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      The Intersection between Food Insecurity and Diabetes: A Review

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          Abstract

          Access to sufficient, safe, and nutritious food not only affects the health of people who experience food insecurity, but also their ability to manage health conditions, such as diabetes. When people find it difficult to access sufficient food, tailoring their food selection to a diabetes regimen is even more difficult. Food insecurity in North America is consistently more prevalent among households with a person living with diabetes, and similarly, diabetes is also more prevalent in food-insecure households. Diabetes management can be stressful due to the many required responsibilities; when compounded with food insecurity, it becomes an even greater challenge. As a result, many food-insecure diabetics find themselves caught between competing priorities such as procuring food, prescribed medications and supplies for diabetes, and managing other living expenses, potentially worsening their condition and overall health. Healthcare providers should be aware and informed about the significant role that food security can play in the prevention and management of diabetes.

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          Most cited references47

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          Housing instability and food insecurity as barriers to health care among low-income Americans.

          Homelessness and hunger are associated with poor health outcomes. Housing instability and food insecurity describe less severe problems securing housing and food. To determine the association between housing instability and food insecurity and access to ambulatory health care and rates of acute health care utilization. Secondary data analysis of the National Survey of American Families. 16,651 low-income adults. Self-reported measures of past-year access: (1) not having a usual source of care, (2) postponing needed medical care, or (3) postponing medication; and past-year utilization: (1) not having an ambulatory care visit, (2) having emergency department (ED) visits, or (3) inpatient hospitalization. 23.6% of subjects had housing instability and 42.7% had food insecurity. In multivariate logistic regression models, housing instability was independently associated with not having a usual source of care (adjusted odds ratio [AOR] 1.31, 95% confidence interval [CI] 1.08 to 1.59), postponing needed medical care (AOR 1.84, 95% CI 1.46 to 2.31) and postponing medications (AOR 2.16, 95% CI 1.70 to 2.74), increased ED use (AOR: 1.43, 95% CI 1.20 to 1.70), and hospitalizations (AOR 1.30, 95% CI 1.01 to 1.67). Food insecurity was independently associated with postponing needed medical care (AOR 1.74, 95% CI 1.38 to 2.21) and postponing medications (AOR 2.15, 95% CI 1.62 to 2.85), increased ED use (AOR 1.39, 95% CI 1.17 to 1.66), and hospitalizations (AOR 1.42, 95% CI 1.09 to 1.85). Housing instability and food insecurity are associated with poor access to ambulatory care and high rates of acute care. These competing life demands may lead to delays in seeking care and predispose to acute care.
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            Nutritional and health consequences are associated with food insecurity among U.S. elderly persons.

            The purpose of this study was to examine the consequences associated with food insecurity for the nutritional and health status of the elderly in the United STATES: The data analyzed were from the Third National Health and Nutrition Examination Survey (1988-1994) and the Nutrition Survey of the Elderly in New York State (1994). Multiple logistic and linear regression analyses were used to assess the extent to which food-insecure elderly were likely to have lower nutrient intake, skinfold thickness, self-reported health status and higher nutritional risk. Regardless of food insecurity status, older people consumed less than the recommended dietary allowance for eight nutrients. Food-insecure elderly persons had significantly lower intakes of energy, protein, carbohydrate, saturated fat, niacin, riboflavin, vitamins B-6 and B-12, magnesium, iron and zinc, as well as lower skinfold thickness. In addition, food-insecure elderly persons were 2.33 (95% confidence interval: 1.73-3.14) times more likely to report fair/poor health status and had higher nutritional risk. These results indicate that food-insecure elderly persons have poorer dietary intake, nutritional status and health status than do food-secure elderly persons. It is necessary to ensure the nutritional well-being of all elderly persons who are at nutritional and health risk, including those who are food insecure and have even poorer nutritional and health status than those who are food secure.
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              Household food insecurity is associated with self-reported pregravid weight status, gestational weight gain, and pregnancy complications.

              Household food insecurity is positively associated with weight among women. The association between household food insecurity and pregnancy-related weight gain and complications is not well understood. To identify whether an independent association exists between household food insecurity and pregnancy-related complications. Data from the Pregnancy, Infection, and Nutrition prospective cohort study were used to assess household food insecurity retrospectively using the US Department of Agriculture 18-item Core Food Security Module among 810 pregnant women with incomes < or =400% of the income/poverty ratio, recruited between January 2001 and June 2005 and followed through pregnancy. Self-reported pregravid body mass index, gestational weight gain, second trimester anemia, pregnancy-induced hypertension, and gestational diabetes mellitus. Multivariate linear, multinomial logistic, and logistic regression analyses. Among 810 pregnant women, 76% were from fully food secure, 14% were from marginally food secure, and 10% were from food insecure households. In adjusted models, living in a food insecure household was significantly associated with severe pregravid obesity (adjusted odds ratio 2.97, 95% confidence intervals [CIs] 1.44 to 6.14), higher gestational weight gain (adjusted beta coefficient 1.87, 95% CI 0.13 to 3.62), and with a higher adequacy of weight gain ratio (adjusted beta .27, 95% CI 0.07 to 0.50). Marginal food security was significantly associated with gestational diabetes mellitus (adjusted odds ratio 2.76, 95% CI 1.00 to 7.66). This study highlights the possibility that living in a food insecure household during pregnancy may increase risk of greater weight gain and pregnancy complications. Copyright 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                416-979-5000 , egucciar@ryerson.ca
                (416) 979-5000 , mvahabi@ryerson.ca
                905-706-4330 , nnorris@ryerson.ca
                905-399-5736 , jpdelmon@ryerson.ca
                416-979-5000 , cfarnum@ryerson.ca
                Journal
                Curr Nutr Rep
                Curr Nutr Rep
                Current Nutrition Reports
                Springer US (Boston )
                2161-3311
                2 October 2014
                2 October 2014
                2014
                : 3
                : 4
                : 324-332
                Affiliations
                [ ]School of Nutrition, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3 Canada
                [ ]Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3 Canada
                [ ]Library and Archives, Ryerson University , 350 Victoria Street, L272-F, Toronto, Ontario M5B 2K3 Canada
                Article
                104
                10.1007/s13668-014-0104-4
                4218969
                25383254
                baa77427-da27-47ff-b8d7-c6409241d3db
                © The Author(s) 2014

                Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

                History
                Categories
                Diabetes and Obesity (MR Carnethon, Section Editor)
                Custom metadata
                © Springer Science+Business Media New York 2014

                Nutrition & Dietetics
                coping strategies,diabetes,diabetes management,diabetes prevention,food insecurity,food security,hypoglycemia,poverty,self-care,self-efficacy,self-management

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