental Nutrition Assistance Program (SNAP) moderated the relation between household food insecurity and HbA1c among Cambodian Americans with depression enrolled in a diabetes prevention trial. METHODS Community health workers assessed household food insecurity and SNAP participation. HbA1c was ascertained using direct enzymatic assay. RESULTS Among the n = 189 respondents, 19% were food insecure, 41% received SNAP benefits, and mean HbA1c = 5.5%. There was a significant interaction between SNAP and food insecurity. HbA1c was highest among participants without SNAP who were food insecure. Simple effects analysis revealed a significant difference within the no SNAP group [Mean (SD): Secure = 5.38 (0.38), Insecure = 5.78 (0.36)] and no difference within the SNAP group [Secure = 5.61(0.44), Insecure = 5.61(0.55)]. Differences remained significant after controlling for demographic, socioeconomic, and clinical indicators. CONCLUSIONS SNAP may protect against the deleterious association between household food insecurity and HbA1c.
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Affiliation(s)
- Angela Bermúdez-Millán
- Department of Public Health Sciences, School of Medicine, UConn Health, Program in Applied Public Health Sciences, Farmington, CT, USA
| | - Richard Feinn
- School of Medicine, Quinnipiac University, Hamden, CT, USA
| | - Chelsey Hahn
- Department of Public Health Sciences, School of Medicine, UConn Health, Program in Applied Public Health Sciences, Farmington, CT, USA
| | - Shanjida A Jui
- Department of Public Health Sciences, School of Medicine, UConn Health, Program in Applied Public Health Sciences, Farmington, CT, USA
| | - S Megan Berthold
- University of Connecticut, School of Social Work, Hartford, CT, USA
| | - Thomas Buckley
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Orfeu Buxton
- Elizabeth Fenton Susman Professor of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Sengly Kong
- Khmer Health Advocates, West Hartford, CT, USA
| | | | - Mary Scully
- Khmer Health Advocates, West Hartford, CT, USA
| | - Julie Wagner
- Department of Behavioral Sciences and Community Health, School of Dental Medicine, UConn Health, Farmington, CT, USA
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27
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Bridge G. Risk of Food Insecurity and Cardiometabolic Health-What Can Be Done? J Nutr 2022; 152:1805-1807. [PMID: 35732470 DOI: 10.1093/jn/nxac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/26/2022] [Accepted: 05/10/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gemma Bridge
- School of Earth and Environment, University of Leeds, Leeds, LS2 9JT, UK
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28
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Nikolaus CJ, Hebert LE, Zamora-Kapoor A, Sinclair K. Risk of Food Insecurity in Young Adulthood and Longitudinal Changes in Cardiometabolic Health: Evidence from the National Longitudinal Study of Adolescent to Adult Health. J Nutr 2022; 152:1944-1952. [PMID: 35285891 PMCID: PMC9361738 DOI: 10.1093/jn/nxac055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies have demonstrated relations between food insecurity, the lack of access to enough nutritious food, and greater risk of diet-sensitive chronic diseases. However, most prior evidence relies on cross-sectional studies and self-reported disease. OBJECTIVES The objective was to assess the longitudinal relation between risk of food insecurity in young adulthood and changes in diet-sensitive cardiometabolic health outcomes across 10 y among non-Hispanic white, non-Hispanic black, American Indian or Alaska Native, and Hispanic adults. METHODS Data from the fourth and fifth waves (n = 3992) of the National Longitudinal Study of Adolescent to Adult Health were used. Measures included risk of food insecurity, body weight, diabetes, and sociodemographic characteristics. Body weight and diabetes were assessed with direct measures. Mixed-effects models assessed the association of risk of food insecurity with BMI, obesity, and diabetes while accounting for sociodemographic characteristics and the complex survey design. RESULTS Risk of food insecurity was associated with increases in BMI as well as incidence of obesity and diabetes from young to middle adulthood in unadjusted and adjusted models (all P < 0.01). In models stratified by race and ethnicity, the relations of risk of food insecurity with body weight outcomes and diabetes varied. CONCLUSIONS Risk of food insecurity in young adulthood was related to BMI and obesity during young and middle adulthood but not in changes over time. Risk of food insecurity in young adulthood related to an increased incidence of diabetes in middle adulthood. However, the relations among specific racial and ethnic groups were unclear. Estimates of the relation between food insecurity and cardiometabolic health outcomes within racial and ethnic groups experiencing the highest prevalence of these conditions should be refined.
