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

Risk it for a biscuit: Food safety behaviours and food insecurity of older adults

Foodborne disease presents a significant public health issue, costing the UK economy £9 billion annually, with many incidences being due to food-related behaviours in the home. Adults aged 60 and over account for around a quarter of the population in England and Wales and are at a greater risk of foodborne disease and may suffer a much higher burden. Research into risky food behaviours has previously focused on larger cohorts and typically treats the over 60's as one homogenous group. The current paper aims to identify the characteristics associated with risky food-related practices related to cooking, cleaning, chilling, cross-contamination, and use-by date adherence. The current research analysed data from the Official Statistics survey, Food and You 2: Wave 6 (2022-23). A series of binary logistic regression models examined the characteristics associated with risky food-related practices. We demonstrate that the characteristics associated with risky behaviours are not uniform, with different factors being associated with specific behaviours. We suggest that risky behaviours cannot be targeted efficiently with a one size fits all approach. This research provides an evidence base for policy makers to target risky food behaviours in this understudied vulnerable group.

The role of nutritional factors in transitioning between early, mid, and late stages of age-related macular degeneration: prospective longitudinal analysis

BACKGROUND

Transitions between different stages of age-related macular degeneration (AMD) are not completely captured by traditional survival models with an end point of advanced AMD.

OBJECTIVES

This study aimed to explore the transitions from early and intermediate AMD to higher nonadvanced and advanced stages and determine the contributions of nutritional factors to these outcomes.

METHODS

Eyes with early or intermediate AMD at baseline, classified according to the Age-Related Eye Disease Study severity score, were included in this prospective longitudinal analysis. Foods and the biologically active nutrients associated with AMD [green leafy vegetables, fish, lutein/zeaxanthin (LZ), and ω-3 (n-3) fatty acids] were determined by a baseline food frequency questionnaire. Progression was defined as eyes transitioning to higher severity groups including nonadvanced and advanced stages over 5 y, confirmed at 2 consecutive visits. Cox proportional hazards models for foods and nutrients were analyzed adjusting for demographics, lifestyle, baseline macular status, a family history of AMD, caloric intake, and genetic risk.

RESULTS

Among 2697 eyes, 616 (23%) progressed to higher severity groups. In the food group model, higher intake of green leafy vegetables reduced incidence of transitions {hazard ratio [HR] (≥2.7 servings/wk compared with none): 0.75; 95% confidence interval [CI]: 0.59, 0.96; P = 0.02}. Higher fish intake was also protective [HR (greater than two 4-ounce servings/wk compared with <2): 0.79; 95% CI: 0.65, 0.95; P = 0.01]. In the nutrient model, LZ intake was protective [HR (≥2 mg/d compared with <2): 0.76; 95% CI: 0.60, 0.96; P = 0.02]. Higher intake of ω-3 fatty acids also tended to be beneficial [HR (≥0.7 g/wk compared with <0.7): 0.85; 95% CI: 0.71, 1.01; P = 0.06].

CONCLUSIONS

Increased consumption of green leafy vegetables, LZ, and fish nutritionally rich in ω-3 fatty acids during the initial stages of AMD may reduce rates of progression to higher severity of this debilitating disease. This trial was registered at clinicaltrials.gov as NCT00594672.

Prevalence of micronutrient inadequacy differs by severity of food insecurity among adults living in Canada in 2015

Household food insecurity is generally associated with poorer quality diets in Canada, but whether household food insecurity heightens the probability of inadequate micronutrient intakes is unknown. The objective of this research was to investigate how prevalence of micronutrient inadequacy differed by severity of household food insecurity among adults in Canada. Using the 2015 Canadian Community Health Survey Nutrition, this study included participants aged 19-64 years who completed up to two 24 h dietary recalls and provided details about household food insecurity (n = 9486). Children and older adults were not included due to sample size limitations. Usual micronutrient intake distributions were estimated by a four-level measure of food insecurity status using the National Cancer Institute method. Welch's t tests assessed differences in prevalence of inadequacy for selected micronutrients. Prevalence differed for some micronutrients among those living in marginally and moderately food insecure compared to food-secure households. The greatest differences in prevalence of inadequacy were observed between severely food-insecure and food-secure households: vitamin A (60.0%, SE = 11.9 vs. 40.6%, SE = 2.7, p < 0.0001), vitamin B6 (42.7%, SE = 9.1 vs. 12.8%, SE = 2.5, p < 0.0001), folate (39.4%, SE = 10.0 vs. 15.9%, SE = 2.2, p < 0.0001), vitamin C (63.3%, SE = 5.2 vs. 29.1%, SE = 2.8, p < 0.0001), calcium (78.6%, SE = 6.4 vs. 58.7%, SE = 1.3, p < 0.0001), magnesium (75.6%, SE = 9.5 vs. 48.7%, SE = 1.2, p < 0.0001), and zinc (34.9%, SE = 10.0 vs. 23.2%, SE = 2.4, p = 0.0009). Apparent underreporting also differed by severity of food insecurity, with increased underreporting observed with worsening food insecurity. The probability of inadequate micronutrient intakes among adults rises sharply with more severe household food insecurity in Canada.

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 its severity among adults receiving antiretroviral therapy in health facilities, northcentral Ethiopia: a multi-facility-based cross-sectional study

Background

Food insecurity plays a crucial role in predicting the spread of HIV due to the adverse effects of coping mechanisms adopted to mitigate it. However, there is a scarcity of context-specific evidence regarding food insecurity among HIV-infected adults. Therefore, this study aimed to assess the context-specific magnitude of food insecurity and associated factors among adults receiving antiretroviral therapy (ART) in health facilities in the North Shewa Zone, Ethiopia, ultimately contributing to the achievement of the 95-95-95 HIV treatment target in the local context.

Methods

A multi-facility cross-sectional study was conducted among 865 HIV-infected adults receiving ART and being followed up for their treatment. We included health facilities that provide ART, including four hospitals and six health centers. A log-binomial regression model was fitted to identify the association between food insecurity and independent variables. Adjusted prevalence ratios (APRs) with a 95% confidence interval were computed to measure the strength of the association.

Results

In this study, 290 (33.7, 95% CI: 30.60, 36.91) of the HIV-infected adults studied had food insecurity during their treatment and follow-up, of which 152 (52.41, 95% CI: 46.64, 58.13) and 110 (37.93%, CI: 32.50, 43.68) of them were found to have severe and moderate forms of food insecurity, respectively. We found that being younger (APR = 2.27, 95% CI: 1.12, 4.60), being female (APR = 1.87, 95% CI: 1.03, 3.39), lacking formal education (APR = 10.79, 95% CI: 14.74, 24.58), having lower educational status (APR = 5.99, 95% CI: 2.65, 13.54), being a daily laborer (APR = 6.90, 95% CI: 2.28, 20.85), having low monthly income (APR = 1.89, 95% CI: 1.11, 3.22), advanced WHO clinical stage (APR = 2.34, 95% CI: 1.08, 5.10), and receiving ART for less than 4 years (AOR = 2.28, 95% CI: 1.09, 4.74) were significantly associated with a high proportion of food insecurity among HIV-infected adults.

Conclusion

The magnitude of food insecurity among HIV-infected adults receiving ART was high, with an extremely high magnitude of severe food insecurity. The finding suggests the need for culture- and context-specific nutritional interventions to address the gender dynamics of food insecurity, attention to the early stage of ART, and the integration of strategies to improve educational status and enhance income-generation activities of HIV-infected adults. This requires an emphasis on the link between food insecurity and HIV in Ethiopia's national food and nutrition policy.

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, inflammation, and immune function among older US adults: Findings from the health and Retirement study

BACKGROUND

Food insecurity (FI) is a pressing public health concern among older adults and has been associated with adverse cardiovascular outcomes. Greater systemic inflammation may provide a pathway to explain these associations, but few studies have examined the link between FI and markers of inflammation. Thus, the objective of the present study was to evaluate the associations between FI and multiple inflammatory and immune functioning biomarkers using a nationally representative study of US adults aged > 50 years.

METHOD

Participants (n = 3,924) were drawn from the longitudinal Health and Retirement Study (HRS). Household FI was assessed using the six-item Short Form Food Security Survey Module from the 2013 HRS Health Care and Nutrition Study. Markers of inflammation (neutrophil-lymphocyte ratio, albumin, hs-CRP, IL6, IL10, IL-1Ra, sTNFR-1, and TGFβ-1) and immune functioning (CMV) were collected during the 2016 HRS Venous Blood Study. Multivariate logistic and linear regression models were used to evaluate associations between household FI and inflammatory and immune functioning biomarkers, adjusting for individual and household sociodemographic characteristics.

RESULTS

The weighted prevalence of FI was 18.8 %. Age and sex-adjusted mean showed that FI was associated with higher levels of inflammation and impaired immune functioning (Ps-value < 0.05). Older adults with FI had higher mean levels of albumin, hs-CRP, IL6, IL10, IL-1Ra, TGFß-1, and CMV seronegative and borderline (Ps-value < 0.05). Multivariate-adjusted regression model showed that FI was associated with high-risk categories of hs-CRP (OR 1.34, 95 % CI 1.06, 1.68), IL-6 (OR 1.66, 95 % CI 1.28, 2.14), IL-1Ra (OR 0.67, 95 % CI 0.48, 0.93), TGFß-1 (OR 1.87, 95 % CI 1.45, 2.42), seronegativity for CMV (OR 0.48, 95 % CI 0.35, 0.64).

