Food insecurity and dyslipidemia in a representative population-based sample in the US

doi:10.1016/j.ypmed.2015.05.009

Preventive Medicine

Volume 77, August 2015, Pages 186-190

https://doi.org/10.1016/j.ypmed.2015.05.009 Get rights and content

Highlights

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The association of food insecurity with dyslipidemia was examined.
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Food insecurity was not associated with high total cholesterol.
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Food insecurity was associated with a higher likelihood of low HDL-C only in women.
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Obesity appears to be a partial mediator of the association in women.

Abstract

Objective

The association of food insecurity with dyslipidemia has not been firmly established. The main objective of this study was to assess whether food insecurity was associated with dyslipidemia.

Method

A population-based sample of 1,663 adults from the 2008–2011 Survey of the Health of Wisconsin was used. Food insecurity was defined as an affirmative response to either of the questions: (1) “In the last 12 months, have you been concerned about having enough food for you or your family?” (2) “In the last 12 months, have your food choices been limited because there wasn’t enough money?” High total cholesterol was defined as total cholesterol (TC) > 240 mg/dL or taking prescribed lipid-lowering medication. Low high-density lipoprotein cholesterol (HDL-C) was defined as < 40 mg/dL in men and < 50 mg/dL in women.

Results

Food insecurity was not associated with high TC either among men or women. Food insecurity was associated with a higher likelihood of low HDL-C among women (adjusted odds ratio [AOR]: 2.31 {95% confidence interval [CI]: 1.42, 3.76}), but not among men. Obesity appears to be a partial mediator of the association among women (P from the Sobel test = 0.01).

Conclusion

These findings suggest that food insecurity may contribute to an increased risk of low HDL-C in women.

Introduction

An estimated 17.6 million (14.5%) of U.S. households experienced food insecurity in 2012 (Coleman-Jensen et al., 2013). This proportion suggests approximately 48.9 million adults struggled to obtain nutritionally adequate and safe foods due to a lack of sufficient resources at some time during 2012 (Coleman-Jensen et al., 2013). In a recent analysis, we estimated that more than 740,000 adults are suffering from food insecurity in Wisconsin (Guerrero et al., 2014).

Food insecurity is the perceived state of lack of food and food availability measured over a certain period of time. A lack of access to food is often associated not only with dietary quantity (i.e., food shortages due to insufficient food availability) but also dietary quality (e.g., lower intake of fruits and vegetables) (Laraia, 2013). Restricted dietary options, a number of coping strategies of dietary behavior to overcome hunger and/or energy deficiency, and subsequent stress among individuals experiencing food insecurity may lead to changes in physical status, poor nutrition, and development of chronic disease (Laraia, 2013).

Previous studies suggest that food insecurity is associated with adverse health outcomes in adults, including poor general health status (Stuff et al., 2004, Vozoris and Tarasuk, 2003), type 2 diabetes mellitus (Seligman et al., 2007, Seligman et al., 2010, Vozoris and Tarasuk, 2003), hypertension (Seligman et al., 2010, Vozoris and Tarasuk, 2003), and cardiovascular disease (Vozoris and Tarasuk, 2003). Also, a paradoxical relationship between food insecurity and increased obesity has been observed in the U.S. adult population, especially among women (Dinour et al., 2007, Gooding et al., 2012, Holben and Pheley, 2006, Laraia et al., 2010, Townsend et al., 2001). It has been hypothesized that food insecurity predisposes individuals to chronic disease by inducing unhealthy dietary behaviors, such as reducing dietary variety and giving preference to a few low-cost, energy-dense, and nutritionally poor foods (Seligman and Schillinger, 2010). Furthermore, fluctuations in the availability of food over time have been associated with psychological stress (Polivy, 1996), which induces metabolic changes that promote fat storage (Adam and Epel, 2007, Torres and Nowson, 2007).

Dyslipidemia, i.e., abnormal serum lipid levels, is a major modifiable risk factor for cardiovascular disease (Fodor, 2010), the leading cause of death and disability in the U.S. (American Heart Association, 2013). Currently, more than half of the U.S. adult population (53%) has dyslipidemia: 13.4% have high total cholesterol (TC), 26.9% have high low-density lipoprotein cholesterol (LDL-C), and 23.3% have low high-density lipoprotein cholesterol (HDL-C) (Tóth et al., 2012). Typically, obesity-related dyslipidemia is characterized by high triglycerides, low HDL-C, and normal or slightly high LDL-C (Klop et al., 2013).

Although food insecurity is associated with increased obesity, a known risk factor for dyslipidemia, previous studies on the associations between food insecurity and dyslipidemia have shown inconsistent results (Dixon et al., 2001, Seligman et al., 2010, Tayie and Zizza, 2009). The purpose of this study was to assess the association between a recent history of food insecurity and dyslipidemia in a representative sample of Wisconsin adults.