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Affiliation(s)
- Cassandra J Nikolaus
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Luciana E Hebert
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Anna Zamora-Kapoor
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
- Department of Sociology, Washington State University, Pullman, WA, USA
| | - Ka`imi Sinclair
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
- College of Nursing, Washington State University, Spokane, WA, USA
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29
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Ziso D, Chun OK, Puglisi MJ. Increasing Access to Healthy Foods through Improving Food Environment: A Review of Mixed Methods Intervention Studies with Residents of Low-Income Communities. Nutrients 2022; 14:nu14112278. [PMID: 35684077 PMCID: PMC9182982 DOI: 10.3390/nu14112278] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 12/22/2022] Open
Abstract
Food insecurity is a broad and serious public health issue in the United States, where many people are reporting lack of access to healthy foods. The reduced availability of healthy, affordable foods has led to increased consumption of energy-dense and nutrient-poor foods, resulting in increasing the risk for many chronic diseases such as obesity, cardiovascular diseases, and type 2 diabetes mellitus. Thus, identifying promising approaches to increase access to healthy foods through improving the food environment is of importance. The purpose of this review article is to highlight how the food environment affects directly a person’s food choices, and how to increase access to healthy foods through improving environmental approaches. The literature search was focused on finding different approaches to improve food security, primarily those with an impact on food environment. Overall, potential solutions were gathered through multilevel environmental approaches, including nutrition education and peer education, community-based participatory research, and policy changes in supplemental nutrition programs. A recommendation to reduce food insecurity is learning to create meals with a variety of seasonal fruits and vegetables purchased from affordable farmers’ markets.
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Abstract
Purpose of Review Sexual and gender minority (SGM) adults experience significant cardiovascular health disparities, yet little is known about diet and food insecurity in this population. This review summarizes recent literature on diet and food insecurity in SGM adults and their contribution to cardiovascular disease (CVD) risk in this population. Recent Findings Existing evidence on diet and food insecurity disparities among SGM adults is inconclusive and research examining their link with CVD risk in SGM adults is limited. The majority of existing studies lack standardized and validated assessments of diet and food insecurity. Correlates of unhealthy diet and food insecurity among SGM adults are poorly understood. Summary Research examining the associations between diet and food insecurity with CVD risk in SGM adults is limited. Longitudinal studies are needed to investigate whether diet and food insecurity contribute to the cardiovascular health disparities observed in SGM adults. Supplementary Information The online version contains supplementary material available at 10.1007/s11883-022-00991-2.
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Robbiati C, Armando A, da Conceição N, Putoto G, Cavallin F. Association between diabetes and food insecurity in an urban setting in Angola: a case–control study. Sci Rep 2022; 12:1084. [PMID: 35058483 PMCID: PMC8776869 DOI: 10.1038/s41598-022-04888-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022] Open
Abstract
Diabetes is common in urban settings in Sub-Saharan Africa. Household food insecurity has been suggested to increase the chance of developing diabetes among adults. The relationship between diabetes and food insecurity has not been explored in Angolan urban settings so far. This case–control (1:2) study investigated the association between diabetes and food insecurity among adults attending six healthcare facilities in Luanda (Angola) between April 2019 and September 2019. All subjects with fasting blood glucose (FBG) levels ≥ 126 mg/dl were included as cases. For each case, the next two subjects with FBG levels < 110 mg/dl were included as controls, to warrant the achievement of the set 1:2 ratio. Food insecurity was assessed using the Food Insecurity Experience Scale (FIES). A total of 663 participants (221 cases and 442 controls) were enrolled in the study. Median FIES raw score was 7 (IQR 1–8) in cases and 5 (IQR 2–8) in controls (p = 0.09). The distribution of FIES levels (0–3; 4–6; 7–8) was different between cases and controls (p < 0.0001), with highest FIES scores (7–8) recorded in 53.0% of cases and 38.2% of controls. Our findings revealed an association between diabetes and severe food insecurity among adults attending healthcare facilities in the capital city of Angola.
