Food insecurity, described as limited access to nutritionally adequate and safe foods due to financial constraints, is a significant barrier to maintaining good health. In 2018, 7.3 million older Americans were food insecure, accounting for 10% of those aged 60 and up in the United States.

One-third of people who are food insecure have various signs of disrupted eating patterns and lower food intake, which is linked to poor health and increased rates of healthcare expenditure.

Food insecurity has been more prevalent in racial and ethnic minority groups, older people with disabilities, low-income households, and those infected with COVID-19 are more likely to be food insecure now than they were a few years ago.

A growing body of research has found links between food insecurity and chronic disease in older people, including diabetes, heart disease, hypertension, renal disease, obesity, and pulmonary disease. According to studies, food-insecure older individuals in the United States and Canada have a higher mortality risk and a shorter life span than their food-secure counterparts.

Despite ample evidence of its negative health repercussions, little is understood about the mechanisms by which food insecurity leads to poor health outcomes. Food instability is hypothesized to cause people to replace healthy diets with low-cost, high-calorie meals, hence increasing visceral fat accumulation and obesity-related chronic illnesses.

Furthermore, recurrent episodes of hunger have been proven to increase vulnerability to infection or the likelihood of peripheral insulin resistance (a precursor to diabetes) in those who are food insecure.

Chronic stress associated with food insecurity opens up a new physiologic pathway that leads to chronic disease: the allostatic load (AL) pathway. The physiologic wear and tear that the body undergoes as a result of chronic stress exposure and repetitive activation of the adaptive stress response is referred to as allostatic load. Chronic activation, whether in terms of length or frequency, can cause dysregulations across various physiologic systems, causing the body to lose its ability to maintain homeostasis. AL’s physiologic effects have been used to explain how socioeconomic disadvantages “get under the skin” as a chronic illness.

A study of Puerto Rican people aged 45 to 75 years discovered a link between food insecurity and AL, which was mediated by dysregulations in the neuroendocrine and inflammatory systems.

The goal of this study was to look at the relationship between food insecurity and AL using data from a national cohort study of US people aged 50 and up. Using data from the Health and Retirement Study (HRS), the team looked at the inflammatory (C-reactive protein), cardiovascular (systolic and diastolic blood pressure, pulse rate, and cystatin C), and metabolic (hemoglobin A1c [HbA1c,] body mass index, waist-to-height ratio, total cholesterol to high-density lipoprotein cholesterol ratio) systems.  

Furthermore, they examined the hypothesis that participation in the Supplemental Nutrition Assistance Program (SNAP) may assist to mitigate the relationship between food insecurity and AL. By employing a longitudinal study design and offering generalizable data on how food insecurity may be associated with an elevated risk of chronic disease, this study improves on previous research.

The median age of the 14,394 participants in the study was 60 (IQR, 56-69) years, 8143 (56.6 percent) were women, 517 (3.6 percent) were moderately food insecure, and 804 (5.6 percent) were severely food insecure. In adjusted models, the incidence rate of AL was 1.05 (95 percent CI, 1.00-1.09) times higher for participants with moderate food insecurity and 1.11 (95 percent CI, 1.07-1.15) times higher for those with severe food insecurity as compared to those who were food secure.

The increased incidence of AL was associated with a high C-reactive protein level (OR, 1.22; 95 percent confidence interval [CI], 1.04-1.44), a high cystatin C level (OR, 1.23; 95 percent CI, 1.01-1.51), a high hemoglobin A1c level (OR, 1.27; 95 percent CI, 1.01-1.59), a high body mass index (OR, 1.84; 95 percent CI, 1.41-2.40), a The interaction between moderate food insecurity and SNAP enrollment ( = 0.18; P =.001) and the interaction between severe food insecurity and SNAP enrollment ( = 0.09; P =.02) were both associated with a decrease in AL.

Conclusion

Food insecurity was linked to greater AL in this national cohort study of US adults aged 50 and up, mostly through dysregulation of the inflammatory and metabolic systems. SNAP membership may alter the relationship between food insecurity and AL.

Source: JAMA Network Open

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