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      Food insecurity, acculturation and diagnosis of CHD and related health outcomes among immigrant adults in the USA

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          Abstract

          Objective:

          To deepen understanding of the relationship between food insecurity, acculturation, and diagnosis of CHD and related health outcomes among immigrant adults.

          Design:

          Using cross-sectional, nationally representative data from the National Health Interview Survey 2011 to 2015, we address two research questions. First, what is the relationship of household food insecurity and acculturation with: CHD, angina pectoris, heart attack, self-rated poor health and obesity? Second, what is the association of food insecurity with these health outcomes over years of living in the USA? We estimate multivariate logistic regressions without (question 1) and with (question 2) an interaction term between food insecurity and acculturation for CHD and related health outcomes.

          Setting:

          USA.

          Participants:

          Low-income immigrant adults.

          Results:

          Food insecurity and acculturation are both associated with diagnosis of CHD and related health outcomes among immigrant adults. Food insecurity and acculturation are associated with the health of female immigrants more than males. Also, the differences by food security status in the probability of having several poor health outcomes (self-rated heath, obesity, women’s angina pectoris) are largest for those in the USA for less than 5 years, decrease for those who have lived in the USA for 5–14 years, and are larger again for those in the USA for 15 or more years.

          Conclusions:

          Recent and long-term food-insecure immigrants are more vulnerable to CHD and related health outcomes than those in the USA for 5–14 years. Further research is needed to understand why.

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          Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review.

          Dariush Mozaffarian (2016)
          Suboptimal nutrition is a leading cause of poor health. Nutrition and policy science have advanced rapidly, creating confusion yet also providing powerful opportunities to reduce the adverse health and economic impacts of poor diets. This review considers the history, new evidence, controversies, and corresponding lessons for modern dietary and policy priorities for cardiovascular diseases, obesity, and diabetes mellitus. Major identified themes include the importance of evaluating the full diversity of diet-related risk pathways, not only blood lipids or obesity; focusing on foods and overall diet patterns, rather than single isolated nutrients; recognizing the complex influences of different foods on long-term weight regulation, rather than simply counting calories; and characterizing and implementing evidence-based strategies, including policy approaches, for lifestyle change. Evidence-informed dietary priorities include increased fruits, nonstarchy vegetables, nuts, legumes, fish, vegetable oils, yogurt, and minimally processed whole grains; and fewer red meats, processed (eg, sodium-preserved) meats, and foods rich in refined grains, starch, added sugars, salt, and trans fat. More investigation is needed on the cardiometabolic effects of phenolics, dairy fat, probiotics, fermentation, coffee, tea, cocoa, eggs, specific vegetable and tropical oils, vitamin D, individual fatty acids, and diet-microbiome interactions. Little evidence to date supports the cardiometabolic relevance of other popular priorities: eg, local, organic, grass-fed, farmed/wild, or non-genetically modified. Evidence-based personalized nutrition appears to depend more on nongenetic characteristics (eg, physical activity, abdominal adiposity, gender, socioeconomic status, culture) than genetic factors. Food choices must be strongly supported by clinical behavior change efforts, health systems reforms, novel technologies, and robust policy strategies targeting economic incentives, schools and workplaces, neighborhood environments, and the food system. Scientific advances provide crucial new insights on optimal targets and best practices to reduce the burdens of diet-related cardiometabolic diseases.
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            Food Insecurity And Health Outcomes.

            Craig Gundersen, James Ziliak (2015)
            Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation's leading health and nutrition issues. We examine recent research evidence of the health consequences of food insecurity for children, nonsenior adults, and seniors in the United States. For context, we first provide an overview of how food insecurity is measured in the country, followed by a presentation of recent trends in the prevalence of food insecurity. Then we present a survey of selected recent research that examined the association between food insecurity and health outcomes. We show that the literature has consistently found food insecurity to be negatively associated with health. For example, after confounding risk factors were controlled for, studies found that food-insecure children are at least twice as likely to report being in fair or poor health and at least 1.4 times more likely to have asthma, compared to food-secure children; and food-insecure seniors have limitations in activities of daily living comparable to those of food-secure seniors fourteen years older. The Supplemental Nutrition Assistance Program (SNAP) substantially reduces the prevalence of food insecurity and thus is critical to reducing negative health outcomes.
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              Food insecurity is associated with chronic disease among low-income NHANES participants.

              Hilary Seligman, Barbara Laraia, Margot Kushel (2010)
              Food insecurity refers to the inability to afford enough food for an active, healthy life. Numerous studies have shown associations between food insecurity and adverse health outcomes among children. Studies of the health effects of food insecurity among adults are more limited and generally focus on the association between food insecurity and self-reported disease. We therefore examined the association between food insecurity and clinical evidence of diet-sensitive chronic disease, including hypertension, hyperlipidemia, and diabetes. Our population-based sample included 5094 poor adults aged 18-65 y participating in the NHANES (1999-2004 waves). We estimated the association between food insecurity (assessed by the Food Security Survey Module) and self-reported or laboratory/examination evidence of diet-sensitive chronic disease using Poisson regression. We adjusted the models to account for differences in age, gender, race, educational attainment, and income. Food insecurity was associated with self-reported hypertension [adjusted relative risk (ARR) 1.20; 95% CI, 1.04-1.38] and hyperlipidemia (ARR 1.30; 95% CI, 1.09-1.55), but not diabetes (ARR 1.19; 95% CI, 0.89-1.58). Food insecurity was associated with laboratory or examination evidence of hypertension (ARR 1.21; 95% CI, 1.04-1.41) and diabetes (ARR 1.48; 95% CI, 0.94-2.32). The association with laboratory evidence of diabetes did not reach significance in the fully adjusted model unless we used a stricter definition of food insecurity (ARR 2.42; 95% CI, 1.44-4.08). These data show that food insecurity is associated with cardiovascular risk factors. Health policy discussions should focus increased attention on ability to afford high-quality foods for adults with or at risk for chronic disease.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Public Health Nutr
                Journal ID (iso-abbrev): Public Health Nutr
                Journal ID (publisher-id): PHN
                Title: Public Health Nutrition
                Publisher: Cambridge University Press (Cambridge, UK )
                ISSN (Print): 1368-9800
                ISSN (Electronic): 1475-2727
                Publication date (Electronic): 13 August 2019
                Publication date (Print): February 2020
                Volume: 23
                Issue: 3
                Pages: 416-431
                Affiliations
                Economic Research Service, United States Department of Agriculture , 355 E. Street SW, Washington, DC 20024, USA
                Author notes
                [* ] Corresponding author: Email mdsmith@ 123456ers.usda.gov
                Author information
                https://orcid.org/0000-0001-9709-4485
                Article
                Publisher ID: 00195 Publisher Item ID: S1368980019001952
                DOI: 10.1017/S1368980019001952
                PMC ID: 10200643
                PubMed ID: 31405405
                SO-VID: 4cfb419d-4d5f-4d5c-acb7-3b468022134d
                Copyright © © The Authors 2019
                License:

                This is a work of the US Government and is not subject to copyright protection in the United States.

                History
                Date received : 04 July 2018
                Date revision received : 07 March 2019
                Date accepted : 30 April 2019
                Page count
                Figures: 5, Tables: 9, Equations: 3, References: 79, Pages: 16
                Categories
                Subject: Research Paper

                ScienceOpen disciplines: Public health
                Keywords: food security,acculturation,healthy immigrant effect,cardiometabolic health,heart-related health
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: food security, acculturation, healthy immigrant effect, cardiometabolic health, heart-related health

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