CONCLUSION

In this nationally representative sample of older adults, FI was positively associated with multiple markers of systemic inflammation and impaired immune functioning. Public health efforts that directly work to reduce FI among older adults are warranted and may result in further improvements in their health and well-being.

Analysis of Food Security of Older Rural Indigenous People in Latin America and the Caribbean

Food insecurity is a critical issue in the Americas, with severe impacts in the Caribbean, Mesoamerica, and South America, particularly affecting older adults in Indigenous and rural contexts where it intersects with poverty, gender, and ethnicity. This study aims to provide an in-depth understanding of the current research about food insecurity among older Indigenous adults in Latin America and the Caribbean. A comprehensive literature review was conducted, utilizing specific search queries and the population, intervention, comparison, and outcome (PICO) strategy across multiple databases to identify the pertinent studies. The findings indicate an increase in academic output on this topic since 2018, with significant emphasis on the interplay between climate change and food insecurity. The review highlights the importance of developing targeted food programs, reforming policies, and fostering collaboration between academia and local communities to implement practical interventions. Despite the growing body of literature, a notable research gap persists in rural areas of Latin America and the Caribbean. This study underscores the necessity of balancing the geographic distribution of research and emphasizes the preservation of cultural practices and the adaptation of public policies to support traditional food practices. It advocates for culturally sensitive interventions and interdisciplinary collaboration to formulate comprehensive strategies. The originality and value of this study lie in its focused analysis of older Indigenous adults, contributing crucial insights to the international literature on food security.

Food insecurity and epigenetic aging in middle-aged and older adults

BACKGROUND

Food insecurity is recognized as a key social determinant of health for older adults. While food insecurity has been associated with morbidity and mortality, few studies have examined how it may contribute to accelerated biological aging. A potential mechanism by which food insecurity may contribute to aging is via epigenetic alterations. We examined the relationship between food insecurity and epigenetic aging, a novel measure of biological aging, in a nationally representative sample of middle-aged and older adults in the United States.

METHODS

Cross-sectional analysis of adults 50 years of age and older from the 2016 Health and Retirement Study (HRS). Financial food insecurity was self-reported via two questions that ascertained having enough money for food or eating less than they felt they should. Epigenetic aging was measured via epigenetic clocks based on DNA methylation patterns that predict aging correlates of morbidity and mortality. Linear regressions were performed to test for differences in the epigenetic clocks, adjusting for biological, socioeconomic, and behavioral factors.

RESULTS

The analysis consisted of 3875 adults with mean age of 68.5 years. A total of 8.1% reported food insecurity. Food insecurity was associated with several characteristics, including younger age, race/ethnic minority, lower income, total wealth, and educational attainment, higher BMI, and less physical activity. Food insecurity was associated with accelerated epigenetic aging compared to food security, as measured via second (Zhang, PhenoAge, GrimAge) and third (DunedinPoAm) generation epigenetic clocks. In particular, food insecurity remained significantly associated with accelerated Zhang (B = 0.09, SE = 0.03, p = 0.011) and GrimAge (B = 0.57, SE = 0.24, p = 0.022) in the fully adjusted models.

CONCLUSIONS

Food insecurity is associated with accelerated epigenetic aging among middle-aged and older adults in the United States. Food insecurity may contribute to DNA methylation alterations across the genome and biological age acceleration. These findings add to a growing understanding of the influence of socioeconomic status on the epigenome and health in aging.

Exploring Sociodemographic and Chronic Disease Factors Associated With Chronic, Seasonal, Intramonthly, and Intermittent Presentations of Food Security Instability

BACKGROUND

Food insecurity impacts 13.5 million US households yearly. Although food security instability (FS-I) can have many temporal presentations, these are not measured in the current US Household Food Security Survey Module.

OBJECTIVE

Explore sociodemographic and chronic disease correlates of 4 FS-I types (chronic, seasonal, intramonthly, and intermittent) using a 3-item US Household Food Security Survey Module instability supplement.

DESIGN

This study was a secondary analysis of cross-sectional survey pilot data collected to validate the US Household Food Security Survey Module instability supplement.

PARTICIPANTS AND SETTING

Adults at risk for food insecurity (n = 420) were recruited and answered the survey on their households' behalf from April to June 2021. The participants were recruited from 7 community organizations from 5 states (California, Florida, Maryland, North Carolina, and Washington).

MAIN OUTCOME MEASURES

The main outcomes were the odds of having a chronic, seasonal, intramonthly, or intermittent FS-I score ≥1 based on several sociodemographic factors and having ≥1 chronic disease.

STATISTICAL ANALYSES PERFORMED

Differences among the 4 FS-I types were analyzed using contingency tables and χ2 tests of independence. Then, mixed-effects logistic binary and conditional regressions were run for each FS-I type using clustering by state and odds ratios and 95% CI to interpret results.

RESULTS

The most common FS-I type experienced by the sample was intramonthly (n = 183 [43%]). Nonchronic food insecurity was most likely to happen during the winter, at the end of the month, or randomly with no certain time frame. FS-I in any form was associated with low income, chronic FS-I was associated with younger age and male sex, seasonal FS-I was associated with having no government-subsidized health insurance and females, intramonthly FS-I was associated with participation in nutrition assistance programs, and intermittent FS-I had lower odds among Hispanic/Latino households.

CONCLUSIONS

Further research is needed to explore other FS-I correlates and establish causative relationships; however, these results can be used with clinical judgment for targeted food insecurity screening and treatment.

Ultra-processed foods consumption among a USA representative sample of middle-older adults: a cross-sectional analysis

The study evaluated the association between ultra-processed foods (UPF) and nutrient intake and identified the socio-demographic characteristics associated with UPF consumption among a nationally representative sample of middle-older adults. Dietary assessment was collected in 2013 using a validated FFQ. The Nova system was used to classify food and drinks into UPF. The percentage of dietary energy from UPF was calculated and used throughout the analyses, and average nutrient intake across quintiles of UPF was evaluated. The determinants associated with the dietary caloric contribution of UPF intake were investigated using linear regression models. A cross-sectional analysis of a nationally representative study of Americans over the age of 50, the Health and Retirement Study, was conducted. The analysis included 6220 participants. The mean age was 65 (se 0·28) years, with 55 % being female. UPF intake accounted for 51 % (se 0·25) of total intake. An increase in the percentage of (%UPF) consumption was correlated with an increase in calories, carbohydrates, saturated fat and sugar, and a decrease in fibre, vitamins and minerals. %UPF intake was inversely associated with being Hispanic, higher income, physical activity, vegetarian diet and Mediterranean diet but positively associated with very low food insecurity. UPF represented half of the calories consumed. A higher %UPF intake was associated with a lower nutrient profile, suggesting decreasing %UPF intake as a strategy to improve the nutritional quality of middle-older adults. A few socio-demographic factors were associated with %UPF, which would help in planning strategies to reduce UPF consumption.

Food Insecurity and Ideal Cardiovascular Health Risk Factors Among US Adolescents

BACKGROUND

Food insecurity, a social and economic condition of limited availability of healthy food, is a risk factor for adverse cardiovascular health outcomes among adults; few studies have been conducted in adolescents. This study explores the association between food insecurity and cardiovascular health risk factors among a nationally representative sample of US adolescents, adopting the American Heart Association's Life's Essential 8 metric.

METHODS AND RESULTS

We analyzed data from 2534 adolescents aged 12 to 19 years from the 2013 to 2018 National Health and Nutrition Examination Surveys. In the sample, 24.8% of adolescents lived in food-insecure households. After multivariable adjustment, food insecurity was associated with a 3.23-unit lower total Life's Essential 8 score (95% CI, -6.32, -0.15) and lower scores on diet quality (β=-5.39 [95% CI, -8.91, -1.87]) and nicotine exposure (β=-4.85 [95% CI, -9.24, -0.45]). Regarding diet, food insecurity was associated with 5% lower Healthy Eating Index-2015 scores [95% CI, -7%, -2%], particularly lower intakes of whole grains and seafood/plant proteins and marginally higher intake of added sugar. Regarding nicotine exposure, food insecurity was associated with ever use of a tobacco product among m (odds ratio, 1.74 [95% CI, 1.20-2.53]). Compared with their food-secure counterparts, food-insecure male (odds ratio, 1.98 [95% CI, 1.07-3.65]) and female (odds ratio, 3.22 [95% CI, 1.60-6.45]) adolescents had higher odds of living with a current indoor smoker.

CONCLUSIONS

In this nationally representative sample of adolescents, food insecurity was associated with multiple indicators of cardiovascular health risk. These findings underscore the need for public health interventions and policies to reduce food insecurity and improve cardioprotective behaviors during adolescence, with particular efforts targeting diet quality and nicotine exposure.

Development of a Needs Assessment for Low-income Seniors in Cleveland Ohio: A student-driven Interprofessional Approach

BACKGROUND AND OBJECTIVE

Older persons with low socioeconomic status in the United States have different and unique health needs compared to younger persons. As part of a student-led, interprofessional partnership, we performed a needs assessment of community dwelling older persons with low socioeconomic status in an urban location within Ohio, USA.

