Measures of Food Inadequacy and Cardiovascular Disease Risk in Black Individuals in the US From the Jackson Heart Study

Zierath, Rani; Claggett, Brian; Hall, Michael E.; Correa, Adolfo; Barber, Sharrelle; Gao, Yan; Talegawkar, Sameera A.; Ezekwe, Edith I.; Tucker, Katherine L.; Diez‐Roux, Ana V.; Sims, Mario; Shah, Amil M.

doi:10.1001/jamanetworkopen.2022.52055

Cited by 10 publications

(6 citation statements)

References 53 publications

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“…How psychosocial-biologic pathways may converge to increase multimorbidity risk in PWH, especially for women and people in impoverished communities, is an area of active investigation. Social determinants of health and trauma history have been linked with chronic inflammation via activation of stress responses, which in turn affects comorbidity risk, potentially exacerbated in PWH and women . Among PWH, ongoing systemic inflammation and immune dysregulation despite ART is associated with NACM development .…”

Section: Discussionmentioning

confidence: 99%

“…Social determinants of health and trauma history have been linked with chronic inflammation via activation of stress responses, which in turn affects comorbidity risk, potentially exacerbated in PWH and women. 35 , 36 , 37 Among PWH, ongoing systemic inflammation and immune dysregulation despite ART is associated with NACM development. 38 , 39 Women with HIV have higher levels of inflammation and immune activation than men with HIV, even after achieving HIV-1 suppression, which may contribute to sex differences in NACM.…”

Section: Discussionmentioning

confidence: 99%

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Aging-Related Comorbidity Burden Among Women and Men With or At-Risk for HIV in the US, 2008-2019

et al. 2023

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ImportanceDespite aging-related comorbidities representing a growing threat to quality-of-life and mortality among persons with HIV (PWH), clinical guidance for comorbidity screening and prevention is lacking. Understanding comorbidity distribution and severity by sex and gender is essential to informing guidelines for promoting healthy aging in adults with HIV.ObjectiveTo assess the association of human immunodeficiency virus on the burden of aging-related comorbidities among US adults in the modern treatment era.Design, Setting, and ParticipantsThis cross-sectional analysis included data from US multisite observational cohort studies of women (Women’s Interagency HIV Study) and men (Multicenter AIDS Cohort Study) with HIV and sociodemographically comparable HIV-seronegative individuals. Participants were prospectively followed from 2008 for men and 2009 for women (when more than 80% of participants with HIV reported antiretroviral therapy use) through last observation up until March 2019, at which point outcomes were assessed. Data were analyzed from July 2020 to April 2021.ExposuresHIV, age, sex.Main Outcomes and MeasuresComorbidity burden (the number of total comorbidities out of 10 assessed) per participant; secondary outcomes included individual comorbidity prevalence. Linear regression assessed the association of HIV status, age, and sex with comorbidity burden.ResultsA total of 5929 individuals were included (median [IQR] age, 54 [46-61] years; 3238 women [55%]; 2787 Black [47%], 1153 Hispanic or other [19%], 1989 White [34%]). Overall, unadjusted mean comorbidity burden was higher among women vs men (3.4 [2.1] vs 3.2 [1.8]; P = .02). Comorbidity prevalence differed by sex for hypertension (2188 of 3238 women [68%] vs 2026 of 2691 men [75%]), psychiatric illness (1771 women [55%] vs 1565 men [58%]), dyslipidemia (1312 women [41%] vs 1728 men [64%]), liver (1093 women [34%] vs 1032 men [38%]), bone disease (1364 women [42%] vs 512 men [19%]), lung disease (1245 women [38%] vs 259 men [10%]), diabetes (763 women [24%] vs 470 men [17%]), cardiovascular (493 women [15%] vs 407 men [15%]), kidney (444 women [14%] vs 404 men [15%]) disease, and cancer (219 women [7%] vs 321 men [12%]). In an unadjusted model, the estimated mean difference in comorbidity burden among women vs men was significantly greater in every age strata among PWH: age under 40 years, 0.33 (95% CI, 0.03-0.63); ages 40 to 49 years, 0.37 (95% CI, 0.12-0.61); ages 50 to 59 years, 0.38 (95% CI, 0.20-0.56); ages 60 to 69 years, 0.66 (95% CI, 0.42-0.90); ages 70 years and older, 0.62 (95% CI, 0.07-1.17). However, the difference between sexes varied by age strata among persons without HIV: age under 40 years, 0.52 (95% CI, 0.13 to 0.92); ages 40 to 49 years, −0.07 (95% CI, −0.45 to 0.31); ages 50 to 59 years, 0.88 (95% CI, 0.62 to 1.14); ages 60 to 69 years, 1.39 (95% CI, 1.06 to 1.72); ages 70 years and older, 0.33 (95% CI, −0.53 to 1.19) (P for interaction = .001). In the covariate-adjusted model, findings were slightly attenuated but retained statistical significance.Conclusions and RelevanceIn this cross-sectional study, the overall burden of aging-related comorbidities was higher in women vs men, particularly among PWH, and the distribution of comorbidity prevalence differed by sex. Comorbidity screening and prevention strategies tailored by HIV serostatus and sex or gender may be needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Aging-Related Comorbidity Burden Among Women and Men With or At-Risk for HIV in the US, 2008-2019

et al. 2023

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“…The prevalence of food insecurity for Black adults with cardiovascular disease was as high as 37.3% in 2013-2014, and the prevalence of food insecurity among Hispanic adults with cardiovascular disease was as high as 42.2% in 2017-2018 [24]. A prospective study showed that economic food insecurity was associated with significantly higher risk of coronary heart disease and systolic heart failure among 3,084 Black participants in the Jackson Heart Study, even after adjustment for baseline cardiovascular risk and socio-economic factors [27]. Hispanic/Latino adolescents are a particularly vulnerable group and have the highest prevalence of adolescent obesity in the United States [28].…”

