The Diet Quality of Food-Insecure Australian Adults—A Nationally Representative Cross-Sectional Analysis

Abstract

Poor diet quality exacerbates risks for acute and chronic conditions. People experiencing food insecurity have an increased likelihood of lower diet quality; however, this has not been investigated in the Australian context. The aim of this cross-sectional study was to examine whether the diet quality of Australian adults differed according to their household food security status. Data were analysed from a nationally representative sample (≥19 years; n = 9115) collected as part of the National Nutrition and Physical Activity Survey 2011-12. Household food security status and socio-demographic and health characteristics were assessed using data from an 18-module health interview. A 24 h dietary recall was used to estimate food and nutrient intakes and to calculate the Dietary Guidelines Index (DGI). DGI is a food-based score (0 to 130) that assesses adherence to the 2013 Australian Dietary Guidelines. Survey-weighted linear regression models, adjusted for age and sex, were used to examine diet quality (total DGI and component scores), and total energy and nutrient intake by food security status. Adults from food-insecure households had a mean total DGI score 3.5 points lower (95% CI −5.57, −1.46) than food-secure adults (p = 0.001). Adults from households experiencing food insecurity, when compared to those who were food-secure, had several lower DGI component scores including for dietary variety (1.6 vs. 2.3, p = 0.009), fruit (3.8 vs. 5.0, p = 0.001) and vegetables (3.7 vs. 4.4, p = 0.010). Adults from food-insecure households consumed on average more carbohydrates (45.6 vs. 43.3, p = 0.004) and total sugar (21.8 vs. 19.0, p = 0.003) as a percentage of daily energy and less protein (18.5 vs. 17.2, p = 0.004), mono-unsaturated fats (11.2 vs. 11.8, p = 0.026) as a percentage of daily energy, and fibre (20.1 vs. 23.0, p = 0.003), than food-secure adults. Sub-optimal diet may be one of the contributing factors to, or outcomes of, poorer health in food-insecure populations. Food security interventions are required to better address nutrition in food-insecure households and should be tailored to the health and socio-demographic characteristics of this population.

Increasing food insecurity severity is associated with lower diet quality

“…In our study, nearly one in two households experienced some degree of food insecurity, and concerningly, and one in five households reported experiencing severe food Fig. 3 Proportion of respondents Australian Recommended Food Score (ARFS) scores categorised into four groups of diet quality: 'needs work' (< 33), 'getting there' (33)(34)(35)(36)(37)(38), 'excellent' (39)(40)(41)(42)(43)(44)(45)(46) or 'outstanding' (47þ) by food insecurity group insecurity which is characterised as skipping meals and experiencing hunger. Unlike other high-income countries, Australia lacks routine food insecurity measurement at national level which is one of the factors that hinders the prioritisation and implementation of effective interventions to support food-insecure Australians (37) .…”

“…In terms of the impact of food insecurity on diet quality, this study reports similar findings to both national and international research. Within Australia, a recent study by Lindberg et al ( 41 ) reported that, on average, food-insecure adults (using a binary food security variable) had a three-point lower total diet quality score (using the dietary guideline index) when compared with food-secure Australians. However, this study was unable to determine food insecurity severity as it utilised a single-item measure, which has also been shown to underestimate food insecurity ( 42 ) .…”

“…Individuals identifying as vegetarian are scored zero for meat protein subscale (out of a total of seven), and instead questions on vegetarian sources of protein are scored double points for meat alternatives, with an additional point awarded if both tofu and lentils are consumed at least once a week, such that total points equate to the same as the meat subscale. User responses were then converted into a total diet quality score (out of a maximum of 73 points) and then categorised into the following groups: 'needs work' (< 33), 'getting there' (33)(34)(35)(36)(37)(38), 'excellent' (39)(40)(41)(42)(43)(44)(45)(46), or 'outstanding' (47þ).…”

“…The unbroken line is the mean ARFS total score by food insecurity group. Broken lines represent the cut-off points for ARFS scores categorised into four groups of diet quality: 'needs work' (< 33), 'getting there'(33)(34)(35)(36)(37)(38), 'excellent'(39)(40)(41)(42)(43)(44)(45)(46) or 'outstanding' (47þ)…”

Increasing food insecurity severity is associated with lower diet quality in Australian adults

“…Food insecurity, the inadequate or insecure access to food due to financial constraints, is a growing concern in high-income countries like Australia (1) . Food insecure adults may have reduced diet quality due to constraints on food purchasing and consumption (2) but further research is needed to understand how the severity of food insecurity impacts diet quality in an Australian setting. This study aimed to examine the relationship between diet quality and increasing severity of household food insecurity using validated measurement tools.…”