Food insecurity and dyslipidemia among adults in the United States

Abstract

Objective

The objective of this study is to estimate the likelihood of dyslipidemia among food insecure men and women.

Method

Men, n = 2572 and women, n = 2977, in the National Health and Nutrition Examination Survey 1999–2002 cholesterol screening sample were included in this study. Gender-stratified descriptive comparisons and logistic regression models were used to study associations between food insecurity and dyslipidemia indicated by abnormal levels of fasting serum triglyceride (TRG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and their ratios.

Results

Food insecurity did not associate with dyslipidemia among men. Among women, the associations between food insecurity and dyslipidemia were not consistent. Compared with the fully food secure, women who were marginally food secure were more likely to have abnormal levels of LDL-C (adjusted OR, 1.85; P = 0.045) and TRG/HDL-C ratio (adjusted OR, 1.91; P = 0.046). Women who were food insecure without hunger were more likely to have abnormal levels of TRG (adjusted OR, 1.90; P = 0.041).

Conclusion

Intermediate-level food insecurity associated with some indicators of dyslipidemia among women but not among men. This observation shows food insecure women may be at risk of dyslipidemia.

Introduction

Recent reports from food security surveys indicate that approximately 11% of adults in the United States are food insecure (Nord et al., 2007). That is, they have limited or uncertain availability of nutritionally adequate and safe food or limited or uncertain ability to acquire acceptable foods in socially acceptable ways (LSRO, 1989). Among the characteristics of food insecure persons are socio-economic deprivation and lack of access to resources, including inadequate access to health care (Seligman et al., 2007). Thus, many food insecure persons may not be aware of underlying disease conditions (Seligman et al., 2007, Kushel et al., 2006). An important risk factor for cardiovascular disease (CVD) is abnormal levels of serum lipids, termed dyslipidemia (National Cholesterol Education Program (NCEP), 2007, American Heart Association (AHA), 2004, Patt et al., 2003, Aronne and Segal, 2002). Dyslipidemia indicated by abnormal levels of serum triglyceride (TRG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) are known risk factors for CVD (NCEP, 2007).

Studies on the associations between food insecurity and factors predisposing to CVD, including dyslipidemia are scarce. Significant associations between food insufficiency and physician-diagnosed self-reported chronic conditions, including heart disease, have been reported among Canadians (Vozoris and Tarasuk, 2003). In one study, food insufficiency did not associate with TC concentration but associated with decreased concentration of HDL-C among older adults (Dixon et al., 1994). A study of the associations between food insecurity and risk of CVD using objective measures and multiple indicators such as concentrations of many related serum lipids will help elucidate associations. It is estimated that coronary heart disease morbidity and mortality could be decreased by 25–35% by treating and alleviating the effects of dyslipidemia (Ballantyne et al., 2000, Jacobson et al., 1998).

Food insecurity associates with poor diet (Dixon et al., 1994, Rose, 2000) and overweight and obesity (Wilde and Peterman, 2006, Adams et al., 2003) which are independent risk factors for CVD (American Heart Association (AHA), 2004, Eckel and Krauss, 1998). Due to its associations with overweight and obesity, and poor dietary habits, it is tempting to assume that food insecurity would associate with risk factors of CVD such as dyslipidemia. This study estimated the likelihood of dyslipidemia among food insecure men and women by examining levels of fasting serum HDL-C, LDL-C, TC and TRG as well as LDL/HDL-C, TC/HDL-C and TRG/HDL-C ratios.