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Nguyen CJ, Pham C, Jackson AM, Ellison NLK, Sinclair KI. Online Food Security Discussion Before and During the COVID-19 Pandemic in Native Hawaiian and Pacific Islander Community Groups and Organizations: Content Analysis of Facebook Posts. Asian Pac Isl Nurs J 2022; 6:e40436. [PMID: 36212246 PMCID: PMC9528231 DOI: 10.2196/40436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background The Native Hawaiian and Pacific Islander (NHPI) population experiences disproportionately higher rates of food insecurity, which is a risk factor for cardiometabolic diseases such as cardiovascular disease, type 2 diabetes, obesity, and hypertension, when compared to white individuals. Novel and effective approaches that address food insecurity are needed for the NHPI population, particularly in areas of the continental United States, which is a popular migration area for many NHPI families. Social media may serve as an opportune setting to reduce food insecurity and thus the risk factors for cardiometabolic diseases among NHPI people; however, it is unclear if and how food insecurity is discussed in online communities targeting NHPI individuals. Objective The objective of this study was to characterize the quantity, nature, and audience engagement of messages related to food insecurity posted online in community groups and organizations that target NHPI audiences. Methods Publicly accessible Facebook pages and groups focused on serving NHPI community members living in the states of Washington or Oregon served as the data source. Facebook posts between March and June 2019 (before the COVID-19 pandemic) and from March to June 2020 (during the COVID-19 pandemic) that were related to food security were identified using a set of 36 related keywords. Data on the post and any user engagement (ie, comments, shares, or digital reactions) were extracted for all relevant posts. A content analytical approach was used to identify and quantify the nature of the identified posts and any related comments. The codes resulting from the content analysis were described and compared by year, page type, and engagement. Results Of the 1314 nonduplicated posts in the 7 relevant Facebook groups and pages, 88 were related to food security (8 in 2019 and 80 in 2020). The nature of posts was broadly classified into literature-based codes, food assistance (the most common), perspectives of food insecurity, community gratitude and support, and macrolevel contexts. Among the 88 posts, 74% (n=65) had some form of engagement, and posts reflecting community gratitude and support or culture had more engagement than others (mean 19.9, 95% CI 11.2-28.5 vs mean 6.1, 95% CI 1.7-10.4; and mean 26.8, 95% CI 12.7-40.9 vs mean 5.3, 95% CI 3.0-7.7, respectively). Conclusions Food security-related posts in publicly accessible Facebook groups targeting NHPI individuals living in Washington and Oregon largely focused on food assistance, although cultural values of gratitude, maintaining NHPI culture, and supporting children were also reflected. Future work should capitalize on social media as a potential avenue to reach a unique cultural group in the United States experiencing inequitably high rates of food insecurity and risk of cardiometabolic diseases.
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Affiliation(s)
- Cassandra Jean Nguyen
- Institute for Research and Education to Advance Community Health Washington State University Seattle, WA United States
| | - Christian Pham
- Elson S Floyd College of Medicine Washington State University Spokane, WA United States
| | - Alexandra M Jackson
- Institute for Research and Education to Advance Community Health Washington State University Seattle, WA United States
| | | | - Ka Imi Sinclair
- Institute for Research and Education to Advance Community Health Washington State University Seattle, WA United States
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Beltrán S, Arenas DJ, Pharel M, Montgomery C, Lopez‐Hinojosa I, DeLisser HM. Food insecurity, type 2 diabetes, and hyperglycaemia: A systematic review and meta-analysis. Endocrinol Diabetes Metab 2022; 5:e00315. [PMID: 34726354 PMCID: PMC8754242 DOI: 10.1002/edm2.315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/18/2021] [Accepted: 10/24/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS Food insecurity (FIS) is a major public health issue with possible implications for type 2 diabetes mellitus (T2DM) risk. We conducted a systematic review and meta-analysis to explore the association between FIS and T2DM. METHODS We performed a systematic search in PubMed, Embase, Scopus, and Web of Science. All cross-sectional, peer-reviewed studies investigating the link between FIS and T2DM were included. Population characteristics, study sizes, covariates, T2DM diagnoses, and diabetes-related clinical measures such as fasting blood glucose (FBG) and HbA1c were extracted from each study. Outcomes were compared between food insecure and food secure individuals. Effect sizes were combined across studies using the random effect model. RESULTS Forty-nine peer-reviewed studies investigating the link between FIS and T2DM were identified (n = 258,250). Results of meta-analyses showed no association between FIS and clinically determined T2DM either through FBG or HbA1c: OR = 1.22 [95%CI: 0.96, 1.55], Q(df = 5) = 12.5, I2 = 60% and OR = 1.21 [95%CI: 0.95, 1.54], Q(df = 5) = 14; I2 = 71% respectively. Standardized mean difference (SMD) meta-analyses yielded no association between FIS and FBG or HbA1c: g = 0.06 [95%CI: -0.06, 0.17], Q(df = 5) = 15.8, I2 = 68%; g = 0.11 [95% CI: -0.02, 0.25], Q(df = 7) = 26.8, I2 = 74% respectively. For children, no association was found between FIS and HbA1c: g = 0.06 [95%CI: 0.00, 0.17], Q(df = 2) = 5.7, I2 = 65%. CONCLUSIONS Despite multiple proposed mechanisms linking FIS to T2DM, integration of the available literature suggests FIS is not associated with clinically determined T2DM or increases in FBG or HbA1c among adult patients.