Section: Ethnic Minoritiesmentioning

confidence: 99%

Food Insecurity, Cardiometabolic Risk and Cardiovascular Disease: A Narrative Review and Call for Action

Saha,

Williams,

Murphy

et al. 2024

OBM Integr Complement Med

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Food insecurity and insufficient access to affordable nutrition have been associated with increased risk for the development of multiple chronic medical conditions, including cardiovascular disease. In this narrative review, we explore the association between food insecurity and the development of chronic medical conditions that confer increased cardiometabolic risk, cardiovascular disease, and mortality. We also identify the various barriers leading to food insecurity and lack of food literacy, with an emphasis on patients with high blood pressure, diabetes mellitus, stroke, congestive heart failure, and coronary heart disease. We discuss recent developments in legislation and public policies and programs designed to expand our understanding and reduce food insecurity at the local, regional, national, and international levels, and identify opportunities for future research and innovation.

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“…Some have hypothesized that FI decreases diet quality and thus leads to worse CVD outcomes. 8,20 Alternate hypotheses include the association of FI with impaired access to care [21][22][23] and increased stress and neurohumoral responses implicated in CVD.…”

Section: Introductionmentioning

confidence: 99%

“…8,20 Alternate hypotheses include the association of FI with impaired access to care 21–23 and increased stress and neurohumoral responses implicated in CVD. 24–26…”

Section: Introductionmentioning

confidence: 99%

Food Insecurity, Cardioprotective Diets, and Mortality Among US Adults

Ambrosini,

Fishman,

Mangalesh

et al. 2024

Preprint

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ImportanceThe DASH and Mediterranean diets are cardioprotective. Food insecurity (FI) limits access to healthy food. The relationship between FI, cardioprotective diets, and mortality is unknown.ObjectiveTo assess whether adherence to the DASH or Mediterranean diet affects all-cause and cardiovascular mortality independent of food insecurity. Furthermore, to evaluate if enrollment in the Supplemental Nutrition Assistance Program (SNAP) significantly affects diet quality and interacts with the relationship between cardioprotective diet adherence and mortality.Design, Setting, ParticipantsA retrospective cohort study using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) including study cycles 1999-2018 and longitudinal mortality data from the National Death Index (NDI). NHANES is a weighted population-based study that represents the non-institutionalized civilian population in the United States. Adults age>18 years with complete food security, dietary recall, and mortality data were included.ExposuresAdherence to DASH or Mediterranean diet and food security status.Main outcomes and measuresAll-cause and cardiovascular disease (CVD) related mortality.Results51,193 eligible adults were analyzed, representing a weighted population size of 207.1 (200.1 – 214.2) million. Participants with FI were more likely to be younger, female, Black or Hispanic, smokers, obese, lower educational attainment, lower income, and less physically active. FI was a significant predictor of all-cause mortality (p=0.006) but not CVD mortality (p=0.263). After adjustment for multiple covariates and food security status, DASH diet non-adherence significantly predicted all-cause mortality in those with hypertension (p=0.038) and coronary heart disease (CHD) (p=0.001), and CVD mortality in CHD (p=0.041). Mediterranean diet non-adherence significantly predicted all-cause mortality across the entire study population (p=0.005). There was no significant interaction effect between adherence to cardioprotective diets and SNAP enrollment in prediction of all-cause or CVD mortality. Food security was a significant predictor of adherence to the Mediterranean diet (p=0.001). SNAP enrollment was associated with improved adherence to the DASH diet among food insecure individuals (p=0.024), and the Mediterranean diet among food secure individuals (p=0.001).Conclusions and relevanceThe relationship between FI and mortality is associated with diet quality. Expanding SNAP eligibility to include food security status may have positive effects on public health.Key pointsQuestionDoes adherence to the DASH or Mediterranean diet decrease all-cause and cardiovascular mortality, and is this related to food insecurity status?FindingsIndependent of food insecurity, impaired adherence to cardioprotective diets predicted increased risk of all-cause and cardiovascular disease mortality in select patient populations with hypertension or coronary heart disease. SNAP enrollment was not a significant effect modifier in the relationship between mortality and diet adherence, but it did predict increased adherence to the DASH diet in food insecure individuals.MeaningOur results support the hypothesis that mortality in FI is mediated by impaired diet quality.

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Measures of Food Inadequacy and Cardiovascular Disease Risk in Black Individuals in the US From the Jackson Heart Study

Cited by 10 publications

References 53 publications

Aging-Related Comorbidity Burden Among Women and Men With or At-Risk for HIV in the US, 2008-2019

Aging-Related Comorbidity Burden Among Women and Men With or At-Risk for HIV in the US, 2008-2019

Food Insecurity, Cardiometabolic Risk and Cardiovascular Disease: A Narrative Review and Call for Action

Food Insecurity, Cardioprotective Diets, and Mortality Among US Adults

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