Food insecurity and poor diet quality are associated with reduced quality of life in older adults

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.

The Influence of Joe Wicks on Physical Activity During the COVID-19 Pandemic: Thematic, Location, and Social Network Analysis of X Data

BACKGROUND

 Social media (SM) was essential in promoting physical activity during the COVID-19 pandemic, especially among people confined to their homes. Joe Wicks, a fitness coach, became particularly popular on SM during this time, posting daily workouts that millions of people worldwide followed.

OBJECTIVE

 This study aims to investigate the influence of Joe Wicks on SM and the impact of his content on physical activity levels among the public.

METHODS

 We used NodeXL Pro (Social Media Research Foundation) to collect data from X (formerly Twitter) over 54 days (March 23, 2020, to May 15, 2020), corresponding to the strictest lockdowns in the United Kingdom. We collected 290,649 posts, which we analyzed using social network analysis, thematic analysis, time-series analysis, and location analysis.

RESULTS

 We found that there was significant engagement with content generated by Wicks, including reposts, likes, and comments. The most common types of posts were those that contained images, videos, and text of young people (school-aged children) undertaking physical activity by watching content created by Joe Wicks and posts from schools encouraging pupils to engage with the content. Other shared posts included those that encouraged others to join the fitness classes run by Wicks and those that contained general commentary. We also found that Wicks' network of influence was extensive and complex. It contained numerous subcommunities and resembled a broadcast network shape. Other influencers added to engagement with Wicks via their networks. Our results show that influencers can create networks of influence that are exhibited in distinctive ways.

CONCLUSIONS

Our study found that Joe Wicks was a highly influential figure on SM during the COVID-19 pandemic and that his content positively impacted physical activity levels among the public. Our findings suggest that influencers can play an important role in promoting public health and that government officials should consider working with influencers to communicate health messages and promote healthy behaviors. Our study has broader implications beyond the status of fitness influencers. Recognizing the critical role of individuals such as Joe Wicks in terms of health capital should be a critical area of inquiry for governments, public health authorities, and policy makers and mirrors the growing interest in health capital as part of embodied and digital experiences in everyday life.

Unraveling the associations between unhealthy lifestyle behaviors and mental health in the general adult Chinese population: A cross-sectional study

BACKGROUND

This study examined the cumulative risk of unhealthy lifestyle behaviors and the associations between overall lifestyle and common mental disorders (CMDs), insomnia, stress, health-related quality of life (HRQOL), and functional impairment. Additionally, the treatment preferences for managing CMDs and insomnia were examined.

METHODS

A survey was conducted on 1487 Chinese Hong Kong adults, assessing their lifestyle behaviors (i.e., diet and nutrition, substance use, physical activity, stress management, restorative sleep, social support, and environmental exposures), mental health-related outcomes, and treatment preferences via a vignette.

RESULTS

The findings revealed significant additive relationships between the number of 'worse' lifestyle domains and the risk of all outcomes. A healthier overall lifestyle was significantly associated with reduced risks of all outcomes (AORs = 0.88 to 0.93). Having healthier practices in diet and nutrition, substance use, stress management, restorative sleep, and social support domains were significantly associated with lower risks of all outcomes (AORs = 0.93 to 0.98), except that substance use was not significantly associated with stress. Physical activity was inversely associated with only depressive symptoms (AOR = 0.98), anxiety symptoms (AOR = 0.99), and stress (AOR = 0.99). Environmental exposures were not significantly associated with functional impairment but with all other outcomes (AORs = 0.98 to 0.99). Besides, lifestyle interventions (55 %) were significantly more preferred for managing CMDs and insomnia relative to psychotherapy (35.4 %) and pharmacotherapy (9.6 %).

CONCLUSIONS

Our findings underscore the importance of considering lifestyle factors when managing CMDs, insomnia, stress, HRQOL, and functional impairment, with a particular emphasis on adopting a multicomponent treatment approach.

Disposition of improving quality of life in older adults: the case of Lithuania

BACKGROUND

Quality of life is a phenomenon that recently required lots of concern, especially for older adults, since healthy aging and longevity have become the focus in life. Most research on the quality of life addresses certain issues of older people having special diseases, health problems, and disorders. Our research is based on holistic quality of life empowering multiple areas of life/domains of older adults without addressing their diseases or health disorders.

AIM

Our research aims at evaluating the quality of life of the research participants (older people), addressing their problematic areas and suggestions for better quality of life.

METHODS

The conducted research implied mixed methods as quantitative survey and reflection based on interviews. We chose participants from the III age university and the ongoing project "Healthy Aging Program".

RESULTS

The research results showed the lowest ratings for emotional and physical health and the highest rating for social health. Also, older adults tend to avoid specifying precise measures to improve their quality of life and demonstrate a more conservative stance regarding the implementation of more radical changes in improving water consumption, exercising, meal planning, and enhancing psychosocial well-being.

CONCLUSIONS

The overall quality of life rating was lower than the average. Older adults are not sufficiently prepared or educated to make significant changes to develop healthier habits in their quality-of-life improvement, though, they demonstrate concern about their quality of life.

Increasing food insecurity severity is associated with lower diet quality

OBJECTIVE

Food insecurity may reduce diet quality, but the relationship between food insecurity severity and diet quality is under-researched. This study aimed to examine the relationship between diet quality and severity of household food insecurity.

DESIGN

A cross-sectional, online survey used the United States Department of Agriculture Household Food Security Six-item Short Form to classify respondents as food secure or marginally, moderately or severely food insecure. The Australian Recommended Food Score (ARFS; scored 0–73) determined diet quality (ARFS total and sub-scale scores). Survey-weighted linear regression (adjusted for age, sex, income, education, location and household composition) was conducted.

SETTING

Tasmania, Australia.

PARTICIPANTS

Community-dwelling adults (aged 18 years and over).

RESULTS

The mean ARFS total for the sample (n 804, 53 % female, 29 % aged > 65 years) was 32·4 (sd = 9·8). As the severity of household food insecurity increased, ARFS total decreased. Marginally food-insecure respondents reported a mean ARFS score three points lower than food-secure adults (B = –2·7; 95 % CI (–5·11, –0·34); P = 0·03) and reduced by six points for moderately (B = –5·6; 95 % CI (–7·26, –3·90); P < 0·001) and twelve points for severely food-insecure respondents (B = –11·5; 95 % CI (–13·21, –9·78); P < 0·001). Marginally food-insecure respondents had significantly lower vegetable sub-scale scores, moderately food-insecure respondents had significantly lower sub-scale scores for all food groups except dairy and severely food-insecure respondents had significantly lower scores for all sub-scale scores.

CONCLUSIONS

Poorer diet quality is evident in marginally, moderately and severely food-insecure adults. Interventions to reduce food insecurity and increase diet quality are required to prevent poorer nutrition-related health outcomes in food-insecure populations in Australia.

