1
|
Venkatesh KK, Yee LM, Wu J, Joseph JJ, Garner J, McNeil R, Scifres C, Mercer B, Reddy UM, Silver RM, Saade G, Parry S, Simhan H, Post RJ, Walker DM, Grobman WA. Diet quality, community food access, and glycemic control among nulliparous individuals with diabetes. Prim Care Diabetes 2024:S1751-9918(24)00124-4. [PMID: 38972826 DOI: 10.1016/j.pcd.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 05/29/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024]
Abstract
Better diet quality regardless of community food access was associated with a higher likelihood of glycemic control in early pregnancy among nulliparous individuals with pregestational diabetes. These findings highlight the need for interventions that address nutrition insecurity for pregnant individuals living with diabetes.
Collapse
Affiliation(s)
- Kartik K Venkatesh
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA; Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA; Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jiqiang Wu
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA; Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joshua J Joseph
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA; Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer Garner
- Division of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca McNeil
- RTI International, Durham, NC, USA; Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christina Scifres
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, USA; Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH, USA; Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA; Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA; Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - George Saade
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA; Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA; Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hyagriv Simhan
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA; Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA; Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca J Post
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Obstetrics and Gynecology, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Daniel M Walker
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Family and Community Medicine, The Ohio State University, Columbus, OH, USA
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA; Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
2
|
McClintock HF, Imel BE. Food insecurity and medication restricting behavior among persons with diabetes in the United States. Nutr Health 2024; 30:341-347. [PMID: 35876349 DOI: 10.1177/02601060221115588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Medication restricting behaviours are common among persons with diabetes increasing risk for poor health outcomes. Persons with diabetes are more likely to experience food insecurity than persons without diabetes. AIM This study aimed to assess the relationship between food insecurity and medication restricting behaviour among persons with diabetes in the United States. METHODS Data from the 2019 National Health Interview Survey (NHIS) data conducted in the United States was used for this analysis. Medication restricting behaviour was assessed by questions asking whether four restricting behaviours were present (skipped medication, took less medication, delayed filling a prescription and/or took less medication due to cost). Food insecurity status was obtained through a 10-item scale and participants were categorized as either food secure, low food security, or very low food security. Poisson regression evaluated the relationship between medication restricting behaviour and food insecurity controlling for confounders. RESULTS Participants with very low food security had a significantly higher mean number of medication restricting behaviours than participants who were food secure (adjusted mean ratio (AMR) = 4.01; 95% confidence interval (CI) = (3.09, 5.21)). Similarly, participants with low food security had a significantly higher mean ratio than participants who were food secure (AMR = 3.76; 95% CI = (2.86. 4.94). CONCLUSION Persons with diabetes who have low or very low food security are at an increased risk for engaging in medication restricting behaviours.
Collapse
Affiliation(s)
- Heather F McClintock
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA, USA
| | - Brittany E Imel
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA, USA
| |
Collapse
|
3
|
Malik FS, Liese AD, Ellyson A, Reid LA, Reboussin BA, Sauder KA, Frongillo EA, Pihoker C, Dabelea D, Reynolds K, Jensen ET, Marcovina S, Bowlby DA, Mendoza JA. Household food insecurity and associations with hemoglobin A 1c and acute diabetes-related complications in youth and young adults with type 1 diabetes: The SEARCH for Diabetes in Youth study. Diabetes Res Clin Pract 2024; 212:111608. [PMID: 38574894 DOI: 10.1016/j.diabres.2024.111608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/20/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024]
Abstract
AIMS To examine, among youth and young adults (YYA) with type 1 diabetes (T1D), the association of household food insecurity (HFI) with: 1) HbA1c and 2) episodes of diabetic ketoacidosis (DKA) and severe hypoglycemia. METHODS HFI was assessed using the U.S. Household Food Security Survey Module in SEARCH for Diabetes in Youth participants with T1D between 2016 and 2019. Linear and logistic regression models adjusted for age, diabetes duration, sex, race, ethnicity, clinic site, parent/participant education, household income, health insurance, and diabetes technology use. RESULTS Of 1830 participants (mean age 20.8 ± 5.0 years, 70.0 % non-Hispanic White), HbA1c was collected for 1060 individuals (mean HbA1c 9.2 % ± 2.0 %). The prevalence of HFI was 16.4 %. In the past 12 months, 18.2 % and 9.9 % reported an episode of DKA or severe hypoglycemia, respectively. Compared to participants who were food secure, HFI was associated with a 0.33 % (95 % CI 0.003, 0.657) higher HbA1c level. Those with HFI had 1.58 (95 % CI 1.13, 2.21) times the adjusted odds of an episode of DKA and 1.53 (95 % CI 0.99, 2.37) times the adjusted odds of an episode of severe hypoglycemia as those without HFI. CONCLUSIONS HFI is associated with higher HbA1c levels and increased odds of DKA in YYA with T1D.
Collapse
Affiliation(s)
- Faisal S Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States.
| | | | - Alice Ellyson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States
| | | | - Beth A Reboussin
- Wake Forest University School of Medicine, Winston-Salem, United States
| | | | | | - Catherine Pihoker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States
| | - Dana Dabelea
- University of Colorado Anschutz Medical Campus, Aurora, United States
| | - Kristi Reynolds
- Kaiser Permanente Southern California, Pasadena, United States
| | | | | | | | - Jason A Mendoza
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States; Fred Hutchinson Cancer Center, Seattle, United States
| |
Collapse
|
4
|
Almohamad M, Dave JM, Calloway EE, Li R, Sharma S. Relationship between Food Security, Nutrition Security, and Diabetes: The Role of Supplemental Nutrition Assistance Program Participation. Curr Dev Nutr 2024; 8:102153. [PMID: 38693968 PMCID: PMC11061707 DOI: 10.1016/j.cdnut.2024.102153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 05/03/2024] Open
Abstract
Background Inadequate nutrition and poor diet quality are associated with a heightened risk of diabetes. The connection between food insecurity measures and diabetes has been established, with evidence indicating that Supplemental Nutrition Assistance Program (SNAP) participation contributes to reductions in food insecurity. Recently developed nutrition security measures, defined as the ability to acquire healthful foods to prevent diseases, and their association with diabetes and SNAP participation are not yet understood. Objectives This study aimed to assess the relationship between food security and nutrition security in relation to diabetes overall and by SNAP participation and nutrition security as potential modifiers. Methods Secondary data analysis of cross-sectional pilot study data collected from adults in 5 US states (N = 517). Logistic regression mixed models included moderation analysis and clustering effects by state to address site-level confounding. Results Higher nutrition security scores among adults, after adjusting for confounders, were significantly associated with lower odds of diabetes risk (adjusted odds ratio = 0.59; 95% confidence interval: 0.40, 0.87; P value = 0.008). Statistically significant interaction effect of differences according to SNAP participation was observed for nutrition security (Phomogeneity/interaction = 0.021), adjusting for age, gender, race/ethnicity, education, employment, National School Lunch Program, Special Supplemental Nutrition Program for Women, Infants, and Children, food pantry use, household with children, survey mode, and food security. The association between food security and diabetes was not statistically significant overall. However, statistically significant interaction effect of differences according to SNAP participation was observed for food security (Phomogeneity/interaction = 0.047). Further, no interaction effect of differences in nutrition security was found between food security and self-reported diabetes/prediabetes (Phomogeneity/interaction = 0.250). Conclusions This study sheds light on the early exploration of the intricate relationship between nutrition security and diabetes. The findings suggest that a higher nutrition security score, after adjusting for confounders, was significantly associated with lower odds of diabetes risk. Notably, there were statistically significant interaction effects in these associations based on SNAP participation.
Collapse
Affiliation(s)
- Maha Almohamad
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
| | - Jayna M Dave
- US Department of Agriculture/ Agricultural Research Service Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Eric E Calloway
- Gretchen Swanson Center for Nutrition, Omaha, NE, United States
| | - Ruosha Li
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
| | - Shreela Sharma
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
| |
Collapse
|
5
|
Short E, Selig JP, Felix HC, Painter J, McElfish PA, Rowland B, Ammerman AS, Bounds K, Henske J, Hudson JS, Li J, Young SG, Long CR. Healthy food delivery for type 2 diabetes management in rural clinics' patients: A comparative effectiveness randomized controlled trial protocol. Contemp Clin Trials 2024; 140:107491. [PMID: 38458560 PMCID: PMC11065573 DOI: 10.1016/j.cct.2024.107491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/29/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Rural populations experience a higher prevalence of both food insecurity and type 2 diabetes mellitus (T2DM) than metropolitan populations and face many challenges in accessing resources essential to optimal T2DM self-management. This study aims to address these challenges by delivering a T2DM-appropriate food box and recipes directly to rural participants' homes. METHODS This is a comparative effectiveness randomized controlled trial including 400 English- or Spanish-speaking rural adult participants with T2DM (HbA1c ≥6.5%) experiencing food insecurity. Participants are randomly assigned to a 3-month Healthy Food Delivery Intervention (HFDI) plus one 60-min virtual consultation with a diabetes educator or consultation only. The HFDI includes a weekly food box delivery with recipes. Data are collected at pre-intervention, 3-months (post-intervention), 9-months, and 15-months. The primary outcome is change in HbA1c, with secondary measures including diet quality (Healthy Eating Index-2015, calculated from one 24-h dietary recall at each data collection time point), cardio-metabolic risk factors (i.e., blood pressure, lipids, body mass index, glucose), and patient-centered outcomes (e.g., T2DM self-efficacy, T2DM-related distress). Process evaluation data (e.g., successful food box deliveries, diabetes educator consultation attendance, intervention satisfaction) are collected during and post-intervention (3-months). A cost-effectiveness analysis based on traditional cost per quality-adjusted life year gain thresholds will be conducted to estimate the incremental cost-effectiveness between HFDI plus consultation and consultation alone. CONCLUSION Findings from this study will provide evidence regarding the effectiveness of an intervention that promotes participant adherence and improves access to healthy food. CLINICAL TRIAL REGISTRATION NCT04876053.
Collapse
Affiliation(s)
- Eliza Short
- Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE 68154, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Jacob Painter
- College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA.
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 MLK, Chapel Hill, NC 27599, USA
| | - Kelsey Bounds
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Joseph Henske
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Jonell S Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48(th) St., Springdale, AR 72762, USA
| | - Sean G Young
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA
| | - Christopher R Long
- Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE 68154, USA
| |
Collapse
|
6
|
Morselli LL, Amjad R, James R, Kindel TL, Kwitek AE, Williams JS, Grobe JL, Kidambi S. Diet in Food Insecurity: A Mediator of Metabolic Health? J Endocr Soc 2024; 8:bvae062. [PMID: 38623381 PMCID: PMC11017326 DOI: 10.1210/jendso/bvae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Indexed: 04/17/2024] Open
Abstract
Objective Food insecurity (FI) is associated with poor metabolic health. It is assumed that energy intake and diet quality underlie this association. We tested the hypothesis that dietary factors (quantity and quality) mediate the association of FI with excess weight, waist circumference and glycemic control [glycohemoglobin (A1C)]. Methods A mediation analysis was performed on data from the National Health And Nutrition Examination Survey using FI as an independent variable; body mass index (BMI), waist circumference, and A1C as metabolic outcome variables and total energy intake, macronutrients, and diet quality measured by the Healthy Eating Index-2015 (HEI-2015) as potential mediators. Results Despite a greater prevalence of obesity in participants experiencing FI, daily reported energy intake was similar in food-secure and -insecure subjects. In adjusted analyses of the overall cohort, none of the examined dietary factors mediated associations between FI and metabolic outcomes. In race-stratified analyses, total sugar consumption was a partial mediator of BMI in non-Hispanic Whites, while diet quality measures (HEI-2015 total score and added sugar subscore) were partial mediators of waist circumference and BMI, respectively, for those in the "other" ethnic group. Conclusion Dietary factors are not the main factors underlying the association of FI with metabolic health. Future studies should investigate whether other social determinants of health commonly present in the context of FI play a role in this association.
Collapse
Affiliation(s)
- Lisa L Morselli
- Department of Medicine, Division of Endocrinology and Molecular Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Rabia Amjad
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Roland James
- Department of Medicine, Division of Endocrinology and Molecular Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Tammy L Kindel
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Anne E Kwitek
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Linda T. and John A. Mellowes Center for Genomic Sciences and Precision Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Joni S Williams
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Justin L Grobe
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Comprehensive Rodent Metabolic Phenotyping Core, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Srividya Kidambi
- Department of Medicine, Division of Endocrinology and Molecular Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| |
Collapse
|
7
|
Young Choi J, Ali MK, Choi D. Determinants of health and mortality in undiagnosed diabetes: A nationally representative US adult, 2011-2020. Diabetes Res Clin Pract 2024; 210:111634. [PMID: 38522632 PMCID: PMC11148774 DOI: 10.1016/j.diabres.2024.111634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/09/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Abstract
AIM This study examines the determinants of health and mortality associated with undiagnosed diabetes among a nationally representative sample of US adults. METHODS Data are from the National Health and Nutrition Examination Survey between 2011 and 2012 and 2019-2020. Diabetes status is categorized into three groups: undiagnosed diabetes, diagnosed diabetes, and no diabetes. Multiple logistic regression is used to estimate the association between undiagnosed diabetes and three domains of risk factors, including sociodemographic and health behavioral and clinical factors. Cox proportional hazards models are performed to compare excess mortality risk between the three groups. RESULTS Young adults, racial minorities, the foreign-born, and individuals with limited access to health care are more likely to be unaware of their diabetes. Moreover, adults without a family history of diabetes and chronic conditions have a higher chance of undiagnosed diabetes. No health behavioral factors are found to be associated with undiagnosed diabetes. Adults with undiagnosed diabetes have a lower risk of all-cause and cardiovascular disease mortality compared to those with diagnosed diabetes, but a higher risk of all-cause mortality than those with no diabetes. CONCLUSION Targeted public health approaches should address sociodemographic and clinical factors to reduce the burden of undiagnosed diabetes.
