Is household food insecurity a determinant of weight status in patients with type 2 diabetes in rural areas?

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

Journal of Immigrant and Minority Health ◽

10.1007/s10903-011-9499-9 ◽

2011 ◽

Vol 13 (6) ◽

pp. 982-989 ◽

Cited By ~ 39

Author(s):

Grace Kollannoor-Samuel ◽

Julie Wagner ◽

Grace Damio ◽

Sofia Segura-Pérez ◽

Jyoti Chhabra ◽

...

Keyword(s):

Social Support ◽

Type 2 Diabetes ◽

Food Insecurity ◽

Household Food Insecurity ◽

Household Food

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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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Agricultural Food Production Diversity and Dietary Diversity among Female Small Holder Farmers in a Region of the Ecuadorian Andes Experiencing Nutrition Transition

Nutrients ◽

10.3390/nu12082454 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2454

Author(s):

Christopher L Melby ◽

Fadya Orozco ◽

Jenni Averett ◽

Fabián Muñoz ◽

Maria José Romero ◽

...

Keyword(s):

Food Insecurity ◽

Rural Areas ◽

Dietary Diversity ◽

Household Food Insecurity ◽

Food Groups ◽

Household Food ◽

Small Holder Farmers ◽

Production Diversity ◽

Small Holder ◽

Agricultural Food

Some rural areas of Ecuador, including the Imbabura Province of the Andes Highlands, are experiencing a double burden of malnutrition where micronutrient deficiencies persist at the same time obesity is increasing as many traditional home-grown foods are being replaced with more commercially prepared convenience foods. Thus, the relationships among agricultural food production diversity (FPD), dietary diversity (DD), and household food insecurity (HFI) of the rural small holder farmers need further study. Therefore, we examined these associations in small holder farmers residing in this Province in the Andes Highlands (elevation > 2500 m). Non-pregnant maternal home managers (n = 558, x age = 44.1, SD = 16.5 y) were interviewed regarding the number of different agricultural food crops cultivated and domestic animals raised in their family farm plots. DD was determined using the Minimum Dietary Diversity for Women Score (MDD-W) based on the number of 10 different food groups consumed, and household food insecurity (HFI) was determined using the 8-item Household Food Insecurity Experience Scale. The women reported consuming an average of 53% of their total food from what they cultivated or raised. Women with higher DD [MMD-W score ≥ 5 food groups (79% of total sample)] were on farms that cultivated a greater variety of crops (x = 8.7 vs. 6.7), raised more animals (x = 17.9 vs. 12.7, p < 0.05), and reported lower HFI and significantly higher intakes of energy, protein, iron, zinc, and vitamin A (all p < 0.05). Multiple regression analyses demonstrated that FPD was only modestly related to DD, which together with years of education, per capita family income, and HFI accounted for 26% of DD variance. In rural areas of the Imbabura Province, small holder farmers still rely heavily on consumption of self-cultivated foods, but greater diversity of crops grown in family farm plots is only weakly associated with greater DD and lower HFI among the female caretakers.

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Household Food Insecurity, Dietary Diversity, Stunting, and Anaemia among Left-Behind Children in Poor Rural Areas of China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16234778 ◽

2019 ◽

Vol 16 (23) ◽

pp. 4778 ◽

Cited By ~ 3

Author(s):

Yang ◽

Yuan ◽

Yang ◽

Zou ◽

Ji ◽

...

Keyword(s):

Food Insecurity ◽

Rural Areas ◽

Dietary Diversity ◽

Rural China ◽

Nutritional Intervention ◽

Food Group ◽

Hunan Province ◽

Household Food Insecurity ◽

Left Behind ◽

Household Food

Left-behind children (LBC) are a newly emerged social group in China. Poor nutritional status is particularly prominent in this population. However, their food insecurity tends to attract very little attention. This study aims to investigate the relationship between food insecurity and undernutrition (stunting and anaemia) in 3 to 5-year-old LBC in rural China. Face-to-face interviews were administered to 553 LBC caregivers in 40 rural villages of Hunan Province, China. The Household Food Insecurity Access Scale (HFIAS) was used to assess household food insecurity (HFI). Dietary diversity score (DDS) and food group consumption frequency were measured by 24 h-recall and food frequency questionnaires (FFQ). Hemoglobin tests and anthropometric measurements including height and weight were measured by trained health professionals. Logistic regression was constructed to assess the association between household food insecurity and dietary diversity, stunting, and anaemia. A high prevalence of household food insecurity was determined (67.6%). The weighted prevalence of stunting and anaemia were 16.6% and 26.5%, respectively. Food insecurity was positively associate with LBC stunting (severe HFI: OR = 6.50, 95% CI: 2.81, 15.00; moderate HFI: OR = 3.47, 95% CI: 1.60, 7.54), and anaemia (severe HFI: OR = 1.91, 95% CI: 1.02, 3.57). LBC with food insecurity had significantly lower dietary diversity than those who were food-secure (p < 0.001). The prevalence of household food insecurity among LBC in poor rural China is high and is associated with low DDS, stunting, and anaemia. Nutritional intervention programs and policies are urgently needed to reduce household food insecurity and undernutrition for this vulnerable population.

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Household level determinants of food insecurity in rural areas of Dire Dawa, eastern Ethiopia

African Journal of Food, Agriculture, Nutrition and Development ◽

10.18697/ajfand.30.3740 ◽

2009 ◽

Vol 9 (30) ◽

pp. 1914-1926

Author(s):

Ayalneh Bogale ◽

◽

Shimelis A ◽

Keyword(s):

Food Security ◽

Food Insecurity ◽

Survey Data ◽

Rural Areas ◽

Rural Households ◽

Household Head ◽

Household Food Insecurity ◽

Household Level ◽

Household Food ◽

Dire Dawa

Even though the struggle to achieve food security at the household level in the rural areas of Ethiopia dates back a long period, it has remained as a challenging goal even today. Making their living on marginal, moisture stressed, heavily degraded and less productive land, households in rural areas of Dire Dawa face persistent food shortages. The design and implementation of effective measures to reduce household food insecurity in the region depends on in-depth understanding of its covariates. This study seeks to address these issues by assessing location specific socio-economic factors that influence food insecurity of households in rural areas of Dire Dawa Administrative region. The analysis is based on survey data gathered from randomly selected 115 sample rural households in the study area. A binary logit model was used to identify the factors influencing household level food insecurity. A total of thirteen explanatory variables were included in the empirical model. The empirical results estimated using the survey data to identify the determinants of food insecurity among rural households in the study area revealed mixed impressions. Among variables considered , family size, annual income, amount of credit received, access to irrigation, age of household head, farm size, and livestock owned showed theoretically consistent and statistically significant effect. However, estimated coefficients of number of oxen owned and dependency ratio showed theoretically inconsistent and statistically insignificant effect on the probability of household to be food insecure.. Estimated coefficients of sex of household head, total off-farm income, education of household head and amount of food aid received were not found to be statistically significant in determining household food insecurity in the study area. The findings imply that improvement in food security situation needs to build assets, improve the functioning of rural financial markets and promote family planning. These areas could provide entry points for policy intervention to reduce hunger and augment household and community livelihood opportunities.

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