METHODS

Three entities participated in the needs assessment: a student-run health clinic, a Federally Qualified Health Center, and an apartment complex of the study population. Health professional students from medical, dental, nursing, social work, nutrition, and physician assistant programs led the needs assessment process. The process consisted of multiple phases, which included preliminary literature review, survey development, data collection, and analysis. The final survey was multidisciplinary, with six content areas covered in 37 items.

RESULTS

One hundred nineteen survey responses were received, and multiple areas of need were identified including food insecurity, dental care access, and mental health. 93% of participants had at least one unmet health need and 39% of respondents met our classification for high need. The needs of the local study population had key differences from previously published data in more generalized populations of older community-dwelling individuals in the United States, notably lower utilization of dental care (43% vs. 66%), increased prevalence of possible food insecurity (30% vs. 17%), and increased use of age-appropriate preventive cancer screening services.

CONCLUSIONS

Multiple areas of need were successfully identified through a student-led interprofessional needs assessment. Future student teams can address the identified needs, again through interprofessional collaborations. This process may have unique benefits to help build robust community-academic partnerships, while fostering interprofessional collaborative opportunities among healthcare students.

Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity

Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition-related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food industry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations.

Food insecurity is associated with low diet quality and unhealthy cooking and eating habits in Iranian women

BACKGROUND

Food insecurity affects diet and nutrition intakes. We explored the relationship between food insecurity and dietary intakes in a group of Iranian women.

METHODS

The cross-sectional study was performed on 190 healthy females aged 20-55 years attending primary healthcare centers in Shiraz. Food insecurity was evaluated by Household Food Insecurity Access Scale, which is a validated tool for assessing food insecurity in developing countries. Diet was assessed using a food frequency questionnaire. The association of dietary patterns and food insecurity was assessed by linear regression.

RESULTS

Assessment of dietary intakes revealed that consumption of red meat, poultry, fish, dairy, fruits, non-starchy vegetables, and nuts decreased whereas that of grains, processed meats, potato, and sugary foods increased with increasing food insecurity. Among nutrients, carbohydrates, fiber, vitamin A, vitamin C, folic acid, potassium, calcium, and magnesium decreased while fat and sodium increased as food insecurity increased. Three major dietary patterns were detected. Healthy dietary patterns showed inverse associations with food insecurity in the crude (β = -0.422 and - 0.435, P < 0.001) and adjusted (adjusted for age, marital status, and educational level) (β = -0.475 and - 0.341, P < 0.001) models of regression analysis but unhealthy pattern did not show an association with food insecurity. Compared to food secure participants, a higher percentage of food insecure individuals indicated unhealthy eating habits, such as skipping breakfast, lower snack ingestion, more fast and fried food consumption, and using unhealthy cooking methods.

CONCLUSION

Overall, this study showed that food insecurity was associated with less healthy diet and unhealthy cooking and eating habits.

Food sufficiency status and sleep outcomes in older adults: the National Health and Aging Trends Study (NHATS)

BACKGROUND

Studies investigating the relationship between food insecurity and sleep among older populations are limited. This study aimed to cross-sectionally examine the associations between food sufficiency status and sleep outcomes in a nationally representative sample of older adults.

METHODS

Our study included 1,665 older adults (≥ 65 years), using data from the 2013 and 2014 National Health and Aging Trends Study (NHATS). Food insufficiency was determined via participants' experience and utilization of food assistance programs (FAP). Sleep outcomes, including nighttime and total sleep hours, sleep latency, and sleep quality, were derived from self-reported data. Multivariable linear regression and logistic regression models were used to estimate the associations between food sufficiency status and sleep outcomes.

RESULTS

In 2013-2014, 86.1% of older adults were classified as food sufficient without FAP, 9.85% as food sufficient with FAP, and 4.08% as food insufficient. Adjusting for sociodemographic characteristics, food sufficient older adults with FAP reported more total sleep hours (𝛽 = 0.31, 95% CI: -0.02, 0.64) than those participants who are food sufficient without FAP. Further adjusting for health factors, food sufficient participants with FAP had more nighttime sleep hours and greater total sleep hours compared to those participants food sufficient without FAP. Compared to those deemed as food sufficient without FAP, food sufficient participants with FAP had lower odds of having longer sleep latency (OR = 0.50, 95% CI: 0.28, 0.89), after further adjusting for physical function performance.

CONCLUSIONS

Among older adults, food sufficiency with FAP is associated with greater total sleep hours, greater nighttime sleep hours, and lower odds of longer sleep latency. Our findings may help inform nutrition food assistance programs targeting older populations.

[Sociodemographic characteristics associated with underweight and overweight in adults aged 50 years and over (ELSI-Brasil): differences between sexes]

The objective were to describe the prevalence of underweight and overweight, assessed by body mass index (BMI), stratified by sex and age group, and to analyze the sociodemographic characteristics associated with BMI in older women and men. This is a cross-sectional analysis of 8,974 participants aged ≥ 50 years from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brasil, 2015-2016). BMI was classified as underweight, eutrophy, and overweight according to the participant's age. A multinomial logistic regression model was used, considering the sociodemographic characteristics of women and men. The results showed a higher prevalence of overweight in women compared to men (64.1% vs. 57.3%). In both sexes, the prevalence of underweight was higher in the longest-lived individuals, while overweight was lower. In women, the chance of underweight was higher than the chance of eutrophy in those who were single/widowed/divorced (OR = 1.95; 95%CI: 1.42-2.66) and in those living in rural areas (OR = 1.58; 95%CI: 1.01-2.49), while the chance of being overweight was lower than the chance of being eutrophy in those living in rural areas (OR = 0.78; 95%CI: 0.62-0.97) and in all geographic macro-regions related to the South Region. For men, the chance of being overweight was lower than the chance of being eutrophy among single/widowed/divorced individuals (OR = 0.58; 95%CI: 0.48-0.69). The richest had a lower chance of being underweight (OR = 0.59; 95%CI: 0.38-0.90), as well as a higher chance of being overweight (OR = 1.52; 95%CI: 1.20-1.92). In conclusion, the sociodemographic characteristics associated with BMI differed between the sexes.

Food insecurity and health-related quality of life among a nationally representative sample of older adults: cross-sectional analysis

BACKGROUND

Food insecurity is a significant health issue among older adults and contributes to poorer quality of life and mental health. However, limited evidence is available among older adults. Thus, the study evaluated the associations between food security and multiple outcomes related to health-related quality of life. We examined whether participants' sex and participation in the federal Supplemental Nutrition Assistance Program (SNAP)/or receiving the Food Stamp program might modify these associations.

METHODS

Cross-sectional analysis of the 2007-2012 National Health and Nutrition Examination Surveys (NHANES). A sample of 3,375 adults aged ≥ 60 years with household incomes ≤ 300% of the federal poverty level (FPBL). Food security was assessed using the 18-item US Household Food Security Survey Module and categorized as food security, marginal food security, and food insecurity. Outcomes were the CDC Health-Related Quality of Life measures (HRQOL-4).

RESULTS

Approximately 8% experienced marginal food security and 12% experienced food insecurity. Over the past month, food insecurity was significantly associated with ≥ 16 days of poor physical health (OR 1.88, 95% CI 1.23, 2.85, P-trend = 0.005), ≥ 16 days of poor mental health (OR 2.22, 95% CI 1.50, 3.28, P-trend < 0.0001), and ≥ 16 days of feeling anxious (OR 3.33, 95% CI 2.30, 4.81, P-trend < 0.0001) after multivariate adjustment. The association between food insecurity and poor physical health was stronger in females (P-interaction = 0.02). There was no evidence for effect modification in any of these associations among those receiving benefits from the federal SNAP/Food Stamp program.

CONCLUSIONS

Food insecurity was positively associated with multiple adverse health outcomes. Public health programs and policies targeted for older adults are needed to mitigate the extent of food insecurity to promote overall health and well-being.

Food Insecurity is Associated With COPD Morbidity and Perceived Stress

Background

Low socioeconomic status (SES) has been associated with worse clinical outcomes in chronic obstructive pulmonary disease (COPD). Food insecurity is more common among individuals with low SES and has been associated with poor outcomes in other chronic illnesses, but its impact on COPD has not been studied.

Methods

Former smokers with spirometry-confirmed COPD were recruited from low-income areas of Baltimore, Maryland, and followed for 9 months as part of a cohort study of diet and indoor air pollution. Food insecurity and respiratory outcomes, including COPD exacerbations and patient-reported outcomes, were assessed at regular intervals. The association between food insecurity and COPD outcomes was analyzed using generalized linear mixed models. Additional analyses examined the association of COPD morbidity with subdomains of food insecurity and the association of food insecurity with psychological well-being measures.

Results

Ninety-nine participants had available data on food insecurity and COPD outcomes. A total of 26.3% of participants were food insecure at 1 or more times during the study. After adjusting for individual SES, neighborhood poverty, and low healthy food access, food insecurity was associated with a higher incidence rate of moderate and severe exacerbations and worse dyspnea, COPD health status, and respiratory-specific quality of life. Subdomains of food insecurity were independently associated with worse patient-reported outcomes. Food insecurity was additionally associated with higher perceived stress.

Discussion

Among former smokers with COPD, food insecurity was associated with a higher incidence of exacerbations, worse patient-reported outcomes, and higher perceived stress. Subdomains of food insecurity were independently associated with worse patient-reported outcomes.