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Affiliation(s)
- Sourik Beltrán
- Department of MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Daniel J. Arenas
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Canada Montgomery
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Horace M. DeLisser
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Abdurahman A, Bule M, Fallahyekt M, Abshirini M, Azadbakht L, Qorbani M, Dorosty AR. Association of Diet Quality and Food Insecurity with Metabolic Syndrome in Obese Adults. Int J Prev Med 2021; 12:138. [PMID: 34912514 PMCID: PMC8631121 DOI: 10.4103/ijpvm.ijpvm_191_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 01/08/2020] [Indexed: 11/29/2022] Open
Abstract
Background: The link between diet quality, food insecurity (FI), and metabolic syndrome (MetS) remains unclear in obese adults. The aim of this study was to examine the association of diet quality and FI with MetS in obese Iranian adults. Methods: This cross-sectional study was conducted on 300 obese adults. Dietary intake was assessed using a validated 168-item food frequency questionnaire. Diet quality and FI were measured using the Diet Quality Index-International (DQI-I) and an adapted USDA2000 household food security status questionnaire, respectively. MetS was defined according to the International Diabetes Federation diagnostic criteria. Association was determined using logistic regression analysis adjusting for potential confounders. Results: MetS subjects had lower DQI-I score than subjects without MetS (67.5 ± 8.7 vs 71.5 ± 7.4, P = 0.05). The prevalence of food insecurity was 48.6% (95% confidence interval (CI): 41.2, 56.1) in MetS subjects and 39.4% (95% CI: 29.4, 49.9) in subjects without MetS. After adjustment, participants in the fourth quartile of DQI-I score had 70% lower odds of MetS (Adjusted odds ratio [AOR], 0.3; 95% CI: 0.1–0.7), 70% lower odds of hypertriglyceridemia (AOR, 0.3; 95% CI: 0.2–0.7) and 60% lower risk of reduced high-density lipoprotein [HDL] (AOR, 0.4; 95% CI: 0.2–0.9) compared with the first quartile. Obese food insecure adults had 60% higher odds of high blood pressure (AOR, 1.6; 95% CI: 1.0–2.6) and 70% higher odds of hypertriglyceridemia (AOR, 1.7; 95% CI: 1.0–2.8) compared with food-secure obese adults. There was no statistically significant interaction observed between DQI-I and food insecurity on MetS. Conclusions: Lower DQI-I score and food insecurity were associated with an increased risk of MetS and some features such as hypertriglyceridemia, reduced HDL, and high blood pressure in obese Iranian adults.
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Affiliation(s)
- Ahmed Abdurahman
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences International Campus (TUMS-IC), Tehran, Iran
| | - Mohammed Bule
- Department of Pharmacy, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Masoume Fallahyekt
- Department of Nutrition, Science and Research, Islamic Azad University, Tehran, Iran
| | - Maryem Abshirini
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Centre, Alborz University of Medical Sciences, Karaj, Iran.,Chronic Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - A R Dorosty
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Te Vazquez J, Feng SN, Orr CJ, Berkowitz SA. Food Insecurity and Cardiometabolic Conditions: a Review of Recent Research. Curr Nutr Rep 2021; 10:243-254. [PMID: 34152581 PMCID: PMC8216092 DOI: 10.1007/s13668-021-00364-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW To understand recent literature that examines associations between food insecurity and cardiometabolic conditions and risk factors. We included original research, systematic reviews, and meta-analyses on the topic of food insecurity and cardiometabolic risk published from January 1, 2017, to December 31, 2020. Editorials, perspectives, and case reports were excluded. After the initial search, 3 reviewers selected studies for inclusion based on relevance and methods. Ultimately, fifty studies were included. RECENT FINDINGS We included 35 studies of adults (20 cross-sectional observational studies, 5 longitudinal observational studies, 5 interventional studies, and 5 meta-analyses/reviews). In adults, food insecurity is associated with greater prevalence of overweight/obesity (especially for women). It is also associated with hypertension, diabetes (including worse glycemic control and more diabetes complications), coronary heart disease, congestive heart failure, stroke, and chronic kidney disease. We included 15 studies of children (11 cross-sectional observational studies and 4 longitudinal observational studies). In children, findings were more nuanced, and in particular, many studies did not find an association between food insecurity and overweight/obesity. However, authors noted that these conditions may not have had time to develop. With notable exceptions, many studies were cross-sectional, and there were few interventions. There is a robust association between food insecurity and cardiometabolic conditions and risk factors in adults, but the picture is less clear in children. Overt cardiometabolic clinical conditions develop more rarely in children, but childhood experiences may set a trajectory for worse health later in life. Detailed life course epidemiologic studies are needed to better understand this relationship. Future interventions should examine how to reduce the prevalence of food insecurity, and how best to improve health for those who experience food insecurity.
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Affiliation(s)
- Jennifer Te Vazquez
- College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shi Nan Feng
- College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Nutrition Science Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Colin J Orr
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Seth A Berkowitz
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 5034 Old Clinic Bldg, CB 7110, Chapel Hill, NC, 27599, USA.
