Research
Original Research
Associations between Food Security Status and Dietary Inflammatory Potential within Lower-Income Adults from the United States National Health and Nutrition Examination Survey, Cycles 2007 to 2014

https://doi.org/10.1016/j.jand.2017.12.003Get rights and content

Abstract

Background

Evidence suggests both that chronic inflammation mediates the association of food insecurity with adverse health outcomes and that diet may be a significant source of inflammation among food insecure individuals.

Objective

To examine whether food security status is associated with dietary inflammatory potential.

Design and participants

Cross-sectional data came from the National Health and Nutrition Examination Survey (NHANES), cycles 2007 to 2014 (n=10,630). The analysis sample is representative of noninstitutionalized US adults with an income-to-poverty ratio ≤3.00.

Main outcome

Dietary Inflammatory Index (DII) score, calculated using the average of two 24-hour dietary recalls, was the main outcome measure.

Statistical analysis

Type III F tests or χ2 tests compared population characteristics by food security status, defined using the US Food Security Survey Module. Multivariable linear regression was used to estimate the association between food security status and the DII score and moderation by demographic factors. Survey weighting procedures accounted for the effects of stratification and clustering used in the NHANES study design.

Results

When accounting for socioeconomic status, demographic factors, and health status, DII score was higher at greater levels of food insecurity (P=0.0033). Those with very low food security had a 0.31 (95% CI=0.12 to 0.49) higher DII score than those with high food security. Age moderated the association between food security status and DII score (interaction P=0.0103), where the magnitude of the association between DII score and severity of food insecurity was higher for those >65 years than for younger age groups.

Conclusion

Food security status may be associated with dietary inflammatory potential, which is hypothesized to play a role in multiple chronic health conditions. Further research is needed to determine the causal nature of this relationship and evaluate how best to implement programs designed to address health disparities within food insecure populations.

Section snippets

Data

Data for this study came from the NHANES 2007 to 2014 cross-sectional samples, collected in 2-year cycles. These were the most recent cycles that had released the variables of interest included in this study. Approval for NHANES and data collection was provided by the National Center for Health Statistics Research Ethics Review Board. Secondary analysis of NHANES data was determined to be exempt from institutional review board by the University of Wisconsin–Madison Health Sciences Institutional

Results

Among all NHANES 2007 to 2014 participants, 11,072 were ≥20 years of age and had an income-to-poverty ratio ≤3.00. Of these participants, 10,630 had nonmissing data for variables of interest. Table 1 presents descriptive statistics by food security status. Those who fared worse socioeconomically tended to be less food secure. The percent of individuals not working but looking for work was three times as high among those with very low food security than among those with high food security (7.8%

Discussion

Although food insecurity has been associated with a number of adverse health outcomes, including poor mental health,52 there is a need for greater evidence regarding underlying biological mechanisms to ascertain the causal nature of these associations. One hypothesis is that food insecurity may influence inflammatory pathways associated with chronic disease due to psychosocial strain or diet quality.53 This study is among the first to examine whether food insecurity is associated with dietary

Conclusion

Results of this study suggest that food insecurity may be associated with dietary inflammatory potential, which has been linked with a number of chronic diseases. Findings further suggest that elderly persons may be especially at risk for a high dietary inflammatory potential when struggling with food insecurity. More evidence is needed to determine whether reducing dietary inflammatory potential among food insecure populations is a viable strategy for addressing health disparities. Although

R. S. Bergmans is a research fellow, Department of Psychiatry, University of Michigan, Ann Arbor.

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    R. S. Bergmans is a research fellow, Department of Psychiatry, University of Michigan, Ann Arbor.

    M. Palta is a professor, Department of Population Health Sciences, University of Wisconsin–Madison.

    D. B. Ehrenthal is an associate professor, Department of Population Health Sciences, University of Wisconsin–Madison.

    K. M. Malecki is an assistant professor, Department of Population Health Sciences, University of Wisconsin–Madison.

    S. A. Robert is a professor and director, School of Social Work, University of Wisconsin–Madison.

    L. M. Berger is a professor, School of Social Work, University of Wisconsin–Madison.

    STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

    FUNDING/SUPPORT Funding that supported R. S. Bergmans’ work on this research comes from the National Institute of Health (NIH) Eunice Kennedy Shriver National Institute for Child Health and Development (NICHD) Training Grant (Demography and Ecology): T32 HD007014. K. M. Malecki’s work on this research was supported by the Center for Demography and Ecology at the University of Wisconsin–Madison (P2C HD047873), the Collaborative Center for Health Equity Administration (WPP3086), the NIH, the National Center for Advancing Translational Science CTSA award UL1TR000427, and the National Institute for Minority Health and Health Disparities award 1P60MD0003428. None of these funding sources had any role in study design; collection, analysis, or interpretation of data; writing the report; or the decision to submit the report for publication. The other authors have no funding sources to report that supported work on this manuscript.

    AUTHOR CONTRIBUTIONS R. S. Bergmans designed this study with contribution from K. M. Malecki. R. S. Bergmans analyzed the data with contribution from K. M. Malecki and M. Palta. R. S. Bergmans interpreted results with contribution from K. M. Malecki, M. Palta, S. A. Robert, L. M. Berger, and D. B. Ehrenthal. R. S. Bergmans wrote the first draft with contribution from K. M. Malecki. All authors contributed to critical revision of subsequent drafts and approved of the final version.

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