Section snippets

Methods

We used the combined Survey of the Health of the Wisconsin (SHOW) samples from 2008 to 2011. The SHOW is a cross-sectional sample of the Wisconsin adult population. It consists of a series of independent annual representative surveys (Nieto et al., 2010). Two-stage, probability-based cluster sampling is used to select households and recruit non-institutionalized/non-active duty adult residents ages 21–74 years (Nieto et al., 2010). In each one-year cycle, approximately 400–1,000 adult

Results

A total of 2,479 individuals participated in SHOW between 2008 and 2011 (survey response rate: 56.0%). We excluded 530 participants because they did not have information on either food security history or serum lipid levels. We excluded another 286 participants because of missing information on covariates. These exclusions resulted in 1,663 study participants with complete data for all of our analyses. Among male participants, those included in our analysis were comparable to those who were

Discussion

Our analyses from a representative population-based sample of Wisconsin adults showed that a recent history of food insecurity was significantly associated with a higher likelihood of low HDL-C levels and a higher prevalence of obesity among women, but not among men. Furthermore, our results suggest that obesity partially mediated the association between a recent history of food insecurity and low HDL-C among women. On the other hand, a recent history of food insecurity was not associated with

Conclusions

Despite these limitations, this study improves our current understanding of how food insecurity is associated with dyslipidemia by providing important population-based data. Gender differences are important to note in understanding high-risk populations and designing effective education and training. Our study suggests that a recent history of food insecurity is associated with a higher likelihood of low HDL-C among women, but not among men. Obesity appears to be a partial mediator of the

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Acknowledgements

This work was supported by the Wisconsin Partnership Program PERC Award (233 PRJ 25DJ), National Institutes of Health’s Clinical and Translational Science Award (5UL 1RR025011), and National Heart Lung and Blood Institute (1 RC2 HL101468). The authors acknowledge the SHOW administrative team and field staff.