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Walker RJ, Walker RE, Mosley-Johnson E, Egede LE. Exploring the Lived Experience of Food Insecure African Americans with Type 2 Diabetes Living in the Inner City. Ethn Dis 2021; 31:527-536. [PMID: 34720556 PMCID: PMC8545483 DOI: 10.18865/ed.31.4.527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose Despite evidence that food insecure African Americans with type 2 diabetes are at particularly high risk for poor health outcomes, there is currently a lack of information on their lived experience. This qualitative study aimed to identify challenges, facilitators, and barriers to effective diabetes care for food insecure African Americans with type 2 diabetes residing in an inner city. Methods In fall 2018, we conducted two focus groups attended by a total of 16 food insecure adults with type 2 diabetes residing in the inner city of Milwaukee, Wisconsin. A standardized moderator guide included questions to explore the role of food insecurity in managing diabetes, and facilitators that improve diabetes management within the context of food insecurity. Focus groups were audio recorded and recordings were transcribed by a professional transcription service. A grounded theory approach was used for analysis. Results Six major challenges existed at the individual level (diet/nutrition, exercise, diabetes knowledge and skills, complications from diabetes, a family history of diabetes, and a preoccupation with food). Five major barriers and facilitators existed both internally and externally to the individuals (access to food, medications, stress, cost of health-related needs and religion/spirituality). Conclusions This study identified multiple challenges, barriers, and facilitators to effective care for food insecure African American adults with type 2 diabetes. It is imperative to incorporate this understanding in future work by using an ecological approach to investigate strategies to address food insecurity beyond a singular focus on access to food.
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Affiliation(s)
- Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Renee E Walker
- Zilber School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI
| | - Elise Mosley-Johnson
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
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Chapanski VDR, Costa MD, Fraiz GM, Hӧfelmann DA, Fraiz FC. Food insecurity and sociodemographic factors among children in São José dos Pinhais, Paraná, Brazil, 2017: a cross-sectional study. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2021; 30:e2021032. [PMID: 34854466 DOI: 10.1590/s1679-49742021000400008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/21/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze association between food insecurity (FI) and sociodemographic factors among children. METHODS The study was carried out from May to November 2017 with mothers of children (18 - 35 months old) enrolled at public education facilities in São José dos Pinhais, Paraná, Brazil. FI was determined by the Brazilian Household Food Insecurity Measurement Scale. Multinomial logistic regression was used with a hierarchical model. RESULTS 395 mothers/children participated. Overall FI prevalence was 34.7% (95%CI 28.5;41.5), with prevalence of 25.7% (95%CI 19.2;32.3) for mild FI (MFI) and 9.0% (95%CI 8.5;9.4) for moderate/severe FI (MSFI). Families in the lowest income tercile had higher likelihood of MFI (OR=3.06 - 95%CI 1.26;7.41) or MSFI (OR=6.35 - 95%CI 1.89;21.4) when compared to the highest tercile. Higher MFI prevalence was identified in male children (OR=2.34 - 95%CI 1.49;3.68). CONCLUSION FI was associated with lower income and MFI with male children. Public policies to increase income must be included in FI reduction strategies.
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Affiliation(s)
| | - Maria Dalla Costa
- Universidade Federal do Paraná, Programa de Pós-Graduação em Odontologia, Curitiba, PR, Brasil
| | - Gabriela Macedo Fraiz
- Universidade de Viçosa, Programa de Pós-Graduação em Ciências da Nutrição, Viçosa, MG, Brasil
| | | | - Fabian Calixto Fraiz
- Universidade Federal do Paraná, Departamento de Estomatologia, Curitiba, PR, Brasil
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Food Insecurity and its Impact on Body Weight, Type 2 Diabetes, Cardiovascular Disease, and Mental Health. CURRENT CARDIOVASCULAR RISK REPORTS 2021; 15:15. [PMID: 34249217 PMCID: PMC8255162 DOI: 10.1007/s12170-021-00679-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 02/07/2023]
Abstract
Purpose of Review Food insecurity (FI) is a serious public health issue affecting 2 billion people worldwide. FI is associated with increased risk for multiple chronic diseases, including obesity, type 2 diabetes, cardiovascular disease, and mental health. We selected these four chronic diseases given their global prevalence and comorbid associations with each other. We evaluated the most recent literature published over the past 5 years and offer strategies for the screening of FI. Recent Findings Recent systematic reviews and meta-analyses report an association between FI and obesity in adult women as well as adult men and women living in low- and middle-income countries. Gender differences also were observed between FI and type 2 diabetes, such that adult women showed an increased risk for type 2 diabetes. This association was influenced by social determinants of health. Very low food security (i.e., high FI) was associated with increased risk for cardiovascular disease and a higher risk for cardiovascular disease mortality. Finally, several studies showed an association between FI and adverse mental health outcomes, including increased risk for stress, depression, anxiety, sleep disorders, and suicidal ideation. Summary FI and its negative association with body weight, type 2 diabetes, cardiovascular disease, and mental health provide a compelling rationale for identification of FI in clinical settings. Brief, well-validated screening measures are available in multiple languages. Despite the need for FI screening, many guidelines do not address its implementation. For this reason, more research and targeted interventions are needed to increase FI screening rates and close the loop in the coordination of resources.
