The Cognitive Burden of Poverty: A Mechanism of Socioeconomic Health Disparities

Translational science approaches for food insecurity research

Food insecurity is a pervasive problem that impacts health and well-being across the lifespan. The human research linking food insecurity to poor metabolic and behavioral health outcomes is inherently correlational and suffers from a high degree of variability both between households and even within the same household over time. Further, food insecurity is impacted by societal and political factors that are largely out of the control of individuals, which narrows the range of intervention strategies. Animal models of food insecurity are being developed to address some of the barriers to mechanistic research. However, animal models are limited in their ability to consider some of the more complex societal elements of the human condition. We believe that understanding the role that food insecurity plays in ingestive behavior and chronic disease requires a truly translational approach, and that understanding the health impacts of this complex social phenomenon requires understanding both its psychological and physiological dimensions. This brief review will outline some key features of food insecurity, highlighting those that are amenable to investigation with controlled animal models and identifying areas where integrating animal and human studies can improve our understanding of the psychological burden and health impacts of food insecurity. In the interest of brevity, this review will largely focus on food insecurity in the United States, as the factors that contribute to food insecurity vary considerably across the globe.

Understanding food insecurity in Los Angeles County during the COVID-19 pandemic and its aftermath: A qualitative interview study

The COVID-19 pandemic brought increases in food insecurity in Los Angeles (L.A.) County, defined as lacking household access to adequate food because of limited money or other resources. Here, we aimed to understand the lived experiences of food insecurity during the COVID-19 pandemic and its aftermath. In August-December 2022, we interviewed 30 residents of L.A. County who were participants in an ongoing internet panel and had reported experiencing food insecurity between April 2020 and July 2021. A stratified-sampling approach was used to recruit a diverse sample with and without government food assistance. We report five key findings, which underscore the stress and worry associated with the experience of food insecurity, and the coping strategies people implemented: (1) The pandemic prompted food insecurity as well as stressful shifts in eating behaviors compared to before the pandemic, with some eating much less food, some eating less nutritious food, and some eating much more due to being stuck at home; (2) Buying food became more effortful and financially challenging; (3) Government food assistance from the Supplemental Nutrition Assistance Program (SNAP) was important for reducing food insecurity, but was sometimes insufficient, inconsistent, and didn't cover all retailers or food items; (4) Interviewees had to rely on their social networks, food banks or pantries, churches, and schools to meet their food needs and cope with food insecurity, but some faced barriers in doing so; (5) For some, food insecurity was worse in late 2022, almost two years after the pandemic started. We conclude with implications for policymakers and practitioners, emphasizing the importance of meeting the needs of diverse residents and addressing food insecurity in the aftermath of the COVID-19 pandemic.

Unveiling the Link Between Antiphospholipid Antibodies and Cognitive Dysfunction in the Almenara Lupus Cohort

OBJECTIVE

Cognitive dysfunction is a prevalent manifestation of systemic lupus erythematosus (SLE). There is evidence for the role of antiphospholipid (aPL) antibodies on its etiopathogenesis. Our objective was to identify the association between aPL antibodies and cognitive dysfunction in SLE patients.

METHODS

This cross-sectional study included 135 patients evaluated from March 2015 to October 2017 at one center. Cognitive deficit was measured using the NEUROPSI test. Disease activity and damage were ascertained using the SLEDAI-2K (SLE Disease Activity Index 2000) and the SDI (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), respectively; aPL antibodies were measured by enzyme-linked immunosorbent assay. The association between cognitive dysfunction and aPL antibodies was evaluated using univariable and multivariable linear regression models adjusted for age, sex, education, socioeconomic status, disease duration, SLEDAI-2K, SDI, mean current dose of prednisone, time of exposure to glucocorticoids, and drug use (immunosuppressants, hydroxychloroquine, aspirin, and warfarin).

RESULTS

One hundred thirty-one patients (97.1%) were women; their mean (SD) age was 46.6 (12.5) years; 59 patients (43.7%) had positivity for at least 1 aPL antibody. IgM anticardiolipin (aCL) was positive in 24.5%, IgG in 13.5%, IgM aβ2GP1 in 16.8%, IgG anti-β2 glycoprotein in 24.6%, and the lupus anticoagulant in 5.3%. Ninety patients (66.7%) had some cognitive dysfunction. In the univariable analysis, a significant correlation between the NEUROPSI score and IgM aCL antibodies was found (B = -20.87 [SE, 3.2]; p < 0.001), which remained significant in the multivariable model (B = -13.89 [SE, 3.14]; p < 0.001).

CONCLUSIONS

IgM aCL antibodies are associated with cognitive dysfunction in patients with SLE. Larger and longitudinal studies are needed to assess the impact of these findings.

Parents, but not their children, demonstrate greater delay discounting with resource scarcity

BACKGROUND

Individuals with obesity tend to discount the future (delay discounting), focusing on immediate gratification. Delay discounting is reliably related to indicators of economic scarcity (i.e., insufficient resources), including lower income and decreased educational attainment in adults. It is unclear whether the impact of these factors experienced by parents also influence child delay discounting between the ages of 8 and 12-years in families with obesity.

METHODS

The relationship between indices of family income and delay discounting was studied in 452 families with parents and 6-12-year-old children with obesity. Differences in the relationships between parent economic, educational and Medicaid status, and parent and child delay discounting were tested.

RESULTS

Results showed lower parent income (p = 0.019) and Medicaid status (p = 0.021) were differentially related to greater parent but not child delay discounting among systematic responders.

CONCLUSIONS

These data suggest differences in how indicators of scarcity influence delay discounting for parents and children, indicating that adults with scarce resources may be shaped to focus on immediate needs instead of long-term goals. It is possible that parents can reduce the impact of economic scarcity on their children during preadolescent years. These findings suggest a need for policy change to alleviate the burden of scarce conditions and intervention to modify delay discounting rate and to improve health-related choices and to address weight disparities.