Social Support Modifies the Association Between Household Food Insecurity and Depression Among Latinos with Uncontrolled Type 2 Diabetes

ABSTRACT Background Household food insecurity (HFI) is a stressor that is associated with type 2 diabetes (T2D). However, little is known about HFI and the insulin resistance (IR) underlying T2D, and the mechanisms involved. Objective We examined the cross-sectional association between HFI and IR among low-income Latinos with T2D and tested whether inflammation and stress hormones mediated this association. Methods HFI was measured with the 6-item US Household Food Security Survey module. IR was calculated from fasting plasma blood glucose and serum insulin. Inflammation was indicated by high-sensitivity C-reactive protein (hsCRP), and stress hormones included urinary cortisol, metanephrine, and normetanephrine. To test for an indirect effect of HFI on homeostasis model assessment of IR, a parallel multiple mediation model was run with biological markers that significantly differed between food security status—entered as mediators in the model. We used 95% bias-corrected bootstrap CIs, with 10,000 bootstrap samples, to assess the significance of the indirect effects. Results The 121 participants with T2D were primarily Puerto Rican (85.8%), aged mean = 60.7 y, and 74% were female. Eighty-two (68%) were classified as food insecure. Compared with food-secure individuals, food-insecure individuals had a significantly higher IR [mean difference (Δ) = 7.21, P = 0.001], insulin (Δ = 9.7, P = 0.019), glucose (Δ = 41, P < 0.001), hsCRP (Δ = 0.8, P = 0.008), cortisol (Δ = 21, P = 0.045), and total cholesterol (Δ = 29, P = 0.004). Groups did not differ on other lipids, metanephrine, normetanephrine, or A1c. The mediation model showed a significant direct effect of HFI on hsCRP (P = 0.020) and on cortisol (P = 0.011). There was a direct effect of cortisol (P = 0.013), hsCRP (P = 0.044), and HFI on IR (P = 0.015). The total combined indirect effect of HFI through cortisol and hsCRP indicated partial mediation. Conclusions Among Latinos with T2D, HFI is associated with IR partially through inflammation and stress hormones. Interventions to ameliorate HFI and mitigate its effects on inflammation, stress, and IR are warranted. This trial was registered at clinicaltrials.gov as NCT01578096.

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Inflammation and Stress Biomarkers Mediate the Relationship Between Household Food Insecurity and Insulin Resistance Among Latinos with Type 2 Diabetes (OR02-02-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz051.or02-02-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Angela Bermudez-Millan ◽

Julie Wagner ◽

Richard Feinn ◽

Sofia Segura-Pérez ◽

Grace Damio ◽

...

Keyword(s):

Insulin Resistance ◽

Type 2 Diabetes ◽

Food Insecurity ◽

Direct Effect ◽

Low Income ◽

Stress Hormones ◽

Household Food Security ◽

Household Food Insecurity ◽

Household Food

Abstract 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. Methods 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.

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The association of household food insecurity with the risk of type 2 diabetes mellitus in adults: a systematic review and meta-analysis

European Journal of Nutrition ◽

10.1007/s00394-018-1705-2 ◽

2018 ◽

Vol 58 (4) ◽

pp. 1341-1350 ◽

Cited By ~ 4

Author(s):

Ahmed A. Abdurahman ◽

Eshetu E. Chaka ◽

S. Nedjat ◽

Ahmed Reza Dorosty ◽

R. Majdzadeh

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Food Insecurity ◽

Meta Analysis ◽

Household Food Insecurity ◽

Household Food

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The Association of Food Insecurity, Inflammation, and Several Socioeconomic Factors with Type 2 Diabetes: A Case-Control Study

Journal of Nutrition and Food Security ◽

10.18502/jnfs.v5i1.2317 ◽

2020 ◽

Author(s):

Hamideh Janzadeh ◽

Hassan Mozaffari-Khosravi ◽

Maryam Javadi

Keyword(s):

Type 2 Diabetes ◽

Food Insecurity ◽

Case Control Study ◽

Economic Status ◽

Case Control ◽

Diabetic Patients ◽

Healthy Individuals ◽

Household Food ◽

Control Study

Background: Considering that food insecurity can be a precursor to health and nutrition problems, determining its associated factors seems necessary in any society. The purpose of this case-control study was to determine the food insecurity, c-reactive protein (CRP), and some socio-economic factors in type 2 diabetic patients. Methods: The present study was conducted on 200 people with type 2 diabetes mellitus (T2DM) and 200 healthy individuals within the age range of 30 to 59 years. Food security was assessed using the US Department of Agriculture Household Food Security questionnaire. Anthropometric index, physical activity, and biochemical factors were measured by questionnaire and blood test. Results: The prevalence of food insecurity was 71% within the diabetic patients, of which, 65.5% had food insecurity without hunger, 3.5% had food insecurity with moderate hunger, and 2% had food insecurity with severe hunger. In addition, 24.9% of the participants were healthy. The level of fasting blood glucose and inflammatory factors (CRP, WBC) were significantly higher in food insecure participants compared to the healthy individuals (P < 0.05). Multivariate logistic analysis showed that food insecurity, BMI > 25, occupational status, economic status, and education level were significantly correlated with T2DM (P < 0.001). Conclusion: As a result, health care providers should take measures to reduce the food insecurity in the community, specifically within T2DM patients. To this end, the individuals' economic status should be improved and the household food patterns should be modified.

