Race and Sex Differences in the Association between Food Insecurity and Type 2 Diabetes

Strings, Sabrina; Ranchod, Yamini K.; Laraia, Barbara A.; Nuru-Jeter, Amani

doi:10.18865/ed.26.3.427

Cited by 25 publications

(28 citation statements)

References 28 publications

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“…Although these interventions have increased access to food, few of the interventions have had a significant effect on glycemic control, suggesting a complex and heterogeneous relationship between glycemic control and food insecurity that is likely mediated by diverse socioeconomic factors. Because of the numerous factors associated with food insecurity, it is difficult to determine causal relationships between food insecurity and glycemic control in patients with diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…4 parts of the country were also more likely to be food insecure ( Figure 1). 1,8 A recent geographic analysis by Leonard and colleagues focused on identifying overlapping areas of food insecurity and determinants of health outcomes indicating overall poor health in the United States. Although there were limitations to this analysis, geographic clustering of food insecurity and concurrent poor health indicators tended to be present in Southeastern US regions with higher non-Hispanic Black populations and higher poverty rates.…”

Section: Prevalence Of Food Insecurity In the United Statesmentioning

confidence: 99%

“…Previous studies have shown that certain social determinants, including a lower socioeconomic status and lack of social support, are associated with higher rates of food insecurity . Other household characteristics, including households with children, households of single parents, households led by non‐Hispanic Black or Hispanic individuals, and households located in major cities within metropolitan areas or rural parts of the country were also more likely to be food insecure (Figure ) . A recent geographic analysis by Leonard and colleagues focused on identifying overlapping areas of food insecurity and determinants of health outcomes indicating overall poor health in the United States.…”

Section: Introductionmentioning

confidence: 99%

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Emerging trends and the clinical impact of food insecurity in patients with diabetes

Flint

Davis

Umpiérrez

2019

Journal of Diabetes

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Food insecurity is a major public health concern in the United States affecting 15 million households according to data in 2017 from the US Department of Agriculture. Food insecurity, or the inability to consistently obtain nutritious food, disproportionately affects socioeconomically disadvantaged households, as well as those with chronic diseases including diabetes mellitus (DM). This review article explores the literature over the past 10 years pertaining to the complex relationship between food insecurity, social determinants of health, and chronic disease with an emphasis on diabetes and glycemic control. Those with diabetes and food insecurity together have been shown to have worse glycemic control compared to those who are food secure, but it remains unclear exactly how food insecurity affects glycemic control. Prior interventional studies have targeted aspects of food insecurity in patients with diabetes but have reported variable outcomes with respect to improvement in glycemic control despite effectively reducing rates of food insecurity. Additionally, few data exist regarding long‐term outcomes and diabetes‐related complications in this population. It is likely that many factors at both the community and individual levels impact glycemic control outcomes in the setting of food insecurity. Further studies are needed to better understand these factors and to create multifaceted targets for future interventional studies aimed at improving glycemic control in this population.

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Section: Discussionmentioning

confidence: 99%

Section: Prevalence Of Food Insecurity In the United Statesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Emerging trends and the clinical impact of food insecurity in patients with diabetes

Flint

Davis

Umpiérrez

2019

Journal of Diabetes

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“…1,[5][6][7] For example, often individuals from racial/ethnic minority groups report higher levels of food insecurity, and over 30% of households with incomes below 185% of the poverty threshold reported food insecurity in the prior year. 1,8 In addition, individuals with cardiometabolic disease, who need to modify their diet to manage disease, are more likely to report food insecurity than those without disease, with nearly 28% of the population with diabetes report being food insecure. 5 In addition, prevalence in groups with undiagnosed diabetes has increased more dramatically than those diagnosed, suggesting changes in diet due to physician recommendations may not explain the full picture.…”

Section: Introductionmentioning

confidence: 99%

Differential Impact of Food Insecurity, Distress, and Stress on Self-care Behaviors and Glycemic Control Using Path Analysis

