Measuring Food Insecurity in Older Adults Using Both Physical and Economic Food Access, NHANES 2013-18

Food Insecurity and Hypoglycemia among Older Patients with Type 2 Diabetes Treated with Insulin or Sulfonylureas: The Diabetes & Aging Study

BACKGROUND

Severe hypoglycemia is a serious adverse drug event associated with hypoglycemia-prone medications; older patients with diabetes are particularly at high risk. Economic food insecurity (food insecurity due to financial limitations) is a known risk factor for hypoglycemia; however, less is known about physical food insecurity (due to difficulty cooking or shopping for food), which may increase with age, and its association with hypoglycemia.

OBJECTIVE

Study associations between food insecurity and severe hypoglycemia.

DESIGN

Survey based cross-sectional study.

PARTICIPANTS

Survey responses were collected in 2019 from 1,164 older (≥ 65 years) patients with type 2 diabetes treated with insulin or sulfonylureas.

MAIN MEASURES

Risk ratios (RR) for economic and physical food insecurity associated with self-reported severe hypoglycemia (low blood glucose requiring assistance) adjusted for age, financial strain, HbA1c, Charlson comorbidity score and frailty. Self-reported reasons for hypoglycemia endorsed by respondents.

KEY RESULTS

Food insecurity was reported by 12.3% of the respondents; of whom 38.4% reported economic food insecurity only, 21.1% physical food insecurity only and 40.5% both. Economic food insecurity and physical food insecurity were strongly associated with severe hypoglycemia (RR = 4.3; p = 0.02 and RR = 4.4; p = 0.002, respectively). Missed meals ("skipped meals, not eating enough or waiting too long to eat") was the dominant reason (77.5%) given for hypoglycemia.

CONCLUSIONS

Hypoglycemia prevention efforts among older patients with diabetes using hypoglycemia-prone medications should address food insecurity. Standard food insecurity questions, which are used to identify economic food insecurity, will fail to identify patients who have physical food insecurity only.

Development of an older adult Nutrition Equity Index (NEI) and association with the Healthy Eating Index (HEI) in older Black and White U.S. adults

OBJECTIVES

We developed a novel measure for older U.S. adults called the Nutrition Equity Index (NEI), which includes functional ability. We compared both the NEI and food insufficiency with Healthy Eating Index (HEI) scores.

DESIGN

The Health, Aging, and Body Composition Study is a prospective, longitudinal cohort of Medicare-eligible, community-dwelling Black and White men and women.

SETTING

Pittsburgh, PA and Memphis, TN.

PARTICIPANTS

Participants (N = 2468, aged 74.7 ± 2.9 years) had baseline (1997-98) and 1-year follow-up NEI data; and 1 year follow-up for food insufficiency, key covariates, and the HEI (diet quality measure) from a 108-item interviewer-administered food frequency questionnaire.

MEASUREMENTS

Food insufficiency was defined from a modified validated question on ample food amount/variety from the U.S. Department of Agriculture. NEI was constructed from 8 questions in three subdomains: food insecurity (food insufficiency, hunger, anxiety about limited food, limited money for food), food access (groceries), and food acquisition (difficulty shopping, preparing meals, carrying groceries). Final NEI categories were low nutrition equity (0), moderate nutrition equity (1), and high nutrition equity (2). Multivariable linear regression compared both NEI and food insufficiency with HEI, adjusted for sociodemographic, lifestyle and comorbidity factors.

RESULTS

Of participants, 13.5% had food insufficiency, 12.1% had low NEI, and 32.5% had moderate NEI. Participants with food insufficiency (vs. food sufficiency) or low NEI (vs. high NEI) were more likely to be Black and have < high school education (both p < 0.0001). In minimally adjusted models, food insufficiency was associated with 2.2 point lower HEI score (p = 0.001), low NEI with 2.6 point lower HEI score (p = 0.001), and moderate NEI with 1.0 point lower HEI score (p < 0.05). Adjusting for race attenuated NEI associations with HEI to non-significance. After multivariable adjustment, food insufficiency was associated with 1.5 point lower HEI score (p = 0.03).