Quality of Life and the Role of Food and Eating as Described by Community-Dwelling Older Adults

While food and eating are important determinants of health, there is limited information on how they affect quality of life (QOL). This study aimed to understand (1) the factors that impact QOL, (2) the effect of food and eating on QOL, from the perspective of community-dwelling older adults. Twenty-five older adults completed semi-structured interviews. The constant comparative method was used to assign codes to participant's responses and organize them into categories, which were used to form a conceptual framework. Five main themes emerged showing factors affecting QOL: health and vitality; independence; mental and emotional well-being; socialization and support; and activities. Four themes were identified demonstrating how food and eating affect QOL: food access and choice; food preparation; health and vitality; and food enjoyment. Relationships between themes suggest food and eating have a broad effect on factors impacting QOL. To develop and tailor community interventions to improve older adults' QOL, measurement tools should include these effects.

Food Insecurity Among Older Adults Living in Low- and Middle-Income Countries: A Scoping Review

BACKGROUND AND OBJECTIVES

Food insecurity is considered an increasing public health problem worldwide with adverse effects, especially among older adults. Although the literature related to food insecurity among older adults in low- and middle-income countries (LMIC) are expanding, little is known about existing patterns and knowledge gaps in these settings. This scoping review aims to provide a comprehensive overview of the current research related to food insecurity among older adults in LMIC.

RESEARCH DESIGN AND METHODS

A systematic search was conducted in November 2021 and revised in July 2022 on six databases using terms related to food insecurity and older adults. Data were extracted, and the emerging themes from the main findings were summarized using a social-ecological model (SEM).

RESULTS

Forty-one studies met the inclusion criteria. Almost half (48.8%) were published in the last 2 years and utilized a quantitative approach (n = 38). Only one study was conducted in a low-income country. Using the SEM, most studies included in this review focused on addressing the relationship between food insecurity with intrapersonal factors.

DISCUSSION AND IMPLICATIONS

Several gaps in the current literature were identified. There is a lack of longitudinal and qualitative studies available on this topic. Also, only 15 LMIC were represented in the literature. A critical point in this review is that only a few studies addressed the relationship between food insecurity and the policy/social structure, institutional, community, and interpersonal levels. These identified gaps can serve as a guide for future research on this topic.

Association between food insecurity and quality of life among older adults (60+) in six low and middle-income countries

Food insecurity is a key social determinant of health and nutrition. However, very few studies have examined the association of food insecurity and quality of life outcomes among older adults in low and middle-income settings. In this study, we examine the association of food insecurity with self-rated poor quality of life, low life satisfaction, and WHO quality of life (WHOQol). Nationally representative data from WHO's Study on global AGEing and adult health (SAGE) consisting of 20,026 older adults were analyzed. The association of food insecurity with self-rated poor quality of life and low life satisfaction was assessed using bivariate and multivariate logistic regression analysis. Multivariate linear regression models examine the association between food insecurity and WHOQol score. Pooled data analysis of six countries showed older adults with severe food insecurity were two times more likely to report poor quality of life (OR = 2.49, CI 2.10, 2.96; p < 0.001) and low life satisfaction (OR = 2.36, CI 1.94, 2.87; p < 0.001), respectively. Similarly, older adults with severe food insecurity had 3.60 (CI-4.25, -2.95; p < 0.001) points lower WHO-QoL score than those who are food secure. These results show that the association of food insecurity is statistically significant with all three outcomes of quality of life in all six countries adjusting for sociodemographic and health measures. Public health and social security interventions are important to prevent food insecurity to promote overall wellbeing of the growing older population in low and middle-income countries.

Food is medicine intervention shows promise for engaging patients attending a safety-net hospital in the Southeast United States

Public health organizations, including the Academy of Nutrition and Dietetics and the American Hospital Association, recognize the importance of achieving food and nutrition security to improve health outcomes, reduce healthcare costs, and advance health equity. In response, federal, state, and private agencies are increasingly seeking to fund healthcare-based interventions to address food insecurity among patients. Simultaneously, nutrition-based interventions targeting chronic diseases have grown across the United States as part of the broader "Food is Medicine" movement. Few studies have examined the successes, challenges, and limitations of such efforts. As Food is Medicine programs continue to expand, identifying common approaches, metrics, and outcomes will be imperative for ensuring program success, replicability, and sustainability. Beginning in 2020, the Food as Medicine (FAM) program, a multipronged, collaborative intervention at Grady Health System has sought to combat food insecurity and improve patient health by leveraging community resources, expertise, and existing partnerships. Using this program as a case study, we (1) outline the collaborative development of the FAM program; (2) describe and characterize patient engagement in the initial 2 years; and (3) summarize strengths and lessons learned for future hospital-based food and nutrition programming. As this case study illustrates, the Food as Medicine program provides a novel model for building health equity through food within healthcare organizations.

Research is still limited on nutrition and quality of life among older adults

Introduction

Globally, the number of older adults is growing exponentially. Yet, while living longer, people are not necessarily healthier. Nutrition can positively impact healthy aging and quality of life (QoL). Two decades ago, nutrition and diet were rarely viewed as key QoL domains, were not part of QoL screening, and QoL studies frequently used unvalidated tools. It is unclear how the nutrition and QoL research area may have since evolved.

Methods

A scoping review was conducted in Pubmed of research with community-living older adults (aged ≥65) from developed economies that included 1 of 29 common, valid QoL instruments, nutrition indices, and was published between 1/2000-12/2022. The review followed published methodology guidance and used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram to document identified studies and record number of included/excluded studies (based on scoping review's pre-specified criteria).

Results

Of 258 studies identified initially, 37 fully met scoping review inclusion criteria; only 2 were QoL studies, 30 focused on nutrition, 3 on measurement tool validation/testing, and 2 were other study types. Most studies (n = 32) were among populations outside of North America; majority were conducted in Europe (n = 22) where the EuroQol 5 Dimension (Eq5D) was used in >1/2 the studies. Of 5 North American studies, the 36-Item Short Form Survey (SF-36) was most frequently used (n = 4). Myriad nutrition indices described various aspects of eating, dietary intake, and nutrition status, making comparability between studies difficult. Studies included several different nutrition questionnaires; Mini Nutritional Assessment (MNA) (n = 8) or Mini Nutritional Assessment Short Form (MNA-SF) (n = 5) were used most frequently. The most frequent anthropometric measure reported was Body Mass Index (BMI) (n = 28). Nutrition-related biochemical indices were reported infrequently (n = 8).

Discussion

The paucity of studies over the last two decades suggests research on nutrition and QoL among community-living older adults remains underdeveloped. Valid QoL instruments and nutrition indices are now available. To ensure greater comparability among studies it is important to develop consensus on core indices of QoL and particularly nutrition. Greater agreement on these indices will advance further research to support healthy aging and improve QoL for community-dwelling older adults.