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Horning ML, Alver B, Porter L, Lenarz-Coy S, Kamdar N. Food insecurity, food-related characteristics and behaviors, and fruit and vegetable intake in mobile market customers. Appetite 2021; 166:105466. [PMID: 34139297 DOI: 10.1016/j.appet.2021.105466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/20/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
Mobile markets (MM) bring affordable, quality, healthy foods to high-need, low-food access communities. However, little is known about food insecurity of MM customers. This manuscript evaluates food insecurity prevalence in MM customers and assesses associations between food insecurity and MM use, food-related characteristics and behaviors, and fruit and vegetable (FV) intake. Customers (N = 302) completed cross-sectional surveys in summer 2019 that assessed: food security, food availability, cooking attitude, self-efficacy for healthy cooking, self-efficacy for cooking and eating FV, social connectedness, and FV intake. Descriptive and multivariate analyses were used to describe and assess associations with food insecurity and FV intake. Results show most MM customers were food insecure (85%). In logistic regression models adjusted for sociodemographic characteristics, long-term MM use (OR = 0.77, CI = 0.60-0.997), access to affordable, quality foods (OR = 0.81, CI = 0.71-0.93), and self-efficacy for both cooking healthy foods (OR = 0.88, CI = 0.80-0.97) and cooking and eating FV (OR = 0.90, CI = 0.82-0.98) were associated with lower odds of food insecurity; negative cooking attitudes (OR = 1.12, CI = 1.02-1.24) were associated with higher odds of food insecurity. Being food insecure (β = -1.37, SE=0.43, p < 0.01) was associated with poorer FV intake; this association attenuated slightly (β = -1.22, SE=0.43, p < 0.01) when length of MM use was added to the general linear model, which was also associated with higher fruit and vegetable intake (β = 0.26, SE=0.10, p = 0.01). Results suggest the MM reaches customers experiencing high levels of food insecurity and long-term MM use is associated with lower food insecurity and higher FV intake. Relationships between food insecurity and several food characteristics/behaviors provide insight for potential targets for wrap-around interventions to address food insecurity among customers. Findings suggest longitudinal evaluation of the MM's impact on food security and other food-related characteristics/behaviors is warranted.
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Affiliation(s)
- Melissa L Horning
- School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN, 55414, USA.
| | - Bonnie Alver
- School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN, 55414, USA.
| | | | | | - Nipa Kamdar
- VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX, USA.
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McClain AC, Evans GW, Dickin KL. Maternal Stress Moderates the Relationship of Food Insufficiency with Body Mass Index Trajectories from Childhood to Early Adulthood among U.S. Rural Youth. Child Obes 2021; 17:263-271. [PMID: 33769835 PMCID: PMC8147486 DOI: 10.1089/chi.2020.0284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Findings on the relationships between household food insufficiency (HFI), maternal stress, and youth body mass index (BMI) are mixed, possibly due to cross-sectional study designs and measurement issues. Furthermore, little is known about how childhood exposure to HFI and maternal stress influences BMI into young adulthood among rural youth. We aimed to determine the independent and moderating relationships of HFI and maternal perceived stress on youth BMI trajectories from age 9 to 24 years. Methods: We used longitudinal data from rural New York youth (n = 341). At youth age 9 years, parents reported HFI using a reliable one-item measure, and mothers responded to the 10-item Perceived Stress Scale (PSS; range: 0-40). BMI was calculated (kg/m2) from objective measures of height and weight at 9, 13, 17, and 24 years. Multivariate random-intercept trajectory models estimated the relationships of HFI and PSS on BMI trajectories (p < 0.05 for main effects, p < 0.10 for interactions). Results: At age 9 years, 16.4% experienced HFI and mean (standard deviation) BMI and PSS were 18.4 (3.6) kg/m2 and 7.7 (2.9), respectively. HFI and PSS were not associated with BMI trajectories (p = 0.18, p = 0.64, respectively), but their interaction was significant (p < 0.01). Each one-unit increase in PSS was associated with 0.6 (0.2) kg/m2 higher mean change in BMI trajectories for youth in food-insufficient, compared with food-sufficient, households. Conclusions: Higher levels of maternal stress in food-insufficient households may lead to greater increases in BMI from childhood to young adulthood. Public health interventions should simultaneously address parental stress and quality food access among low-income rural households.
