Mental Illness, Not Obesity Status, is Associated with Food Insecurity Among the Elderly in the Health and Retirement Study

Food insecurity and body mass index among older people: A systematic review and meta-analysis

Food insecurity, characterized by inadequate access to sufficient and nutritious food, poses a significant challenge to the health and well-being of older adults. This systematic review and meta-analysis was aimed to examine the association between food insecurity and body mass index (BMI) in older people, i.e., aging 60 and above. PRISMA 2020 guidelines were followed. The protocol was registered in PROSPERO in advance (ID CRD 42024543271). PubMed/MEDLINE, and Scopus were searched up to February 2024. Out of 5834 retrieved article, a total of 13 studies met the inclusion criteria, encompassing diverse geographic regions and socioeconomic contexts. The meta-analysis revealed a significant association between food insecurity and higher BMI (both obesity and overweight) in older adults. Pooled estimates indicated that food-insecure older individuals were more likely to be overweight or obese (combined) compared to their food-secure counterparts [OR= 1.29 (95% CI= 1.28-1.30), p<0.001; I2= 94.92]. Results were also confirmed for overweight or obesity alone. Notably, food insecurity was linked to increased consumption of energy-dense, nutrient-poor foods, contributing to higher BMI. These findings underscore the complex relationship between food insecurity and BMI among older adults, emphasizing the need for targeted interventions to address food access and nutritional quality.

Nutrition and Food Security Among Veterans: Operationalizing Nutritional Functioning

OBJECTIVE

To assess injured military veterans' experiences, beliefs, and daily physical and psychosocial functioning in relation to food and nutrition.

DESIGN

We used a convergent mixed-methods study design and the International Classification of Functioning, Disability, and Health to operationalize the core constructs and influencing factors related to physical and psychosocial functioning, food, and nutrition.

SETTING

Three Veterans Affairs polytrauma rehabilitation centers.

PARTICIPANTS

Veterans who served in the United States military on or after September 11, 2001, and whose medical diagnoses met the criteria for polytrauma; at least 1 mild traumatic brain injury and at least 1 associated comorbidity (eg, posttraumatic stress disorder, chronic musculoskeletal pain, vestibular disturbances), for a total N of 43.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Themes from survey responses and semistructured interview data were pooled into core constructs and influencing factors.

RESULTS

Thirty-seven veterans completed all surveys and participated in recorded interviews. Based on qualitative and quantitative data, veterans' relation to food and nutrition (ie, nutritional functioning) was found to be characterized by 5 core constructs, including food background, nutrition knowledge, meal aptitude, resource navigation, and navigation to/of food spaces. Nutritional functioning was found to be shaped by 5 influencing factors, including injuries and health conditions, ideological and cultural exposures, relations, current beliefs, and current behaviors.

CONCLUSIONS

Nutritional functioning (food background, nutrition knowledge, meal aptitude, resource navigation, navigation to/of food spaces) among injured veterans is complex and shaped by multiple physical, psychosocial, economic, and cultural factors.

Food Insecurity Associated with Higher Stress, Depressive Symptoms, and Lower Diet Quality among Women Caregivers in North Carolina

BACKGROUND

Research suggests a bidirectional relationship between food insecurity and stress, but few studies have examined associations of food insecurity with stress and other indicators of cardiometabolic health, including depression, diet quality, and body weight, among lower-income women in the U.S.

METHODS

This cross-sectional study analyzed data from lower-income women caregivers living in North Carolina (n = 100): 42% Black/African American, 25% Hispanic/Latina, and 33% White women. Multivariable linear regression models were used to determine associations of food insecurity status with perceived stress, depressive symptoms, diet quality, and body mass index (BMI). Multivariable logistic regression models were used to determine associations of food insecurity with clinical depression and BMI ≥ 30 kg/m2. Associations were examined with and without adjustment for perceived stress.

RESULTS

Forty-two percent of the sample were experiencing food insecurity. Compared to food secure caregivers, food-insecure caregivers had significantly higher perceived stress (β: +7.51; 95%CI: 4.19, 10.84) and depressive symptoms (β: +3.55; 95%CI: 0.54, 6.56) and lower diet quality (β: -9.10; 95%CI: -15.81, -2.40). Associations with BMI outcomes were not statistically significant.