Collapse
Affiliation(s)
- Ji Young Choi
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322 USA.
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322 USA; Emory Global Diabetes Research Center of the Woodruff Health Sciences Center and Emory University, Atlanta, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, USA
| | - Daesung Choi
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322 USA
| |
Collapse
|
8
|
Lee G, Liu R, McPeek Hinz ER, Bettger JP, Purakal J, Spratt SE. Leveraging Student Volunteers to Connect Patients with Social Risk to Resources On a Coordinated Care Platform: A Case Study with Two Endocrinology Clinics. Int J Integr Care 2024; 24:10. [PMID: 38370570 PMCID: PMC10870950 DOI: 10.5334/ijic.7633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 01/30/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Although unmet social needs can impact health outcomes, health systems often lack the capacity to fully address these needs. Our study describes a model that organized student volunteers as a community-based organisation (CBO) to serve as a social referral hub on a coordinated social care platform, NCCARE360. Description Patients at two endocrinology clinics were systematically screened for social needs. Patients who screened positive and agreed to receive help were referred via NCCARE360 to student 'Help Desk' volunteers, who organised as a CBO. Trained student volunteers called patients to place referrals to resources and document them on the platform. The platform includes documentation at several levels, acting as a shared information source between healthcare providers, volunteer student patient navigators, and community resources. Navigators followed up with patients to problem-solve barriers and track referral outcomes on the platform, visible to all parties working with the patient. Discussion Of the 44 patients who screened positive for social needs and were given referrals by Help Desk, 41 (93%) were reached for follow-up. Thirty-six patients (82%) connected to at least one resource. These results speak to the feasibility and utility of organising undergraduate student volunteers into a social referral hub to connect patients to resources on a coordinated care platform. Conclusion Organising students as a CBO on a centralized social care platform can help bridge a critical gap between healthcare and social services, addressing health system capacity and ultimately improving patients' connections with resources.
Collapse
Affiliation(s)
- Grace Lee
- Trinity College of Arts & Sciences, Duke University, Durham, North Carolina, USA
| | - Rebecca Liu
- Trinity College of Arts & Sciences, Duke University, Durham, North Carolina, USA
| | | | - Janet Prvu Bettger
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - John Purakal
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Samuel Dubois Cook Center on Social Equity, Duke University, Durham, North Carolina, USA
| | - Susan E. Spratt
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Population Health Management Office, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
9
|
Park S, Chen J, Bustamante AV. Adverse Consequences of Food Insecurity Among U.S. Adults Beyond Health Outcomes. Am J Prev Med 2024; 66:146-153. [PMID: 37690588 DOI: 10.1016/j.amepre.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Food insecurity is associated with poorer health, but the adverse consequences of food insecurity may extend beyond just health outcomes. Thus, this study examined the association between food insecurity and health insurance coverage, access to care, healthcare utilization, and financial hardships among U.S. adults. METHODS This study employed a retrospective longitudinal cohort study design using panel data from the 2016-2017 Medical Expenditure Panel Survey. Linear probability models were used to examine the association between food insecurity in 1 year and outcomes of interest (health insurance coverage, access to care, healthcare utilization, and financial hardships) in the subsequent year. Analysis was conducted in April 2023. RESULTS Food insecurity was associated with higher uninsured rates and lower private coverage rates (3.5 [95% CI: 1.6-5.5] and -3.9 [95% CI: -6.2, -1.7] percentage points). Moreover, food insecurity was associated with lower access to care, including delay in receiving necessary medical care and delay in obtaining necessary prescription drugs (2.9 [95% CI: 1.0-4.8] and 4.1 [95% CI: 2.1-6.2]). Furthermore, food insecurity was associated with a higher rate of emergency room visits (2.8 [95% CI: 0.1-5.7]), whereas associations with inpatient, outpatient, and prescription drug use were not significant. Food insecurity was also associated with greater financial hardships, such as experiencing difficulties paying medical bills (9.6 [95% CI: 6.7-12.6]). CONCLUSIONS These findings highlight the adverse consequences of food insecurity on access to and affordability of care for U.S. adults and families. Food insecurity can have far-reaching implications for the well-being of individuals and families.
Collapse
Affiliation(s)
- Sungchul Park
- Department of Health Policy and Management, College of Health Science, BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seongbuk-gu, Seoul, Republic of Korea.
| | - Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland
| | - Arturo Vargas Bustamante
- Department of Health Policy and Management, Fielding School of Public Health, UCLA, UCLA Latino Policy and Politics Institute, Los Angeles, California
| |
Collapse
|
10
|
Stroud B, Jacobs MM, Palakshappa D, Sastre LR. A Rural Delivery-Based Produce Prescription Intervention Improves Glycemic Control and Stress. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:803-814. [PMID: 37737814 DOI: 10.1016/j.jneb.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 08/19/2023] [Accepted: 08/27/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE We examined the impact of a pilot 24-week delivery-based produce prescription (PRx) intervention with tailored education and culinary resources for rural patients (n = 40) with type-2 diabetes in underresourced communities on behavioral and clinical outcomes. METHODS We used a single group pretest-posttest design that included a home-delivered PRx, culturally tailored recipes, and health/nutrition education handouts. Measures included hemoglobin A1c (HbA1c), self-reported fruit/vegetable consumption, and stress. Descriptive statistics, t-tests, and Wilcoxon signed rank tests were conducted. RESULTS Mean HbA1c decreased from 7.6 ± 1.6% to 7.1% ± 1.4% (P = 0.001). Self-reported consumption of fruit/vegetables improved, including frequency and serving size of beans (P = 0.01 and P = 0.01), serving size of lettuce salad (P = 0.02), and serving size of vegetable soup (P = 0.001). Perceived stress decreased (P = 0.01). CONCLUSION AND IMPLICATIONS Findings from this pilot PRx intervention suggest a delivery-based PRx with tailored educational resources has the potential to reduce HbA1c and stress while improving fruit/vegetable consumption within rural patients with type-2 diabetes in underresourced communities.
Collapse
Affiliation(s)
- Brandon Stroud
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC.
| | - Molly M Jacobs
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
| | - Deepak Palakshappa
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC; Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lauren R Sastre
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC
| |
Collapse
|
11
|
Douglas F. What qualitative research can tell us about food and nutrition security in the UK and why we should pay attention to what it is telling us. Proc Nutr Soc 2023:1-10. [PMID: 37799071 DOI: 10.1017/s0029665123003713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Poor dietary patterns leading to poorer health and increased health care use have affected people living in disadvantaged economic circumstances in the UK for decades, which many fear will be exacerbated due to the UK's current so-called 'cost of living crisis'. The voices of experts by experience of those health and social inequalities are not routinely included in health improvement intervention development in relation to obesity prevention policy and programmes. Obesity is highly correlated with food insecurity experience in high-income country contexts (where food insecurity data are routinely collected) and is similarly socially patterned. Using a health equity lens, this review paper highlights qualitative research findings that have revealed the perspectives and direct experiences of people living with food insecurity, or those others supporting food-insecure households, that shed light on the role and influence of the socio-economic contextual factors food-insecure people live with day-to-day. Insights from qualitative research that have focused on the granular detail of day-to-day household resource management can help us understand not only how food insecurity differentially impacts individual household members, but also how behavioural responses/food coping strategies are playing into pathways that lead to avoidable ill health such as obesity, diabetes and other chronic health conditions, including mental health problems. This review paper concludes by discussing research and policy implications in relation to food-insecure households containing people with chronic health conditions, and for pregnant women and families with infants and very young children living in the UK today.
Collapse
Affiliation(s)
- Flora Douglas
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
| |
Collapse
|
12
|
Brown AD, Liese AD, Shapiro ALB, Frongillo EA, Wilkening G, Fridriksson J, Merchant AT, Henkin L, Jensen ET, Reboussin BA, Shah AS, Marcovina S, Dolan LM, Dabelea D, Pihoker C, Mendoza JA. Household Food Insecurity and Cognition in Youth and Young Adults with Youth-Onset Diabetes. Pediatr Diabetes 2023; 2023:6382663. [PMID: 38765732 PMCID: PMC11100256 DOI: 10.1155/2023/6382663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Objective We evaluated the association of household food insecurity (FI) with cognition in youth and young adults with type 1 diabetes (T1D) or type 2 diabetes (T2D). Design In this cross-sectional study, age-adjusted scores for composite Fluid Cognition, and sub-domain scores for Receptive Language and Inhibitory Control and Attention, were modeled stratified by diabetes-type using linear regression, with FI in the past year as the predictor, controlling for covariates. Tests for processing speed, inhibitory control/attention, working memory, episodic memory, and cognitive flexibility were administered to measure composite Fluid Cognition score. The NIHT-CB Picture Vocabulary Test was used to assess Crystallized Cognition score and rapid identification of congruent versus noncongruent items were used to assess Inhibitory Control and Attention score. Setting The SEARCH for Diabetes in Youth study, representative of 5 U.S. states. Participants Included 1574 youth and young adults with T1D or T2D, mean age of 21 years, mean diabetes duration of 11 years, 51% non-Hispanic white, and 47% had higher HbA1c levels (>9% HbA1c). Results Approximately 18% of the 1,240 participants with T1D and 31% of the 334 with T2D experienced FI. The food-insecure group with T1D had a lower composite Fluid Cognition score (β= -2.5, 95% confidence interval (CI)= -4.8, -0.1) and a lower Crystallized Cognition score (β= -3.4, CI= -5.6, -1.3) than food-secure peers. Findings were attenuated to non-significance after adjustment for demographics. Among T2D participants, no associations were observed. In participants with T1D effect modification by glycemic levels were found in the association between FI and composite Fluid Cognition score but adjustment for socioeconomic characteristics attenuated the interaction (p=0.0531). Conclusions Food-insecure youth and young adults with T1D or T2D did not have different cognition compared to those who were food-secure after adjustment for confounders. Longitudinal research is needed to further understand relations amongst these factors.
Collapse
Affiliation(s)
- Andrea D. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, USA 29208
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, USA 29208
| | - Allison L. B. Shapiro
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, USA 80045
| | - Edward A. Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, 915 Greene Street Columbia, SC, USA 29208
| | - Greta Wilkening
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, USA 80045
| | - Julius Fridriksson
- Department of Communication Sciences & Disorders, University of South Carolina, 1705 College Street Columbia, SC, USA 29208
| | - Anwar T. Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, USA 29208
| | - Leora Henkin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC, USA 27101
| | - Elizabeth T. Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC USA 27101
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC, USA 27101
| | - Amy S. Shah
- Department of Pediatrics, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center and The University of Cincinnati, 3333 Burnet Avenue, MLC 4002 Cincinnati, OH, USA 45229
| | - Santica Marcovina
- Medpace Reference Laboratories, 5365 Medpace Way, Cincinnati, OH, USA 45227
| | - Lawrence M. Dolan
- Department of Pediatrics, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center and The University of Cincinnati, 3333 Burnet Avenue, MLC 4002 Cincinnati, OH, USA 45229
| | - Dana Dabelea
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, USA 80045
- Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, USA 80045
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Box 356320, Seattle WA, USA 98115-8160
| | - Jason A. Mendoza
- Department of Pediatrics, University of Washington, Box 356320, Seattle WA, USA 98115-8160
- Seattle Children’s Research Institute, PO Box 5371, Seattle, WA, USA 98145-5005
| |
Collapse
|
13
|
Krasnovsky L, Crowley AP, Naeem F, Wang LS, Wu GD, Chao AM. A Scoping Review of Nutritional Biomarkers Associated with Food Security. Nutrients 2023; 15:3576. [PMID: 37630766 PMCID: PMC10459650 DOI: 10.3390/nu15163576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Food insecurity affects more than 40 million individuals in the United States and is linked to negative health outcomes due, in part, to poor dietary quality. Despite the emergence of metabolomics as a modality to objectively characterize nutritional biomarkers, it is unclear whether food security is associated with any biomarkers of dietary quality. This scoping review aims to summarize studies that examined associations between nutritional biomarkers and food security, as well as studies that investigated metabolomic differences between people with and without food insecurity. PubMed, Embase, Scopus, and AGRICOLA were searched through August 2022 for studies describing food insecurity and metabolic markers in blood, urine, plasma, hair, or nails. The 78 studies included consisted of targeted assays quantifying lipids, dietary nutrients, heavy metals, and environmental xenobiotics as biochemical features associated with food insecurity. Among those biomarkers which were quantified in at least five studies, none showed a consistent association with food insecurity. Although three biomarkers of dietary quality have been assessed between food-insecure versus food-secure populations, no studies have utilized untargeted metabolomics to characterize patterns of small molecules that distinguish between these two populations. Further studies are needed to characterize the dietary quality profiles of individuals with and without food insecurity.