CONCLUSION

Food insufficiency was associated with lower dietary quality in this sample of older Black and White U.S. adults. NEI performed similarly to food insufficiency for HEI associations prior to multivariable adjustment and identified more older adults with nutrition inequity, who may be at risk for poor health outcomes.

Prevalence and Correlates of Food Insecurity Among Older Adults in the United States

This study analyzed the 2021 National Health Interview Survey (NHIS) to assess food insecurity among adults aged 65 and older. Among 8,877 older adults, 4 percent (N=287) reported low or very low food security levels. Those who identified as Black or African American and Hispanic or Latino were more likely to experience food insecurity compared to White individuals. The study found that merely surpassing the poverty threshold might not be sufficient to protect against food insecurity. It also underscored socioemotional support's protective role in older adults' food security. Social workers must recognize various factors influencing food security among older adults.

Food insecurity and disability among working-age and older adults

OBJECTIVE

To explore relationships between disability, food insecurity (FI) and age and examine how socio-economic factors impact risk of FI among disabled people in working and older age.

DESIGN

Logistic regression models used to analyse the contribution of socio-economic factors to gaps in risk of FI for disabled people. In models stratified into working and older age groups, differences in risk of FI for disabled and non-disabled people were examined by employment, education and assets.

SETTING

England, Wales and Northern Ireland, 2016 and 2018.

PARTICIPANTS

A representative sample of 6187 adults aged 16+, of whom 28 % were disabled, from the Food & You survey.

RESULTS

The gap in FI risk by disability status decreased as age increased. For ages 25-34 for disabled v. non-disabled people, risk of FI was 31 % (95 % CI 21-41 %) v. 10 % (8-12 %); at ages 45 to 54, it was 18 % (11-23 %) v. 7 % (5-8 %), and at ages 75+, there was no gap in risk. Accounting for socio-economic variables halved the gap in risk among working ages. However, among working-age adults, FI among disabled people in full-time work was 15 % (11-20 %) compared with only 7 % (6-9 %) among non-disabled people in full-time work. Among older people, disabled people without savings were at higher risk of FI (5 % (3-7 %)) than non-disabled people without savings (2 % (1-3 %)) but having savings closed risk gap.

CONCLUSIONS

Socio-economic resources partially explain disparities in FI risk when disabled. Disparities remained for people in full-time work and among people without savings in older age.

Nourishing the Mind: How Food Security Influences Mental Wellbeing

Food insecurity is a significant public health problem worldwide and critical to mental health. There is a complex relationship between food security and mental health. We carried out a narrative review study aiming to address how food insecurity impacts mental wellbeing by focusing on the mental health repercussions of food insecurity, recognizing its pivotal role in attaining Sustainable Development Goals 2 (on hunger) and 3 (on enhancing global wellbeing). A comprehensive search was conducted on PubMed and Google Scholar, incorporating Google searches for pertinent reports and policy documents. To address these questions, we emphasized and elucidated the interconnectedness between food security and mental health. The review shows that food security and mental health share a profound relationship influenced by multifaceted factors like socioeconomic conditions, access to nutritious food, and societal inequalities. We then provide recommendations for integrating food security into mental health strategies based on the insights and conclusions drawn. Strategies ranging from sustainable farming practices to urban agriculture initiatives and digital mental health services demonstrate avenues for enhancing food safety and mental wellbeing. This highlights the need for collaborative interdisciplinary efforts and systemic reforms to address these interconnected challenges.

A positive association between food insecurity and the prevalence of overactive bladder in U.S. adults

Objective

This study aims to examine the correlation between overactive bladder (OAB) and food insecurity.

Methods

We conducted a cross-sectional analysis utilizing extensive population data derived from the National Health and Nutrition Examination Survey 2007-2018. The status of Household food insecurity is evaluated by the US Food Security Survey Module. To explore the relationship between food insecurity and OAB, three multivariable logistic regression models were carried out. Additionally, interaction and stratified analyses were also performed to find whether some factors have the potential to alter the correlation.

