Aging and Chronic Disease
Community and Public Health Nutrition
Maternal, Perinatal and Pediatric Nutrition
Objectives : Household food insecurity (HFI) is a stressor that is associated with hyperglycemia type 2 diabetes (T2D). However, little is known about HFI and the insulin resistance underlying hyperglycemia and T2D, and mechanisms involved have not been elucidated. We examined HFI and insulin resistance among low-income Latinos with T2D and tested whether inflammation and stress hormones mediated this relationship.
This study is cross-sectional. HFI was measured with the Spanish and English versions of the 6-item US Household Food Security Survey Module. Insulin resistance was calculated from fasting blood glucose and insulin. Inflammation was indicated by high-sensitivity C-reactive protein, and stress hormones included cortisol, metanephrine and normetanephrine.
Results : The 121 participants were primarily Puerto Rican (85.8%), aged mean=60.7 years and 74% were female. Eighty-two (68%) were classified as food insecure. Compared to food secure individuals, food insecure individuals had a significantly higher hsCRP (p=.008), cortisol (p=.045), insulin (p=.019), glucose (p<.001), insulin resistance (p=001), and total cholesterol (p=.004). Groups did not differ on other lipids, metanephrine, normetanephrine, or A1c. A parallel multiple mediation model showed a significant direct effect of HFI on hsCRP (p=.020) and on cortisol (p=.011). There was a direct effect of cortisol (p=.013), hsCRP (p=.044) and HFI on insulin resistance (p=.015). The total combined indirect effect of food insecurity through cortisol and hsCRP was indicated partial mediation.
Conclusions : Among Latinos with T2D, HFI is associated with insulin resistance partially through inflammation and stress hormones. Interventions to ameliorate HFI and mitigate its effects on inflammation, stress, and insulin resistance is warranted.
Funding Sources :
Supported by the National Institute of Minority Health and Health Disparities (R01MD005879) to Drs. Rafael Pérez-Escamilla and Julie Wagner and the American Diabetes Association (7-13-TS-31) to Dr. Julie Wagner.