2019

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BACKGROUND: The aim of this study was to investigate the direct and indirect pathways through which food insecurity influences glycemic control and self-care behaviors. METHODS: Using data collected from 615 adults with type 2 diabetes, we investigated pathways between food insecurity and diabetes outcomes using path analysis. We included measures of perceived stress, diabetes distress, diabetes fatalism, and depression as psychosocial factors in the pathway. Self-care behaviors included general diet, specific diet, exercise, blood sugar testing, foot care, and medication adherence. Analyses were conducted using Stata v14, to include both direct and indirect effects, with standardized estimates to allow comparison of paths. RESULTS: Food insecurity was directly associated with stress (r = 0.43, p < 0.001), depression (r = 0.34, p < 0.001), fatalism (r = 0.09, p = 0.03), and distress (r = 0.36, p < 0.001). The type of stress, however, was differentially associated with outcomes, with distress associated with HbA1c (r = 0.25, p < 0.001), general and specific diet (r = − 0.28 and − 0.17, respectively, p = 0.001), and medication adherence (r = − 0.26, p < 0.001), while stress was associated with specific diet (r = − 0.14, p = 0.005) and medication adherence (r = − 0.15, p < 0.001) and depression was associated with exercise (r = − 0.06, p = 0.007). Food insecurity was indirectly associated with HbA1c (r = 0.08, p = 0.001), and four self-care behaviors (general diet, specific diet, exercise, and medication adherence). CONCLUSIONS: Food insecurity influences self-care behaviors indirectly via multiple psychosocial factors, and glycemic control indirectly through diabetes distress, supporting the hypothesis that stress is an important mechanism. Programs to improve access to resources and manage psychosocial concerns should be combined with foodbased programs for food insecure populations with diabetes.

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“…Despite such empirical evidence, studies on food insecurity and its potential relationship to acculturation is lacking. In fact, a recent study evaluating the burden of food insecurity, excluded Asian Americans from the study due to low sample [ 27 ]; thus further limiting the body of literature on the burden of food insecurity among the population. As such, our study addresses this critical gap in the literature.…”

Section: Introductionmentioning

confidence: 99%

The Overlooked Burden of Food Insecurity among Asian Americans: Results from the California Health Interview Survey

Becerra

Mshigeni

Becerra

2018

IJERPH

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Objective: Food insecurity remains a major public health issue in the United States, though lack of research among Asian Americans continue to underreport the issue. The purpose of this study was to evaluate the prevalence and burden of food insecurity among disaggregated Asian American populations. Methods: The California Health Interview Survey, the largest state health survey, was used to assess the prevalence of food insecurity among Asian American subgroups with primary exposure variable of interest being acculturation. Survey-weighted descriptive, bivariate, and multivariable robust Poisson regression analyses, were conducted and alpha less than 0.05 was used to denote significance. Results: The highest prevalence of food insecurity was found among Vietnamese (16.42%) and the lowest prevalence was among Japanese (2.28%). A significant relationship was noted between prevalence of food insecurity and low acculturation for Chinese, Korean, and Vietnamese subgroups. Language spoken at home was significant associated with food insecurity. For example, among Chinese, being food insecure was associated with being bilingual (prevalence ratio [PR] = 2.51) or speaking a non-English language at home (PR = 7.24), while among South Asians, it was associated with speaking a non-English language at home was also related to higher prevalence (PR = 3.62), as compared to English speakers only. Likewise, being foreign-born also related to being food insecure among Chinese (PR = 2.31), Filipino (PR = 1.75), South Asian (PR = 3.35), Japanese (PR = 2.11), and Vietnamese (PR = 3.70) subgroups, when compared to their US-born counterparts. Conclusion: There is an imperative need to address food insecurity burden among Asian Americans, especially those who have low acculturation.

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Race and Sex Differences in the Association between Food Insecurity and Type 2 Diabetes

Cited by 25 publications

References 28 publications

Emerging trends and the clinical impact of food insecurity in patients with diabetes

Emerging trends and the clinical impact of food insecurity in patients with diabetes

Differential Impact of Food Insecurity, Distress, and Stress on Self-care Behaviors and Glycemic Control Using Path Analysis

The Overlooked Burden of Food Insecurity among Asian Americans: Results from the California Health Interview Survey

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