Results

There were 29,129 participants enrolled in the study. Compared to the other three groups, individuals with full food security exhibited a lower proportion of nocturia, urinary urgency incontinence, and OAB. In the fully-adjusted model, it was found that people experiencing food insecurity have a significantly higher prevalence of OAB compared to those with food security in the fully-adjusted model (OR = 1.540, 95%CI 1.359-1.745). Additionally, there was a significant association between the levels of food insecurity and an increased risk of OAB prevalence was also observed (marginal food security: OR = 1.312, low food security: OR = 1.559, and very low food security: OR = 1.759). No significant interaction was seen in the fully-adjusted model.

Conclusion

There is a strong positive correlation between food insecurity and the prevalence of OAB. Similarly, the correlation between levels of food insecurity and OAB also indicates the same trend. Namely, the more insecure food, the higher risk of OAB prevalence in the population.

Does Self-Perceived Diet Quality Align with Nutrient Intake? A Cross-Sectional Study Using the Food Nutrient Index and Diet Quality Score

A reliable diet quality (DQ) assessment is critical to empower individuals to improve their dietary choices. Controversies persist as to whether self-perceived DQ is accurate and correlated with actual DQ as assessed by validated nutrient intake indexes. We used National Health and Nutrition Examination Surveys data to examine whether a higher self-perceived DQ was positively associated with a more optimal nutrient intake as reflected by the Food Nutrient Index (FNI) and Diet Quality Score (DQS). Comparative analyses were performed for three self-perceived DQ groups: (I) "excellent or very good" DQ, (II) "good or fair" DQ, and (III) "poor" DQ. The FNI and DQS differed substantially across groups and sexes. FNI scores ranged from 65 to 69 in participants with a self-reported excellent or very good DQ, whereas participants with a self-perceived poor DQ scored significantly lower (53-59). We also observed age- and sex-specific patterns, with the lowest overall FNI scores found in males aged 18-30 years and females aged 31-50 years. DQ intergroup differences were more pronounced in females than in males. Our findings suggest that higher self-perceived DQ is associated with a more optimal nutrient intake and indicate potential helpfulness of self-perceived DQ as a quick and still underexplored indicator with intrinsic limitations.

Development and Validation of a Physical Food Security Tool for Older Adults

BACKGROUND

Current measures of food insecurity focus on economic access to food, but not on the physical aspect of food insecurity that captures the inability to access food or prepare meals. This is particularly relevant among the older adult population who are at a high risk of functional impairments.

OBJECTIVES

To develop a short-form physical food security (PFS) tool among older adults using statistical methods based on the Item Response Theory (Rasch) model.

METHODS

Pooled data from adults aged ≥60 y of the NHANES (2013-2018) (n = 5892) were used. The PFS tool was derived from the physical limitation questions included in the physical functioning questionnaire of NHANES. Item severity parameters, fit and reliability statistics, and residual correlation between items were estimated using the Rasch model. The construct validity of the tool was assessed by examining associations with the Healthy Eating Index (HEI)-2015 scores, self-reported health, self-reported diet quality, and economic food insecurity, using weighted multivariable linear regression analysis, controlling for potential confounders.

RESULTS

A 6-item scale was developed, which had adequate fit statistics and high reliability (0.62). It was categorized based on raw score severity into high, marginal, low, and very low PFS. Very low PFS was associated with respondent's self-reported poor health (OR = 23.8; 95% CI: 15.3, 36.9; P < 0.0001), self-reported poor diet (OR = 3.9; 95% CI: 2.8, 5.5; P < 0.0001), low and very low economic food security (OR = 6.08; 95% CI: 4.23, 8.76; P < 0.0001), and with lower mean HEI-2015 index score, in comparison to older adults with high PFS (54.5 compared with 57.5, P = 0.022).

