Food Insecurity May Increase Risk for Prediabetes in US Adolescents

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Researchers explored the association between food insecurity and the risk for obesity and prediabetes in adolescents and young adults.

Food insecurity is associated with an increased risk for elevated blood pressure and prediabetes, according to study results published in Metabolic Syndrome and Related Disorders.

The goal of the study was to explore the association between food insecurity and obesity and prediabetes risk in adolescents and young adults in the United States. The researchers also assessed the effect of participation in the Supplemental Nutrition Assistance Program (SNAP) in this population.

Cross-sectional data from a nationally representative sample of US adolescents and young adults participating in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2014 were used for this study. Food security was assessed using the US Department of Agriculture 18-item household food security questionnaire. The food security questionnaire was administered to participants with a household income-to-poverty ratio <5.0. Information about participation in SNAP was self-reported.

Complete data were available from 2662 individuals (aged 12-19 years; 52% male), including 1977 (81.6%) food-secure patients and 685 (18.4%) food-insecure patients.

Percentage of food insecurity was higher in Hispanic and black adolescents (P <.0001), in patients with household income-to-poverty ratio <1.0 vs 2.0 to 3.0 (P <.0001), and in individuals with parental education up to a high school level vs higher education (P <.0001).

Food-insecure adolescents had significantly higher hemoglobin A1c (5.21% vs 5.16%; P =.03) and increased odds of elevated blood pressure (adjusted odds ratio [aOR], 1.65; 95% CI, 1.38-1.98) and prediabetes/diabetes (aOR, 1.96; 95% CI, 1.17-3.19). Of note, food-insecure adolescents did not have a higher body mass index z score or increased overall odds of metabolic syndrome, being either overweight or obese, or being obese.

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Food-secure adolescents who used SNAP had a higher BMI z score (0.80 vs 0.59; P =.03) and fasting glucose measurements (93.95 vs 92.83 mg/dL; P =.005) compared with adolescents who did not use SNAP, corresponding to increased odds for being overweight/obese (aOR, 1.63; 95% CI, 1.11-2.40) and having prediabetes/diabetes (aOR, 5.29; 95% CI, 1.73-16.13). In addition, the researchers reported a potential trend toward higher hemoglobin A1c in SNAP users vs nonusers (P =.05). Anthropometric and laboratory measures did not differ significantly in food-insecure individuals who participated vs did not participate in SNAP.

The study had several limitations, including the cross-sectional NHANES design, lack of consistent assessment of physical activity, and the fact that a large number of patients did not answer questions regarding SNAP usage.

“Ongoing efforts are still needed toward food assistance as important public health efforts aimed at mitigating the adverse outcomes related to food insecurity,” wrote the researchers.

“We want to emphasize that our study does not identify SNAP as a driver of adverse health associations… Our data showing SNAP associated with increased odds of prediabetes/diabetes and overweight/obesity in food-secure children suggest that there exists room for improvement within SNAP,” they added.

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Lee AM, Scharf RJ, Filipp SL, Gurka MJ, DeBoer MD. Food insecurity is associated with prediabetes risk among U.S. adolescents, NHANES 2003-2014. Metab Syndr Relat Disord. 2019;17(7):347-354.