Pathways by Which Food Insecurity Is Associated With Atherosclerotic Cardiovascular Disease Risk

Background Food insecurity (FI) has been associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk; however, the pathways by which FI leads to worse cardiovascular health are unknown. We tested the hypothesis that FI is associated with ASCVD risk through nutritional/anthropome...

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Autores principales:	Deepak Palakshappa, Edward H. Ip, Seth A. Berkowitz, Alain G. Bertoni, Kristie L. Foley, David P. Miller, Mara Z. Vitolins, Gary E. Rosenthal
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	atherosclerotic cardiovascular disease food insecurity social determinants of health Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/64d3dcfecc7a48558adece498e2bad89
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spelling	oai:doaj.org-article:64d3dcfecc7a48558adece498e2bad892021-11-16T10:22:43ZPathways by Which Food Insecurity Is Associated With Atherosclerotic Cardiovascular Disease Risk10.1161/JAHA.121.0219012047-9980https://doaj.org/article/64d3dcfecc7a48558adece498e2bad892021-11-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.021901https://doaj.org/toc/2047-9980Background Food insecurity (FI) has been associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk; however, the pathways by which FI leads to worse cardiovascular health are unknown. We tested the hypothesis that FI is associated with ASCVD risk through nutritional/anthropometric (eg, worse diet quality and increased weight), psychological/mental health (eg, increased depressive symptoms and risk of substance abuse), and access to care pathways. Methods and Results We conducted a cross‐sectional study of adults (aged 40–79 years) using the 2007 to 2016 National Health and Nutrition Examination Survey. Our primary exposure was household FI, and our outcome was 10‐year ASCVD risk categorized as low (<5%), borderline (≥5% –<7.5%), intermediate (≥7.5%–<20%), and high risk (≥20%). We used structural equation modeling to evaluate the pathways and multiple mediation analysis to determine direct and indirect effects. Of the 12 429 participants, 2231 (18.0%) reported living in a food‐insecure household; 5326 (42.9%) had a low ASCVD risk score, 1402 (11.3%) borderline, 3606 (29.0%) intermediate, and 2095 (16.9%) had a high‐risk score. In structural models, we found significant path coefficients between FI and the nutrition/anthropometric (β, 0.130; SE, 0.027; P<0.001), psychological/mental health (β, 0.612; SE, 0.043; P<0.001), and access to care (β, 0.110; SE, 0.036; P=0.002) pathways. We did not find a significant direct effect of FI on ASCVD risk, and the nutrition, psychological, and access to care pathways accounted for 31.6%, 43.9%, and 15.8% of the association, respectively. Conclusions We found that the association between FI and ASCVD risk category was mediated through the nutrition/anthropometric, psychological/mental health, and access to care pathways. Interventions that address all 3 pathways may be needed to mitigate the negative impact of FI on cardiovascular disease.Deepak PalakshappaEdward H. IpSeth A. BerkowitzAlain G. BertoniKristie L. FoleyDavid P. MillerMara Z. VitolinsGary E. RosenthalWileyarticleatherosclerotic cardiovascular diseasefood insecuritysocial determinants of healthDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 22 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	atherosclerotic cardiovascular disease food insecurity social determinants of health Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	atherosclerotic cardiovascular disease food insecurity social determinants of health Diseases of the circulatory (Cardiovascular) system RC666-701 Deepak Palakshappa Edward H. Ip Seth A. Berkowitz Alain G. Bertoni Kristie L. Foley David P. Miller Mara Z. Vitolins Gary E. Rosenthal Pathways by Which Food Insecurity Is Associated With Atherosclerotic Cardiovascular Disease Risk
description	Background Food insecurity (FI) has been associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk; however, the pathways by which FI leads to worse cardiovascular health are unknown. We tested the hypothesis that FI is associated with ASCVD risk through nutritional/anthropometric (eg, worse diet quality and increased weight), psychological/mental health (eg, increased depressive symptoms and risk of substance abuse), and access to care pathways. Methods and Results We conducted a cross‐sectional study of adults (aged 40–79 years) using the 2007 to 2016 National Health and Nutrition Examination Survey. Our primary exposure was household FI, and our outcome was 10‐year ASCVD risk categorized as low (<5%), borderline (≥5% –<7.5%), intermediate (≥7.5%–<20%), and high risk (≥20%). We used structural equation modeling to evaluate the pathways and multiple mediation analysis to determine direct and indirect effects. Of the 12 429 participants, 2231 (18.0%) reported living in a food‐insecure household; 5326 (42.9%) had a low ASCVD risk score, 1402 (11.3%) borderline, 3606 (29.0%) intermediate, and 2095 (16.9%) had a high‐risk score. In structural models, we found significant path coefficients between FI and the nutrition/anthropometric (β, 0.130; SE, 0.027; P<0.001), psychological/mental health (β, 0.612; SE, 0.043; P<0.001), and access to care (β, 0.110; SE, 0.036; P=0.002) pathways. We did not find a significant direct effect of FI on ASCVD risk, and the nutrition, psychological, and access to care pathways accounted for 31.6%, 43.9%, and 15.8% of the association, respectively. Conclusions We found that the association between FI and ASCVD risk category was mediated through the nutrition/anthropometric, psychological/mental health, and access to care pathways. Interventions that address all 3 pathways may be needed to mitigate the negative impact of FI on cardiovascular disease.
format	article
author	Deepak Palakshappa Edward H. Ip Seth A. Berkowitz Alain G. Bertoni Kristie L. Foley David P. Miller Mara Z. Vitolins Gary E. Rosenthal
author_facet	Deepak Palakshappa Edward H. Ip Seth A. Berkowitz Alain G. Bertoni Kristie L. Foley David P. Miller Mara Z. Vitolins Gary E. Rosenthal
author_sort	Deepak Palakshappa
title	Pathways by Which Food Insecurity Is Associated With Atherosclerotic Cardiovascular Disease Risk
title_short	Pathways by Which Food Insecurity Is Associated With Atherosclerotic Cardiovascular Disease Risk
title_full	Pathways by Which Food Insecurity Is Associated With Atherosclerotic Cardiovascular Disease Risk
title_fullStr	Pathways by Which Food Insecurity Is Associated With Atherosclerotic Cardiovascular Disease Risk
title_full_unstemmed	Pathways by Which Food Insecurity Is Associated With Atherosclerotic Cardiovascular Disease Risk
title_sort	pathways by which food insecurity is associated with atherosclerotic cardiovascular disease risk
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/64d3dcfecc7a48558adece498e2bad89
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Pathways by Which Food Insecurity Is Associated With Atherosclerotic Cardiovascular Disease Risk

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