Examining Predictors of Nutritional Risk among Older Adults: A Needs Assessment

Older adults are the fastest growing population in the United States. This group is at risk for developing chronic diseases resulting from high nutritional risk. The objective of this study was to assess nutritional risks and their key predictors among older adults. In this cross-sectional study, the Dietary Screening Tool, the Nutrition Self-efficacy Scale, food security, perceived health, and sociodemographics were measured. A total of 475, English-speaking adults, 50 years of age or older, residing in Maryland and attending senior congregate sites, participated in the study (urban n = 215, rural n = 260). Results showed 88.8% of participants were classified as being nutritionally 'at risk' or 'possible' risk. Higher education level, higher nutrition self-efficacy, and food security were significant predictors associated with lower nutritional risk among older adults. Implementing suitable and effective nutrition interventions requires assessing diet and identifying the needs specific to older adult populations. Utilizing appropriate screening tools is an important step in improving overall diets and may reduce barriers to adopting healthy eating behaviors in this population.

Determinants of Nutritional Risk among Community-Dwelling Older Adults with Social Support

BACKGROUND

It is well established that older adults are at risk for malnutrition due to several social and non-social determinants, namely physiological, psychosocial, dietary and environmental determinants. The progression to malnutrition is often insidious and undetected. Thus, nutritional assessment should consider a complex web of factors that can impact nutritional status (NS). The primary objective of this study was to assess the NS of older adults attending senior centres (SCs) and to identify its predictors.

METHODS

This cross-sectional study enrolled a sample of community-dwelling older adults in Lisbon. NS was assessed using Mini Nutritional Assessment (MNA^®). Malnutrition or malnutrition risk (recategorised into a single group) was predicted using binary logistic regression models, considering those participants classified as having a normal NS as the reference group. Data were collected through face-to-face interviews and anthropometric indices were measured according to Isak procedures.

RESULTS

A sample of 337 older adults, with an average age of 78.4 years old (range 66-99), mostly women (n = 210; 62.3%), were enrolled. Older adults at risk of malnutrition accounted for 40.7% of the sample. Being older (OR = 1.045, CI 95% [1.003-1.089], p = 0.037), having a worse perception of health status (OR = 3.395, CI 95% [1.182-9.746], p = 0.023), having or having had depression (OR = 5.138, CI 95% [2.869-9.201], p < 0.001), and not having or having had respiratory tract problems (OR = 0.477, CI 95% [0.246-0.925], p = 0.028) were independent predictors of malnutrition or malnutrition risk. An intermediate time of SC attendance was associated with a lower probability of malnutrition or risk (OR = 0.367, CI 95% [0.191-0.705], p = 0.003).

CONCLUSIONS

NS among older adults has a multifactorial aetiology, with a strongly social component and is related to health circumstances. Further research is needed to timely identify and understand nutritional risk among this population.

The Interactions of Food Security, Health, and Loneliness among Rural Older Adults before and after the Onset of COVID-19

Older adults and those living in rural areas face unique challenges to health and food security which were exacerbated during the COVID-19 pandemic. We examine the interrelationships among food security, physical health, and loneliness among rural older adults before the onset of and during the COVID-19 pandemic. Using data from a cross-sectional household survey of older adults in rural Indiana, administered May 2020 through July 2020, our results show a higher prevalence of food insecurity, poorer physical health, and increased loneliness after the onset of the pandemic. Path analyses confirmed the interrelationship between food security, health, and the absence of loneliness before and after the onset of COVID-19. Loneliness emerged as a major pathway through which the pandemic impacted quality of life, particularly affecting older women and physical health. Policy initiatives should consider the unique experiences and challenges associated with rural life among older adults and create food security initiatives that incorporate socialization while also considering the challenges associated with poor physical health in older age. Furthermore, our analysis shows that those who are vulnerable to food security, poor health, and loneliness in the absence of a global pandemic remain vulnerable during a pandemic.

The association of food insecurity with tooth decay and periodontitis among middle-aged and older adults in the United States and Korea

INTRODUCTION

Food insecurity is an important social determinant of health, but there is limited understanding of its relationship with adult oral health. This study examined the associations between food insecurity and dental diseases (caries and periodontitis) among middle-aged and older adults in the United States and South Korea.

METHODS

This study focused on middle-aged (40-59 years) and older adults (>59 years) who participated in the 2011-2016 US National Health and Nutrition Examination Surveys (NHANES) or the 2013-2015 South Korean NHANES. The exposure was food insecurity severity (food secure/early-stage food insecurity/middle-stage or severe food insecurity) assessed using the 18-item US Household Food Security Survey Module. The two outcomes were any untreated tooth decay and periodontitis measured using the Modified Community Periodontal Index of Treatment Needs. Covariate-adjusted odds ratios (OR) with 95% confidence intervals (CI) were generated using multivariable logistic regression models.

RESULTS

Middle or severe food insecurity was associated with significantly higher odds of having untreated tooth decay than no food insecurity, but only among middle-aged adults in the United States (OR: 1.4, 95% CI 1.2, 1.9; P = .037) and Korea (OR = 1.8; 95% CI:1.0, 3.2; P = .036) and older adults in the United States (OR: 2.6, 95% CI 1.7, 4.0; P < .001). The associations between food insecurity and periodontitis were inconsistent across age group and country.

CONCLUSION

Differing cultural norms and access to dental services in the United States and South Korea may influence the relationship between food insecurity and oral health. Future research should explore how addressing food insecurity could help to promote the oral health of middle-aged and older adults in diverse sociocultural contexts.

Chronic diseases and emotional disorders are associated with low perception of quality of life in food insecurity/security

Understanding individual perception of Quality of Life (QoL) can help combat social and health inequalities. We aimed to identify factors associated with Low Perceived Quality of Life (LPQoL) in 295 adults and older adults with food security and food insecurity, in the city of Natal, Brazil. A cross-sectional study was conducted from June to December 2019, with collection of data on socioeconomic demographic status, lifestyle information, non-communicable diseases (NCDs) and risk factors, emotional disorders, food (in) security and quality of life. To assess food insecurity, the Brazilian Scale of Food Insecurity—EBIA was used, and the WHOQOL-Bref questionnaire was used to assess quality of life. Poisson's Regression was used to verify associations between variables and LPQoL, stratifying the sample into food secure (FS) and food insecure (FI) groups. In the FI group, being overweight, older adult, having no partner, drinking alcoholic beverages twice a week or more, and not having daily availability of water were associated with LPQoL, and in the FS group, having diabetes, monthly family income in the 1st and 2nd tertiles, and never having studied was associated with LPQoL. Reporting emotional disorders and sleeping &lt; 7 h/day were associated with LPQoL in both FI and FS groups. LPQoL was associated with the occurrence of NCDs and risk factors, and emotional disorders, regardless of the food security measure. However, the lack of adequate access to water highlights the social vulnerability of the FI group.

Differences in Health-Related Quality of Life and Its Associated Factors Among Older Adults in Urban and Rural Areas

Purpose

Urban-rural health disparity is one of the most prominent challenges in China today. The goal of this study is to find differences in health-related quality of life (HRQoL) and its associated factors among older people in urban and rural areas.

