Food Insecurity, Poor Diet Quality Linked to Poor Diabetes Management

A recent analysis of data from the National Health and Nutrition Examination Surveys suggests outlining the impact of inadequate diet and food insecurity on diabetes management among adults in the US.

As emphasis on recognizing and addressing the social determinants of health in the management of chronic conditions, results of the study, which found food security and high diet quality was linked to great diabetes control, offer clinicians a more intimate understanding of the role of food insecurity on risk of adverse outcomes in people with diabetes.

“In this nationally representative study among US adults with diabetes, food insecurity plus low diet quality was associated with higher HbA1c levels even after accounting for sociodemographic characteristics and health behaviors, with food insecurity having a greater impact on metabolic outcomes than low diet quality,” wrote investigators. “Healthcare providers treating adults with diabetes may consider including an assessment of food insecurity as a part of their overall approach to diabetes-related healthcare, particularly for their patients with suboptimal HbA1c and those living in low-income or under-resourced communities.”

As the role of lifestyle and social determinants of health in care of chronic disease have both grown in recent years, the impact of food insecurity and diet quality have become a greater focal point in research efforts than ever before. In the current study, a team from the US Centers for Disease Control and the National Institute of Diabetes and Digestive and Kidney Disease sought to examine how food insecurity might impact the risk of suboptimal glycemic control in adults with diabetes in the US. With this in mind, investigators designed their study as a series of cross-sectional analysis leveraging data obtained from adults aged 20 years and older who participated in the 2013-2018 survey cycles of the National Health and Nutrition Examination Surveys (NHANES).

From the NHANES, investigators obtained data related 2075 adults for inclusion in their analyses. This cohort had a mean age of 60.4 years, 53.0% were men, 15.3% were living below the poverty threshold, and 19.3% met criteria for being food insecure. For the purpose of analysis, questionnaire and diet quality was assessed using quartiles of the 2015 Healthy Eating Index. The primary outcome of interest was the association between household food insecurity and diet quality with optimal diabetes management, which was assessed using logistic regression models with adjustment for sociodemographic characteristics, healthcare utilization, smoking, medication for diabetes, blood pressure, or cholesterol, and body mass index.

Upon analysis, investigators found 17.6% of adults had both food insecurity and low diet quality, 14.2% had food insecurity and a high diet quality, 33.1% had food security and low diet quality, and 35.2% had food security and a high diet quality. Further analysis indicated those with food insecurity and low diet quality were significantly more likely to have an HbA1c of 7.0% or greater (OR, 1.85 [95% CI, 1.23-2.80]) and an HbA1c of 8.0% or greater (OR, 1.79 [95% CI, 1.04-3.08]) compared to those with food security and a high diet quality. Investigators also pointed out food insecurity and a high diet quality was significantly associated with elevated HbA1c and feed security with low diet quality was also associated with elevated HbA1c compared to food security and a high diet quality.

“Future research on food insecurity among adults with diabetes might focus on how food insecurity affects metabolic outcomes and address the multiple pathways that may contribute to these outcomes,” investigators added. “Healthcare delivery systems could link patients to social or food services as part of clinical care, in addition to point-of-care interventions that promote healthier lifestyles.”

This study, “Food insecurity, diet quality, and suboptimal diabetes management among US adults with diabetes,” was published in BMJ Open Diabetes Research & Care.