CONCLUSION

Findings support removing stigma in nutrition assistance programs and clinical interactions, motivate future longitudinal studies, and inform the development of destigmatizing interventions for health promotion or disease prevention.

Impact of food insecurity on cognitive health in older adults: insights from the NHANES 2011-2014 data

Purpose

To investigate the relationship between food insecurity and cognitive decline among elderly Americans.

Methods

Utilizing NHANES 2011-2014 data, we examined cognitive function via the Immediate Recall Test (IRT), Delayed Recall Test (DRT), Animal Fluency Test (AFT), Digit Symbol Substitution Test (DSST) and assessed food security through the US Food Security Survey Module. Multiple regression models were used to adjust for demographic and health variables.

Results

Food insecurity demonstrated a significant association with lower cognitive function scores. The effects of food insecurity on cognitive function were moderated by factors such as smoking and alcohol use, indicating a direct influence of food insecurity on cognitive decline.

Conclusion

This study underscores the importance of food security for cognitive health in the elderly and advocates for targeted interventions to address nutritional disparities and enhance cognitive functioning in aging populations.

Food Insecurity and Diet Quality Among Adults on Medicaid With and Without a Mental Illness Diagnosis

BACKGROUND

Adults with mental illnesses are more likely to have low income and diet-related chronic diseases.

OBJECTIVE

This study examined associations of mental illness diagnosis status with food insecurity and diet quality and whether the relationship between food security status and diet quality differed by mental illness diagnosis status in adult Medicaid beneficiaries.

DESIGN

This was a secondary cross-sectional analysis of baseline (2019-2020) data collected as part of the LiveWell study, a longitudinal study evaluating a Medicaid food and housing program.

PARTICIPANTS/SETTING

Participants were 846 adult Medicaid beneficiaries from an eastern Massachusetts health system.

MAIN OUTCOME MEASURES

Food security was measured with the 10-item US Adult Food Security survey module (0 = high food security, 1-2 = marginal food security, 3-10 = low/very low food security). Mental illness diagnoses included health record-documented anxiety, depression, or serious mental illness (eg, schizophrenia, bipolar disorder). Healthy Eating Index (HEI-2015) scores were calculated from 24-hour dietary recalls.

STATISTICAL ANALYSES

Multivariable regression analyses adjusted for demographics, income, and survey date.

RESULTS

Participants' mean (standard deviation) age was 43.1 (11.3) years, and 75% were female, 54% Hispanic, 33% non-Hispanic White, and 9% non-Hispanic Black. Fewer than half (43%) of participants reported high food security, with almost one third (32%) reporting low or very low food security. The 341 (40%) participants with one or more mental illness diagnosis had greater odds of low/very low food security (adjusted odds ratio [OR], 1.94; 95% confidence interval [CI], 1.38-2.70) and had similar mean HEI-2015 scores (53.1 vs 56.0; P = 0.12) compared with participants with no mental illness diagnosis. Mean adjusted HEI-2015 scores did not significantly differ by high vs low/very low food security for those without a mental illness diagnosis (57.9 vs 54.9; P = 0.052) or those with a mental illness diagnosis (53.0 vs 52.9; P = 0.99).

CONCLUSION

In a cohort of adults with Medicaid, those with mental illness diagnoses had higher odds of experiencing food insecurity. Overall, diet quality among adults in this sample was low but did not differ by mental illness diagnosis or food security status. These results highlight the importance of augmenting efforts to improve both food security and diet quality among all Medicaid participants.

Senior food insecurity in the USA: a systematic literature review

OBJECTIVE

Understanding the factors associated with senior food insecurity is key to understanding senior-specific needs to develop targeted interventions and ultimately lower the prevalence and the incidence of food insecurity. We aimed to systematically review published literature and summarise the associated factors of food insecurity in older adults in the USA.

DESIGN

We searched PubMed, Scopus, Web of science, EconLit and JSTOR databases for peer-reviewed articles published in English between January 2005 and September 2019 that assessed food security or its associated factors for US adults aged 60 years and older. After a two-step screening process, twenty articles were retained and included in the review.

SETTING

NA.

PARTICIPANTS

NA.