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Affiliation(s)
- Amanda C. McClain
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
- Address correspondence to: Amanda C. McClain, PhD, MS, School of Exercise and Nutritional Sciences, San Diego State University, ENS 313, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Gary W. Evans
- Department of Design + Environmental Analysis, Department of Human Development, Cornell University, Ithaca, NY, USA
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Zhu Y, Mangini LD, Hayward MD, Forman MR. Food insecurity and the extremes of childhood weight: defining windows of vulnerability. Int J Epidemiol 2021; 49:519-527. [PMID: 31750907 DOI: 10.1093/ije/dyz233] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Weight extremes and food insecurity (FIS) represent public-health challenges, yet their associations in childhood remain unclear. We aimed to investigate the longitudinal time-specific relationship between FIS and risk of overweight/obesity and underweight in kindergarten through 8th grade. METHODS In the prospective Early Childhood Longitudinal Study-Kindergarten Cohort (1998-2007) of 6368 children, household FIS was assessed by the validated US Household Food Security Survey Module in kindergarten, 3rd, 5th and 8th grades. Multivariable linear-regression and Poisson-regression models were computed. RESULTS Compared with children experiencing food security (FS), children exposed to FIS in 5th grade had 0.19 [95% confidence interval (CI): 0.07-0.30] and 0.17 (0.06-0.27) higher body mass index z-score (BMIZ) in the 5th and 8th grades, respectively, whereas FIS in the 8th grade was associated with a 0.29 (0.19-0.40) higher BMIZ at the same wave, after adjusting for covariates and FIS at earlier waves. Children with FIS vs FS had 27% (relative risk: 1.27, 95% CI: 1.07-1.51), 21% (1.21, 1.08-1.35) and 28% (1.28, 1.07-1.53) higher risk of overweight/obesity in the 3rd, 5th and 8th grades, respectively, adjusting for covariates and FIS at prior wave(s). Children with FIS vs FS in kindergarten had a 2.76-fold (1.22-6.25) higher risk of underweight in the 8th grade. CONCLUSIONS Proximal exposure to household FIS was associated with a higher risk of overweight/obesity in the 3rd, 5th and 8th grades. FIS in kindergarten was associated with a risk of underweight in the 8th grade. Thus, FIS coexists in weight extremes during vulnerable early-life windows in the USA, similarly to the global burden of FIS.
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Affiliation(s)
- Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Lauren D Mangini
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Mark D Hayward
- Population Research Center, The University of Texas at Austin, Austin, TX, USA
| | - Michele R Forman
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
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Beltrán S, Pharel M, Montgomery CT, López-Hinojosa IJ, Arenas DJ, DeLisser HM. Food insecurity and hypertension: A systematic review and meta-analysis. PLoS One 2020; 15:e0241628. [PMID: 33201873 PMCID: PMC7671545 DOI: 10.1371/journal.pone.0241628] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/17/2020] [Indexed: 12/26/2022] Open
Abstract
Background Food insecurity (FIS) is an important public health issue associated with cardiovascular risk. Given the association of FIS with diets of poorer nutritional quality and higher salt intake as well as chronic stress, numerous studies have explored the link between FIS and hypertension. However, no systematic review or meta-analysis has yet to integrate or analyze the existing literature. Methods We performed a wide and inclusive search of peer-reviewed quantitative data exploring FIS and hypertension. A broad-terms, systematic search of the literature was conducted in PubMed, Embase, Scopus, and Web of Science for all English-language, human studies containing primary data on the relationship between FIS and hypertension. Patient population characteristics, study size, and method to explore hypertension were extracted from each study. Effect sizes including odds ratios and standardized mean differences were extracted or calculated based on studies’ primary data. Comparable studies were combined by the random effects model for meta-analyses along with assessment of heterogeneity and publication bias. Results A total of 36 studies were included in the final analyses. The studies were combined into different subgroups for meta-analyses as there were important differences in patient population characteristics, methodology to assess hypertension, and choice of effect size reporting (or calculability from primary data). For adults, there were no significantly increased odds of elevated blood pressures for food insecure individuals in studies where researchers measured the blood pressures: OR = 0.91 [95%CI: 0.79, 1.04; n = 29,781; Q(df = 6) = 7.6; I2 = 21%]. This remained true upon analysis of studies which adjusted for subject BMI. Similarly, in studies for which the standardized mean difference was calculable, there was no significant difference in measured blood pressures between food secure and FIS individuals: g = 0.00 [95%CI: -0.04, 0.05; n = 12,122; Q(df = 4) = 3.6; I2 = 0%]. As for retrospective studies that inspected medical records for diagnosis of hypertension, there were no significantly increased odds of hypertension in food insecure adults: OR = 1.11 [95%CI: 0.86, 1.42; n = 2,887; Q(df = 2) = 0.7; I2 = 0%]. In contrast, there was a significant association between food insecurity and self-reports of previous diagnoses of hypertension: 1.46 [95%CI: 1.13, 1.88; n = 127,467; Q(df = 7) = 235; I2 = 97%]. Only five pediatric studies were identified which together showed a significant association between FIS and hypertension: OR = 1.44 [95%CI: 1.16, 1.79; n = 19,038; Q(df = 4) = 5.7; I2 = 30%]. However, the small number of pediatric studies were not sufficient for subgroup meta-analyses based on individual study methodologies. Discussion In this systematic review and meta-analysis, an association was found between adult FIS and self-reported hypertension, but not with hypertension determined by blood pressure measurement or chart review. Further, while there is evidence of an association between FIS and hypertension among pediatric subjects, the limited number of studies precluded a deeper analysis of this association. These data highlight the need for more rigorous and longitudinal investigations of the relationship between FIS and hypertension in adult and pediatric populations.