Collapse
Affiliation(s)
- Lev Krasnovsky
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.P.C.); (F.N.); (L.S.W.)
| | - Aidan P. Crowley
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.P.C.); (F.N.); (L.S.W.)
| | - Fawaz Naeem
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.P.C.); (F.N.); (L.S.W.)
| | - Lucy S. Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.P.C.); (F.N.); (L.S.W.)
| | - Gary D. Wu
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Ariana M. Chao
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA;
| |
Collapse
|
14
|
Berkowitz SA, Basu S, Hanmer J. Eliminating Food Insecurity in the USA: a Target Trial Emulation Using Observational Data to Estimate Effects on Health-Related Quality of Life. J Gen Intern Med 2023; 38:2308-2317. [PMID: 36814050 PMCID: PMC10406772 DOI: 10.1007/s11606-023-08095-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Food insecurity is associated with many aspects of poor health. However, trials of food insecurity interventions typically focus on outcomes of interest to funders, such as healthcare use, cost, or clinical performance metrics, rather than quality of life outcomes that may be prioritized by individuals who experience food insecurity. OBJECTIVE To emulate a trial of a food insecurity elimination intervention, and quantify its estimated effects on health utility, health-related quality of life, and mental health. DESIGN Target trial emulation using longitudinal, nationally representative data, from the USA, 2016-2017. PARTICIPANTS A total of 2013 adults in the Medical Expenditure Panel Survey screened positive for food insecurity, representing 32 million individuals. MAIN MEASURES Food insecurity was assessed using the Adult Food Security Survey Module. The primary outcome was the SF-6D (Short-Form Six Dimension) measure of health utility. Secondary outcomes were mental component score (MCS) and physical component score (PCS) of the Veterans RAND 12-Item Health Survey (a measure of health-related quality of life), Kessler 6 (K6) psychological distress, and Patient Health Questionnaire 2-item (PHQ2) depressive symptoms. KEY RESULTS We estimated that food insecurity elimination would improve health utility by 80 QALYs per 100,000 person-years, or 0.008 QALYs per person per year (95% CI 0.002 to 0.014, p = 0.005), relative to the status quo. We also estimated that food insecurity elimination would improve mental health (difference in MCS [95% CI]: 0.55 [0.14 to 0.96]), physical health (difference in PCS: 0.44 [0.06 to 0.82]), psychological distress (difference in K6: -0.30 [-0.51 to -0.09]), and depressive symptoms (difference in PHQ-2: -0.13 [-0.20 to -0.07]). CONCLUSIONS Food insecurity elimination may improve important, but understudied, aspects of health. Evaluations of food insecurity interventions should holistically investigate their potential to improve many different aspects of health.
Collapse
Affiliation(s)
- Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Sanjay Basu
- Research and Development, Waymark, San Francisco, CA, USA
| | - Janel Hanmer
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
15
|
Alawode O, Humble S, Herrick CJ. Food insecurity, SNAP participation and glycemic control in low-income adults with predominantly type 2 diabetes: a cross-sectional analysis using NHANES 2007-2018 data. BMJ Open Diabetes Res Care 2023; 11:e003205. [PMID: 37220963 PMCID: PMC10230897 DOI: 10.1136/bmjdrc-2022-003205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/25/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Diabetes, characterized by elevated blood glucose levels, affects 13% of US adults, 95% of whom have type 2 diabetes (T2D). Social determinants of health (SDoH), such as food insecurity, are integral to glycemic control. The Supplemental Nutrition Assistance Program (SNAP) aims to reduce food insecurity, but it is not clear how this affects glycemic control in T2D. This study investigated the associations between food insecurity and other SDoH and glycemic control and the role of SNAP participation in a national socioeconomically disadvantaged sample. RESEARCH DESIGN AND METHODS Adults with likely T2D and income <185% of the federal poverty level (FPL) were identified using cross-sectional National Health and Nutrition Examination Survey (NHANES) data (2007-2018). Multivariable logistic regression assessed the association between food insecurity, SNAP participation and glycemic control (defined by HbA1c 7.0%-8.5% depending on age and comorbidities). Covariates included demographic factors, clinical comorbidities, diabetes management strategies, and healthcare access and utilization. RESULTS The study population included 2084 individuals (90% >40 years of age, 55% female, 18% non-Hispanic black, 25% Hispanic, 41% SNAP participants, 36% low or very low food security). Food insecurity was not associated with glycemic control in the adjusted model (adjusted OR (aOR) 1.181 (0.877-1.589)), and SNAP participation did not modify the effect of food insecurity on glycemic control. Insulin use, lack of health insurance, and Hispanic or another race and ethnicity were among the strongest associations with poor glycemic control in the adjusted model. CONCLUSIONS For low-income individuals with T2D in the USA, health insurance may be among the most critical predictors of glycemic control. Additionally, SDoH associated with race and ethnicity plays an important role. SNAP participation may not affect glycemic control because of inadequate benefit amounts or lack of incentives for healthy purchases. These findings have implications for community engaged interventions and healthcare and food policy.
Collapse
Affiliation(s)
- Oluwatobi Alawode
- Department of Obstetrics and Gynecology, Meharry Medical College, Nashville, Tennessee, USA
| | - Sarah Humble
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Cynthia J Herrick
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
- Department of Medicine, Division of Endocrinology, Metabolism, and Lipid Research, Washington University in St Louis, St Louis, Missouri, USA
| |
Collapse
|
16
|
Sun H, Weaver CM. Trends in Diet Quality and Increasing Inadequacies of Micronutrients Vitamin C, Vitamin B12, Iron and Potassium in US Type 2 Diabetic Adults. Nutrients 2023; 15:nu15081980. [PMID: 37111200 PMCID: PMC10142510 DOI: 10.3390/nu15081980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Prevalence of diabetes was high and rose significantly in the US between 1999 and 2018. A healthy dietary pattern that provides micronutrient adequacy is one of the most important lifestyle choices for battling the progress of diabetes. Yet, the patterns and trends of diet quality of the US type 2 diabetes are understudied. OBJECTIVES We aim to examine the patterns and trends of diet quality and major food sources of macronutrients of US type 2 diabetic adults. METHODS The 24 h dietary recalls of 7789 type 2 diabetic adults, comprising 94.3% of total adults with diabetes from the US National Health and Nutrition Examination Survey cycles (1999-2018), were analyzed. Diet quality was measured by the total Healthy Eating Index (HEI)-2015 scores and 13 individual components. Trends of usual intakes of vitamin C (VC), vitamin B12 (VB12), iron, and potassium and supplements from two 24 h recalls were also examined for type 2 diabetic population. RESULTS Diet quality of type 2 diabetic adults worsened between 1999 and 2018 while that of US adults of general population improved based on the total HEI 2015 scores. For people with type 2 diabetes, consumption of saturated fat and added sugar increased while consumption of vegetables and fruits declined significantly, although consumption of refined grain declined and consumption of seafood and plant protein increased significantly. In addition, usual intakes of micronutrients VC, VB12, iron, and potassium from food sources declined significantly during this period. CONCLUSIONS Diet quality generally worsened for US type 2 diabetic adults between 1999 and 2018. Declining consumptions of fruits, vegetables, and non-poultry meat may have contributed to the increasing inadequacies of VC, VB12, iron, and potassium in the US type 2 diabetic adults.
Collapse
Affiliation(s)
- Hongbing Sun
- Department of Earth and Chemical Sciences, Rider University, 2083 Lawrenceville Road, Lawrenceville, NJ 08648, USA
| | - Connie M Weaver
- School of Exercise and Nutritional Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| |
Collapse
|
17
|
Gold R, Kaufmann J, Cottrell EK, Bunce A, Sheppler CR, Hoopes M, Krancari M, Gottlieb LM, Bowen M, Bava J, Mossman N, Yosuf N, Marino M. Implementation Support for a Social Risk Screening and Referral Process in Community Health Centers. NEJM CATALYST INNOVATIONS IN CARE DELIVERY 2023; 4:10.1056/CAT.23.0034. [PMID: 37153938 PMCID: PMC10161727 DOI: 10.1056/cat.23.0034] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Evidence is needed about how to effectively support health care providers in implementing screening for social risks (adverse social determinants of health) and providing related referrals meant to address identified social risks. This need is greatest in underresourced care settings. The authors tested whether an implementation support intervention (6 months of technical assistance and coaching study clinics through a five-step implementation process) improved adoption of social risk activities in community health centers (CHCs). Thirty-one CHC clinics were block-randomized to six wedges that occurred sequentially. Over the 45-month study period from March 2018 to December 2021, data were collected for 6 or more months preintervention, the 6-month intervention period, and 6 or more months postintervention. The authors calculated clinic-level monthly rates of social risk screening results that were entered at in-person encounters and rates of social risk-related referrals. Secondary analyses measured impacts on diabetes-related outcomes. Intervention impact was assessed by comparing clinic performance based on whether they had versus had not yet received the intervention in the preintervention period compared with the intervention and postintervention periods. In assessing the results, the authors note that five clinics withdrew from the study for various bandwidth-related reasons. Of the remaining 26, a total of 19 fully or partially completed all 5 implementation steps, and 7 fully or partially completed at least the first 3 steps. Social risk screening was 2.45 times (95% confidence interval [CI], 1.32-4.39) higher during the intervention period compared with the preintervention period; this impact was not sustained postintervention (rate ratio, 2.16; 95% CI, 0.64-7.27). No significant difference was seen in social risk referral rates during the intervention or postintervention periods. The intervention was associated with greater blood pressure control among patients with diabetes and lower rates of diabetes biomarker screening postintervention. All results must be interpreted considering that the Covid-19 pandemic began midway through the trial, which affected care delivery generally and patients at CHCs particularly. Finally, the study results show that adaptive implementation support was effective at temporarily increasing social risk screening. It is possible that the intervention did not adequately address barriers to sustained implementation or that 6 months was not long enough to cement this change. Underresourced clinics may struggle to participate in support activities over longer periods without adequate resources, even if lengthier support is needed. As policies start requiring documentation of social risk activities, safety-net clinics may be unable to meet these requirements without adequate financial and coaching/technical support.
Collapse
Affiliation(s)
- Rachel Gold
- Lead Research Scientist, OCHIN, Portland, Oregon, USA
- Senior Investigator, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Jorge Kaufmann
- Biostatistician, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Erika K Cottrell
- Senior Investigator, OCHIN, Portland, Oregon, USA
- Research Associate Professor, Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Arwen Bunce
- Qualitative Research Scientist, OCHIN, Portland, Oregon, USA
| | - Christina R Sheppler
- Research Associate III, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Megan Hoopes
- Manager of Research Analytics, OCHIN, Portland, Oregon, USA
| | | | - Laura M Gottlieb
- Professor of Family and Community Medicine, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Meg Bowen
- Practice Coach, OCHIN, Portland, Oregon, USA
| | | | - Ned Mossman
- Director of Social and Community Health, OCHIN, Portland, Oregon, USA
| | - Nadia Yosuf
- Project Manager III, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Miguel Marino
- Assistant Professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
18
|
Kosmas JA, Wildes JE, Graham AK, O'Connor SM. The role of stress in the association among food insecurity, eating disorder pathology, and binge eating-related appetitive traits. Eat Behav 2023; 49:101709. [PMID: 36822033 PMCID: PMC10238633 DOI: 10.1016/j.eatbeh.2023.101709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Growing literature demonstrates a positive association between food insecurity (FI) and eating disorder pathology. Additionally, FI has been associated with two appetitive traits strongly linked to binge eating, food responsiveness and emotional overeating. However, little research has investigated factors that might help to explain these associations. One hypothesis is that experiencing FI may increase stress, and that eating disorder pathology, particularly binge eating-related phenotypes, may serve as a coping strategy. This study explores stress as a potential mechanism in the association between FI and general eating disorder pathology, as well as two appetitive traits strongly associated with binge eating (food responsiveness and emotional overeating). METHODS Cis-gender women (N = 634) completed online questionnaires assessing FI, stress, eating disorder pathology (measured via the total score on the Short Eating Disorder Examination Questionnaire), and binge eating-related appetitive traits (measured via the Adult Eating Behavior Questionnaire). Cross-sectional indirect effects analyses with a 1000-sample bootstrap were used to test pathways among FI, stress, and eating-related constructs. RESULTS FI was significantly associated with eating disorder pathology and associated appetitive traits (ps < 0.001). Stress explained a significant proportion of the correlation between FI and each eating-related construct. CONCLUSIONS Our findings extend prior research on the relationships between FI, eating disorder pathology, and binge eating-related appetitive traits to provide preliminary evidence that stress may act as an underlying mechanism. Future studies should use longitudinal designs to assess the prospective relationships among these constructs.