Methods

A multi-stage stratified sampling method was conducted in Shanxi Province, with a total of 3250 older adults participated in this cross-sectional survey. HRQoL was assessed using the Chinese version of the EQ-5D-5L. Tobit regression models were employed to identify associated factors for HRQoL.

Results

The mean EQ-5D utility score of the total sample was 0.87± 0.23, with a statistically significant difference observed between urban (0.89 ± 0.22) and rural areas (0.86 ± 0.23). Obesity (Coe=−0.10, p=0.021) and nutrition awareness (Coe=−0.14, p=0.009) were two unique associated factors to rural older adults’ HRQoL. While, age (Urban: Coe=0.13, p=0.001; Rural: Coe=−0.019, p<0.001), socioeconomic status (Urban: Coe=0.13, p<0.001; Rural: Coe=0.14, p<0.001), number of chronic non-communicable diseases (Urban: Coe=−0.20, p<0.001; Rural: Coe=−0.15, p<0.001), sleep quality (Urban: Coe=−0.22, p<0.001; Rural: Coe=0.15, p<0.001) and daytime sleepiness (Urban: Coe=−0.13, p<0.001; Rural: Coe=−0.13, p<0.001) were found to be associated with HRQoL regardless of the residential area.

Conclusion

This study suggested that rural older adults are facing HRQoL disadvantages compared to those in urban area. Accordingly, more attention should be devoted to rural older adults’ HRQoL, particularly to the unique factors like body weight and nutrition awareness. Targeted policies and interventions should be implemented to improve HRQoL and bridge the urban-rural HRQoL gap.

A methodological proposal for assessing food insecurity from a multidimensional perspective

The aim of this study was to develop a methodological proposal for the assessment of food and nutritional insecurity (FNiS) in adults and older adults (Vigi-FNiS). The proposal was developed using data from the BRAZUCA Natal survey, a cross-sectional study with 411 people living in Natal in the state of Rio Grande do Norte, Brazil. The association between sociodemographic, health and nutrition variables and food insecurity (FI) was tested using Poisson multiple regression. Overall prevalence of FI was 42.1% (37.4%-46.9%) and was higher in women (47.5%), adults (48.2%) and black people (52.7%). The following variables were included in the Vigi-FNiS: people aged <18 years living in the household (A) (AdjPR=1.3; 1.1-1.6); family income (B) in quintiles (Q1: AdjPR=5, 4; 2.5-11.7; Q2: AdjPR=4.8; 2.2-10.5; Q3: AdjPR=3.8; 1.8-8.5; Q4 AdjPR=2.2; 1.0-5.1); inadequate treatment of drinking water (C) (AdjPR=1.3; 1.1-1.5); presence of chronic non-communicable diseases (D) (AdjPR=1.3; 1.1-1.7); not eating fruit for breakfast (E) (AdjPR=1.7; 1.3-2.5);eating meals on the couch or in bed (F) (AdjPR=1.3; 1.1-1.6); and skipping either lunch or dinner or dinner (G) (AdjPR=1.4; 1.2-1.7). A cutoff point for FNiS of 2.3 was adopted (Kappa=0.47; sensitivity=0.82; specificity=0.67; PPV=0.64; NPV=0.83).

Meeting Older Adults' Food Needs: Interviews with Area Agency on Aging Staff, Food Bank Staff, and Older Adults

Area Agencies on Aging (AAAs) and food banks provide nutritious food for in-need older adults. The objective of this study was to identify successes, challenges, and opportunities associated with meeting the food needs of older adults. We used semi-structured telephone interviews with AAA nutrition staff (n = 5), food bank program coordinators (n = 5) and executives (n = 6), and older adults (n = 60) in Iowa. AAAs and food banks identified providing healthy food and client satisfaction as successes and funding and staff/volunteer capacity as challenges. Before the pandemic, the relationships between these organizations were limited, but both saw opportunities for collaboration. Older adults described coordination between AAAs and food banks during the COVID-19 crisis. AAAs and food banks play an important role in meeting older adults' food needs, but their effectiveness is limited by challenges related to funding and capacity. There is a need to identify feasible and sustainable strategies for collaboration past this crisis.

Food Pantry Usage Patterns are Associated with Client Sociodemographics and Health

Characterizing food pantry (FP) clients' FP usage patterns may provide opportunities to tailor health-related interventions. Respondents (n=245) at seven FPs reported their frequency and reliance on FPs and their sociodemographics, health status, and health-related trade-offs. Clients were categorized via latent class analysis. Higher FP usage was associated with being older, having a household member with heart disease, and putting off buying medicine to buy food. Lower FP usage was associated with higher levels of education and having a household member with cancer. Findings highlight the potential importance of measuring FP clients' degree of FP use.

A methodological proposal for assessing food insecurity from a multidimensional perspective

Abstract The aim of this study was to develop a methodological proposal for the assessment of food and nutritional insecurity (FNiS) in adults and older adults (Vigi-FNiS). The proposal was developed using data from the BRAZUCA Natal survey, a cross-sectional study with 411 people living in Natal in the state of Rio Grande do Norte, Brazil. The association between sociodemographic, health and nutrition variables and food insecurity (FI) was tested using Poisson multiple regression. Overall prevalence of FI was 42.1% (37.4%-46.9%) and was higher in women (47.5%), adults (48.2%) and black people (52.7%). The following variables were included in the Vigi-FNiS: people aged <18 years living in the household (A) (AdjPR=1.3; 1.1-1.6); family income (B) in quintiles (Q1: AdjPR=5, 4; 2.5-11.7; Q2: AdjPR=4.8; 2.2-10.5; Q3: AdjPR=3.8; 1.8-8.5; Q4 AdjPR=2.2; 1.0-5.1); inadequate treatment of drinking water (C) (AdjPR=1.3; 1.1-1.5); presence of chronic non-communicable diseases (D) (AdjPR=1.3; 1.1-1.7); not eating fruit for breakfast (E) (AdjPR=1.7; 1.3-2.5);eating meals on the couch or in bed (F) (AdjPR=1.3; 1.1-1.6); and skipping either lunch or dinner or dinner (G) (AdjPR=1.4; 1.2-1.7). A cutoff point for FNiS of 2.3 was adopted (Kappa=0.47; sensitivity=0.82; specificity=0.67; PPV=0.64; NPV=0.83).

