Food Insecurity Negatively Impacts Gluten Avoidance and Nutritional Intake in Patients With Celiac Disease

Abstract

Background: Food insecurity is a major public health challenge. For patients with celiac disease (CeD), food insecurity may be particularly detrimental as it threatens the cornerstone of their treatment: adoption of a gluten-free diet (GFD). We aimed to characterize the prevalence of food insecurity in patients with CeD and evaluate its impact on GFD adoption and nutritional intake. Methods: We analyzed data from patients with CeD participating in the US National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014. Food insecurity was defined using the US Department of Agriculture 18-Item Standard Food Security Survey Module. Survey-weighted logistic regression was used to assess differences in demographic characteristics of CeD patients living with food insecurity and the impact of food security on GFD adoption. Multivariable survey-weighted linear regression was used to evaluate the effect of food insecurity on nutritional intake of macronutrients and micronutrients. Results: Overall, 15.9% (95% confidence interval: 10.6%, 23.1%) of patients with CeD in the United States [weighted N=2.9 million (95% confidence interval: 2.2, 3.5 million)] are food insecure. Food insecure patients with CeD were disproportionately younger, poorly educated, nonwhite, living in poverty, and were significantly less likely to adopt a GFD (24.1% vs. 67.9%, P=0.02). Food insecurity was associated with significantly lower consumption of protein, carbohydrates, fat, and most vitamins and minerals. Conclusions: One in 6 patients with CeD are food insecure, negatively impacting GFD adoption and the ability to meet recommended daily intake of most micronutrients. Less than one quarter of food insecure CeD patients adhere to a GFD.

Food insecurity and other barriers to adherence to a gluten-free diet in individuals with celiac disease and non-celiac gluten sensitivity in the Netherlands: a mixed-methods study

“…The prevalence of food insecurity in our study was similar to previous reported data from the United States among individuals with CeD (23, 24), and higher than previous reported data among a general sample of adults with a relatively low socioeconomic position living in the Netherlands (33). Our findings confirm the established correlation between food insecurity, lower income and educational level(34).…”

“…A recent review of national survey data collected in the United States between 2008 and 2014, revealed the negative effects of food insecurity in individuals with CeD. Food insecurity was found to be significantly associated with decreased adherence to a gluten-free diet, as well as a reduced intake of essential nutrients, such as protein, various vitamins and several minerals (24). Notably, individuals with CeD already are at higher risk of certain vitamin and mineral deficiencies due to malabsorption, making them particularly vulnerable to the adverse effects of food insecurity.…”

Food insecurity screening practices in a pediatric gastroenterology population

“…Etiologies of food insecurity include poverty, unemployment, low‐income, lack of affordable housing, systemic racism and racial discrimination, chronic health conditions, expensive dietary treatments, and lack of access to healthcare 9 . Within pediatric gastroenterology clinics, prior studies reported rates of food insecurity ranging from 13% to 17% 10,11 . Caregiver responses from our survey indicated that 10%−15% of families recalled being asked about food insecurity by a healthcare team member despite the numerous studies showing the impact that it may have on disease management.…”

“…9 Within pediatric gastroenterology clinics, prior studies reported rates of food insecurity ranging from 13% to 17%. 10,11 Caregiver responses from our survey indicated that 10%−15% of families recalled being asked about food insecurity by a healthcare team member despite the numerous studies showing the impact that it may have on disease management. For example, a study of patients with celiac disease demonstrated that one in six patients faced food insecurity, and less than one-quarter of those patients adhered to a gluten-free diet.…”

“…Caregiver responses from our survey indicated that 10%−15% of families recalled being asked about food insecurity by a healthcare team member despite the numerous studies showing the impact that it may have on disease management. For example, a study of patients with celiac disease demonstrated that one in six patients faced food insecurity, and less than one‐quarter of those patients adhered to a gluten‐free diet 10 . Furthermore, another study of patients with celiac disease found patients who endorsed food insecurity were more likely to have intentional gluten exposures 12 .…”