Collapse
Affiliation(s)
- Jacqueline A Kosmas
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, USA
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, USA
| | | |
Collapse
|
19
|
Mabli J, Monzella K, Franckle RL, Delgado PL. Food Insecurity Transitions and Changes in Employment and Earnings. Am J Prev Med 2023; 64:368-376. [PMID: 36464558 DOI: 10.1016/j.amepre.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/21/2022] [Accepted: 09/30/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Many low-income U.S. households experience food security changes over time, but little is known about how labor market transitions contribute to these changes. This paper uses longitudinal survey data collected from 2017 to 2020 to explore how changes in employment and earnings are associated with changes in food security status. METHODS Analyses were conducted in the spring of 2022 and include nearly 3,500 individuals who participated in the Supplemental Nutrition Assistance Program Employment and Training program. Individuals responded to surveys at 2 points in time-12 months and 36 months after study enrollment-which asked for employment, earnings, and food security information. Logistic regression models were used to estimate the associations between food security transitions and employment and earnings changes. Analyses also were conducted to assess whether these associations differed on the basis of individuals' previous employment and earnings volatility. RESULTS Individuals who experienced a job loss 2 months before the second survey interview had higher odds of becoming food insecure (OR=2.67; 95% CI=1.24, 5.75); those who experienced an earnings reduction in the month before the interview also had higher odds of becoming food insecure (OR=1.89; 95% CI=1.03, 3.47). The association between experiencing a job loss and becoming food insecure was greater among those who had experienced past earnings changes. There were no statistically significant associations between changes in earnings and employment and the likelihood of becoming food secure. CONCLUSIONS Employment losses and earnings reductions are associated with becoming food insecure among Supplemental Nutrition Assistance Program Employment and Training participants. Providing additional support to individuals who experience these losses and reductions may reduce their risk of becoming food insecure.
Collapse
Affiliation(s)
- James Mabli
- Human Services, Mathematica, Cambridge, Massachusetts.
| | | | | | | |
Collapse
|
20
|
Shrodes JC, Williams A, Nolan TS, Radabaugh JN, Braun A, Kline D, Zhao S, Brock G, Garner JA, Spees CK, Joseph JJ. Feasibility of Cooking Matters for Diabetes: A 6-week Randomized, Controlled Cooking and Diabetes Self-Management Education Intervention. J Acad Nutr Diet 2023; 123:492-503.e5. [PMID: 35944873 PMCID: PMC10909744 DOI: 10.1016/j.jand.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 07/08/2022] [Accepted: 07/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Diabetes self-management education and support is the cornerstone of diabetes care, yet <10% of adults with diabetes manage their condition successfully. Feasible interventions are needed urgently. OBJECTIVE Our aim was to assess the feasibility of a cooking intervention with food provision and diabetes self-management education and support. DESIGN This was a waitlist-controlled, randomized trial. PARTICIPANTS/SETTING Thirteen adults with type 1 or type 2 diabetes who participated in Cooking Matters for Diabetes (CMFD) participated in 2 focus groups. INTERVENTION CMFD was adapted from Cooking Matters and the American Diabetes Association's diabetes self-management education and support intervention into a 6-week program with weekly lesson-aligned food provisions. MAIN OUTCOME MEASURES Feasibility was evaluated quantitatively and qualitatively along the following 5 dimensions: demand, acceptability, implementation, practicality, and limited efficacy. STATISTICAL ANALYSIS Two coders extracted focus group themes with 100% agreement after iterative analysis, resulting in consensus. Administrative data were analyzed via descriptive statistics. RESULTS Mean (SD) age of focus group participants was 57 (14) years; 85% identified as female; 39% identified as White; 46% identified as Black; and income ranged from <$5,000 per year (15%) to $100,000 or more per year (15%). Mean (SD) baseline hemoglobin A1c was 8.6% (1.2%). Mean attendance in CMFD was 5 of 6 classes (83%) among all participants. Demand was high based on attendance and reported intervention utilization and was highest among food insecure participants, who were more likely to report using the food provisions and recipes. Acceptability was also high; focus groups revealed the quality of instructors and interaction with peers as key intervention strengths. Participant ideas for implementation refinement included simplifying recipes, lengthening class sessions, and offering more food provision choices. Perceived effects of the intervention included lower hemoglobin A1c and body weight and improvements to health-related quality of life. CONCLUSIONS The CMFD intervention was feasible according to the measured principles of demand, acceptability, implementation, practicality, and limited efficacy.
Collapse
Affiliation(s)
- Jennifer C Shrodes
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, Ohio
| | - Amaris Williams
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, Ohio
| | - Timiya S Nolan
- The Ohio State University College of Nursing, Columbus, Ohio
| | - Jessica N Radabaugh
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ashlea Braun
- Department of Nutritional Sciences, School of Education and Human Sciences, Oklahoma State University, Stillwater, Oklahoma
| | - David Kline
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Songzhu Zhao
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Guy Brock
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jennifer A Garner
- The School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, Ohio; The John Glenn College of Public Affairs, The Ohio State University, Columbus, Ohio
| | - Colleen K Spees
- Division of Medical Dietetics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Joshua J Joseph
- The Ohio State University College of Medicine, Columbus, Ohio.
| |
Collapse
|
21
|
Williams A, Shrodes JC, Radabaugh JN, Braun A, Kline D, Zhao S, Brock G, Nolan TS, Garner JA, Spees CK, Joseph JJ. Outcomes of Cooking Matters for Diabetes: A 6-week Randomized, Controlled Cooking and Diabetes Self-Management Education Intervention. J Acad Nutr Diet 2023; 123:477-491. [PMID: 35961614 PMCID: PMC10862535 DOI: 10.1016/j.jand.2022.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 07/08/2022] [Accepted: 07/24/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Diabetes self-management education and support is the cornerstone of diabetes care, yet only 1 in 2 adults with diabetes attain hemoglobin A1c (HbA1c) targets. Food insecurity makes diabetes management and HbA1c control more difficult. OBJECTIVE Our aim was to test whether a cooking intervention with food provision and diabetes self-management education and support improves HbA1c and diabetes management. DESIGN This was a waitlist-controlled, randomized trial. PARTICIPANTS/SETTING Participants were 48 adults with type 1 or type 2 diabetes. INTERVENTION Cooking Matters for Diabetes was adapted from Cooking Matters and the American Diabetes Association diabetes self-management education and support intervention into a 6-week program with weekly food provision (4 servings). MAIN OUTCOME MEASURES Surveys (ie, Summary of Diabetes Self-Care Activities; Medical Outcomes Study Short Form Health Survey, version 1; Diet History Questionnaire III; 10-item US Adult Food Security Survey Module; and Stanford Diabetes Self-Efficacy Scale) were administered and HbA1c was measured at baseline, post intervention, and 3-month follow-up. STATISTICAL ANALYSIS Mixed-effects linear regression models controlling for sex and study wave were used. RESULTS Mean (SD) age of participants was 57 (12) years; 65% identified as female, 52% identified as White, 40% identified as Black, and 19 (40%) were food insecure at baseline. Intervention participants improved Summary of Diabetes Self-Care Activities general diet score (0 to 7 scale) immediately post intervention (+1.51; P = .015) and 3 months post intervention (+1.23; P = .05), and improved Medical Outcomes Study Short Form Health Survey, version 1, mental component score (+6.7 points; P = .025) compared with controls. Healthy Eating Index 2015 total vegetable component score improved at 3 months (+0.917; P = .023) compared with controls. At baseline, food insecure participants had lower self-efficacy (5.6 vs 6.9 Stanford Diabetes Self-Efficacy Scale; P = .002) and higher HbA1c (+0.77; P = .025), and demonstrated greater improvements in both post intervention (+1.2 vs +0.4 Stanford Diabetes Self-Efficacy Scale score; P = .002, and -0.12 vs +0.39 HbA1c; P = .25) compared with food secure participants. CONCLUSIONS Cooking Matters for Diabetes may be an effective method of improving diet-related self-care and health-related quality of life, especially among food insecure patients, and should be tested in larger randomized controlled trials.
Collapse
Affiliation(s)
- Amaris Williams
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jennifer C Shrodes
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jessica N Radabaugh
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ashlea Braun
- Department of Nutritional Sciences, School of Education and Human Sciences, Oklahoma State University, Stillwater, Oklahoma
| | - David Kline
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Songzhu Zhao
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Guy Brock
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Timiya S Nolan
- The Ohio State University College of Nursing, Columbus, Ohio
| | - Jennifer A Garner
- The School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, Ohio; The John Glenn College of Public Affairs, The Ohio State University, Columbus, Ohio
| | - Colleen K Spees
- Division of Medical Dietetics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Joshua J Joseph
- The Ohio State University College of Medicine, Columbus, Ohio.
| |
Collapse
|
22
|
Dong T, Harris K, Freedman D, Janus S, Griggs S, Iyer Y, Nasir K, Neeland IJ, Rajagopalan S, Al-Kindi SG. Food insecurity and atherosclerotic cardiovascular disease risk in adults with diabetes. Nutrition 2023; 106:111865. [PMID: 36473415 PMCID: PMC9851285 DOI: 10.1016/j.nut.2022.111865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Adults with diabetes are at an increased risk of atherosclerotic cardiovascular disease (ASCVD), and food insecurity may be a major and underappreciated risk compounder in this population. We sought to analyze the prevalence of food insecurity and its association with ASCVD in adults with diabetes. METHODS A total of 6424 participants with diabetes were included from the 2019 and 2020 National Health Interview Survey. Food insecurity was determined with a 10-question U.S. Adult Food Security Survey Module, and classified as high, marginal, low, and very low. ASCVD was defined as a self-reported history of coronary artery disease, myocardial infarction, or stroke. RESULTS Of the 6424 included participants (weighted: n = 21 690 217), 5 405 543 (24.4%) reported a history of ASCVD and 2 946 061 (13.3%) were identified as food insecure (low or very low food security). Adults with food insecurity were more likely to have ASCVD than adults who were food secure (28.9% vs 23.7%; P = 0.008). In the multivariate analyses adjusted for traditional cardiovascular risk factors, all levels of food insecurity were associated with ASCVD compared with food-secure adults (marginal security: odds ratio [OR]: 1.60; 95% confidence interval [CI], 1.18-2.18]; P = 0.003; low security: OR: 2.09; 95% CI, 1.58-2.74]; P < 0.001; very low security: OR: 1.69; 95% CI, 1.22-2.34]; P = 0.001). The association persisted when adjusted for income, location, education, and insurance status. In adults with diabetes and ASCVD, income was a negative factor for food insecurity (OR: 0.71; 95% CI, 0.62-0.80; P < 0.001), but female sex and smoking were positive factors (OR: 1.90; 95% CI, 1.29-2.80; P = 0.001; and OR: 1.97; 95% CI, 1.23-3.18; P = 0.005; respectively). At younger ages, the prevalence of food insecurity increased, especially in adults with ASCVD. CONCLUSIONS We showed that 13% of U.S. adults with diabetes are food insecure, which was associated with ASCVD independent of traditional and socioeconomic risk factors. Our findings emphasize the importance of recognizing food insecurity as a driver of ASCVD in adults with diabetes, and encourage future efforts at reducing this disparity.
Collapse
Affiliation(s)
- Tony Dong
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kristen Harris
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Darcy Freedman
- Mary Ann Swetland Center for Environmental Health, Case Western Reserve University, Cleveland, Ohio, USA; School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Scott Janus
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Stephanie Griggs
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yasaswini Iyer
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas, USA
| | - Ian J Neeland
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA; Center for Integrated and Novel Approaches in Vascular-Metabolic Disease, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Sanjay Rajagopalan
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA; Center for Integrated and Novel Approaches in Vascular-Metabolic Disease, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Sadeer G Al-Kindi
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA; Center for Integrated and Novel Approaches in Vascular-Metabolic Disease, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA.
| |
Collapse
|
23
|
Venkatesh KK, Joseph JJ, Clark A, Gabbe SG, Landon MB, Thung SF, Yee LM, Lynch CD, Grobman WA, Walker DM. Association of community-level food insecurity and glycemic control among pregnant individuals with pregestational diabetes. Prim Care Diabetes 2023; 17:73-78. [PMID: 36379871 PMCID: PMC10286113 DOI: 10.1016/j.pcd.2022.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/19/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
AIM To evaluate whether pregnant individuals with pregestational diabetes who live in a food-insecure community have worse glycemic control compared to those who do not live in a food-insecure community. METHODS A retrospective analysis of pregnant individuals with pregestational diabetes enrolled in a multidisciplinary prenatal and diabetes care program. The exposure was community-level food insecurity per the Food Access Research Atlas. The outcomes were hemoglobin A1c (A1c) < 6.0 % in early and late pregnancy, and an absolute decrease in A1c ≥ 2.0 % and mean change in A1c across pregnancy. RESULTS Among 418 assessed pregnant individuals with pregestational diabetes, those living in a food-insecure community were less likely to have an A1c < 6.0 % in early pregnancy compared to those living in a community without food insecurity [16 % vs. 30 %; adjusted risk ratio (aRR): 0.55; 95 % CI: 0.33-0.92]. Individuals living in a food-insecure community were more likely to achieve a decrease in A1c ≥ 2.0 % [35 % vs. 21 %; aRR: 1.55; 95 % CI: 1.06-2.28] and a larger mean decrease in A1c across pregnancy [mean: 1.46 vs. 1.00; adjusted beta: 0.47; 95 % CI: 0.06-0.87)]. CONCLUSIONS Pregnant individuals with pregestational diabetes who lived in a food-insecure community were less likely to enter pregnancy with glycemic control, but were more likely to have a reduction in A1c and achieve similar A1c status compared to those who lived in a community without food insecurity. Whether interventions that address food insecurity improve glycemic control and consequent perinatal outcomes remains to be studied.