Quality of life and socio-demographic factors associated with nutritional risk in Brazilian community-dwelling individuals aged 80 and over: cluster analysis and ensemble methods

Introduction

The aim of the present study was to use cluster analysis and ensemble methods to evaluate the association between quality of life, socio-demographic factors to predict nutritional risk in community-dwelling Brazilians aged 80 and over.

Methods

This cross-sectional study included 104 individuals, both sexes, from different community locations. Firstly, the participants answered the sociodemographic questionnaire, and were sampled for anthropometric data. Subsequently, the Mini-Mental State Examination (MMSE) was applied, and Mini Nutritional Assessment Questionnaire (MAN) was used to evaluate their nutritional status. Finally, quality of life (QoL) was assessed by a brief version of World Health Organizations' Quality of Life (WHOQOL-BREF) questionnaire and its older adults' version (WHOQOL-OLD).

Results

The K-means algorithm was used to identify clusters of individuals regarding quality-of-life characteristics. In addition, Random Forest (RF) and eXtreme Gradient Boosting (XGBoost) algorithms were used to predict nutritional risk. Four major clusters were derived. Although there was a higher proportion of individuals aged 80 and over with nutritional risk in cluster 2 and a lower proportion in cluster 3, there was no statistically significant association. Cluster 1 showed the highest scores for psychological, social, and environmental domains, while cluster 4 exhibited the worst scores for the social and environmental domains of WHOQOL-BREF and for autonomy, past, present, and future activities, and intimacy of WHOQOL-OLD.

Conclusion

Handgrip, household income, and MMSE were the most important predictors of nutritional. On the other hand, sex, self-reported health, and number of teeth showed the lowest levels of influence in the construction of models to evaluate nutritional risk. Taken together, there was no association between clusters based on quality-of-life domains and nutritional risk, however, predictive models can be used as a complementary tool to evaluate nutritional risk in individuals aged 80 and over.

Food Insecurity, Race and Ethnicity, and Cognitive Function Among United States Older Adults

BACKGROUND

Cognitive impairment and dementia are severe public health issues in aging populations, which can be exacerbated by insufficient or unhealthy dietary intake. Food (in)security status is linked to cognitive function among older adults, but the relationship is complex and can vary by sociodemographic characteristics.

OBJECTIVE

This article aimed to investigate the association between food insecurity and cognitive function among United States older adults and explore potential variations by race and ethnicity groups.

METHODS

We prospectively examined changes in cognitive function and incidence of cognitive impairment alongside the presence of self-reported food insecurity among older adults of different racial and ethnic groups. Data were from the 2012-2018 Health and Retirement Study (HRS) and the 2013 Health Care and Nutrition Study (HCNS), including N = 6,638 United States adults aged 50 years and older. Food insecurity was measured by a self-reported United States Household Food Security Survey Module, and cognitive function was assessed by the modified version of the Telephone Interview for Cognitive Status.

RESULTS

Results showed that 17% of United States older adults reported food insecurity in the 2013 HCNS. Compared with food secure older adults, those reporting food insecurity experienced worsened cognitive functioning over time (B = -0.63, p < .001), and they were more likely to have onset of cognitive impairment (OR= 1.46, p < .001) in the 6-y observation. Compared with non-Hispanic White older adults, being non-Hispanic Black, non-Hispanic Other, or Hispanic was associated with 2.96, 2.09, or 1.26 odds (p < .001) of cognitive impairment (2012-2018), respectively. Older adults of racial and ethnic minority groups also had higher risks of experiencing the double burden of cognitive impairment alongside food insecurity compared with non-Hispanic White older adults.

CONCLUSION

Findings underscore racial and ethnic structural disparities in food security and cognitive health in the United States aging population.

Financial Hardship on Food Security in Ageing Populations

Objective: This study investigated the prevalence of food security, and the association of food security with financial hardship and socio-demographic characteristics among the ageing population in Thailand. Methods: The study extracted data on 1,197 persons age 60 years or older from a nationally-representative sample survey of Thai households. The food security data were collected using the Food Insecurity Experience Scale (FIES), developed by the Food and Agriculture Organization. Multiple regression analysis was used to investigate the association between financial hardship, socio-demographic characteristics, and food security. Results: Of the total sample, 71% had food security. The least probability of having food security was observed in the respondents who sometimes and often had income problems (p < 0.001), and felt dissatisfied with their financial situation (p < 0.001). The respondents who were female, at oldest-old age, with lower than primary school education and in the Northeast were less likely to have food security. Conclusion: These findings suggest the need for government assistance for those who are experiencing financial hardship to help them manage their finances and food security more effectively, taking into account different socio-demographic characteristics.

Food insecurity is associated with chronic pain and high-impact chronic pain in the USA

OBJECTIVE

This study evaluated whether food insecurity (US Adult Food Security Survey) was associated with chronic pain (≥ 3 months) and high-impact chronic pain (i.e. pain that limits work and life) among US adults.

DESIGN

Cross-sectional analysis.

SETTING

Nationally representative sample of non-institutionalised adults in the USA.

PARTICIPANTS

79 686 adults from the National Health Interview Survey (2019-2021).

RESULTS

Marginal, low and very low food security were associated with increased prevalence odds of chronic pain (OR: 1·58 (95 % CI 1·44, 1·72), 2·28 (95 % CI 2·06, 2·52) and 3·37 (95 % CI 3·01, 3·78), respectively) and high-impact chronic pain (OR: 1·28 (95 % CI 1·14, 1·42), 1·55 (95 % CI 1·37, 1·75) and 1·90 (95 % CI 1·65, 2·18), respectively) in a dose-response fashion (P-trend < 0·0001 for both), adjusted for sociodemographic, socio-economic and clinically relevant factors. Participation in Supplemental Nutrition Assistance Program (SNAP) and age modified the association between food insecurity and chronic pain.

CONCLUSIONS

These findings illustrate the impact of socio-economic factors on chronic pain and suggest that food insecurity may be a social determinant of chronic pain. Further research is needed to better understand the complex relationship between food insecurity and chronic pain and to identify targets for interventions. Moreover, the consideration of food insecurity in the clinical assessment of pain and pain-related conditions among socio-economically disadvantaged adults may be warranted.

Impact of food insecurity and food environment on the diet quality of older African Americans during the COVID-19 pandemic

Introduction

A high quality diet is vital in promoting wellbeing and ensuring good health, particularly for those living with chronic conditions. Older African Americans, already burdened with a higher prevalence of chronic conditions, also face a higher risk for suboptimal diets. The COVID-19 pandemic had lasting effects on access to healthy food for all Americans, but some demographic groups were disproportionately affected. Older African Americans, who already experienced reduced access to healthy food pre-pandemic, were particularly afflicted, but the full extent of the pandemic's impact on their food insecurity and food environment remains unclear.

Methods

To address this gap, we conducted a study among 102 older African Americans in South Los Angeles between October 2021 and July 2022 during the COVID-19 pandemic. Participants completed surveys on dietary intake, food insecurity, and neighborhood food environment. We measured dietary quality using the healthy eating index (HEI)-2015. The analysis included descriptive, bivariate chi-square, t-tests, analysis of variance, and multiple linear and logistic regression.

Results

While overall dietary quality was suboptimal, most participants met the guidelines for fruit and vegetable consumption. Food insecurity was associated with lower overall diet quality and lower total fruit and whole fruit intake. However, there was no association between food environment and diet quality.

Discussion

In light of our findings, further intervention is critical to improving diet quality, especially among older African Americans living with chronic conditions in the post-pandemic era.

Malnutrition-related mortality trends in older adults in the United States from 1999 to 2020

BACKGROUND

Malnutrition mortality in older adults is underrepresented in scientific literature. This obscures any recent changes and hinders needed social change. This study aims to assess malnutrition mortality trends in older adults (≥ 65 years old) from 1999 to 2020 in the United States (U.S.).

METHODS

Mortality data from the Centers for Disease Control and Prevention's (CDC) Wide-Ranging Online Data for Epidemiology Research (WONDER) database were extracted. The ICD-10 Codes E40 - E46 were used to identify malnutrition deaths. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) were extracted by gender, age, race, census region, and urban-rural classification. Joinpoint regression analysis was used to calculate annual percentage changes (APC) of AAMR by the permutation test and the parametric method was used to calculate 95% confidence intervals. Average Annual Percentage Changes (AAPC) were calculated as the weighted average of APCs.

RESULTS

Between 1999 and 2020, 93,244 older adults died from malnutrition. Malnutrition AAMR increased from 10.7 per 100,000 in 1999 to 25.0 per 100,000 in 2020. The mortality trend declined from 1999 to 2006 (APC = -8.8; 95% CI: -10.0, -7.5), plateaued till 2013, then began to rise from 2013 to 2020 with an APC of 22.4 (95% CI: 21.3, 23.5) and an overall AAPC of 3.9 (95% CI: 3.1, 4.7). Persons ≥ 85 years of age, females, Non-Hispanic Whites, residents of the West region of the U.S., and urban areas had the highest AAPCs in their respective groups.

CONCLUSION

Despite some initial decrements in malnutrition mortality among older adults in the U.S., the uptrend from 2013 to 2020 nullified all established progress. The end result is that malnutrition mortality rates represent a historical high. The burden of the mortality uptrends disproportionately affected certain demographics, namely persons ≥ 85 years of age, females, Non-Hispanic Whites, those living in the West region of the U.S., and urban areas. Effective interventions are strongly needed. Such interventions should aim to ensure food security and early detection and remedy of malnutrition among older adults through stronger government-funded programs and social support systems, increased funding for nursing homes, and more cohesive patient-centered medical care.