The Relationship between Political, Economic, Social, and Cultural Vulnerability and Food Insecurity among Adults Aged 50 Years and Older

Individuals experience food insecurity when they worry about or have limited access to nutritious foods. Food insecurity negatively impacts older adults' health. Social exclusion is a theoretical framework describing how unequal access to rights, resources, and capabilities results in political, economic, social, and cultural vulnerability, which leads to health disparities. We used the Health and Retirement Study to cross-sectionally examine associations between vulnerability and experiencing food insecurity in adults 50 years and older using the social exclusion framework. We tested the association between experiencing food insecurity and indicators of political, economic, social, and cultural vulnerability using logistic regression controlling for demographic and health-related factors. Analyses were performed with all respondents and sub-group of respondents with incomes less than 400% of the federal poverty level (FPL). Assets (OR = 0.97 in both samples), income (OR = 0.85, 0.80 in 400% FPL sub-sample), perceived positive social support from other family (OR = 0.86, 0.84 in 400% FPL sub-sample), and perceived everyday discrimination (OR = 1.68, 1.82 in 400% FPL sub-sample) were significantly associated with food insecurity. Perceived positive social support from spouses, children, or friends and U.S. citizenship status were not significantly associated with food insecurity. Further research is needed to define and measure each dimension of vulnerability in the social exclusion framework. Interventions and policies designed to prevent food insecurity should address these vulnerabilities.

Likely Exacerbation of Psychological Disorders from Covid-19 Response

Anxiety and fear felt by people around the world regarding the coronavirus pandemic is real and can be overwhelming, resulting in strong emotional reactions in adults and children. With depressive and anxiety disorders already highly prevalent in the general population (300 million worldwide), depression and/or anxiety specifically because of the pandemic response is likely. Moreover, the current state of panic in the face of uncertainty is apt to produce significant amounts of stress. While this situation has the potential to cause psychological disorders in previously unaffected populations, perhaps more impactful is the exacerbation of symptoms of many existing disorders including anxiety, depression, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) and hoarding disorder.

Food insecurity and brain health in adults: A systematic review

Food insecurity has been associated with adverse effects on physical health and well-being in both high and low-income countries, but effects on brain health are not clear. The purpose of this systematic review was to determine the relationship between food insecurity and important brain health outcomes in adults including depression, stroke, cognitive impairment and dementia. Electronic databases were searched to find studies which investigated relations between food insecurity and predefined brain health outcomes. Thirty studies met the inclusion criteria for review of which 23 were conducted in high income countries and seven in low- or middle-income countries. Most studies (n = 24) were cross-sectional, five were prospective and 1 was a case-control design. Seven studies reporting outcomes relating to cognitive performance and 24 relating to depression. No studies investigated relations between food insecurity and stroke or dementia. There was substantial heterogeneity in the populations studied as well as measures of food insecurity and outcomes which made comparisons between studies difficult. Overall, the findings highlighted that individuals who were food insecure had increased likelihood of depressive symptoms and poorer global cognition than those who were food secure. It is possible that social support and food aid programmes attenuate the effects of food insecurity on depressive symptoms. Future research is needed to determine whether interventions to alleviate food insecurity can benefit brain health in vulnerable populations.

Food Insecurity and Influenza and Pneumonia Vaccines Uptake Among Community-Dwelling Older Adults in the United States

Influenza and pneumonia vaccines can reduce morbidities and mortality associated with infectious diseases among older adults. Food security, good nutrition, and high-quality diets are critical for the wellbeing of older adults. However, little is known about the relationship between food insecurity and use of preventive health services, such as influenza and pneumonia vaccinations, among older adults. In this study, we analyzed data on 40,555 adults aged ≥ 65 years from the 2014-2018 National Health Interview Survey in the United States. Through multiple hierarchical logistic regression models, we investigated the associations between food insecurity and influenza and pneumonia vaccines uptake in this population. We found that, during 2014-2018, about 12.6 million (5.3%) adults aged ≥ 65 years lived in food-insecure households in the United States. Of those, 60.6% reported getting an influenza vaccine in the past 12 months, and 54.2% reported ever getting a pneumonia vaccine. Compared to food-secure older adults, food-insecure individuals were not significantly different in terms of influenza vaccine uptake. However, they were 25% less likely to have ever gotten a pneumonia vaccine (adjusted odds ratio = 0.75, 95% CI 0.65-0.86, P < .001). Efforts should be made to develop strategies to improve immunization rates among food-insecure older adults. Healthcare providers could routinely assess their vaccination status and screen them for food insecurity. Also, community level screening and intervention programs should target food-insecure older adults, who often face structural disadvantages. Future studies could explore and identify the underlying predictive factors contributing to low pneumonia vaccination rates among food-insecure older adults.

Food Security, Dietary Intake, and Foodways of Urban Low-Income Older South African Women: An Exploratory Study

This cross-sectional study explored the differences in sociodemographics, dietary intake, and household foodways (cultural, socioeconomic practices that affect food purchase, consumption, and preferences) of food secure and food insecure older women living in a low-income urban setting in South Africa. Women (n = 122) aged 60-85 years old were recruited, a sociodemographic questionnaire was completed, and food security categories were determined. The categories were dichotomised into food secure (food secure and mild food insecurity) and food insecure (moderate and severe). A one-week quantified food frequency questionnaire was administered. Height and weight were measured to calculate body mass index (BMI, kg/m2). Most participants (>90%) were overweight/obese, unmarried/widowed, and breadwinners with a low monthly household income. Food insecure participants (36.9%) more frequently borrowed money for food (57.8% vs. 39.0%, p = 0.04), ate less so that their children could have more to eat (64.4%. vs. 27.3%, p = 0.001), and had higher housing density (1.2 vs. 1.0, p = 0.03), compared to their food-secure counterparts. Overall, <30% of participants met the WHO (Geneva, Switzerland) recommended daily servings of healthy foods (fruits, vegetables, and dairy products), but >60% perceived that they consumed an adequate amount of healthy foods. The overall low-quality diet of our cohort was associated with poor nutritional perceptions and choices, coupled with financial constraints.

Food Insecurity Among Older Adults: 10-Year National Trends and Associations with Diet Quality

BACKGROUND/OBJECTIVES

Food insecurity has emerged as a critical health issue for older adults. Food insecurity has been shown to disrupt healthy eating patterns, but these associations have not been widely studied among older adults. The objectives of the present study were to: (1) examine national trends in food insecurity across a 10-year period, and (2) evaluate the associations between food insecurity and multiple diet quality indices in a recent and nationally representative sample of adults aged 60 or older.

DESIGN

Cross-sectional analysis of the 2007-2016 National Health and Nutrition Examination Surveys.

SETTING

Nationally representative sample of the United States.

PARTICIPANTS

The analytic sample was comprised of 5,097 adults aged 60 or older, with household incomes at or below 300% of the federal poverty level.

MEASUREMENTS

Household food security was measured using the 18-item US Household Food Security Survey Module. Diet was assessed using two 24-hour dietary recalls. Multivariate linear and logistic regression models examined the associations between household food security and three evidence-based diet quality indices, adjusting for sociodemographic and health characteristics.