Collapse
Affiliation(s)
- Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, the United States of America.
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, The Ohio State University, Columbus, OH, the United States of America
| | - Aaron Clark
- Department of Family and Community Medicine, The Ohio State University, Columbus, OH, the United States of America
| | - Steven G Gabbe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, the United States of America
| | - Mark B Landon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, the United States of America; Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, The Ohio State University, Columbus, OH, the United States of America; Department of Family and Community Medicine, The Ohio State University, Columbus, OH, the United States of America; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, the United States of America
| | - Stephen F Thung
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, the United States of America; Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, The Ohio State University, Columbus, OH, the United States of America; Department of Family and Community Medicine, The Ohio State University, Columbus, OH, the United States of America; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, the United States of America
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, the United States of America
| | - Courtney D Lynch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, the United States of America
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, the United States of America
| | - Daniel M Walker
- Department of Family and Community Medicine, The Ohio State University, Columbus, OH, the United States of America
| |
Collapse
|
24
|
Khunti K, Feldman EL, Laiteerapong N, Parker W, Routen A, Peek M. The Impact of the COVID-19 Pandemic on Ethnic Minority Groups With Diabetes. Diabetes Care 2023; 46:228-236. [PMID: 35944272 PMCID: PMC10090266 DOI: 10.2337/dc21-2495] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/10/2022] [Indexed: 02/03/2023]
Abstract
Major ethnic disparities in diabetes care, especially for intermediate outcomes and diabetes complications, were evident prior to the coronavirus disease 2019 (COVID-19) pandemic. Diabetes is a risk factor for severe COVID-19, and the combination of these ethnic disparities in diabetes care and outcomes may have contributed to the inequity in COVID-19 outcomes for people with diabetes. Overall, ethnic minority populations have suffered disproportionate rates of COVID-19 hospitalization and mortality. Results from the limited number of studies of COVID-19 in ethnic minority populations with diabetes are mixed, but there is some suggestion that rates of hospitalization and mortality are higher than those of White populations. Reasons for the higher incidence and severity of COVID-19-related outcomes in minority ethnic groups are complex and have been shown to be due to differences in comorbid conditions (e.g., diabetes), exposure risk (e.g., overcrowded living conditions or essential worker jobs), and access to treatment (e.g., health insurance status and access to tertiary care medical centers), which all relate to long-standing structural inequities that vary by ethnicity. While guidelines and approaches for diabetes self-management and outpatient and inpatient care during the pandemic have been published, few have recommended addressing wider structural issues. As we now plan for the recovery and improved surveillance and risk factor management, it is imperative that primary and specialist care services urgently address the disproportionate impact the pandemic has had on ethnic minority groups. This should include a focus on the larger structural barriers in society that put ethnic minorities with diabetes at potentially greater risk for poor COVID-19 outcomes.
Collapse
Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - Eva L. Feldman
- Department of Neurology, School of Medicine, University of Michigan, Ann Arbor, MI
| | | | - William Parker
- Department of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Ash Routen
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - Monica Peek
- Department of Medicine, University of Chicago, Chicago, IL
| |
Collapse
|
25
|
Malik FS, Liese AD, Reboussin BA, Sauder KA, Frongillo EA, Lawrence JM, Bellatorre A, Pihoker C, Loots B, Dabelea D, Mayer-Davis E, Jensen E, Turley C, Mendoza JA. Prevalence and Predictors of Household Food Insecurity and Supplemental Nutrition Assistance Program Use in Youth and Young Adults With Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Care 2023; 46:278-285. [PMID: 34799431 PMCID: PMC9887610 DOI: 10.2337/dc21-0790] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the prevalence of household food insecurity (HFI) and Supplemental Nutrition Assistance Program (SNAP) participation among youth and young adults (YYA) with diabetes overall and by type, and sociodemographic characteristics. RESEARCH DESIGN AND METHODS The study included participants with youth-onset type 1 diabetes and type 2 diabetes from the SEARCH for Diabetes in Youth study. HFI was assessed using the 18-item U.S. Household Food Security Survey Module (HFSSM) administered from 2016 to 2019; three or more affirmations on the HFSSM were considered indicative of HFI. Participants were asked about SNAP participation. We used χ2 tests to assess whether the prevalence of HFI and SNAP participation differed by diabetes type. Multivariable logistic regression models were used to examine differences in HFI by participant characteristics. RESULTS Of 2,561 respondents (age range, 10-35 years; 79.6% ≤25 years), 2,177 had type 1 diabetes (mean age, 21.0 years; 71.8% non-Hispanic White, 11.8% non-Hispanic Black, 13.3% Hispanic, and 3.1% other) and 384 had type 2 diabetes (mean age, 24.7 years; 18.8% non-Hispanic White, 45.8% non-Hispanic Black, 23.7% Hispanic, and 18.7% other). The overall prevalence of HFI was 19.7% (95% CI 18.1, 21.2). HFI was more prevalent in type 2 diabetes than type 1 diabetes (30.7% vs. 17.7%; P < 0.01). In multivariable regression models, YYA receiving Medicaid or Medicare or without insurance, whose parents had lower levels of education, and with lower household income had greater odds of experiencing HFI. SNAP participation was 14.1% (95% CI 12.7, 15.5), with greater participation among those with type 2 diabetes compared with those with type 1 diabetes (34.8% vs. 10.7%; P < 0.001). CONCLUSIONS Almost one in three YYA with type 2 diabetes and more than one in six with type 1 diabetes reported HFI in the past year-a significantly higher prevalence than in the general U.S. population.
Collapse
Affiliation(s)
- Faisal S. Malik
- Department of Pediatrics, University of Washington, Seattle, WA
- Seattle Children’s Research Institute, Seattle, WA
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Katherine A. Sauder
- Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, CO
| | - Edward A. Frongillo
- Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC
| | | | - Anna Bellatorre
- Department of Epidemiology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA
- Seattle Children’s Research Institute, Seattle, WA
| | - Beth Loots
- Seattle Children’s Research Institute, Seattle, WA
| | - Dana Dabelea
- Department of Epidemiology, University of Colorado Denver School of Medicine, Aurora, CO
| | | | - Elizabeth Jensen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Christine Turley
- Department of Pediatrics, University of South Carolina, Columbia, SC
| | - Jason A. Mendoza
- Department of Pediatrics, University of Washington, Seattle, WA
- Seattle Children’s Research Institute, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| |
Collapse
|
26
|
Smith L, Shin JI, Jacob L, López Sánchez GF, Schuch F, Tully MA, Oh H, Veronese N, Soysal P, Butler L, Barnett Y, Koyanagi A. Food insecurity and physical multimorbidity among adults aged ≥ 50 years from six low- and middle-income countries. Eur J Nutr 2023; 62:489-497. [PMID: 36129530 PMCID: PMC9491254 DOI: 10.1007/s00394-022-02999-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/31/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Food insecurity and multimoribidity (i.e., ≥ 2 chronic conditions) may be linked bidirectionally, but there are no studies on this topic from LMICs. Therefore, the aim of the present study was to examine the association between food insecurity and physical multimorbidity in a large representative sample of older adults from six LMICs. METHODS Cross-sectional, community-based data on adults aged ≥ 50 years from the World Health Organization's Study on Global AGEing and Adult Health (SAGE) conducted in China, Ghana, India, Mexico, Russia, and South Africa were analyzed. A total of 11 chronic physical conditions were assessed. Past 12 month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted to assess the associations. RESULTS Data on 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; age range 50-114 years; 47.9% males] were analyzed. After adjustment for potential confounders, in the overall sample, compared to being food secure, moderate and severe food insecurity were associated with 1.29 (95% CI 1.06-1.56) and 1.56 (95% CI 1.13-2.16) times higher odds for multimorbidity, respectively CONCLUSION: Food insecurity was associated with greater odds for multimorbidity in older adults from LMICs. Addressing food insecurity in the general population may reduce risk for multimorbidity, while screening for food insecurity and addressing it among those with multimorbidity may lead to better clinical outcomes, pending future longitudinal research.
Collapse
Affiliation(s)
- Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, 03372, Korea
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830, Barcelona, Barcelona, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78000, Versailles, France
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain.
| | - Felipe Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Mark A Tully
- School of Health Sciences, Institute of Mental Health Sciences, Ulster University, Newtownabbey, BT15 1ED, Northern Ireland
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, 90007, USA
| | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, 90133, Palermo, Italy
| | - Pinar Soysal
- Department of Geriatric Medicine, Bezmialem Vakif University, 34093, Istanbul, Turkey
| | - Laurie Butler
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Yvonne Barnett
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830, Barcelona, Barcelona, Spain
- ICREA, Pg, Lluis Companys 23, 08010, Barcelona, Spain
| |
Collapse
|
27
|
Abstract
Medication nonadherence in individuals with diabetes can lead to adverse health outcomes. Young and middle-aged adults are more likely to have low food security than other age groups. However, little research has focused on the relationship between food security and medication adherence in this population. The objective of this study was to examine the relationship between food security and medication adherence among young and middle-aged adults with diabetes. This study used 2019 National Health Interview Survey data. Persons were included if they were aged less than 50 and had a diabetes diagnosis. Individuals were categorized as nonadherent to medication if they answered "yes" to one question indicating nonadherence. Food security status was categorized as food secure, low food security, and very low food security. Among adults under age 50 with diabetes, nearly a fifth were categorized as having low or very low food security. Approximately a quarter of the participants were not adherent. Respondents with low food security and very low food security were significantly more likely to be nonadherent to medication than those who were food secure. People with diabetes under the age of 50 who have low or very low food security are at an increased risk for nonadherence to medication.
Collapse
Affiliation(s)
- Brittany E Imel
- Department of Public Health, College of Health Sciences, Arcadia University
| | | |
Collapse
|
28
|
Berkowitz SA, Kruse GR, Ball Ricks KA, Burch J, Ouimet E, Kitzis B, Forrest C, Terranova J, Stewart PW, Buse JB, Keyserling TC, Wexler DJ, Delahanty LM. Medically tailored meals for food insecurity and type 2 diabetes: Protocol for the Food as Medicine for Diabetes (FAME-D) trial. Contemp Clin Trials 2023; 124:107039. [PMID: 36470556 PMCID: PMC9839527 DOI: 10.1016/j.cct.2022.107039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Food insecurity is associated with worse glycemic management for individuals with type 2 diabetes mellitus (T2DM), but whether medically tailored meals (MTM), a food insecurity intervention, can improve glycemic management is unclear. OBJECTIVE To describe the protocol for a trial assessing whether an MTM plus lifestyle intervention improves hemoglobin A1c (HbA1c) and participant-reported outcomes, relative to a food subsidy (money that can be spent on foods participants choose), for adults with both T2DM and food insecurity. METHODS The Food as Medicine for Diabetes (FAME-D) randomized clinical trial (goal n = 200) is a pragmatic trial with an active comparator. Participants, who will have T2DM and report food insecurity, will be randomly assigned to a 6-month MTM plus telephone-delivered lifestyle change intervention, or a 6-month food subsidy ($40/month). The primary outcome is HbA1c at 6 months. Secondary outcomes include HbA1c at 12 months to assess whether the intervention effect (if any) is sustained, along with weight, food insecurity, diabetes distress, and health-related quality of life. Qualitative analyses of semi-structured interviews will help understand why, how, and under what circumstances the intervention achieved its observed results. CONCLUSION Results from FAME-D will help inform clinical management of food insecurity when it co-occurs with T2DM. Further, results may be useful as healthcare payors are considering coverage for MTM interventions. CLINICALTRIALS gov: NCT04828785.
Collapse
Affiliation(s)
- Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| | - Gina R Kruse
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Katharine A Ball Ricks
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jessica Burch
- Community Servings, Inc, Boston, MA, United States of America
| | - Ethan Ouimet
- Community Servings, Inc, Boston, MA, United States of America
| | - Beth Kitzis
- Community Servings, Inc, Boston, MA, United States of America
| | - Colleen Forrest
- Community Servings, Inc, Boston, MA, United States of America
| | - Jean Terranova
- Community Servings, Inc, Boston, MA, United States of America
| | - Paul W Stewart
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - John B Buse
- Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Thomas C Keyserling
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Deborah J Wexler
- Harvard Medical School, Boston, MA, United States of America; Diabetes Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Linda M Delahanty
- Harvard Medical School, Boston, MA, United States of America; Diabetes Unit, Massachusetts General Hospital, Boston, MA, United States of America
| |
Collapse
|
29
|
Schiavoni KH, Helscel K, Vogeli C, Thorndike AN, Cash RE, Camargo CA, Samuels-Kalow ME. Prevalence of social risk factors and social needs in a Medicaid Accountable Care Organization (ACO). BMC Health Serv Res 2022; 22:1375. [PMID: 36403024 PMCID: PMC9675191 DOI: 10.1186/s12913-022-08721-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background Health-related social needs (HRSN) are associated with higher chronic disease prevalence and healthcare utilization. Health systems increasingly screen for HRSN during routine care. In this study, we compare the differential prevalence of social risk factors and social needs in a Medicaid Accountable Care Organization (ACO) and identify the patient and practice characteristics associated with reporting social needs in a different domain from social risks. Methods Cross-sectional study of patient responses to HRSN screening February 2019-February 2020. HRSN screening occurred as part of routine primary care and assessed social risk factors in eight domains and social needs by requesting resources in these domains. Participants included adult and pediatric patients from 114 primary care practices. We measured patient-reported social risk factors and social needs from the HRSN screening, and performed multivariable regression to evaluate patient and practice characteristics associated with reporting social needs and concordance to social risks. Covariates included patient age, sex, race, ethnicity, language, and practice proportion of patients with Medicaid and/or Limited English Proficiency (LEP). Results Twenty-seven thousand four hundred thirteen individuals completed 30,703 screenings, including 15,205 (55.5%) caregivers of pediatric patients. Among completed screenings, 13,692 (44.6%) were positive for ≥ 1 social risk factor and 2,944 (9.6%) for ≥ 3 risks; 5,861 (19.1%) were positive for social needs and 4,848 (35.4%) for both. Notably, 1,013 (6.0%) were negative for social risks but positive for social needs. Patients who did not identify as non-Hispanic White or were in higher proportion LEP or Medicaid practices were more likely to report social needs, with or without social risks. Patients who were non-Hispanic Black, Hispanic, preferred non-English languages or were in higher LEP or Medicaid practices were more likely to report social needs without accompanying social risks. Conclusions Half of Medicaid ACO patients screened for HRSN reported social risk factors or social needs, with incomplete overlap between groups. Screening for both social risks and social needs can identify more individuals with HRSN and increase opportunities to mitigate negative health outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08721-9.