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Household food insecurity has been linked to adverse health outcomes, but the pathways driving these associations are not well understood. The stress experienced by those in food-insecure households and having to prioritize between food and other essential needs could lead to physiologic dysregulations [i.e., allostatic load (AL)] and, as a result, adversely impact their health.
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A recent study in children from low-income households found that compared to those with food security, children who experience food insecurity have significantly lower diet quality due to lower intake of greens and beans and seafood and plant proteins and higher intake of added sugar [14]. In cross-sectional, observational studies with adults, food insecurity is associated with an increased odds of having insulin resistance [15] and elevated lipid [16], C-reactive protein (CRP) [17] and cortisol levels [18]. Additional evidence shows that high insulin and cortisol levels promote fat storage [19], and that stress, glucocorticoids, and associated abdominal adiposity alter adipokine levels - hormones secreted by fat cells that regulate hunger and fullness [20].
Food insecurity affects one in seven households with children in the United States, disproportionately impacts households headed by women and minorities, and is associated with childhood comorbidities, including obesity. While food insecurity likely contributes to poor health through its effect on diet, such a simplistic understanding likely obscures the effects of poverty-related stress and other Adverse Childhood Experiences, on metabolic health.
Over two summers, 100 children, ages 8–12 years, will be recruited from low-income households in an urban, Rhode Island community, to participate in an 8-week trial designed to isolate the experience of food insecurity. Summer represents a natural risk period of food insecurity in children, such that children will be randomized to receive weekly shipments of five breakfast and lunch meals that mimic school meals or to experience the likely onset of summertime food insecurity and receive a weekly newsletter on community resources that is not expected to affect food insecurity. Through assessment visits at baseline, mid-summer and end of summer, we will examine group differences in change in diet quality, biomarkers of Metabolic Syndrome, inflammation, and stress, BMI z-scores, and child measures of behavior and anxiety and depression symptoms. We will also explore the impact of caregiver mood and stress on the health effects of food insecurity.
Findings stand to clarify the mechanisms by which food insecurity affects child health outcomes and to inform how to best address food insecurity in the context of poverty-related stress.
This trial has been registered at ClinicalTrials.gov (NCT04968496).
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Mobile markets (MM) bring affordable, quality, healthy foods to high-need, low-food access communities. However, little is known about food insecurity of MM customers. This manuscript evaluates food insecurity prevalence in MM customers and assesses associations between food insecurity and MM use, food-related characteristics and behaviors, and fruit and vegetable (FV) intake. Customers (N = 302) completed cross-sectional surveys in summer 2019 that assessed: food security, food availability, cooking attitude, self-efficacy for healthy cooking, self-efficacy for cooking and eating FV, social connectedness, and FV intake. Descriptive and multivariate analyses were used to describe and assess associations with food insecurity and FV intake. Results show most MM customers were food insecure (85%). In logistic regression models adjusted for sociodemographic characteristics, long-term MM use (OR = 0.77, CI = 0.60–0.997), access to affordable, quality foods (OR = 0.81, CI = 0.71–0.93), and self-efficacy for both cooking healthy foods (OR = 0.88, CI = 0.80–0.97) and cooking and eating FV (OR = 0.90, CI = 0.82–0.98) were associated with lower odds of food insecurity; negative cooking attitudes (OR = 1.12, CI = 1.02–1.24) were associated with higher odds of food insecurity. Being food insecure (β = −1.37, SE=0.43, p < 0.01) was associated with poorer FV intake; this association attenuated slightly (β = −1.22, SE=0.43, p < 0.01) when length of MM use was added to the general linear model, which was also associated with higher fruit and vegetable intake (β = 0.26, SE=0.10, p = 0.01). Results suggest the MM reaches customers experiencing high levels of food insecurity and long-term MM use is associated with lower food insecurity and higher FV intake. Relationships between food insecurity and several food characteristics/behaviors provide insight for potential targets for wrap-around interventions to address food insecurity among customers. Findings suggest longitudinal evaluation of the MM's impact on food security and other food-related characteristics/behaviors is warranted.
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Dyslipidemia, defined as having abnormal serum lipid levels, is an important risk factor for cardiovascular disease (CVD) [1,2], which is the leading cause of death and disability worldwide, especially in the United States [3,4].
Previous experimental and occupational health studies have shown the toxic effects of relatively high-level cadmium and lead on lipid metabolism. However, limited studies investigated the relationships between serum lipid levels and exposure to low-level lead and cadmium in adults.
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Elucidating these social factors and their associations with people's health represents an ongoing challenge in modern medicine which will hopefully lead to collaborative efforts and solutions that extend beyond the boundaries of traditional clinical medicine. Food security might be one of the upstream risk factors that have an effect on cardiovascular health (Abeyta et al., 2012; Seligman et al., 2007, 2010; Shin et al., 2015). Given the impact of food security on an individual's health, health care organizations and providers, especially primary care providers, should consider screening and targeting food security as part of the standard of care, provided that this is done using a patient and family-centered approach and with consideration of available resources for referral to a social worker or social service program when appropriate (Garg et al., 2016).
The social and economic environment has become a major area of interest regarding the determinants of cardiovascular health. Among markers of economic distress, food insecurity has been found associated with metabolic disorders, dyslipidemia, and obesity, but no previous studies have examined its association with overall cardiovascular health.
We conducted a cross-sectional analysis among 2935 participants in the Survey of the Health of Wisconsin (SHOW), a statewide population-based representative sample. The presence of food insecurity was determined by an affirmative answer to the question “In the last 12 months, have you been concerned about having enough food for you or your family?” Cardiovascular health (CVH) was defined based on the American Heart Association Life's Simple 7 criteria and classified as “poor,” “intermediate,” or “ideal” using previously published criteria. “Good” CVH was defined as having no poor in any of the seven criteria (any amount of intermediate or ideal). Crude and adjusted odds ratios (OR) of good CVH according to presence of food insecurity were calculated using logistic regression models. Overall, food insecurity was associated with a decreased likelihood of good CVH (OR 0.53; 95% Confidence Interval 0.31 to 0.92; p = 0.02). This association persisted in models controlling for age, gender, race, and urbanization.
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After 2010, on average, an estimated total of 13.5 million additional people were food insecure over 2011 to 2013 over and above the historical trend (Loopstra et al., 2015a). Given evidence that food insecurity places adults and children at elevated risk of eating diets of poor quality (Kirkpatrick and Tarasuk, 2008), with long term implications for health including diet-related chronic conditions, such as dyslipidemia and inflammation (Parker et al., 2010; Seligman et al., 2010; Shin et al., 2015; Tayie and Zizza, 2009), as well as more immediate risks such as nutrient inadequacy and iron deficiency (Skalicky et al., 2006), there is considerable cause for concern. Referring to the UK situation, the UK Faculty of Public Health argued that recent evidence of increasing malnutrition and hunger constituted a “public health emergency” (UK Faculty of Public Health, 2014).
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Food insecurity and dyslipidemia in a representative population-based sample in the US

Highlights

Abstract

Objective

Method

Results

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Conclusions

Conflict of interest statement

Acknowledgements

Physiol. Behav.

Nutr. Res.

J. Am. Diet. Assoc.

J. Nutr.

J. Nutr.

Adv. Nutr. Bethesda

J. Am. Diet. Assoc.

Obstet. Gynecol. Clin. N. Am.

Am. J. Cardiol.

J. Am. Diet. Assoc.

J. Lipid Res.

J. Am. Diet. Assoc.

J. Nutr.

Physiol. Behav.

J. Nutr.

Prev. Med.

Nutrition

J. Clin. Lipidol.

J. Nutr.

J. Nutr.

Heart disease and stroke statistics-2013 update. Executive summary

Circulation

The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations

J. Pers. Soc. Psychol.

Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: Systematic review and meta-analysis of interventional studies

BMJ