RESULTS

The majority of studies were cross-sectional (70 %), consisted of data from one state (60 %), and had large sample sizes. Food-insecure individuals were more likely to be younger, less educated, Black or African American, female, a current smoker, low income, and self-report fair/poor health, have chronic conditions, and utilise government assistance programmes. Food insecurity was associated with medication non-adherence, poor mental health outcomes and limitations in physical functioning. Results were mixed for overweight/obesity status. There was no discernable pattern related to the consistency of findings by the assessed quality of the included studies.

CONCLUSIONS

Food insecurity is a prevalent and pervasive issue for older adults. The numerous correlates identified suggest that interventions aimed at enhancing food and nutrition safety net and medication assistance programmes are warranted, and upstream, systemic-level interventions may be best suited to deal with the correlates of food insecurity.

Food insecurity as a risk factor for obesity: A review

Obesity is considered a 21^st-century epidemic and it is a metabolic risk factor for Non-Communicable Diseases such as cardiovascular diseases, type 2 diabetes, metabolic syndrome, hypertension, some types of cancer, among others. Thus, its prevention and treatment are important public health concerns. Obesity within the context of food insecurity adds an additional layer of complexity to the current obesity epidemic. Efficient policies and interventions ought to take into consideration the effects of food insecurity on the risks of developing obesity among food insecure households. This review aims to analyze the recent available evidence around the obesity – food insecurity paradox. Most of the literature has consistently shown that there is a significant association between food insecurity and obesity, specifically in women of high-income countries. However, mechanisms explaining the paradox are still lacking. Even though researchers have tried to analyze the issue using different individual and societal variables, these studies have failed to explain the mediatory mechanisms of the food insecurity–obesity relationship since the proposed mechanisms usually lack strength or are purely theoretical. The research focus should shift from cross-sectional models to other research designs that allow the exploration of pathways and mechanisms underlying the food insecurity and obesity relationship, such as longitudinal studies, which will hopefully lead to consecutive research testing the effectiveness of different approaches and scale up such interventions into diverse contexts among those affected by obesity and the different degrees of food insecurity.

Influence of Social Adversity on Perceived Health Status and Depressive Symptoms among Portuguese Older People

This study aims to investigate how exposure to poverty, food insecurity, and abuse at older ages relates to health outcomes. A questionnaire collecting data on sociodemographic and economic characteristics, health status, depressive symptoms, food insecurity, and abuse was administered to a sample of 677 older adults. Logistic regression was used to quantify the association of poverty, food insecurity, and abuse with perceived health status and depressive symptoms. If the older person only reported experiences of abuse, it was more likely to report the presence of depressive symptoms, even after adjustment for covariates. If it was only reported the experience of food insecurity, it was more likely to report a worse health status. Older people exposed to at least two factors of vulnerability were significantly more likely to report (very) poor perceived health status (OR: 7.11, 95% CI: 2.77–18.25) and the presence of relevant depressive symptoms (OR: 4.34; 95% CI: 2.04–9.22). Thus, the combined effect of vulnerabilities was significantly associated with worse health among older people. Public health policies to mitigate these adverse exposures should be developed to promote health and well-being in this population.

Rural-urban differences in food insecurity and associated cognitive impairment among older adults: findings from a nationally representative survey

INTRODUCTION

Due to rapid urbanization, Covid-19 pandemic and increasing food prices, a higher rate of food insecurity has been observed in recent years in India. Thus, we aim to study the prevalence of food insecurity among older Indian adults and the association of food insecurity as a modifiable risk factor with late-life cognitive impairment.

METHOD

Data for this study were obtained from the recent release of the Longitudinal Ageing Study in India (2017-18). The total sample size for the study was 31,464 older adults aged 60 years and above. Cognitive functioning was measured through five broad domains (memory, orientation, arithmetic function, executive function, and object naming) adapted from the cognitive module of the US Health and Retirement Study (HRS). Descriptive statistics along with cross-tabulation were presented in the study. Additionally, multivariable logistic regression analysis was used to fulfil the objectives of the study.