CONCLUSIONS

The proposed 6-item PFS scale captures a new dimension of food insecurity that can inform on how older adults experience food insecurity. The tool will require further testing and evaluation in larger and different contexts to demonstrate its external validity.

Food Insecurity and Hearing Loss Are Interrelated: A Cross-Sectional Population-Based Study

OBJECTIVES

We aimed to assess whether objectively measured hearing loss and self-perceived hearing handicap in adults are independently associated with food insecurity, and vice versa.

DESIGN

Cross-sectional population-based study.

POPULATION

2,500 participants aged 50+ years from the Blue Mountains Hearing Study, with both complete pure-tone audiometry data and information on food security status.

MEASUREMENTS

The pure-tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz (PTA0.5-4KHz) >25 dB HL in the better ear, established the presence of hearing loss. Self-perceived hearing handicap was assessed by administering the Hearing Handicap Inventory for Elderly Screening (HHIE-S total scores of ≥8 indicates hearing handicap). A 12-item food security survey was administered, comprising statements related to individual and household food situations.

RESULTS

Food insecurity was reported by 12.8% of study participants. After adjusting for all potential confounders, any self-perceived hearing handicap significantly increased the likelihood of participants reporting food insecurity by 94% (p<0.0001). Participants reporting any, mild or severe self-perceived hearing handicap had around 2-fold greater odds of experiencing food insecurity. Objectively measured hearing loss did not significantly influence the food security status of study participants. Conversely, food insecurity was significantly associated with both objectively measured hearing loss and self-perceived hearing handicap: multivariate-adjusted OR 1.37 (95% CI 1.01-1.88) and OR 1.83 (95% CI 1.40-2.39), respectively.

CONCLUSIONS

Food insecurity was an important social determinant of hearing health among community-dwelling adults. Conversely, participants with a significant self-perceived hearing handicap were more likely to experience food insecurity. These findings add to our understanding of the substantial public health impact of both food insecurity and hearing loss and may highlight areas for future intervention.

The Diet Quality of Food-Insecure Australian Adults-A Nationally Representative Cross-Sectional Analysis

Poor diet quality exacerbates risks for acute and chronic conditions. People experiencing food insecurity have an increased likelihood of lower diet quality; however, this has not been investigated in the Australian context. The aim of this cross-sectional study was to examine whether the diet quality of Australian adults differed according to their household food security status. Data were analysed from a nationally representative sample (≥19 years; n = 9115) collected as part of the National Nutrition and Physical Activity Survey 2011-12. Household food security status and socio-demographic and health characteristics were assessed using data from an 18-module health interview. A 24 h dietary recall was used to estimate food and nutrient intakes and to calculate the Dietary Guidelines Index (DGI). DGI is a food-based score (0 to 130) that assesses adherence to the 2013 Australian Dietary Guidelines. Survey-weighted linear regression models, adjusted for age and sex, were used to examine diet quality (total DGI and component scores), and total energy and nutrient intake by food security status. Adults from food-insecure households had a mean total DGI score 3.5 points lower (95% CI -5.57, -1.46) than food-secure adults (p = 0.001). Adults from households experiencing food insecurity, when compared to those who were food-secure, had several lower DGI component scores including for dietary variety (1.6 vs. 2.3, p = 0.009), fruit (3.8 vs. 5.0, p = 0.001) and vegetables (3.7 vs. 4.4, p = 0.010). Adults from food-insecure households consumed on average more carbohydrates (45.6 vs. 43.3, p = 0.004) and total sugar (21.8 vs. 19.0, p = 0.003) as a percentage of daily energy and less protein (18.5 vs. 17.2, p = 0.004), mono-unsaturated fats (11.2 vs. 11.8, p = 0.026) as a percentage of daily energy, and fibre (20.1 vs. 23.0, p = 0.003), than food-secure adults. Sub-optimal diet may be one of the contributing factors to, or outcomes of, poorer health in food-insecure populations. Food security interventions are required to better address nutrition in food-insecure households and should be tailored to the health and socio-demographic characteristics of this population.