Collapse
|
30
|
Berkowitz SA, Palakshappa D, Seligman HK, Hanmer J. Changes in Food Insecurity and Changes in Patient-Reported Outcomes: a Nationally Representative Cohort Study. J Gen Intern Med 2022; 37:3638-3644. [PMID: 34993877 PMCID: PMC9585105 DOI: 10.1007/s11606-021-07293-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cross-sectional studies have found that health-related quality of life and mental health are worse among food-insecure compared with food-secure individuals. However, how these outcomes change as food insecurity changes is unclear. OBJECTIVE To evaluate how common patient-reported health-related quality of life and mental health scales change in response to changes in food security. DESIGN Retrospective cohort study using data representative of the civilian, adult, non-institutionalized population of the USA. PARTICIPANTS Food insecure adults who completed the 2016-2017 Medical Expenditure Panel Survey. MAIN MEASURES Mental health, as measured by the mental component score of the Veterans Rand 12-Item Health Survey (VR-12) (primary outcome), along physical health (physical component score of the VR-12), self-rated health status, psychological distress (Kessler 6), depressive symptoms (PHQ2), and the SF-6D measure of health utility. We fit linear regression models adjusted for baseline outcome level, age, gender, race/ethnicity, education, health insurance, and family size followed by predictive margins to estimate the change in outcome associated with a 1-point improvement in food security. KEY RESULTS A total of 1,390 food-insecure adults were included. A 1-point improvement in food security was associated with a 0.38 (95%CI 0.62 to 0.14)-point improvement in mental health, a 0.15 (95%CI 0.02 to 0.27)-point improvement in psychological distress, a 0.05 (95%CI 0.01 to 0.09)-point improvement in depressive symptoms, and a 0.003 (95%CI 0.000 to 0.007)-point improvement in health utility. Point estimates for physical health and self-rated health were in the direction of improvement, but were not statistically significant. CONCLUSIONS Improvement in food insecurity was associated with improvement in several patient-reported outcomes. Further work should investigate whether similar changes are seen in food insecurity interventions, and the most useful scales for assessing changes in health-related quality of life and mental health in food insecurity interventions.
Collapse
Affiliation(s)
- Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 5034 Old Clinic Bldg, CB 7110, Chapel Hill, NC, 27599, USA.
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Deepak Palakshappa
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hilary K Seligman
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
- Center for Vulnerable Populations at San Francisco General Hospital & Trauma Center, San Francisco, CA, USA
| | - Janel Hanmer
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
31
|
Gajda R, Jeżewska-Zychowicz M, Styczyńska M, Jarossová MA. Food Insecurity in the Households of Polish Elderly: Diversity in the Perception of Its Causes by Demographic and Socioeconomic Characteristics. Foods 2022; 11:3222. [PMCID: PMC9601627 DOI: 10.3390/foods11203222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The aging of societies and the quality of life of the elderly may be accompanied by food insecurity. The aim of the study was to find the relationships between the perceptions of various causes of food insecurity, i.e., financial, social, health, and spatial, and then between those and the selected sociodemographic characteristics. The survey was conducted in late 2018 and early 2019 among 760 people aged 65 and older in two regions of Poland. Factor analysis with the use of principal component analysis (PCA) was used to identify the main causes of the prevalence of food insecurity. Cluster analysis using Ward’s hierarchical classification and logistic regression analysis were used to assess the relationship between the identified reasons for food insecurity, demographic characteristics, and socioeconomic status (SES). Two groups of causes that favor the experience of food insecurity among the elderly were identified, i.e., economic–social reasons and spatial–health reasons. They relate to such situations of food insecurity as concerns about food shortages, lack of staple foods, limited size or frequency of meals, and skipping meals. The high importance of economic–social (HE-S) reasons was associated with the low importance of spatial–health (LS-H) reasons, and conversely, the high importance of spatial–health (HS-H) causes was associated with the low importance of economic–social (LE-S) causes. HE-S and LS-H reasons were combined with low SES and residence in a city of more than 100,000 inhabitants. HS-H causes, on the other hand, were associated with LE-S causes and living in rural areas or towns of fewer than 100,000 inhabitants, as well as high SES. This specificity should be considered in the development of strategies and interventions aimed at reducing the phenomenon of experiencing food insecurity in the elderly population.
Collapse
Affiliation(s)
- Robert Gajda
- Department of Human Nutrition, Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wroclaw, Poland
- Correspondence:
| | - Marzena Jeżewska-Zychowicz
- Department of Food and Consumption Market Research, Faculty of Human Nutrition, Warsaw University of Life Sciences, Nowoursynowska 166, 02-787 Warsaw, Poland
| | - Marzena Styczyńska
- Department of Human Nutrition, Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wroclaw, Poland
| | - Małgorzata Agnieszka Jarossová
- Department of Marketing, Faculty of Commerce, University of Economics in Bratislava, Dolnozemská Cesta 1, 852 35 Bratislava, Slovakia
| |
Collapse
|
32
|
Holben DH, Marshall MB. Reprint of: Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States. J Acad Nutr Diet 2022; 122:S55-S66. [PMID: 36122960 DOI: 10.1016/j.jand.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is the position of the Academy of Nutrition and Dietetics that systematic and sustained action is needed to achieve food and nutrition security in the United States. To achieve food security, effective interventions are needed, along with adequate funding for, and increased utilization of, food and nutrition assistance programs; inclusion of nutrition education in such programs; strategies to support individual and household economic stability; and research to measure impact on food insecurity- and health-related outcomes. Millions of individuals living in the United States experience food insecurity. Negative nutritional and non-nutritional outcomes are associated with food insecurity across the lifespan, including substandard academic achievement, inadequate intake of key nutrients, increased risk for chronic disease, and poor psychological and cognitive functioning. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, play key roles in addressing food insecurity and are uniquely positioned to make valuable contributions through competent and collaborative practice, provision of comprehensive food and nutrition education and training, innovative research related to all aspects of food insecurity, and advocacy efforts at the local, state, regional, and national levels.
Collapse
|
33
|
Casagrande SS, Bullard KM, Siegel KR, Lawrence JM. Food insecurity, diet quality, and suboptimal diabetes management among US adults with diabetes. BMJ Open Diabetes Res Care 2022; 10:10/5/e003033. [PMID: 36288809 PMCID: PMC9615992 DOI: 10.1136/bmjdrc-2022-003033] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/08/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A healthy diet is recommended to support diabetes management, including HbA1c, blood pressure, and cholesterol (ABC) control, but food insecurity is a barrier to consuming a healthy diet. We determined the prevalence of food insecurity and diet quality among US adults with diabetes and the associations with ABC management. RESEARCH DESIGN AND METHODS Cross-sectional analyses were conducted among 2075 adults ≥20 years with diagnosed diabetes who participated in the 2013-2018 National Health and Nutrition Examination Surveys. Food insecurity was assessed using a standard questionnaire and diet quality was assessed using quartiles of the 2015 Healthy Eating Index. Adjusted ORs (aOR, 95% CI) were calculated from logistic regression models to determine the association between household food insecurity/diet quality and the ABCs while controlling for sociodemographic characteristics, healthcare utilization, smoking, medication for diabetes, blood pressure, or cholesterol, and body mass index. RESULTS Overall, 17.6% of adults had food insecurity/low diet quality; 14.2% had food insecurity/high diet quality; 33.1% had food security/low diet quality; and 35.2% had food security/high diet quality. Compared with adults with food security/high diet quality, those with food insecurity/low diet quality were significantly more likely to have HbA1c ≥7.0% (aOR=1.85, 95% CI 1.23 to 2.80) and HbA1c ≥8.0% (aOR=1.79, 95% CI 1.04 to 3.08); food insecurity/high diet quality was significantly associated with elevated HbA1c; and food security/low diet quality with elevated A1c. CONCLUSIONS Food insecurity, regardless of diet quality, was significantly associated with elevated A1c. For people with food insecurity, providing resources to reduce food insecurity could strengthen the overall approach to optimal diabetes management.
Collapse
Affiliation(s)
- Sarah S Casagrande
- Public Health & Scientific Research, DLH Holdings, Atlanta, Georgia, USA
| | - Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen R Siegel
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jean M Lawrence
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
34
|
Stotz SA, Budd Nugent N, Ridberg R, Byker Shanks C, Her K, Yaroch AL, Seligman H. Produce prescription projects: Challenges, solutions, and emerging best practices – Perspectives from health care providers. Prev Med Rep 2022; 29:101951. [PMID: 36161127 PMCID: PMC9502043 DOI: 10.1016/j.pmedr.2022.101951] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sarah A. Stotz
- University of Colorado, Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
- Corresponding author at: University of Colorado, Anschutz Medical Campus, Colorado School of Public Health, Mail Stop F800, 13055 East 17th Avenue, Aurora, CO 80045.
| | | | | | | | - Ka Her
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Amy L. Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Hilary Seligman
- Division of General Internal Medicine, University of California, San Francisco, CA and Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA, USA
| |
Collapse
|
35
|
Choi YJ, Crimmins EM, Ailshire JA. Food insecurity, food environments, and disparities in diet quality and obesity in a nationally representative sample of community-dwelling older Americans. Prev Med Rep 2022; 29:101912. [PMID: 35911578 PMCID: PMC9326331 DOI: 10.1016/j.pmedr.2022.101912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Yeon Jin Choi
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue #218, Los Angeles, CA, USA
| | - Eileen M. Crimmins
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue #218, Los Angeles, CA, USA
| | - Jennifer A. Ailshire
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue #218, Los Angeles, CA, USA
| |
Collapse
|
36
|
Gold R, Kaufmann J, Gottlieb LM, Weiner SJ, Hoopes M, Gemelas JC, Torres CH, Cottrell EK, Hessler D, Marino M, Sheppler CR, Berkowitz SA. Cross-Sectional Associations: Social Risks and Diabetes Care Quality, Outcomes. Am J Prev Med 2022; 63:392-402. [PMID: 35523696 DOI: 10.1016/j.amepre.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/25/2022] [Accepted: 03/11/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Social risks (e.g., food/transportation insecurity) can hamper type 2 diabetes mellitus (T2DM) self-management, leading to poor outcomes. To determine the extent to which high-quality care can overcome social risks' health impacts, this study assessed the associations between reported social risks, receipt of guideline-based T2DM care, and T2DM outcomes when care is up to date among community health center patients. METHODS A cross-sectional study of adults aged ≥18 years (N=73,484) seen at 186 community health centers, with T2DM and ≥1 year of observation between July 2016 and February 2020. Measures of T2DM care included up-to-date HbA1c, microalbuminuria, low-density lipoprotein screening, and foot examination, and active statin prescription when indicated. Measures of T2DM outcomes among patients with up-to-date care included blood pressure, HbA1c, and low-density lipoprotein control on or within 6‒12 months of an index encounter. Analyses were conducted in 2021. RESULTS Individuals reporting transportation or housing insecurity were less likely to have up-to-date low-density lipoprotein screening; no other associations were seen between social risks and clinical care quality. Among individuals with up-to-date care, food insecurity was associated with lower adjusted rates of controlled HbA1c (79% vs 75%, p<0.001), and transportation insecurity was associated with lower rates of controlled HbA1c (79% vs 74%, p=0.005), blood pressure (74% vs 72%, p=0.025), and low-density lipoprotein (61% vs 57%, p=0.009) than among those with no reported need. CONCLUSIONS Community health center patients received similar care regardless of the presence of social risks. However, even among those up to date on care, social risks were associated with worse T2DM control. Future research should identify strategies for improving HbA1c control for individuals with social risks. TRIAL REGISTRATION This study is registered at www. CLINICALTRIALS gov NCT03607617.
