Food insecurity and dyslipidemia in a representative population-based sample in the US
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.
References (46)
- et al.
Stress, eating and the reward system
Physiol. Behav.
(2007) Low economic status is associated with suboptimal intakes of nutritious foods by adults in the National Health and Nutrition Examination Survey 1999-2002
Nutr. Res.
(2007)- et al.
The food insecurity-obesity paradox: a review of the literature and the role food stamps may play
J. Am. Diet. Assoc.
(2007) - et al.
Dietary intakes and serum nutrients differ between adults from food-insufficient and food-sufficient families: Third National Health and Nutrition Examination Survey, 1988-1994
J. Nutr.
(2001) - et al.
Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents
J. Nutr.
(2008) Food insecurity and chronic disease
Adv. Nutr. Bethesda
(2013)- et al.
Household food insecurity is associated with self-reported pregravid weight status, gestational weight gain, and pregnancy complications
J. Am. Diet. Assoc.
(2010) - et al.
Gender differences in lipid metabolism and the effect of obesity
Obstet. Gynecol. Clin. N. Am.
(2009) - et al.
Modulation of high-density lipoproteins in a population in Istanbul, Turkey, with low levels of high-density lipoproteins
Am. J. Cardiol.
(2005) - et al.
How is food insecurity associated with dietary behaviors? An analysis with low-income, ethnically diverse participants in a nutrition intervention study
J. Am. Diet. Assoc.
(2010)
Longitudinal impact of physical activity on lipid profiles in middle-aged adults: the Atherosclerosis Risk in Communities Study
J. Lipid Res.
Psychological consequences of food restriction
J. Am. Diet. Assoc.
Food insecurity is associated with chronic disease among low-income NHANES participants
J. Nutr.
Sex differences in the regulation of body weight
Physiol. Behav.
Household food insecurity is associated with adult health status
J. Nutr.
Food insecurity and dyslipidemia among adults in the United States
Prev. Med.
Relationship between stress, eating behavior, and obesity
Nutrition
Prevalence of lipid abnormalities in the United States: the National Health and Nutrition Examination Survey 2003-2006
J. Clin. Lipidol.
Food insecurity is positively related to overweight in women
J. Nutr.
Household food insufficiency is associated with poorer health
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
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