RESULTS

Across the 10-year period, food insecurity increased significantly from 5.5% to 12.4% among older adults; this increase was more pronounced among lower-income older adults. From the linear regression models, food insecurity was associated with lower scores on the Healthy Eating Index (β = -1.90, 95% confidence interval (CI) = -3.70, -0.09), the Alternate Healthy Eating Index-2010 (β = -1.47, 95% CI = -2.51, -0.44), and the Mediterranean Diet Score (β = -0.54, 95% CI = -1.06, -0.01) after multivariate adjustment. Further adjustment for the presence of chronic medical conditions did not attenuate these results.

CONCLUSION

Food insecurity is associated with lower overall diet quality among older adults, supporting the need for clinical efforts to identify those at risk of food insecurity and public health efforts to alleviate food insecurity and promote healthy eating behaviors among older adults.

The Link between Food Security and Life Satisfaction: Panel Data Analysis

The goal of this study is to explore the causal relationship between food (in)security and life satisfaction in a global setting. We explore this relationship using conventional ordinary least squares (OLS) regression and instrumental variable two-stage least squares (IV 2SLS) method. Using data from 105 countries over the period 2012–2019, we found that food insecurity is significantly and negatively related to life satisfaction. The results are robust even after controlling for GDP growth, government size, quality of political and legal institutions. In addition, by adopting natural disaster data, we show that food insecurity has causal negative effect on life satisfaction. In particular, a one standard deviation increase in instrumented food insecurity decreases life satisfaction by 0.8 points (slightly less than one standard deviation). The results remain robust for a series of tests. Future studies should extend our findings by exploring the role of food security in other measures of quality of life.

Food insecurity and depression among low-income adults in the USA: does diet diversity play a role? Findings from the 2013-2014 National Health and Nutrition Examination Survey

OBJECTIVE

Food insecurity is associated with a greater risk of depression among low-income adults in the USA. Members of food-insecure households have lower diet diversity than their food-secure counterparts. This study examined whether diet diversity moderates the association between food insecurity and depression.

DESIGN

Multiple logistic regression was conducted to examine independent associations between food insecurity and depression, between diet diversity and depression, and the moderating effect of diet diversity in the food insecurity-depression link.

SETTING

Cross-sectional data from the National Health and Nutrition Examination Survey (2013-2014).

PARTICIPANTS

2636 low-income adults aged 18 years and older.

RESULTS

There was a positive association between food insecurity and depression among low-income adults. Diet diversity was not associated with depression. Diet diversity had a moderating effect on the association between food insecurity and depression among low-income adults.

CONCLUSIONS

Food insecurity is independently associated with depression among low-income adults in the USA. However, this association differs across levels of diet diversity. Longitudinal studies are needed to confirm the role diet diversity may play in the pathway between food insecurity and depression.

Prevalence and correlates of food insecurity in community-based individuals with severe mental illness receiving long-acting injectable antipsychotic treatment

People with severe mental illness (SMI) have numerous risk factors that may predispose them to food insecurity (FI); however, the prevalence of FI and its effects on health are under-researched in this population. The present study aimed to describe the prevalence of FI and its relationship to lifestyle factors in people with SMI. This cross-sectional study recruited people with SMI receiving long-acting injectable (LAI) antipsychotic medication from community services at three sites in Sydney, Australia. Assessments were completed on physical health and lifestyle factors. χ2 Tests, independent-samples t tests and binary logistic regression analyses were calculated to examine relationships between lifestyle factors and FI. In total, 233 people completed the assessments: 154 were males (66 %), mean age 44·8 (sd 12·7) years, and the majority (70 %) had a diagnosis of schizophrenia. FI was present in 104 participants (45 %). People with FI were less likely to consume fruits (OR 0·42, 95 % CI 0·24, 0·74, P = 0·003), vegetables (OR 0·39, 95 % CI 0·22, 0·69, P = 0·001) and protein-based foods (OR 0·45, 95 % CI 0·25, 0·83, P = 0·011) at least once daily, engaged in less moderate to vigorous physical activity (min) (OR 0·997, 95 % CI 0·993, 1·000, P = 0·044), and were more likely to smoke (OR 1·89, 95 % CI 1·08, 3·32, P = 0·026). FI is highly prevalent among people with SMI receiving LAI antipsychotic medications. Food-insecure people with SMI engage in less healthy lifestyle behaviours, increasing the risk of future non-communicable disease.

Midlife vulnerability and food insecurity: Findings from low-income adults in the US National Health Interview Survey

Background

Food insecurity, limited access to adequate food, in adulthood is associated with poor health outcomes that suggest a pattern of accelerated aging. However, little is known about factors that impact food insecurity in midlife which in turn could help to identify potential pathways of accelerated aging.

Methods

Low-income adults (n = 17,866; 2014 National Health Interview Survey), ages 18 to 84, completed a 10-item food security module and answered questions regarding health challenges (chronic conditions and functional limitations) and financial worry. We used multinomial logistic regression for complex samples to assess the association of health challenges and financial worry with food insecurity status and determine whether these associations differed by age group, while adjusting for poverty, sex, race/ethnicity, education, family structure, social security, and food assistance.

Results

Food insecurity rates were highest in late- (37.5%) and early- (36.0%) midlife, relative to younger (33.7%) and older (20.2%) age groups and, furthermore, age moderated the relationship between food insecurity and both risk factors (interaction p-values < .05, for both). The effects of poor health were stronger in midlife relative to younger and older ages. Unlike younger and older adults, however, adults in midlife showed high levels of food insecurity regardless of financial worry.

Conclusions

Findings suggest that food insecurity in midlife may be more severe than previously thought. Greater efforts are needed to identify those at greatest risk and intervene early to slow premature aging.

Oral health-related quality of life and unmet dental needs among women living with HIV

BACKGROUND

Oral health-related quality of life (OHRQoL) is a multidimensional, perception-based measure of how oral health affects social and physical functioning and self-image. OHRQoL is important for assessing women living with HIV (WLWH) who may have unmet dental needs and experience disparities that impact dental care accessibility.

METHODS

In 2016, the authors conducted an assessment of OHRQoL among a national sample of 1,526 WLWH in the Women's Interagency HIV Study using the Oral Health Impact Profile instrument, which assesses the frequency of 14 oral health impact items. OHRQoL was measured using multivariable linear regression with a negative binomial distribution to assess the association between report of a recent unmet dental need and OHRQoL.

RESULTS

"Fair or poor" oral health condition was reported by 37.8% (n = 576) of WLWH. Multivariable linear regression showed that unmet dental needs had the strongest positive association with poor OHRQoL (difference in Oral Health Impact Profile mean, 2.675; P < .001) compared with not having unmet needs. The frequency of dental care utilization was not associated with higher OHRQoL. Older age, fair or poor dental condition, smoking, symptoms of anxiety and loneliness, and poor OHRQoL were also associated with worse OHRQoL.

CONCLUSION

Self-perceived impact of oral health on social and physical function and self-image, as measured by OHRQoL, may be an easily assessable but underrecognized aspect of OHRQoL, particularly among women aging with HIV.