Collapse
Affiliation(s)
- Rachel Gold
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon; OCHIN Inc., Portland, Oregon.
| | - Jorge Kaufmann
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Laura M Gottlieb
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Saul J Weiner
- Department of Medicine, College of Medicine, The University of Illinois at Chicago, Chicago, Illinois
| | | | - Jordan C Gemelas
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | | | - Erika K Cottrell
- OCHIN Inc., Portland, Oregon; Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Miguel Marino
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | | | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
37
|
Osborn B, Albrecht SS, Fleischer NL, Ro A. Food insecurity, diabetes, and perceived diabetes self-management among Latinos in California: Differences by nativity and duration of residence. Prev Med Rep 2022; 28:101856. [PMID: 35711286 PMCID: PMC9194646 DOI: 10.1016/j.pmedr.2022.101856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/14/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
We examined associations between food security (FS) status and type 2 diabetes (T2D) prevalence and perceived T2D self-management by nativity and US duration of residence among Latinos living in California. We used the California Health Interview Survey (2012-2017) and included Latinos who lived below 200% of the federal poverty line (n = 16,254) and for our management outcome, those with T2D (n = 2284). Latinos with low FS (OR = 1.44, 95% CI 1.14-1.83) or very low FS (OR = 1.87, 95% CI 1.33-2.61) had a higher odds of T2D compared to their food-secure counterparts. When stratified by nativity/duration in the US, US-born Latinos and Latino immigrants with >10 years duration had a higher odds of T2D if they reported low FS (US-born: OR = 1.60, 95% CI 1.02-2.52; >10 yrs: OR = 1.48, 95% CI 1.12-1.97) or very low FS (US-born: OR = 2.37, 95% CI 1.45-3.86; >10 yrs: OR = 1.78, 95% CI 1.15-2.76) compared to their food-secure counterparts. There was no association among immigrants with <10 years duration. For perceived T2D self-management, those with low or very low FS had lower odds of reporting proper management (OR = 0.56, 95% CI 0.36-0.86; OR = 0.46, 95% CI 0.26-0.83) compared to their food-secure counterparts. When stratified by nativity, the US-born did not differ in their perceived self-management by FS status, while immigrants with low or very FS had lower odds of perceived self-management (OR = 0.54, 95% CI 0.34-0.86; OR = 0.36, 95% CI 0.17-0.74), compared to their food-secure counterparts. Food insecurity may be an important contributor to T2D prevalence and perceived T2D self-management for Latino immigrants.
Collapse
Affiliation(s)
- Brandon Osborn
- Program in Public Health, University of California, Irvine, Anteater Instruction and Research Building (AIRB), Room 2030, 653 E. Peltason Road, Irvine, CA 92697-3957, United States
| | - Sandra S. Albrecht
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 703, New York, NY 10032, United States
| | - Nancy L. Fleischer
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, United States
| | - Annie Ro
- Program in Public Health, University of California, Irvine, Anteater Instruction and Research Building (AIRB), Room 2030, 653 E. Peltason Road, Irvine, CA 92697-3957, United States
| |
Collapse
|
38
|
Toma KG, Masini I, Johnson G, Birring P, Alkafaji R, Do C, Cui CL, Malinak D, Beck E. Implementation of an On-Site Food Prescription Project to Address Food Insecurity in Multiple Free Clinic Sites Serving an Adult Latinx Population. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2022.2097037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Kalodiah G. Toma
- Department of Medicine, University of California, San Diego, California, USA
| | - Irene Masini
- Department of Medicine, University of California, Irvine, California, USA
| | - Garrick Johnson
- Department of Medicine, University of California, Riverside, California, USA
| | - Paramveer Birring
- Department of Medicine, University of California, Irvine, California, USA
| | - Rhaya Alkafaji
- Department of Medicine, University of California, San Diego, California, USA
| | - Carter Do
- Department of Medicine, Rush University Medical College, Chicago, Illinois, USA
| | - Christina L. Cui
- Department of Vascular and Endovascular Surgery, Duke University, Durham, North Carolina, USA
| | - David Malinak
- Department of Medicine, University of California, San Diego, California, USA
- Department of Internal Medicine, VA San Diego Healthcare System, San Diego, California, USA
| | - Ellen Beck
- Department of Medicine, University of California, San Diego, California, USA
| |
Collapse
|
39
|
Weinstein JM, Kahkoska AR, Berkowitz SA. Food Insecurity, Missed Workdays, And Hospitalizations Among Working-Age US Adults With Diabetes. Health Aff (Millwood) 2022; 41:1045-1052. [PMID: 35787082 PMCID: PMC9840294 DOI: 10.1377/hlthaff.2021.01744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Food insecurity is associated with poor clinical outcomes among adults with diabetes, but associations with nonclinical outcomes, such as missed work, have not been well characterized. Our objective was to assess the associations between food insecurity, health-related missed workdays, and overnight hospitalizations. We pooled National Health Interview Survey data from the period 2011-18 to analyze food insecurity among 13,116 US adults ages 18-65 who had diabetes. Experiencing food insecurity, compared with being food secure, was associated with increased odds of reporting any health-related missed workdays, more than twice the rate of health-related missed workdays, and increased odds of overnight hospitalization within the prior twelve months. There was no significant association between food insecurity and the number of nights spent hospitalized. These findings underscore the broad impacts of food insecurity on health and wellness for working-age adults with diabetes. When weighing the costs and benefits of proposed interventions to address food insecurity, policy makers should consider potential benefits related to productivity in addition to implications for health care use.
Collapse
Affiliation(s)
- Joshua M. Weinstein
- Department of Health Policy and Management, Gillings School
of Global Public Health, University of North Carolina at Chapel Hill
| | - Anna R. Kahkoska
- Department of Nutrition, Gillings School of Global Public
Health, University of North Carolina at Chapel Hill
| | - Seth A. Berkowitz
- Division of General Medicine and Clinical Epidemiology,
Department of Medicine, University of North Carolina at Chapel Hill School of
Medicine, Chapel Hill, NC
| |
Collapse
|
40
|
Venkatesh KK, Germann K, Joseph J, Kiefer M, Buschur E, Thung S, Costantine MM, Gabbe S, Grobman WA, Fareed N. Association Between Social Vulnerability and Achieving Glycemic Control Among Pregnant Individuals With Pregestational Diabetes. Obstet Gynecol 2022; 139:1051-1060. [PMID: 35675602 PMCID: PMC10953616 DOI: 10.1097/aog.0000000000004727] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/13/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the association between community-level social vulnerability and achieving glycemic control (defined as hemoglobin A1c [Hb A1c] less than 6.0% or less than 6.5%) among individuals with pregestational diabetes. METHODS We conducted a retrospective cohort of individuals with pregestational diabetes with singleton gestations from 2012 to 2016 at a tertiary care center. Addresses were geocoded using ArcGIS and then linked at the census tract to the Centers for Disease Control and Prevention's 2018 SVI (Social Vulnerability Index), which incorporates 15 Census variables to produce a composite score and four scores across thematic domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation). Scores range from 0 to 1, with higher values indicating greater community-level social vulnerability. The primary outcome was Hb A1c less than 6.0%, and, secondarily, Hb A1c less than 6.5%, in the second or third trimesters. Multivariable Poisson regression with robust error variance was used to evaluate the association between SVI score as a continuous measure and target Hb A1c. RESULTS Among 418 assessed pregnant individuals (33.0% type 1; 67.0% type 2 diabetes), 41.4% (173/418) achieved Hb A1c less than 6.0%, and 56.7% (237/418) Hb A1c less than 6.5% at a mean gestational age of 29.5 weeks (SD 5.78). Pregnant individuals with a higher SVI score were less likely to achieve Hb A1c less than 6.0% compared with those with a lower SVI score. For each 0.1-unit increase in SVI score, the risk of achieving Hb A1c less than 6.0% decreased by nearly 50% (adjusted risk ratio [aRR] 0.53; 95% CI 0.36-0.77), and by more than 30% for Hb A1c less than 6.5% (adjusted odds ratio 0.67; 95% CI 0.51-0.88). With regard to specific SVI domains, those who scored higher on socioeconomic status (aRR 0.50; 95% CI 0.35-0.71) as well as on household composition and disability (aRR 0.55; 95% CI 0.38-0.79) were less likely to achieve Hb A1c less than 6.0%. CONCLUSION Pregnant individuals with pregestational diabetes living in an area with higher social vulnerability were less likely to achieve glycemic control, as measured by HgbA1c levels. Interventions are needed to assess whether addressing social determinants of health can improve glycemic control in pregnancy.
Collapse
Affiliation(s)
- Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the College of Medicine, the Division of Endocrinology, Department of Medicine, and the Department of Bioinformatics, The Ohio State University, Columbus, Ohio
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
Sex differences are an important consideration when researching and establishing policies for nutrition and optimal health. For women's health, there are important physiologic, neurologic, and hormonal distinctions throughout the lifecycle that impact nutritional needs. Distinct from those for men, these nutritional needs must be translated into appropriate nutrition policy that aims to not only avoid overt nutritional deficiency, but also to promote health and minimize risk for chronic disease. Through a series of webinars, scientific experts discussed the advances in the understanding of the unique nutritional needs, challenges and opportunities of the various life stages for women across the life course and identified emerging nutritional interventions that may be beneficial for women. Nevertheless, there is concern that existing nutrition policy intended for women's health is falling short with examples of programs that are focused more on delivering calories than achieving optimal nutrition. To be locally effective, targeted nutrition needs to offer different proposals for different cultural, socio-economic, and geographic communities, and needs to be applicable at all stages of growth and development. There must be adequate access to nutritious foods, and the information to understand and implement proven nutritional opportunities. Experts provided recommendations for improvement of current entitlement programs that will address accessibility and other social and environmental issues to support women properly throughout the lifecycle.
Collapse
|
42
|
Sharedalal P, Shah N, Sreenivasan J, Michaud L, Sharedalal A, Kaul R, Panza JA, Aronow WS, Cooper HA. Trends in 10-Year Predicted Risk of Cardiovascular Disease Associated With Food Insecurity, 2007-2016. Front Cardiovasc Med 2022; 9:851984. [PMID: 35686041 PMCID: PMC9170893 DOI: 10.3389/fcvm.2022.851984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/29/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Consumption of a healthy diet improves cardiovascular (CV) risk factors and reduces the development of cardiovascular disease (CVD). Food insecure (FIS) adults often consume an unhealthy diet, which can promote obesity, type 2 diabetes mellitus (T2DM), hypertension (HTN), and hyperlipidemia (HLD). The Supplemental Nutrition Assistance Program (SNAP) is designed to combat food insecurity by increasing access to healthy foods. However, there is a paucity of data on the association of SNAP participation among FIS adults and these CVD risk factors. Methods The National Health and Nutrition Examination Survey (NHANES) is a publicly available, ongoing survey administered by the Centers for Disease Control and Prevention and the National Center for Health Statistics. We analyzed five survey cycles (2007-2016) of adult participants who responded to the CVD risk profile questionnaire data. We estimated the burden of select CVD risk factors among the FIS population and the association with participation in SNAP. Results Among 10,449 adult participants of the survey, 3,485 (33.3%) identified themselves as FIS. Food insecurity was more common among those who were younger, female, Hispanic, and Black. Among the FIS, SNAP recipients, when compared to non-SNAP recipients, had a lower prevalence of HLD (36.3 vs. 40.1% p = 0.02), whereas rates of T2DM, HTN, and obesity were similar. Over the 10-year survey period, FIS SNAP recipients demonstrated a reduction in the prevalence of HTN (p < 0.001) and HLD (p < 0.001) which was not evident among those not receiving SNAP. However, obesity decreased only among those not receiving SNAP. The prevalence of T2DM did not change over the study period in either group. Conclusion Over a 10-year period, FIS adults who received SNAP demonstrated a reduction in the prevalence of HTN and HLD, which was not seen among those not receiving SNAP. However, the prevalence of obesity and T2DM did not decline among SNAP recipients, suggesting that additional approaches are required to impact these important CVD risk factors.