Food insecurity is associated with lower diet quality among dental students

PURPOSE

Food insecurity is associated with lower diet quality, adverse health outcomes, and academic difficulty among undergraduate students. The objective was to identify the relationship between food security status and diet quality in dental students.

METHODS

All dental students attending Howard University (n = 286) or the University of Iowa (n = 326) during the fall 2021 semester were invited to complete a cross-sectional survey designed to query demographics, food security status (i.e., United States Department of Agriculture's ten item Adult Food Security Module), and diet quality (i.e., short Healthy Eating Index). The survey was administered using the Qualtrics platform.

RESULTS

Response rates were similar for Howard (32.5%) and Iowa (29.4%). Students with food insecurity (46.0%) were slightly older and more likely to be Black or other, first generation professional/graduate students, and receive financial aid than peers with food security (p < 0.050). Food insecurity was associated with lower intakes of fruits and vegetables (p ≤ 0.005), higher intakes of added sugars (p < 0.001), and lower diet quality (p = 0.003). In linear regression analyses that controlled for other variables, food insecurity (p = 0.012), school site (p = 0.027), and gender (p = 0.039) were predictive of lower diet quality.

CONCLUSIONS

The inability to procure adequate and appropriate foods was associated with marginal dietary habits (i.e., less than ideal food choices and eating behaviors) and lower diet quality in dental students. Both marginal dietary habits and lower diet quality increase chronic disease risk and may present a barrier to academic success. Addressing food insecurity among dental students is necessary to ensure equitable opportunities for a healthy workforce in the future.

Older family caregivers' diet-related disparities: Cross-sectional evidence from Finland

BACKGROUND

Some older family caregivers experience financial vulnerabilities due to their caregiving role, which may affect their ability to afford appropriate food. This study aimed to assess the extent to which there are diet-related disparities among older family caregivers in Eastern Finland.

METHODS

This study is based on the multidisciplinary LifEstyle, NutriTion and Oral health in caregivers (LENTO) study. In total, 125 family caregivers were included. Data were collected between June and December 2019. Participants were assessed on health, nutritional status and sociodemographic factors. The associations and predictors of diet-related disparities were assessed using the independent samples t-test, ANOVA-test, χ2 -tests and binary logistic regression.

RESULTS

The mean age of family caregivers was 74 years (SD = 8). Most were female (72%), 20% had malnutrition risk and 30% reported having 'moderately enough money' or less, which was identified as 'subjective poverty'. Family caregivers experiencing subjective poverty were less likely to consume two or more portions of fruit and vegetables daily and were more likely overweight. Study participants' diet-related disparities were further associated with several health inequalities, including comorbidity, depression, diabetes (Type I or II) and osteoporosis.

CONCLUSIONS

Older family caregivers have diet-related disparities, further associated with health inequalities. Family caregivers' diet-related disparities require increasing attention in healthcare. Addressing family caregivers' food insecurity risk would enhance their health equity. Lack of assessment of diet-related disparities will only deepen health inequalities.

Experiences of poverty amongst low-income older adults living in a high-income country: A qualitative study

AIM

To understand the experience of low-income older adults living in poverty in a high-income country.

DESIGN

A qualitative study based on Gadamer's hermeneutic phenomenology.

METHODS

A convenience sample of twenty-seven low-income older adults were interviewed in-depth between September 2021 and January 2022. Fleming's method for conducting phenomenological qualitative studies was followed and ATLAS.ti software was used for data analysis.

RESULTS

Three main themes were extracted from the analysis: (i) 'living in the shadow of poverty', (ii) 'unprotected by the 'social shield' of the welfare state' (iii) 'the struggle to attain good health'.

CONCLUSION

Living in poverty affects all spheres of life. Older adults living in poverty feel excluded from social support policies and laws. This has a negative impact on the older adults' mental health and can lead to social isolation.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nursing interventions to promote health amongst older adults living in poverty should include an assessment of the patient's social determinants and a focus on increasing social participation. Older people living in poverty experience difficulties accessing formal social support so nurses should implement patient navigation interventions that aim to help them overcome the complexities of the system. Nursing interventions to improve mental health amongst older adults living in poverty are much needed.

IMPACT

Living in poverty increases older adults' vulnerability. Older adults living in poverty suffer from mental health issues as they live under constant pressure to meet their basic needs and lack formal social support. These findings are important for nurses, who play a pivotal role in the design, implementation and evaluation of policies and interventions that promote health equity.

REPORTING METHOD

The study has been conducted following the COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

There has been no public or patient involvement in the design or development of the study.

Food insecurity gaps in the Supplemental Nutrition Assistance Program based on disability status

BACKGROUND

Households including someone with disabilities experience disproportionately high food insecurity rates and likely face disproportionate barriers accessing Supplemental Nutrition Assistance Program (SNAP) benefits.

OBJECTIVE

This article aims to examine the role of SNAP with regard to food insecurity disparities based on disability status.

METHODS

Modified Poisson regression models examined food insecurity risk based on disability status (household includes no one with disabilities vs. those with work-limiting disabilities or non-work-limiting disabilities) among 2018 Survey of Income and Program Participation households eligible for SNAP (income ≤130% of the poverty threshold). Weighted estimates were used to account for the study design and non-response.

RESULTS

Households including someone with work-limiting disabilities were more than twice as likely to be food insecure than households including no one with disabilities (PR = 2.16, 95% CI: 1.90, 2.45); households including someone with non-work-limiting disabilities were 65% more likely (PR = 1.65, 95% CI: 1.39, 1.95). However, disparities were more pronounced among households not participating in SNAP (PR = 2.67, 95% CI: 2.22, 3.23 for work-limiting disabilities and PR = 1.86, 95% CI: 1.44, 2.40 for non-work-limiting disabilities) than SNAP-participating households (PR = 1.71, 95% CI: 1.45, 2.03 and PR = 1.46, 95% CI: 1.17, 1.82, respectively). Approximately 4.2 million low-income U.S. households including someone with disabilities are food insecure. Of these, 1.4 million were not participating in SNAP and another 2.8 million households were food insecure despite participating in SNAP.

CONCLUSIONS

Access to SNAP benefits is not proportionate to the scale of food insecurity among households that include people with disabilities. Action is needed to strengthen food assistance for those with disabilities.

Differences in mobile food market customer outcomes between 2019 and 2021

OBJECTIVES

To evaluate the outcomes of increasing mobile market service from mostly biweekly in 2019 to weekly in 2021.

DESIGN

Repeated, cross-sectional customer intercept surveys.

SAMPLE

Mobile market customers in Summers 2019 (N = 302) and 2021 (N = 72).

INTERVENTION

Mobile food markets bring affordable, high-quality foods to communities that lack such access.

MEASURES/ANALYSIS

Outcomes included food security, fruit/vegetable intake, and food-related characteristics and behaviors. General linear and logistic regression models were used to assess associations between outcomes and survey year and length of mobile market shopping. Models were adjusted for economic assistance use, race, and ethnicity.

RESULTS

No outcomes were significantly different between 2019 (with mostly biweekly service) and 2021 (with weekly service). Length of mobile market shopping (e.g., >2 years, 1-2 years, etc.) was positively associated with affordable, quality food access (β = 0.20, SE = 0.10, p = .03) and fruit/vegetable intake (β = 0.28, SE = 0.08, p < .001) as well as lower odds of food insecurity in the last 12 months (aOR = 0.79, 95% CI = 0.64, 0.99).

CONCLUSIONS

Despite COVID-19 interrupting scheduled market service, the length of time that a survey respondent identified as a full-service mobile market customer was associated with higher food access and fruit/vegetable intake and reduced food insecurity odds. These findings suggest promise and encourage further evaluation.

Similarities and Dissimilarities in Diet Quality Differences by Acculturation Level between Mexican Americans and Other Hispanic Americans: National Health and Nutrition Examination Survey 2015-2018

BACKGROUND

Evidence suggests dietary acculturation can increase obesity and chronic disease risks. However, acculturation effects on diet quality among subgroups of Hispanic Americans is not well studied.

OBJECTIVES

Estimating percentages of Hispanic Americans with low, moderate, and high acculturation using 2 proxy measures with different language variables was the first objective. Identifying similarities and dissimilarities in diet quality differences by acculturation level between Mexican Americans and other Hispanic Americans was the second objective.

METHODS

The study sample included 1733 Mexican American and 1191 other Hispanic participants aged ≥16 y from National Health and Nutrition Examination Survey 2015-2018. Proxy measures included in the 2 acculturation scales were nativity/United States residence length, immigration age, language spoken at home (home), and language of dietary recall (recall). Replicate 24-h dietary recalls were conducted, and diet quality was assessed using the 2015 Healthy Eating Index. Analyses included statistical methods for complex survey designs.

RESULTS

For Mexican Americans, 8%, 35%, and 58% had low, moderate, and high acculturation on the home scale compared with 8%, 30%, and 62% on the recall scale. For other Hispanics, 17%, 39%, and 43% had low, moderate, and high acculturation on the home scale compared with 18%, 34%, and 48% on the recall scale. Similarities between ethnicities included higher acculturation associated with lower intakes of fruits, vegetables, total protein foods, seafood and plant proteins, and saturated fats and greater intake of sodium. Dissimilarities included higher acculturation associated with more whole grains and added sugars intakes and less refined grains intake (Mexican Americans), and less total dairy and fatty acids intakes (other Hispanic Americans).