RESULTS

It was found that 7.7% of older adults in rural areas reduced their size of meals due to unavailability (urban, 3.2%), 41.2% of them did not eat enough food of their choice (urban, 38.3%), 6.9% were hungry but did not eat food (urban, 2.6%), 5.0% did not eat for whole day (urban, 2.2%), and 6.9% lost weight due to lack of food in their household (urban, 2.9%). It was found that older adults who did not have enough food of their choice had significantly higher odds [AOR: 1.24; CI: 1.14, 1.35] of suffering from cognitive impairment in reference to their counterparts. Similarly, the older adults who were hungry but did not eat were 30% [AOR: 1.30; CI: 1.02, 1.73] more likely to suffer from cognitive impairment in reference to their counterparts. Interaction model revealed that older adults who had food insecurity in rural areas had higher odds of cognitive impairment than older adults who had food insecurity in urban areas.

CONCLUSION

The findings of the study highlight that the food security status in older adults may bring about greater challenges due to their limited economic resources. Interventions focusing on food security may have unintended positive impacts on late-life mental wellbeing as the older age is associated with higher cognitive deficits.

Associations Between Food Insecurity and Common Mental Health Problems Among Reproductive-Aged Women in Kabul-Afghanistan

Background: Food insecurity has been linked to poor health outcomes, however this relationship is poorly understood among women of reproductive age. Therefore, we investigated the relationship between food insecurity and common mental health problems (CMHPs) in this population of women in Kabul, Afghanistan.

Method: A cross-sectional study was conducted with 421 women of reproductive age from four health centers located in four randomly selected zones in the city of Kabul. We used the United State Department of Agriculture (USDA) food-insecurity questionnaire, multiple 24-h recall for dietary intake, the Depression, the Anxiety and Stress Scale (DASS-21) to assess major mental health problems, and the International Physical Activity Questionnaire (IPAQ) to assess physical activity.

Result: Food insecurity affected 69.6% of reproductive-aged women. In total, 44.9, 10.9, and 13.9% of food-insecure participants had food insecurity without hunger, food insecurity with hunger, and food insecurity with severe hunger, respectively. Depression, anxiety, and stress were prevalent among food-insecure participants at 89.4, 90.8, and 85.7%, respectively. Food insecurity was associated with depression (OR = 4.9, 95% CI: 2.7–8.9), anxiety (OR = 4.7, 95% CI: 2.5–8.8), and stress (OR = 3.8, 95% CI: 2.2–6.7). Women's household ownership, family size, and hypertension, on the other hand, were not associated with food insecurity.

Conclusion: This study found food insecurity was associated with CMHPs among a sample of reproductive-aged women in Kabul, Afghanistan. Further longitudinal studies are needed to confirm these findings.

Prevalence of food insecurity in people with major depression, bipolar disorder, and schizophrenia and related psychoses: A systematic review and meta-analysis

People with severe mental illness (SMI), such as major depression, bipolar disorder, and schizophrenia, experience numerous risk factors that may predispose them to food insecurity; however, the prevalence of food insecurity and its effects on health are under-researched in this population group. This systematic review and meta-analysis aimed to describe the prevalence and correlates of food insecurity in people with SMI. A comprehensive electronic search was conducted up to March 2021. Random effects meta-analysis was employed to determine the prevalence of food insecurity in SMI, and odds ratio (OR) of food insecurity in people with SMI compared to non-psychiatric controls/general population. Twenty-nine unique datasets (31 publications) were included. Prevalence estimate of food insecurity in people with SMI was 40% (95% CI 29-52%, I² = 99.7%, N = 27). People with SMI were 2.71 (95% CI 1.72-3.25) times more likely to report food insecurity than the comparator group (Z = 11.09, p < 0.001, I² = 95%, N = 23). The odds of food insecurity in SMI were higher in high/high-middle income countries compared to low/low-middle income countries, likely due to the high food insecurity rates in the general population of lower income countries. There was no difference in food insecurity rates by diagnosis. Food insecurity should be a consideration for health professionals working with community-dwelling people with SMI.

Food insecurity and nutritional status among older adults: a systematic review

CONTEXT

Food insecurity (FI), characterized by difficulty or inability to access adequate food, has become a public health problem.

OBJECTIVE

To analyze studies relating FI with nutritional status (NS) among older adults and the associated factors.