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Maternal resources and household food security: evidence from Nicaragua

Public Health Nutrition ◽

10.1017/s1368980014003000 ◽

2015 ◽

Vol 18 (16) ◽

pp. 2915-2924 ◽

Cited By ~ 11

Author(s):

Kammi K Schmeer ◽

Barbara A Piperata ◽

Andrés Herrera Rodríguez ◽

Virgilio Mariano Salazar Torres ◽

Francisco José Centeno Cárdenas

Keyword(s):

Social Support ◽

Young Children ◽

Food Insecurity ◽

Economic Status ◽

Social Resources ◽

Household Food Security ◽

Household Food Insecurity ◽

Household Food ◽

Maternal Resources ◽

Specific Food

AbstractObjectiveWomen (especially mothers) are theorized as critical to reducing household food insecurity through their work and caregiver roles. The present study tests these assumptions, assessing how maternal economic and social resources are associated with food insecurity in households with young children.DesignData from a population-based sample of households was collected in León, Nicaragua (n 443). Data include a newly validated measure of household food insecurity (ELCSA), maternal resource measures, and household economic status and demographics. Regression analysis tests the statistical associations (P<0·05) of maternal resources with household, adult-specific and child-specific food insecurity.SettingMunicipality of León, Nicaragua.SubjectsHouseholds with children aged 3–11 years in rural and urban León.ResultsOnly 25 % of households with young children were food secure, with 50 % mildly food insecure and 25 % moderately/severely food insecure. When mothers contributed substantially to household income, the odds of moderate/severe household food insecurity were 34 % lower than when their spouse/partner was the main provider. The odds of food insecurity were 60 % lower when mothers managed household money, 48 % lower when mothers had a secondary (v. primary) education, 65 % higher among single mothers and 16 % lower with each indicator of social support. Results were similar for adult- and child-specific food insecurity.ConclusionsThis research provides new evidence that maternal economic and social resources are important for reducing household food insecurity and adult- and child-specific food insecurity. Women’s social status, social support and access to economic resources need to be enhanced as a part of policies aimed to reduce food insecurity in high-poverty settings.

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Pathways between food insecurity and glycaemic control in individuals with type 2 diabetes

Public Health Nutrition ◽

10.1017/s1368980018001908 ◽

2018 ◽

Vol 21 (17) ◽

pp. 3237-3244 ◽

Cited By ~ 3

Author(s):

Rebekah J Walker ◽

Joni Strom Williams ◽

Leonard E Egede

Keyword(s):

Social Support ◽

Type 2 Diabetes ◽

Glycaemic Control ◽

Food Insecurity ◽

Direct Effect ◽

Perceived Stress ◽

Structural Equation ◽

Self Care ◽

Indirect Pathway

AbstractObjectiveFood insecurity is reported in approximately 28 % of individuals with diabetes in the USA and is associated with poor glycaemic and lipid control. The present study aimed to understand the direct and indirect pathways through which food insecurity impacts glycaemic control in individuals with diabetes.Design/Setting/SubjectsAdults (n 615) with type 2 diabetes completed validated questionnaires after recruitment from two primary care clinics. Structural equation modelling was used to investigate mechanisms through which food insecurity influences diabetes self-care behaviours and glycaemic control, including investigation into possible direct and indirect effects of perceived stress and social support.ResultsThe final model showed that higher food insecurity was directly significantly related to increased stress (r=0·14, P<0·001) and increased glycosylated Hb (r=0·66, P=0·03). Higher stress was significantly related to poorer self-care (r=−0·54, P<0·001) and lower social support (r=−0·41, P<0·001). There was no significant direct association between food insecurity and self-care, or between perceived stress and glycaemic control.ConclusionsFood insecurity had both a direct effect on glycaemic control and an indirect effect on self-care through stress. The indirect pathway suggests that efforts to address stress may influence the ability of individuals to perform diabetes self-care behaviours. The direct effect on glycaemic control suggests that pathways independent of self-care behaviours may also be necessary to improve diabetes outcomes. Results from the study suggest a multipronged approach is necessary to address food insecurity in individuals with diabetes.

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The Effect of Maternal Depressive Symptoms on Infant Feeding Practices in Rural Ethiopia: Community Based Birth Cohort Study

10.21203/rs.2.18526/v1 ◽

2019 ◽

Author(s):

Yitbarek Kidane Woldetensay ◽

Tefera Belachew ◽

Shibani Ghosh ◽

Eva Johanna Kantelhardt ◽

Hans Konrad Biesalski ◽

...