CONCLUSIONS

Higher acculturation is associated with worsening diet quality for fruits, vegetables, and protein foods in all Hispanic Americans. However, associations of higher acculturation with worsening diet quality for grains, added sugars, dairy, and fatty acids were present only in specific subgroups of Hispanic Americans.

Relationship between Food Insecurity and Nutritional Risk among Older Adults in Poland-A Preliminary Study

Aging populations may be associated with increased nutritional risk, malnutrition, and food insecurity. This study aims to examine the relationship between food insecurity and nutritional risk, taking into account selected characteristics of the study group, and factors describing nutritional risk. It was conducted between May and July 2021, among 417 people aged 60 and older, in two regions of Poland. Questions from the SCREEN-14 questionnaire were used to assess nutritional risk. Selected questions from the HFSS questionnaire (U.S. Household Food Security Survey Module) concerning the elderly were used to assess food insecurity. A K-means cluster analysis was used to separate homogeneous clusters into food security indicators and nutritional risk factors. The Mann-Whitney U test and Kruskal-Wallis test were used to compare mean values between groups, and the Chi-square test was used to verify the differences. Two clusters were distinguished: I-"low food security and high nutritional risk" and II-"high food security and low nutritional risk". Cluster I included people aged 60-65, and over 75, living in urban areas, living alone or with family, with unfavorable economic situations and family relationships. Cluster II was composed of people aged 71-75, who were rural residents, living with a partner, with favorable economic situations and family relations. The vast majority of nutritional risk factors were found in Cluster I and among those at high nutritional risk. The largest number of people were affected by such nutritional risk factors such as difficulty in chewing or biting, loss in appetite, skipping meals, and perceiving one's weight as abnormal. Moreover, the group of people most significantly affected by high nutritional risk were in unfavorable economic situations, had poor family relationships, lived alone or with family, rated their health as worse than their peers, were overweight and obese, had metabolic disease, or impeding mobility. The results obtained can be applied to the planning of social and health policies for the elderly in Poland.

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.

Diet and Food and Nutrition Insecurity and Cardiometabolic Disease

Poor nutrition is the leading cause of poor health, health care spending, and lost productivity in the United States and globally, which acts through cardiometabolic diseases as precursors to cardiovascular disease, cancer, and other conditions. There is great interest in how the social determinants of health (the conditions in which people are born, live, work, develop, and age) impact cardiometabolic disease. Food insecurity is an example of a powerful social determinant of health that impacts health outcomes. Nutrition insecurity, a distinct but related concept to food insecurity, is a direct determinant of health. In this article, we provide an overview of how diet in early life relates to cardiometabolic disease and then continue to focus on the concepts of food insecurity and nutrition insecurity. In the discussions herein we make important distinctions between the concepts of food insecurity and nutrition insecurity and provide a review of their concepts, histories, measurement and assessment devices, trends and prevalence, and links to health and health disparities. The discussions here set the stage for future research and practice to directly address the negative consequences of food and nutrition insecurity.

Impact of Food Insecurity and Undernutrition on Frailty and Physical Functioning in Aging People With HIV in the United States

ABSTRACT

We conducted an observational cross-sectional study to explore whether food insecurity or undernutrition was associated with frailty or low physical functioning in aging persons with HIV (PWH). Forty-eight PWH aged 50 years and older were enrolled. Independent samples t -tests and chi-square tests were used to examine the relationship of food insecurity or undernutrition to frailty or physical function. Participants were 58.6 (±6.3) years old, 83% male, 77% White, 21% Hispanic. In total, 44% experienced food insecurity and 71% experienced undernutrition, whereas 23% were frail and 69% were prefrail. Food insecurity was associated with impaired total short physical performance battery score ( p = .02), impaired balance ( p = .02), slower chair rise time ( p = .03), and weight loss within 12 months ( p = .05). Undernutrition was related to female gender ( p = .01), worse frailty ( p = .04), and weaker grip strength ( p = .03). In this sample of undernourished and frail PWH, strong relationships between undernutrition and frailty were observed.

Social Service Providers' Perceptions of Older Adults' Food Access During COVID-19

The COVID-19 pandemic exacerbated risk factors for food insecurity among older adults, while also altering how government agencies and social service organizations could serve this population given their disproportionate vulnerability to the virus. The current study sought to understand social service providers' perspectives about how low-income community-dwelling older adults' access to food and related resources changed during the COVID pandemic. Data were collected via in-depth interviews with 22 social service providers from Oregon-based public and private social service agencies. Responses indicated that changes to older adults' food access during the pandemic stemmed from increases in public benefit amounts and social distancing guidelines. Participants indicated that temporary increases in SNAP allotments supported older adults' food security. Additionally, social distancing guidelines disrupted usual ways of procuring food, such as going to grocery stores, obtaining food with the assistance of family or neighbors, receiving deliveries from social programs, and visiting congregate meal sites. Food assistance programs changed their operations to reduce in-person interaction and increase the use of technology. When investigating older adults' food access, future research should consider adults' experiences of and barriers to SNAP receipt, social support from social networks and safety net programs, and technology access and knowledge.

The association between food insecurity and cognitive impairment among the US adults: The mediation role of anxiety or depression

BACKGROUND

Using a nationally representative sample, this study aimed to examine (1) socio-demographic and health-related disparities in cognitive impairment, (2) the association between food insecurity and cognitive impairment, and (3) the mediation role of anxiety or depression in the pathway between food insecurity and cognitive impairment.

METHODS

Cross-sectional data of 28,508 adults from the 2020 National Health Interview Survey were analyzed. Multivariable logistic regression models were used to estimate associations with cognitive impairment. Mediation analyses were conducted using the four-way decomposition method under a counterfactual framework.

RESULTS

Disparities in cognitive impairment were observed across socio-demographic and health-related characteristics (all p < 0.0001). Food insecurity was significantly associated with cognitive impairment in the overall population and the magnitude of the association was greater for the young or middle-aged, females and non-Hispanic Blacks than the general population (AOR ranged from 1.19 to 2.54, all p < 0.01). With anxiety as a mediator, 28.66 % of the total effect of food insecurity on cognitive impairment was attributable to mediation only, and 22.39 % was attributable to interaction (between food insecurity and anxiety) and mediation. With depression as a mediator, 22.33 % of the total effect was attributable to mediation only, and 16.00 % was attributable to interaction (between food insecurity and depression) and mediation.

LIMITATIONS

The cross-sectional design prevents inference of causality.

CONCLUSIONS

Ensuring available and adequate food resources is important to prevent adverse cognitive outcomes. Clinical interventions or treatments for anxiety or depression may help improve cognitive function.

Relationships Among Acculturation Using Two Different Language Variables, Diet Quality, and Accuracy of Diet Quality Assessment in Non-Hispanic Asians Residing in the United States

BACKGROUND

Evidence suggests acculturation can increase risks of poor diet, obesity, and chronic diseases. Yet questions remain regarding acculturation proxy measures and associations with diet quality in Asian Americans.

OBJECTIVE

Primary objectives included estimating percentages of Asian Americans with low, moderate, and high acculturation using two proxy measures of acculturation based on different language variables and determining if diet quality differences existed among acculturation levels using the two proxy acculturation measures.

METHODS

Study sample included 1,275 Asian participants ≥16 years of age from National Health and Nutrition Examination Survey 2015-2018. Nativity/length of US residence, immigration age, language spoken at home (home), and language of dietary recall (recall) were used as proxy measures for two acculturation scales. Replicate 24-hour dietary recalls were conducted and diet quality was assessed using 2015 Healthy Eating Index (HEI-2015). Statistical methods for complex survey designs were used for analysis.

RESULTS

Using home and recall language, 26% vs 9% of participants were classified with low, 50% vs 63% with moderate, and 24% vs 28% with high acculturation. On the home language scale, participants with low and/or moderate acculturation had higher scores (0.5-5.5 points) for vegetables, fruits, whole grains, seafood and plant protein, saturated fats, added sugars, and total HEI-2015 than participants with high acculturation; participants with low acculturation had lower refined grains score (1.2 points) than participants with high acculturation. Results were similar for the recall language scale except differences between participants with moderate and high acculturation also were observed for fatty acids.

CONCLUSIONS

Although percentages of Asian Americans classified with low, moderate, and high acculturation differed between two proxy measures for acculturation, diet quality differences among acculturation groups were remarkably similar between the two proxy measures. Hence, use of either language variable may yield comparable results regarding relationships between acculturation and diet in Asian Americans.

Food Insecurity and Cognitive Trajectories in Community-Dwelling Medicare Beneficiaries 65 Years and Older

Importance

Food insecurity has a known association with prevalent impaired cognition. However, it is unknown whether food insecurity has a longitudinal association with cognitive decline among older adults.

Objective

To determine whether food insecurity is associated with a faster decline in cognitive function among community-dwelling older adults.

Design, Setting, and Participants

This retrospective cohort study used data from a nationally representative sample of Medicare beneficiaries 65 years and older recruited for the National Health and Aging Trends Study (NHATS). Community-dwelling NHATS participants were followed up for a maximum of 7 years (mean [SD] follow-up duration, 5.4 [1.1] years). Data were collected from January 1, 2012, to December 31, 2020, and analyzed from December 23, 2021, to December 6, 2022.