DATA SEARCH

Articles published up to June 2020 were investigated in 5 databases: PubMed, Embase, Scopus, LILACS, and Web of Science. The search, selection, extraction, and quality evaluation were carried out by 2 reviewers.

DATA EXTRACTION

The authors identified characteristics of the studies and the main data regarding the relationship of interest.

RESULTS

Twenty-two studies were included in the review and their characteristics are summarized and presented using narrative synthesis. In 10 studies (45.4%), a relationship was observed between FI and malnutrition; in another 6 (27.3%), a relationship was observed between FI and being overweight.

CONCLUSION

A relationship was identified between FI, especially severe forms, and malnutrition, as well as between FI, especially mild forms, and people being overweight. Thus, FI among older adults relates to a 2-fold burden of nutritional outcomes, depending on the level.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020185086.

Food insecurity, food-related characteristics and behaviors, and fruit and vegetable intake in mobile market customers

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.

Determinants of food insecurity among elderly people: findings from the Canadian Community Health Survey

Food insecurity among elderly people is a major public health concern due to its association with several health conditions. Despite growing research and implementation of diverse income-based policy measures, food insecurity among elderly people remains a major policy issue in Canada. Additional research could inform food policy beyond strategies that target improving the financial resources of elderly people. Drawing data from the Canadian Community Health Survey (N = 24,930), we explored the correlates of food insecurity among older adults using negative log-log logistic regression techniques. Our findings show that certain categories of elderly people are more prone to food insecurity. These segments include seniors who are visible minorities (OR = 1.29, p < 0.01), live alone (OR = 1.13, p < 0.05), have a very weak sense of community belonging (OR = 1.40, p < 0.001), in poor physical health (OR = 1.20, p < 0.01), and those in lower age and income categories. These findings corroborate previous studies that demonstrate that food insecurity among elderly people is a complex phenomenon influenced by diverse socio-economic factors. In Canada, food security policies targeted at elderly people have largely prioritised poverty alleviation through income support programmes. While these programmes can improve the purchasing power of elderly people, they may not be sufficient in ensuring food security. There is a need to embrace and further investigate an integrated approach that pays attention to other contextual socio-economic dynamics.

Prevalence and Risk Factors for Food Insecurity Among Low-Income US Military Veterans

OBJECTIVE

Ensuring access to sufficient foods at all times is critical to veterans' health and well-being. Food insecurity has not been well explored in the veteran population. We examined the prevalence and predictors of food insecurity among low-income veterans, because the highest rates of food insecurity are among low-income households. We also examined rates of Supplemental Nutrition Assistance Program (SNAP) participation among subgroups at the highest risk of food insecurity.

METHODS

We used univariate analyses and 2011-2017 National Health Interview Survey (NHIS) data on veterans aged ≥21 with family incomes <200% of the federal poverty level to estimate the prevalence of food insecurity. We used bivariate analyses to identify correlates of food insecurity and estimate SNAP participation rates among subgroups of low-income veterans. Percentages were weighted using NHIS survey weights.

RESULTS

Of 5146 low-income veterans, 22.5% reported being food insecure in the previous month. Food insecurity was significantly associated with being aged <65 (33.0% aged 45-64 and 29.7% aged 21-44) compared with 15.0% and 6.4% among veterans aged 65-74 and ≥75, respectively (P < .001); unemployed compared with employed or not in the labor force (39.4%, 22.7%, and 20.2%, respectively; P < .001); in fair or poor health compared with good, very good, or excellent heath (31.8% vs 18.2%; P < .001); and having experienced serious psychological distress in the past month (56.3%) compared with not having experienced such distress (19.7%; P < .001). Although overall SNAP participation among low-income veterans was estimated to be 27.0%, participation rates were highest among veterans who had experienced serious psychological distress (44.1%), were unemployed (39.2%), and were renting their home (39.0%).

CONCLUSIONS

Some low-income veterans are at greater risk of food insecurity than other veterans. Postseparation programs, civilian support services, and veterans' health providers should be aware of the characteristics that place veterans at highest risk of food insecurity.

Food Insecurity Among Veterans: Resources to Screen and Intervene

A screener was created in the VA electronic health record clinical reminder system to facilitate an interdisciplinary approach to identifying and addressing food insecurity.