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Affiliation(s)
- Sourik Beltrán
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Marissa Pharel
- Rush Medical College, Rush University, Chicago, Illinois, United States of America
| | - Canada T. Montgomery
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Itzel J. López-Hinojosa
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Daniel J. Arenas
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Horace M. DeLisser
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Barone A, Krummel DA, Lee SY. Availability of Food Options and Nutrition Education in Local Food Pantries. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:492-502. [PMID: 32094023 DOI: 10.1016/j.jneb.2019.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 12/04/2019] [Accepted: 12/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Explore the availability of food options and nutrition education at food pantries and identify the barriers to offering them to pantry clients. DESIGN Cross-sectional, mixed-methods study. SETTING Food pantry, Cincinnati, OH. PARTICIPANTS A total of 41 food pantry coordinators (aged 63.4 ± 9.1 years), recruited by e-mail/phone in an urban area. PHENOMENON OF INTEREST Availability of food options and nutrition education and barriers to improving food options and providing nutrition education at food pantries. ANALYSIS Survey data were collected using Qualtrics and analyzed using SPSS software. In-depth interviews were transcribed verbatim, transcripts were independently coded, and codes and themes were discussed until a consensus was reached. RESULTS The availability of fresh produce, dairy, low-sodium canned vegetables, and whole grains were limited, and 10 food pantries (24%) offered nutrition education to their clients. Challenges to improving food options were lack of space and equipment for storage and transportation. Identified barriers to providing nutrition education included the lack of space, funding, personnel with nutrition expertise, and clients' low interest in nutrition education. CONCLUSIONS AND IMPLICATIONS The availability of healthy food choices and nutrition education were limited at local food pantries. Collaborative efforts with community partners and nutrition experts may be necessary to overcome those barriers.
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Affiliation(s)
- Adam Barone
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH
| | - Debra A Krummel
- Department of Rehabilitation, Exercise, and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH
| | - Seung-Yeon Lee
- Department of Rehabilitation, Exercise, and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH.
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Abstract
PURPOSE OF REVIEW This review summarizes emerging evidence for the relationship between food insecurity and eating disorder (ED) pathology, outlines priorities for future research in this area, and comments on considerations for clinical and public health practice. RECENT FINDINGS Among adults, food insecurity is cross-sectionally associated with higher levels of overall ED pathology, binge eating, compensatory behaviors, binge-eating disorder, and bulimia nervosa. Evidence for similar relationships among adolescents has been less robust; however, compared to studies of adults, there have been substantially fewer studies conducted in adolescents to date. Emerging evidence consistently indicates that food insecurity is cross-sectionally associated with bulimic-spectrum ED pathology among adults. Findings emphasize the need for ED research to include marginalized populations who have historically been overlooked in the ED field. Much more research is needed to better understand the relationship between food insecurity and ED pathology and to determine effective ways to intervene.
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Affiliation(s)
- Vivienne M Hazzard
- Sanford Center for Biobehavioral Research, 120 Eighth Street South, Fargo, ND, 58103, USA.
| | - Katie A Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Laura Hooper
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Banerjee S, Radak T. Association between food insecurity, cardiorenal syndrome and all-cause mortality among low-income adults. Nutr Health 2019; 25:245-252. [PMID: 31464165 DOI: 10.1177/0260106019869069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Food insecurity is known to be a major public health issue. There is limited data on food insecurity and chronic disease in the general population. AIM We aimed to assess effect of food insecurity on mortality of individuals with chronic disease like cardiorenal syndrome (CRS). METHODS The study was conducted on participants aged 20 years or older in the United States living below the 130% Federal Poverty Level. We assessed food insecurity utilizing the Household Food Security Survey Module in NHANES survey for the years 1999 to 2010 with mortality follow-up. Prospective analysis was performed using complex samples Cox regression with adjustment for known confounders to determine the relationship of food insecurity and CRS. RESULTS Prevalence of food insecurity among the low-income population was 16.1% among males and 21.7% among females. The mean follow-up was 6.5 years. For all-cause mortality, the overall unadjusted hazard ratio (HR) of food insecurity to no food insecurity was 1.28 (95% confidence interval [CI], 1.18-1.37, p < 0.001). Adjusted HR was elevated, 2.81 (CI 1.57-5.05, p < 0.001), among participants who were CRS-positive and food insecure but closer to 1.0 (2.48 CI 1.73-3.55, p < 0.001) among those who were CRS-positive and food secure, after controlling for medical and demographic risk factors. CONCLUSIONS Food insecurity is associated with higher mortality than food security. Food insecurity also may modify the effect of CRS on all-cause mortality in a representative general population. Social policy, when addressing food insecurity, should be inclusive among those with specific chronic diseases.
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Affiliation(s)
| | - Timothy Radak
- Walden University School of Health Sciences, Baltimore, MD, USA
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