PRACTICAL IMPLICATIONS

Dentists should implement OHRQoL assessments in their management of the care of patients with HIV to identify those who do have significant oral health impacts.

Food Insecurity and Aging: A Scoping Study of the Literature

Literature on food insecurity (FI) and aging is limited and scattered across disciplines, the reasons for which include the nascence of the study of "hunger" more generally, and relatively lower rates of FI among older people. This scoping review synthesized and characterized the current research to prompt a more critical examination of food insecurity and aging. Data extraction included reviewing and characterizing the empirical, methodological and conceptual contributions of each study, accessed from selected health sciences and social sciences databases. Thirty-eight studies were included from 2,041 titles. Different methods and operationalizations of FI and age were found to be used across studies. Thematic analysis revealed, with few exceptions, consistent tendencies towards the biomedicalization of the FI issue alongside aging. These findings reinforce the value of population-level monitoring of FI and uptake of standard measures. Moving forward, the issue of FI and aging is an opportune topic for critical social analysis.

Intakes of energy, macronutrients and micronutrients of a population in severe food insecurity risk in Brazil

OBJECTIVE

To analyse usual intakes of energy, macronutrients and micronutrients, and their percentage of inadequacy, in a Brazilian population at severe food insecurity (SFI) risk, determined from a predictive model using two national databases.

DESIGN

Cross-sectional study. Our study used a statistical model to predict SFI using the 2009 National Sample Household Survey, where the Brazilian Food Insecurity Scale measured SFI.

SETTING

Brazil.

PARTICIPANTS

The model was applied in a probabilistic sample of 34 003 Brazilians aged 10 years or older that participated in a national dietary survey during 2008-2009. The application of the model generated the probability of each individual being in SFI. The probability of SFI was grouped into quartiles (first quartile with the lowest SFI risk, fourth quartile with highest probability of SFI risk).

RESULTS

The intakes of macro- and micronutrients were associated with SFI. The amount of energy and nutrients in the diet tended to be lower among individuals in the fourth quartile, with highest probability of SFI. The average intake of all studied minerals (Ca, Fe, Na, Mg) was less in individuals in the fourth quartile. Only Na presented a higher percentage of inadequacy in the first quartile, the one with a lower chance of SFI.

CONCLUSIONS

The food intake of the Brazilian population at higher SFI risk is characterized by energy reduction, reduced consumption of macronutrients and high prevalence of inadequate micronutrient intakes, as well as a lower mean intakes, when compared with the first quartile with the lowest SFI risk.

Association of recommended food score with depression, anxiety, and quality of life in Korean adults: the 2014-2015 National Fitness Award Project

Background

A healthy diet is a key determinant of an individual’s health status and is closely related to mental health and quality of life (QoL); however, the exact nature of the relationship is unknown. This study hypothesized that a higher diet quality score is associated with a lower observance of symptoms of depression and anxiety and a higher QoL.

Methods

This study evaluated 1,295 adults (521 men; 774 women) aged 19–64 years, who participated in the 2014–2015 National Fitness Award Project. Diet quality was measured by the recommended food score (RFS), and mental health and QoL were assessed by the beck depression inventory (BDI), beck anxiety inventory (BAI), and the World Health Organization QoL–Brief (WHOQoL–BREF).

Results

After adjusting for covariates, the individuals with depression had a significantly lower RFS value compared to those without depression, and the group with a QoL score above the median had a higher RFS value than the group with a QoL score below the median. These trends occurred in both men and women. Subjects in the highest tertile of RFS showed a lower odds of depression (OR = 0.51, 95% CI = 0.32–0.81, p-trend = 0.0043) and a QoL score below the median (OR = 0.40, 95% CI = 0.30–0.54, p-trend < 0.0001) compared with those in the lowest tertile. The RFS was not associated with anxiety.

Conclusions

Our data suggest that higher diet quality may be associated with lower depressive symptoms and a better QoL in Korean adults.

Measuring and Understanding Food Insecurity in Australia: A Systematic Review

The number of Australians seeking food aid has increased in recent years; however, the current variability in the measurement of food insecurity means that the prevalence and severity of food insecurity in Australia is likely underreported. This is compounded by infrequent national health surveys that measure food insecurity, resulting in outdated population-level food insecurity data. This review sought to investigate the breadth of food insecurity research conducted in Australia to evaluate how this construct is being measured. A systematic review was conducted to collate the available Australian research. Fifty-seven publications were reviewed. Twenty-two used a single-item measure to examine food security status; 11 used the United States Department of Agriculture (USDA) Household Food Security Survey Module (HFSSM); two used the Radimer/Cornell instrument; one used the Household Food and Nutrition Security Survey (HFNSS); while the remainder used a less rigorous or unidentified method. A wide range in prevalence and severity of food insecurity in the community was reported; food insecurity ranged from 2% to 90%, depending on the measurement tool and population under investigation. Based on the findings of this review, the authors suggest that there needs to be greater consistency in measuring food insecurity, and that work is needed to create a measure of food insecurity tailored for the Australian context. Such a tool will allow researchers to gain a clear understanding of the prevalence of food insecurity in Australia to create better policy and practice responses.

Food Insecurity and Health-Related Quality of Life: A Cross-Sectional Analysis of Older Adults in Florida, U.S

Individuals 65 years or older will comprise an estimated 20.0% of the U.S. population by 2030. This study investigated the association between food insecurity and health-related quality of life (HRQoL) among an older adult population (n = 234). HRQoL was measured using Healthy Days, a validated survey tool developed by the Centers of Disease Control and Prevention. Food-insecure individuals were more likely to report ≥14 physically unhealthy days (OR = 1.49, 95% CI 0.47-4.78) and ≥14 days with activity limitations (OR = 4.07, 95% CI 0.68-24.1). Although nonsignificant, the findings highlight food insecurity as a potentially important social determinant of health throughout the life course, including at an older age.

The Association between Stressful Events and Food Insecurity: Cross-Sectional Evidence from Australia

A considerable body of empirical evidence exists on the demographic and socio-economic correlates of food insecurity in Australia. An important omission from recent studies, however, is an understanding of the role of stressful life events, or stressors in explaining exposure to food insecurity. Using nationally representative data from the 2014 General Social Survey and multivariable logistic regression, this paper reports on the association between 18 discrete stressors and the likelihood of reporting food insecurity in Australia. The results, adjusted for known correlates of food insecurity and complex survey design, show that exposure to stressors significantly increased the likelihood of experiencing food insecurity. Importantly, stressors related to employment and health approximately doubled the odds of experiencing food insecurity. The results underscore the complex correlates of food insecurity and indicates that conceptually it interacts with many important social and economic problems in contemporary Australia. There is no simple fix to food insecurity and solutions require co-ordination across a range of social and economic policies.

