Aging and Chronic Disease
Community and Public Health Nutrition
Maternal, Perinatal and Pediatric Nutrition
Investigate differences in the associations between adiposity, cardiovascular health (CVH), and food insecurity by key social determinants (sex, race, and health literacy) in a sample of underserved patients.
The sample included 800 patients (21-74 years old; 67% African American; 84% female) with obesity (body mass index [BMI] ≥ 30). Adiposity was assessed using BMI and waist circumference (WC). CVH was assessed using the American Heart Association Life’s Simple 7. Food insecurity was determined by the 6-Item Food Security Survey. Health literacy was measured using the REALM-SF. Mixed models with interaction terms between food insecurity and sex, race, and health literacy were analyzed for BMI, WC, and CVH. Stratified models were then analyzed as indicated by significant interaction terms.
Mean BMI, WC, and CVH were 37.3 kg/m2 (±4.6), 113.5 cm (±12.4), 6.7 (±1.9), respectively. Thirty-one percent of patients were food insecure and 31% had low health literacy. Significant food insecurity by sex interactions were seen for adiposity. Sex-stratified models showed women who were food insecure had greater BMI (38.2 vs. 37.2 kg/m2; p=0.02) and WC (114.0 vs 111.2 cm; p=0.007) than food secure counterparts, but associations were not significant in men. Significant food insecurity by health literacy interactions were also seen for adiposity. Health literacy-stratified models showed food insecure participants with better health literacy had greater BMI (39.1 vs. 37.7 kg/m2; p=0.004) and WC (121.7 vs. 118.2 cm; p=0.007) than food secure counterparts, but associations were not significant in those with low health literacy. No significant interactions were observed for race.
Significant differences in adiposity were seen in food insecure vs. food secure women, as well as in food insecure vs. food secure patients with better health literacy. These data suggest that adiposity is a greater burden in food insecure patients and may pose challenges for obesity treatment in underserved populations.
Funding Sources :
This research was supported by the PCORI (#OB-1402-10977), the NIGMS of the NIH that funds the Louisiana Clinical and Translational Science Center (1 U54 GM104940), and NORC Center Grant “Nutrition and Metabolic Health Through the Lifespan” sponsored by NIDDK (#P30DK072476).