Keyword(s):

Social Support ◽

Intimate Partner Violence ◽

Depressive Symptoms ◽

Food Insecurity ◽

Infant Feeding ◽

Partner Violence ◽

Intimate Partner ◽

Household Food Insecurity ◽

Maternal Depressive Symptoms ◽

Household Food

Abstract Background: Infant feeding is a multidimensional and multi-risk factor practice with a vital role in ensuring optimal child health, growth and development. Maternal depressive symptoms have been shown to have adverse consequences on feeding practices. However, most of these findings were based on single infant feeding practice (IFP) dimension; e.g. early initiation of breastfeeding, exclusive breastfeeding or introduction of complementary foods. This study aims to explore the longitudinal relationship between maternal depressive symptoms and IFPs in rural Ethiopia using summary IFP index. Methods: This study uses existing data from the ENGINE birth cohort study. The study had an open cohort design, with rolling recruitment and follow up of pregnant women for a period of two years. It was conducted from March 2014 to March 2016 in three districts (Woliso, Tiro-Afeta and Gomma) in the southwest of Ethiopia. The sample size was 4680 with pregnant women recruited between 12 and 32 weeks of gestation. Data were collected once during pregnancy for all women (twice for those in the first trimester), at birth, and then every three months until the child was 12 months old. Data collection was conducted by trained nurses electronically using Open Data Kit (ODK) software. A composite measure of IFP index was computed using 14 WHO recommended infant and young child feeding (IYCF) practice indicators. Maternal depressive symptoms (prenatal and postnatal) were assessed using the patient health questionnaire (PHQ-9). Linear multilevel mixed effects model was fitted to assess longitudinal relationship of IFPs and maternal depression. Results: Early postnatal depressive symptoms were inversely and significantly associated with IFPs (ß= -1.031, P=0.001). However, prenatal maternal depression was not significantly associated with IFPs (ß= -0.024, P=0.953). Similarly, intimate partner violence (ß= -0.208, P=0.001) was negatively associated with IFPs. On the other hand, maternal social support (ß= 0.107, P=0.002) and maternal social participation (ß= 0.552, P<0.001) were positively associated with IFPs. Maternal education and gestational age at birth were other important factors positively associated with IFPs. Moreover, contrary to expected, moderate household food insecurity (ß= 0.836, P=0.003), severe household food insecurity (ß= 1.034, P=0.01) and infant morbidity episodes (ß= 0.625, P=0.013) were positively associated with IFPs. Conclusion: Early postnatal depressive symptoms and intimate partner violence were negative predictors of IFPs. On the other hand, maternal education, gestational age at birth, maternal social support and social participation are positive predictors of IFPs. Overall, we conclude that a multitude of factors are related to IFPs and hence coordinated, multi-sectoral and multi-stakeholder interventions including maternal depressive symptoms screening and management are needed to improve IFPs.Key words: Infant feeding practices, prenatal depression, postnatal depression, household food insecurity, intimate partner violence, social support, Ethiopia

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Maternal Social Support Is Associated with Child Complementary Feeding, and Household Food Security in the Vakinankaratra Region, Madagascar

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_060 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 855-855

Author(s):

Joel Komakech ◽

Hasina Rakotomanana ◽

Christine Walters ◽

Deana Hildebrand ◽

Barbara Stoecker

Keyword(s):

Social Support ◽

Food Security ◽

Food Insecurity ◽

Complementary Feeding ◽

Dietary Diversity ◽

Feeding Practices ◽

Household Food Security ◽

Household Food Insecurity ◽

Household Food ◽

Maternal Social Support

Abstract Objectives There is limited research on the associations between maternal social support and household food security and child feeding practices in Madagascar. Our study examined the association between maternal social support, household food security, and feeding practices among mothers of children 6 - 24 months in the Vakinankaratra region, Madagascar. Methods This cross-sectional study included 344 mother-child dyads. The Medical Outcomes Study (MOS) Social Support Index was used for maternal social support scores. A mean score of >4 was considered optimal social support with ≤2 as none or little support. Food insecurity scores were determined using the Household Food Insecurity Access Scale (HFIAS). Complementary feeding practices were assessed using the World Health Organization (WHO) IYCF guidelines. Logistic and linear regression models tested the association between social support, complementary feeding practices, and household food insecurity. The models were adjusted for household, maternal and child confounders. Statistical significance was set at P < 0.05. Results Almost half of the mothers (49.1%) were supported by their spouses, although only 37.8% of mothers had optimal social support. Less than half of infants (36.34%) met minimum dietary diversity (≥4 of 7 food groups). Mothers with optimal social support had lower household food insecurity (b = −0.85, P = 0.016, R,2 = 0.10) in the adjusted models. Furthermore, children of mothers with higher social support were more likely to meet minimum dietary diversity scores (AOR = 2.36 [1.21–4.56], P = 0.021) and to achieve the minimum adequate diet (AOR = 2.32 [1.17–4.61], P = 0.018). Although maternal social support was significantly associated with child minimum meal frequency in the bivariate analysis, it became nonsignificant in the final adjusted model (AOR = 1.70 [0.93–3.11], P = 0.387). Conclusions Increased maternal social support was significantly associated with household food security, child dietary diversity, and diet adequacy. Integrating parental peer support in nutrition interventions may be effective in improving food security, and child feeding practices in the Vakinankaratra region of Madagascar. Funding Sources This study was funded by Oklahoma State University.

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