Food Insecurity among Older Aboriginal and Torres Strait Islanders

It is well established that Indigenous populations are at a heightened risk of food insecurity. Yet, although populations (both Indigenous and non-Indigenous) are ageing, little is understood about the levels of food insecurity experienced by older Indigenous peoples. Using Australian data, this study examined the prevalence and correlates of food insecurity among older Aboriginal and Torres Strait Islanders. Using nationally representative data, we employed ordinal logistic regression models to investigate the association between socio-demographic characteristics and food insecurity. We found that 21% of the older Aboriginal and Torres Strait Islander population were food insecure, with 40% of this group exposed to food insecurity with food depletion and inadequate intake. This places this population at a 5 to 7-fold risk of experiencing food insecurity relative to their older non-Indigenous peers. Measures of geography, language and low socio-economic status were highly associated with exposure to food insecurity. Addressing food insecurity offers one pathway to reduce the disparity in health outcomes between Aboriginal and Torres Strait Islanders and non-Indigenous Australians. Policies that consider both remote and non-remote Australia, as well as those that involve Aboriginal people in their design and implementation are needed to reduce food insecurity.

Higher vegetable intake and vegetable variety is associated with a better self-reported health-related quality of life (HR-QoL) in a cross-sectional survey of rural northern Ghanaian women in fertile age

Background

A higher vegetable intake plays an important role in promoting general health and well-being, but there is a dearth of data on the independent effect of vegetable intake on health-related quality of life (HR-QoL). This study contributes to evidence on the independent effect of vegetable consumption on HR-QoL among women in fertile age.

Methods

A cross-sectional study of a sample of rural women in fertile age (15–49 years, n = 187), randomly selected from 6 rural communities in the Tolon and Savelugu Districts, Northern Region of Ghana. Vegetable consumption in the past month was assessed with a 27-item semi-quantitative food frequency questionnaire; self-reported HR-QoL with the Short Form Health Survey (SF-36); nutritional status with anthropometry; household food security with the household hunger scale (HHS) and demographic and socio-economic related covariates with a pre-tested semi-structured questionnaire using face-face interviews. Generalised Linear Models were fitted to assess adjusted mean scores and their 95% confidence intervals (95% CIs) by terciles of vegetable intake and vegetable variety score (VVS) for the HR-QoL, its physical health (PH) and mental health (MH) domains and the SF-36 subscales.

Results

The mean vegetable intake of the women was 324.6 ± 196.1 g/day. The mean scores of the HR-QoL, PH and MH were 69.5 ± 13.6, 72.6 ± 17.4 and 66.4 ± 12.6 respectively. The alpha Cronbach measure of reliability for the HR-QoL, PH and MH were 0.78, 0.75 and 0.62 respectively. After adjusting for potential confounders such as age, body-mass-index (BMI), parity, educational status, occupation, marital status, HHS and household asset index, we observed an increasing trend across terciles of vegetable intake in the past month for the HR-QoL (P-trend = 0.0003), PH (P-trend = 0.02), MH (P-trend = 0.001) as well as the physical functioning (P-trend = 0.01), role-physical (P-trend <.0001), and role emotional (P-trend <.0001) domains of the SF-36. The multivariate model of the results also showed a significant increasing trend in the adjusted mean scores of the HR-QoL (P-trend = 0.04), MH (P-trend = 0.001) as well as 4 subscales of the SF-36 [role-physical (P-trend = 0.02), role-emotional (P-trend = 0.05), emotional well-being (P-trend = 0.002) and vitality (P-trend <.0001)] across terciles of the VVS.

Conclusion

The results of the present study suggest a potential beneficial role of high vegetable intake and consumption of more varied vegetables on HR-QoL. Further research is needed to determine the mechanisms driving these influences.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5845-3) contains supplementary material, which is available to authorized users.

Food Insecurity in Older Adults: Results From the Epidemiology of Chronic Diseases Cohort Study 3

Introduction: The public health problem of food insecurity also affects the elderly population. This study aimed to estimate the prevalence of household food insecurity and its associations with chronic disease and health-related quality of life characteristics in individuals ≥65 years of age living in the community in Portugal. Methods: The data were collected from the Epidemiology of Chronic Diseases Cohort Study 3 (EpiDoC3)-Promoting Food Security Study (2015-2016), which was the third evaluation wave of the EpiDoC and represented the Portuguese adult population. Food insecurity was assessed using a psychometric scale adapted from the Brazilian Food Insecurity Scale. The data on sociodemographic variables, chronic disease, and management of chronic disease were self-reported. Health-related quality of life were assessed using the European Quality of Life Survey (version validated for the Portuguese population). Logistic regression models were used to determine crude and adjusted odds ratios (for age group, gender, region, and education). The dependent variable was the perceived level of food security. Results: Among older adults, 23% were living in a food-insecure household. The odds of living in a food-insecure household were higher for individuals in the 70-74 years age group (odds ratio (OR) = 1.405, 95% confidence interval (CI) 1.392-1.417), females (OR = 1.545, 95% CI 1.534-1.556), those with less education (OR = 3.355, 95% CI 3.306-3.404), low income (OR = 4,150, 95% CI 4.091-4.210), and those reporting it was very difficult to live with the current income (OR = 16.665, 95% CI 16.482-16.851). The odds of having a chronic disease were also greater among individuals living in food-insecure households: diabetes mellitus (OR = 1.832, 95% CI 1.818-1.846), pulmonary diseases (OR = 1.628, 95% CI 1.606-1.651), cardiac disease (OR = 1.329, 95% CI 1.319-1.340), obesity (OR = 1.493, 95% CI 1.477-1.508), those who reduced their frequency of medical visits (OR = 4.381, 95% CI 4.334-4.428), and who stopped taking medication due to economic difficulties (OR = 5.477, 95% CI 5.422-5.532). Older adults in food-insecure households had lower health-related quality of life (OR = 0.212, 95% CI 0.210-0.214). Conclusions: Our findings indicated that food insecurity was significantly associated with economic factors, higher values for prevalence of chronic diseases, poor management of chronic diseases, and decreased health-related quality of life in older adults living in the community.

Food insecurity and depressive symptoms of older adults living alone in South Korea

In South Korea, the number of older adults living alone is rapidly increasing with the growth of the ageing population. Although there is some evidence of a link between financial strain and depression in this population, there is limited empirical evidence on the relationship between food insecurity and depression in older adults living alone despite the fact that they have a high prevalence of food insecurity and tend to seek food assistance. This study aims to investigate whether food insecurity explains depressive symptoms in Korean older adults living alone. We employed data from the Korea Welfare Panel Study collected from a large-scale national sample in South Korea. Our sample consisted of 815 older adults aged 65 or older who lived alone. Conducting ordinary least square regression analyses, we tested the main effect of food insecurity on depression and the interaction effect of food insecurity and low income. We found that the relationship between food insecurity and depressive symptoms differed by low-income status (b = 6.27, p = 0.047). The association was significant only in the low-income group (b = 1.37, p = 0.04). These findings suggest that protecting access to food may be a promising strategy to lessen depressive symptoms associated with financial strain among older adults living alone.