Collapse
Affiliation(s)
- Parija Sharedalal
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, United States
| | - Neal Shah
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, United States
| | - Jayakumar Sreenivasan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, United States
| | - Liana Michaud
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, United States
| | - Anmol Sharedalal
- School of Medicine, St. George’s University, St. George’s, Grenada
| | - Risheek Kaul
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, United States
| | - Julio A. Panza
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, United States
| | - Wilbert S. Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, United States
| | - Howard A. Cooper
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, United States
| |
Collapse
|
43
|
Liese AD, Davis RE, Diaz D, Stucker J, Reid LA, Jindal M, Stancil M, Jones SJ. Experiences of Food Insecurity and Type 2 Diabetes Management in Adults. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2020.1826380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Angela D. Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Rachel E. Davis
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Diana Diaz
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jessica Stucker
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Lauren A. Reid
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Meenu Jindal
- Department of Internal Medicine, Prisma Health Upstate, Greenville, SC, USA
| | - Michelle Stancil
- Department of Diabetes Management, Prisma Health Upstate, Greenville
| | - Sonya J. Jones
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| |
Collapse
|
44
|
Delk JA, Al-Dahir S, Singleton BA, Kirchain W, Bailey-Wheeler J. The Effect of Food Access on Type 2 Diabetes Control in Patients of a New Orleans, Louisiana Clinic. J Am Pharm Assoc (2003) 2022; 62:1675-1679. [DOI: 10.1016/j.japh.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
|
45
|
Byhoff E, Guardado R, Xiao N, Nokes K, Garg A, Tripodis Y. Association of Unmet Social Needs with Chronic Illness: A Cross-Sectional Study. Popul Health Manag 2022; 25:157-163. [PMID: 35171031 PMCID: PMC9058872 DOI: 10.1089/pop.2021.0351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Screening for social needs during routine medical visits is increasingly common. To date, there are limited data on which social needs are most predictive of health outcomes. The aim of this study is to build a predictive model from integrated social needs screening and health data to identify individual or clusters of social needs that are predictive of chronic illnesses. Using the electronic medical record data from a Federally Qualified Health Center collected from January 2016 to December 2020, demographic, diagnosis, and social needs screening data were used to look at adjusted and unadjusted associations of individual unmet social needs with chronic illnesses (n = 2497). The least absolute shrinkage and selection operator (LASSO) model was used to identify which social need(s) were associated with overall burden of chronic illness, and individual diagnoses of hypertension, obesity, diabetes, and psychiatric illness. The LASSO model identified age, race, language, gender, insurance, transportation, and food insecurity as significant predictors of any chronic illness. Using these variables in a multivariable model, transportation (adjusted odds ratio [aOR] 1.66) was the only social need that remained significantly associated with chronic illness diagnosis. Transportation need was also significantly associated with diabetes (aOR 1.44) and psychiatric illness (aOR 1.98). Food insecurity was associated with obesity (aOR 10.21). Using LASSO models to identify significant social needs, transportation was identified as a predictor in 3 of the 5 models. Further research is warranted to evaluate if addressing patients' transportation needs has the potential to mitigate chronic disease sequelae for vulnerable adults to advance health equity.
Collapse
Affiliation(s)
- Elena Byhoff
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Rubeen Guardado
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Nan Xiao
- Greater Lawrence Family Health Center, Lawrence, Massachusetts, USA
| | - Keith Nokes
- Greater Lawrence Family Health Center, Lawrence, Massachusetts, USA
- Department of Family Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Yorghos Tripodis
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts, USA
| |
Collapse
|
46
|
Mottl AK, Alicic R, Argyropoulos C, Brosius FC, Mauer M, Molitch M, Nelson RG, Perreault L, Nicholas SB. KDOQI US Commentary on the KDIGO 2020 Clinical Practice Guideline for Diabetes Management in CKD. Am J Kidney Dis 2022; 79:457-479. [PMID: 35144840 PMCID: PMC9740752 DOI: 10.1053/j.ajkd.2021.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022]
Abstract
In October 2020, KDIGO (Kidney Disease: Improving Global Outcomes) published its first clinical practice guideline directed specifically to the care of patients with diabetes and chronic kidney disease (CKD). This commentary presents the views of the KDOQI (Kidney Disease Outcomes Quality Initiative) work group for diabetes in CKD, convened by the National Kidney Foundation to provide an independent expert perspective on the new guideline. The KDOQI work group believes that the KDIGO guideline takes a major step forward in clarifying glycemic targets and use of specific antihyperglycemic agents in diabetes and CKD. The purpose of this commentary is to carry forward the conversation regarding optimization of care for patients with diabetes and CKD. Recent developments for prevention of CKD progression and cardiovascular events in people with diabetes and CKD, particularly related to sodium/glucose cotransporter 2 (SGLT2) inhibitors, have filled a longstanding gap in nephrology's approach to the care of persons with diabetes and CKD. The multifaceted benefits of SGLT2 inhibitors have facilitated interactions between nephrology, cardiology, endocrinology, and primary care, underscoring the need for innovative approaches to multidisciplinary care in these patients. We now have more interventions to slow kidney disease progression and prevent or delay kidney failure in patients with diabetes and kidney disease, but methods to streamline their implementation and overcome barriers in access to care, particularly cost, are essential to ensuring all patients may benefit.
Collapse
|
47
|
Olstad DL, Beall R, Spackman E, Dunn S, Lipscombe LL, Williams K, Oster R, Scott S, Zimmermann GL, McBrien KA, Steer KJD, Chan CB, Tyminski S, Berkowitz S, Edwards AL, Saunders-Smith T, Tariq S, Popeski N, White L, Williamson T, L'Abbé M, Raine KD, Nejatinamini S, Naser A, Basualdo-Hammond C, Norris C, O'Connell P, Seidel J, Lewanczuk R, Cabaj J, Campbell DJT. Healthy food prescription incentive programme for adults with type 2 diabetes who are experiencing food insecurity: protocol for a randomised controlled trial, modelling and implementation studies. BMJ Open 2022; 12:e050006. [PMID: 35168964 PMCID: PMC8852661 DOI: 10.1136/bmjopen-2021-050006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The high cost of many healthy foods poses a challenge to maintaining optimal blood glucose levels for adults with type 2 diabetes mellitus who are experiencing food insecurity, leading to diabetes complications and excess acute care usage and costs. Healthy food prescription programmes may reduce food insecurity and support patients to improve their diet quality, prevent diabetes complications and avoid acute care use. We will use a type 2 hybrid-effectiveness design to examine the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of a healthy food prescription incentive programme for adults experiencing food insecurity and persistent hyperglycaemia. A randomised controlled trial (RCT) will investigate programme effectiveness via impact on glycosylated haemoglobin (primary outcome), food insecurity, diet quality and other clinical and patient-reported outcomes. A modelling study will estimate longer-term programme effectiveness in reducing diabetes-related complications, resource use and costs. An implementation study will examine all RE-AIM domains to understand determinants of effective implementation and reasons behind programme successes and failures. METHODS AND ANALYSIS 594 adults who are experiencing food insecurity and persistent hyperglycaemia will be randomised to a healthy food prescription incentive (n=297) or a healthy food prescription comparison group (n=297). Both groups will receive a healthy food prescription. The incentive group will additionally receive a weekly incentive (CDN$10.50/household member) to purchase healthy foods in supermarkets for 6 months. Outcomes will be assessed at baseline and follow-up (6 months) in the RCT and analysed using mixed-effects regression. Longer-term outcomes will be modelled using the UK Prospective Diabetes Study outcomes simulation model-2. Implementation processes and outcomes will be continuously measured via quantitative and qualitative data. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Calgary and the University of Alberta. Findings will be disseminated through reports, lay summaries, policy briefs, academic publications and conference presentations. TRIAL REGISTRATION NUMBER NCT04725630. PROTOCOL VERSION Version 1.1; February 2022.
Collapse
Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Reed Beall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharlette Dunn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine L Lipscombe
- 2Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kienan Williams
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
| | - Richard Oster
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Sara Scott
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gabrielle L Zimmermann
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Knowledge Translation Platform, Alberta SPOR SUPPORT Unit, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry A McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada
| | - Kieran J D Steer
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Catherine B Chan
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Sheila Tyminski
- Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Seth Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Gatineau, Quebec, Canada
| | - Alun L Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
| | - Terry Saunders-Smith
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Saania Tariq
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Naomi Popeski
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Laura White
- Alberta Region, First Nations and Inuit Health Branch, Indigenous Services Canada, Edmonton, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mary L'Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Sara Nejatinamini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aruba Naser
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Cardiovascular Health and Stroke Strategic Clinic Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Petra O'Connell
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Judy Seidel
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Primary Health Care Integration Network, Primary Health Care, Alberta Health Services, Calgary, Alberta, Canada
| | - Richard Lewanczuk
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Calgary, Alberta, Canada
| | - Jason Cabaj
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David J T Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University Drive NW, Calgary, Alberta, Canada
| |
Collapse
|
48
|
Food Insecurity Is Associated with Mental-Physical Comorbidities among U.S. Adults: NHANES 2013 to 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031672. [PMID: 35162697 PMCID: PMC8835150 DOI: 10.3390/ijerph19031672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/22/2022] [Accepted: 01/29/2022] [Indexed: 11/17/2022]
Abstract
The co-occurrence of mental and physical conditions has increased significantly during the last decade. However, research examining the influence of social factors such as food insecurity is limited. The purpose of this study was to examine the association between food insecurity and mental–physical comorbidity status among U.S. adults. Data for this analysis were drawn from the National Health and Nutrition Examination Survey (NHANES) for the years 2013–2016. Respondents ages 18 and older who reported at least one of three chronic conditions (i.e., type 2 diabetes mellitus, hypertension, and hyperlipidemia) and responded to a nine-item depression scale were included in the analytic sample. The prevalence of food insecurity among those with depression and a cardiometabolic condition was 34% compared to 13% among those with a cardiometabolic condition only. Findings from multinomial logistic regression models indicated that food insecurity was associated with higher risk of mental–physical comorbidity (OR: 3.6, 95% CI: 2.26–5.76). Respondents reporting poor diet and poor self-reported health had higher odds of comorbid depression and cardiometabolic conditions. Female respondents had increased odds of comorbid depression and cardiometabolic conditions. Food insecurity is associated with co-occurring depression and cardiometabolic disease and may have implications for disease management.
Collapse
|
49
|
Ojinnaka CO, Bruening M. Black-White racial disparities in health care utilization and self-reported health among cancer survivors: The role of food insecurity. Cancer 2021; 127:4620-4627. [PMID: 34415573 DOI: 10.1002/cncr.33871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Non-Hispanic Blacks continue to have worse cancer outcomes than non-Hispanic Whites. Suboptimal health care utilization and poor self-reported health among non-Hispanic Blacks contribute to these disparities. The relationship between race, food security status (FSS), and health care utilization or self-reported health among cancer survivors is not clear. This study aims to fill this gap in the science. METHODS The 2011-2018 National Health Interview Survey data were used. Bivariate and multivariable logistic regression analyses were used to examine the relationship between race (non-Hispanic Whites or non-Hispanic Blacks), FSS (high, marginal, low, or very low), health care utilization, and self-reported health among cancer survivors. Analyzed health care utilization measures included cost-related medication underuse (CRMU), cost-related delayed care, cost-related forgone care, seeing/talking to a medical specialist, seeing/talking to a general doctor, and overnight hospital stay. RESULTS A higher proportion of Blacks reported very low food security in comparison with Whites (10.58% vs 4.24%; P ≤ .0001). Blacks were significantly less likely to report a medical specialist visit and more likely to report fair/poor health in the past 12 months even after adjustments for FSS. There was a dose-response relationship between FSS and CRMU, cost-related delayed care, cost-related forgone care, overnight hospital stay, and self-reported health status for both Whites and Blacks. CONCLUSIONS Significant disparities in health care utilization and self-reported health across race and FSS persist among cancer survivors. Interventions that target food insecurity have the potential to reduce suboptimal health care utilization and self-reported health among cancer survivors.
Collapse
Affiliation(s)
| | - Meg Bruening
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| |
Collapse
|
50
|
Shaheen M, Kibe LW, Schrode KM. Dietary quality, food security and glycemic control among adults with diabetes. Clin Nutr ESPEN 2021; 46:336-342. [PMID: 34857217 PMCID: PMC8646986 DOI: 10.1016/j.clnesp.2021.09.735] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/26/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Nutritionally adequate diets can slow the progression of diabetes, but adherence to recommended dietary choices can be hindered by food insecurity. We examined the relationship between dietary quality, food insecurity, and glycemic control among adults with Type 2 Diabetes. METHODS We analyzed data from the National Health and Nutrition Examination Survey (2011-2016) for 1682 adults =>20 years old with Type 2 diabetes. Glycemic control was measured by HbA1c. Dietary quality was computed using the Healthy Eating Index 2015 score. Food security was assessed by a questionnaire. We analyzed the data using multinomial regression models. RESULTS About 16% of the population had an HbA1c ≥ 9; 31.8% had food insecurity; 68.3% consumed a poor quality diet. About 24% consumed a poor quality diet and had food insecurity. In the multinomial model, an HbA1c of 8-<9% was associated with poor diet quality (adjusted odds ratio (AOR) = 5.2, 95% confidence interval (CI) = 1.4-19.2, p = 0.01) and food insecurity (AOR = 8.5, 95% CI = 1.4-52.0, p = 0.02). Those with both factors had higher odds of both an HbA1c 8-<9% (AOR = 6.1, 95% CI = 1.5-24.8, p = 0.01) and HbA1c ≥ 9% (AOR = 6.7, 95% CI = 2.0-22.2, p < 0.01). Other risk factors for poor glycemic control were being Black or Hispanic, having no regular source of care, and ever having visited a diabetes specialist (p < 0.05). CONCLUSIONS Poor glycemic control among adults with diabetes was associated with poor quality of diet and/or food insecurity, being Black, Hispanic, and lacking a regular source of care. There is a need for policies that improve access to healthy food in patients with type 2 diabetes, particularly among minority populations.
Collapse
Affiliation(s)
- Magda Shaheen
- Department of Internal Medicine, Charles R. Drew University, 1731 E 120th St, Los Angeles, CA 90059, USA.
| | - Lucy W Kibe
- Physician Assistant Program, Charles R. Drew University, 1731 E 120th St, Los Angeles, CA 90059, USA.
| | - Katrina M Schrode
- Department of Psychiatry, Charles R. Drew University, 1731 E 120th St, Los Angeles, CA 90059, USA.
| |
Collapse
|