Exposures

Self-reported food insecurity assessed from 2012 to 2019.

Main Outcomes and Measures

Primary outcomes were immediate memory, delayed memory, and executive function collected from 2013 to 2020. Immediate and delayed recall were assessed by a 10-item word-list memory task (range, 0-10, with higher scores indicating more words recalled). Executive function was measured by the clock drawing test (range, 0-5, with higher scores indicating more accurate depiction of a clock). Each year's cognitive functions were linked to the prior year's food insecurity data. Linear mixed-effects models with random slopes and intercepts were used to examine the association between food insecurity and cognitive decline. Analytic weights in each year were applied to represent community-dwelling Medicare beneficiaries 65 years and older in 2011.

Results

Of 3037 participants, a weighted 57.8% (raw count, 1345) were younger than 75 years, 56.2% (raw count, 1777) were women, and most (84.9% [raw count, 2268]) were White. Over 7 years, 417 (weighted proportion, 12.1%) experienced food insecurity at least once. Food insecurity was associated with a faster decline in executive function in a fully adjusted model: the mean difference of annual change in executive function score between people exposed to and not exposed to food insecurity was -0.04 (95% CI, -0.09 to -0.003) points. However, food insecurity was not associated with changes in immediate and delayed memory (0.01 [95% CI, -0.05 to 0.08] and -0.01 [95% CI, -0.08 to 0.06], respectively).

Conclusions and Relevance

Among community-dwelling older adults, food insecurity was prevalent and associated with a decline in executive function. Interventions and policies aiming to increase healthy food access or reduce food insecurity should be assessed for their impact on older adults' cognitive outcome.

Associations of Food Insecurity with Dietary Inflammatory Potential and Risk of Low Muscle Strength

Food insecurity refers to the uncertain availability of or limited access to nutritious food. Poor diets prevalent among food insecure populations may incite an inflammatory state and subsequently negatively affect skeletal muscle metabolism. To examine the inflammatory mechanistic potential of the association between food insecurity and the risk of low muscle strength, we analyzed cross-sectional data from 8624 adults aged ≥20 years from the Korean National Health and Nutrition Examination Survey 2014-2015. Household food security status was assessed using an 18-item food security survey module. The inflammatory potential of diets was estimated by the dietary inflammation index (DII). Low muscle strength was ascertained using hand grip strength. In the multivariable-adjusted model, greater food insecurity was significantly associated with a higher DII score and risk of low muscle strength. The multivariable-adjusted mean difference (95% confidence interval) on the DII, comparing the "moderate-to-severe" food insecurity group with the "food secure" group, was 0.43 (0.06-0.80) (P-trend: <0.001) and the odds ratio (95% confidence intervals) of low muscle strength for the same comparison groups was 2.06 (1.07-3.96) (P-trend: 0.005). Our results suggest that individuals with greater food insecurity may be susceptible to diets with greater inflammatory potential, which may contribute to a loss of muscle strength.

Relationship between food insecurity and geriatric syndromes in older adults: A multicenter study in Turkey

AIMS

In this study, the aim was to determine the prevalence of geriatric syndromes such as frailty, sarcopenia risk and malnutrition in older adults and to investigate the relationship between food insecurity, and frailty, risk of sarcopenia and malnutrition.

METHODS

The study was cross-sectional. It was conducted between February 2022 and June 2022 with 707 older adults. The data were collected through the face-to-face interview method with a questionnaire including the Descriptive Information Form, Household Food Insecurity Access Scale (HFIAS), Frail Scale, Sarcopenia Risk Screening Scale (SARC-F) and Mini Nutritional Assessment-Short Form (MNA-SF). Numbers, percentages, mean, standard deviation, Pearson chi-square test and binary logistic regression analysis were used in data analysis.

RESULTS

In the present sample, 30% of the participants experienced some degree of food insecurity. The prevalence of frailty, sarcopenia risk, and malnutrition in the participants was 15.3%, 19.5%, and 1.3%, respectively. We determined that food insecurity was not associated with pre-frailty/frailty and sarcopenia risk. After adjusment for potential counfounders moderate and severe food insecurity was associated with higher odds of malnutrition risk and malnutrition (AOR: 2.06, 95% CI: 1.21-3.51, p:0.007).

CONCLUSION

While food insecurity is not associated with pre-frailty/frailty and sarcopenia risk, moderate and severe food insecurity is a modifiable risk factor for malnutrition risk and malnutrition. Thus, economic and social policies to eliminate food insecurity should be implemented, and efforts to prevent food insecurity should be planned through inter-sectoral cooperation.

The association between chronic conditions, COVID-19 infection, and food insecurity among the older US adults: findings from the 2020-2021 National Health Interview Survey

BACKGROUND

This study aims to examine how the presence of chronic conditions or positive COVID-19 infection (as exposures) is related to food insecurity (as an outcome) in the older population and whether there is a dose-response relationship between the number of chronic conditions and the severity of food insecurity.

METHODS

Cross-sectional data of 17,977 older adults (≥ 65 years) from the 2020-2021 National Health Interview Survey were analyzed. Chronic conditions included physical health conditions (i.e., arthritis, coronary heart diseases, hypertension, stroke, prediabetes, diabetes, asthma, chronic obstructive pulmonary disease, and disability) and mental health conditions (i.e., anxiety and depression disorder). COVID-19 infection status was determined by a self-reported diagnosis of COVID-19. Household food insecurity was measured using the 10-item US Department of Agriculture (USDA) Food Security Survey Module with a 30-day look-back window. Multinomial logistic regression models were used to examine the association between health conditions and food insecurity controlling for socio-demographic factors.

RESULTS

Our results indicated that 4.0% of the older adults lived in food-insecure households. The presence of chronic conditions was significantly associated with higher odds of being food insecure independent of socio-demographic factors (AOR ranged from 1.17 to 3.58, all p < 0.0001). Compared with participants with 0-1 chronic condition, the odds of being (low or very low) food insecure was 1.09 to 4.07 times higher for those with 2, or ≥ 3 chronic conditions (all p < 0.0001). The severity of food insecurity significantly increased as the number of chronic conditions increased (p for trend < 0.0001). Besides, COVID-infected participants were 82% more likely to be very low food secure than the non-infected participants (AOR = 1.82, 95% CI: 1.80, 1.84).

CONCLUSIONS

The presence of chronic conditions or positive COVID-infection is independently associated with household food insecurity. Clinical health professionals may help identify and assist individuals at risk of food insecurity. Management and improvement of health conditions may help reduce the prevalence and severity of food insecurity in the older population.

Food Insufficiency, Supplemental Nutrition Assistance Program (SNAP) Status, and 9-Year Trajectory of Cognitive Function in Older Adults: The Longitudinal National Health and Aging Trends Study, 2012-2020

BACKGROUND

Despite findings from cross-sectional studies, how food insecurity experience/Supplemental Nutrition Assistance Program (SNAP) status relates to cognitive decline over time has not been fully understood.

OBJECTIVES

We aimed to investigate the longitudinal associations between food insecurity/SNAP status and cognitive function in older adults (≥65 y).

METHODS

Longitudinal data from the National Health and Aging Trends Study 2012-2020 were analyzed (n = 4578, median follow-up years = 5 y). Participants reported food insecurity experience (5-item) and were classified as food sufficient (FS, no affirmative answer) and food insufficient (FI, any affirmative answer). The SNAP status was defined as SNAP participants, SNAP eligible nonparticipants (≤200% Federal Poverty Line, FPL), and SNAP ineligible nonparticipants (>200% FPL). Cognitive function was measured via validated tests in 3 domains, and the standardized domain-specific and combined cognitive function z-scores were calculated. Mixed-effect models with a random intercept were used to study how FI or SNAP status was associated with combined and domain-specific cognitive z-scores over time, adjusting for static and time-varying covariates.

RESULTS

At baseline, 96.3% of the participants were FS and 3.7% were FI. In a subsample (n = 2832), 10.8% were SNAP participants, 30.7% were SNAP eligible nonparticipants, and 58.6% were SNAP ineligible nonparticipants. Compared with the FS group in the adjusted model (FI vs. FS), FI was associated with faster decline in the combined cognitive function scores [-0.043 (-0.055, -0.032) vs. -0.033 (-0.035, -0.031) z-scores per year, P-interaction = 0.064]. Cognitive decline rates (z-scores per year) in the combined score were similar in SNAP participants (β = -0.030; 95% CI: -0.038, -0.022) and SNAP ineligible nonparticipants (β = -0.028; 95% CI: -0.032, -0.024), both of which were slower than the rate in SNAP eligible nonparticipants (β = -0.043; 95% CI: -0.048, -0.038; P-interaction < 0.0001).

CONCLUSIONS

Food sufficiency and SNAP participation may be protective factors preventing accelerated cognitive decline in older adults.

A Cross-Sectional Analysis of Food Perceptions, Food Preferences, Diet Quality, and Health in a Food Desert Campus

The sensory properties of foods guide food choices and intake, importantly determining nutritional and health status. In communities that have inconsistent access to nutritious foods, such as food deserts, food taste perceptions and preferences have yet to be explored. The purpose of this study was to examine how taster status (supertaster vs. non-taster) and food security status (high or marginal vs. low or very low) influences food taste intensities, food preferences and perceptions, and diet quality in a cohort of students from a food desert campus in the Central Valley of California. Moreover, the complex relationship of socioeconomic status, race/ethnicity, and sex on cardiometabolic and cognitive health warrants further examination. Two hundred fifty participants (aged 18-24 years) living in a food desert campus were recruited in 2018 for this cross-sectional study where participants underwent taste tests on selected fruits, vegetables, and nuts, and clinical tests (anthropometrics, blood glucose, blood pressure, and endothelial function), cognitive function tests (memory and attention), diet quality assessment (Healthy Eating Index (HEI)), and food preference and perception assessments. Food taste intensities were influenced by sex with bitter and umami taste intensities of several foods being perceived more intensely by males. Moreover, food liking was largely influenced by ethnicity with Hispanics having higher liking ratings for several foods compared with non-Hispanics. Both, Hispanics and females, had higher total fruit HEI scores and lower attention scores than non-Hispanics and males, respectively. Females also had lower blood pressure, reactive hyperemia index, and fasting blood glucose. Food-insecure individuals rated cost and convenience as more important factors for overall food consumption and had lower attention scores than those with higher food-security status. Future research should consider the complex interactions of factors such as taste and flavor perception, sex, ethnicity, prior exposure to foods, and other environmental factors when studying food preferences and health in young adults.

Examining the Complex (Curvilinear and Contingent) Associations between Social Distancing Compliance and Subjective Health during a Global Health Crisis

OBJECTIVES

This study investigated a potential curvilinear link between social distancing behavior and subjective health in later life. It also evaluated whether food insecurity and community social capital moderated the focal relationship.

METHODS

Data were drawn from three waves of the COVID Impact Survey (N = 19,234). Mixed-effects models were fitted.

RESULTS

Social distancing has a non-monotonic (U-shaped) relationship with subjective health, i.e., individuals with low and high levels of social distancing show relatively better health. Moreover, the negative linear relationship between social distancing and health is weaker among people suffering from food insecurity as well as those living in communities with lower stocks of social capital.

DISCUSSION

This study sheds new light on the health implications of social distancing during the pandemic. Our findings dovetail with the steeling hypothesis, i.e., that social distancing is less harmful for U.S. older adults exposed to prior stressful or vulnerable conditions.

Food insecurity and loneliness amongst older urban subsidised housing residents: The importance of social connectedness

Food insecurity and loneliness are shockingly large and growing problems in the older population in the U.S. and globally. Thus, the study's primary aim was to investigate the prevalence as well as the association between these two social determinants of health in the marginalised and often underserved population of older residents of urban subsidised housing (also referred to as social housing or affordable housing). Of particular interest was whether a greater sense of loneliness increases the risk of older residents being food insecure. The study uses survey data gathered through in-person interviews conducted onsite in English or Spanish with 216 of the 300 older adults (72% response rate) living in a subsidised housing community in a central neighbourhood of a U.S. northeastern city. Amongst the 216 participants, 50% identified as Black and 45% identified as Latino. In addition to food insecurity and loneliness, the survey assessed participants' health, food access challenges, and sociodemographic characteristics. Results revealed a 34% food insecurity prevalence rate amongst the participants which is higher than the estimate of slightly less than 10% of the U.S. older population being food insecure. The participants' 34% loneliness rate was also higher than the 19%-29% prevalence range in U.S. older population studies. Bivariate analyses highlighted the interrelatedness or intertwining of food insecurity, loneliness, poor health and food access challenges whilst a series of logistic regressions further explored the significant association of loneliness with food insecurity. Loneliness increased the odds ratio of food insecurity in the binary (unadjusted) regression (p < 0.001, OR = 3.1) and the multivariate (adjusted) regression that included all covariates (p < 0.05, OR = 2.4). Overall, the findings underscore the need for greater awareness of loneliness as a public health threat as well as future research exploring how loneliness may intensify the health consequences of food insecurity in later life.

Diet Quality and Contextual Factors Influencing Food Choice among Adolescents with Food Security and Food Insecurity in Baltimore City

This study evaluated differences in overall diet quality, diet quality components, and food-related contextual factors between adolescents with food security and those with food insecurity. Mixed methods analysis was conducted on data from three 24-h dietary recalls from 61 adolescents ages 14–19 years old living in Baltimore, Maryland, USA in 2020–2021. All adolescents were sampled from households eligible for the Supplemental Nutrition Assistance Program in 2020. There were no significant differences in overall diet quality or components between adolescents with food security and those with food insecurity in this sample, except for seafood and plant proteins, which was higher for adolescents with food insecurity. Qualitative analysis found that adolescents were largely influenced by their parents and the home food environment, and that workplace environments enabled adolescents to eat foods high in refined grains, sugar, and saturated fat. These findings provide insight about the experiences of low-income adolescents during times when they are home for prolonged periods (i.e., emergency school closures, summer, and winter breaks). Programs and policies that aim to improve healthy food access may positively impact adolescent food security and diet quality, and it is important to ensure that healthy foods are available and accessible to adolescents in the places where they spend the most time. Multilevel interventions in the home, school, and workplace may be most effective in encouraging healthy eating behaviors among adolescents.

Food insecurity as a risk factor of sarcopenic obesity in older adults

Sarcopenic obesity is characterized by the loss of muscle strength, mass and muscle functionality and increased adipose tissue (obesity) according to different criteria and cut-off points. The prevalence of sarcopenic obesity among older adults is growing worldwide, and many factors are involved in its development. Diet and food security have been described as the main contributors to the development of obesity and sarcopenia. Food insecurity consists of limited or uncertain access to adequate and nutritious foods. This narrative review aims to summarize the existing data on food insecurity as a risk factor for sarcopenic obesity in the elderly.

Food Insecurity and Less Frequent Cooking Dinner at Home Are Associated with Lower Diet Quality in a National Sample of Low-Income Adults in the United States during the Initial Months of the Coronavirus Disease 2019 Pandemic

BACKGROUND

Food insecurity is a critical public health problem in the United States that has been associated with poor diet quality. Cooking dinner more frequently is associated with better diet quality.

OBJECTIVE

This study aimed to examine how food insecurity and dinner cooking frequency are associated with diet quality during the initial months of the coronavirus disease 2019 pandemic.

DESIGN

This cross-sectional study analyzed data from a national web-based survey (June 23 to July 1, 2020).

PARTICIPANTS/SETTING

Participants were 1,739 low-income (<250% of the federal poverty level) adults in the United States.

MAIN OUTCOME MEASURES

The outcome was diet quality, measured by the Prime Diet Quality Score (PDQS-30D). The PDQS-30D is a food frequency questionnaire-based, 22-component diet quality index.

STATISTICAL ANALYSES PERFORMED

Food security status (high, marginal, low, or very low) and frequency of cooking dinner (7, 5 to 6, 3 to 4, or 0 to 2 times/week) were evaluated in relation to PDQS-30D scores (possible range = zero to 126) in age- and sex and gender-, and fully adjusted linear regression models. Postestimation margins were used to predict mean PDQS-30D score by food security status and dinner cooking frequency. The interaction between food security status and frequency of cooking dinner was also tested.

RESULTS

Overall, the mean PDQS-30D score was 51.9 ± 11 points (possible range = zero to 126). The prevalence of food insecurity (low/very low) was 43%, 37% of the sample cooked 7 times/week and 15% cooked 0 to 2 times/week. Lower food security and less frequent cooking dinner were both associated with lower diet quality. Very low food security was associated with a 3.2-point lower PDQS-30D score (95% CI -4.6 to -1.8) compared with those with high food security. Cooking dinner 0 to 2 times/week was associated with a 4.4-point lower PDQS-30D score (95% CI -6.0 to -2.8) compared with cooking 7 times/week. The relationship between food insecurity and diet quality did not differ based on cooking dinner frequency.

CONCLUSIONS

During the initial months of the coronavirus disease 2019 pandemic food insecurity and less frequently cooking dinner at home were both associated with lower diet quality among low-income Americans. More research is needed to identify and address barriers to low-income households' ability to access, afford and prepare enough nutritious food for a healthy diet.

Food insecurity, food environments, and disparities in diet quality and obesity in a nationally representative sample of community-dwelling older Americans

Food insecurity, reflecting a household's low ability to purchase healthy food, is a public health concern that is associated with poor diet and obesity. Poor food environments, characterized as a neighborhood with low access to healthy, affordable food, may amplify the negative impact of food insecurity on diet and obesity. This study aims to investigate whether food insecurity and food environments are jointly associated with an increased risk of poor diet quality and obesity. We used data from a nationally representative sample of community-dwelling older adults in the Health and Retirement Study Health Care and Nutrition Survey and the National Neighborhood Data Archive to investigate the role of household and neighborhood characteristics on diet and obesity. Weighted regression models were estimated to examine the relationship between food insecurity and food environments as well as their interaction with diet quality and obesity. Food insecure respondents had lower Healthy Eating Index scores and were more likely to be obese than food secure respondents. Living in a poor food environment was associated with lower Healthy Eating Index scores, but not with obesity. We did not find any interaction between food insecurity and food environment in determining either healthy eating or obesity. Reducing food insecurity and increasing access to healthy food environments may encourage healthier eating among older adults, while alleviating food-related hardship may also reduce their obesity risk.