Table 4.

Associations Between SNAP Participation and Adolescent Cardiometabolic Health: NHANES 2003–2010

	Continuous measure				Clinical definitionb
Measures	Mean ± SE		Multivariate- adjustedc		n (%)		Multivariate- adjustedd
	Boys	Girls	β	95% CI	Boys	Girls	OR	95% CI
Systolic blood pressure (in mmHg)
Higher-income nonparticipants	112.7 ± 0.5	107.2 ± 0.4	Ref.		60 (3.9)	10 (2.1)	Ref.
Income-eligible nonparticipants	112.6 ± 0.7	107.0 ± 0.5	0.02	−0.13, 0.18	39 (4.8)	9 (0.8)	0.93	0.46, 1.87
SNAP participants	111.7 ± 0.6	107.2 ± 0.6	0.03	−0.14, 0.20	26 (7.3)	10 (1.1)	1.09	0.44, 2.71
Fasting triglycerides (in mg/dL)
Higher-income nonparticipants	88.1 ± 3.6	87.7 ± 4.2	Ref.		41 (9.9)	28 (11.3)	Ref.
Income-eligible nonparticipants	91.9 ± 4.3	87.3 ± 4.2	−0.02	−0.23, 0.20	31 (12.5)	22 (9.5)	1.09	0.40, 2.94
SNAP participants	92.5 ± 5.0	88.2 ± 4.6	0.10	−0.11, 0.31	23 (11.4)	19 (9.8)	1.37	0.49, 3.79
HDL cholesterol (in mg/dL)
Higher-income nonparticipants	49.0 ± 0.5	54.3 ± 0.7	Ref.		198 (23.7)	194 (25.6)	Ref.
Income-eligible nonparticipants	49.2 ± 0.7	54.4 ± 0.6	−0.03	−0.21, 0.15	166 (24.5)	175 (24.4)	1.02	0.70, 1.49
SNAP participants	49.5 ± 0.7	52.4 ± 0.7	−0.13	−0.32, 0.06	136 (28.8)	194 (31.5)	1.36f	0.86, 2.17
Fasting glucose (in mg/dL)
Higher-income nonparticipants	96.4 ± 1.0	91.7 ± 0.6	Ref.		85 (24.3)	28 (10.6)	Ref.
Income-eligible nonparticipants	96.1 ± 1.6	91.5 ± 0.7	0.12	−0.13, 0.36	66 (21.3)	33 (11.5)	0.96	0.48, 1.90
SNAP participants	96.7 ± 2.0	94.3 ± 2.1	0.29	0.04, 0.53	85 (21.4)	24 (13.0)	1.15	0.56, 2.35
Cardiometabolic risk (Z score)e
Higher-income nonparticipants	0.7 ± 0.2	−0.5 ± 0.2	Ref.		28 (7.3)	16 (6.0)	Ref.
Income-eligible nonparticipants	0.6 ± 0.2	−0.5 ± 0.2	0.20	−0.40, 0.80	19 (6.9)	16 (5.2)	1.16	0.51, 2.60
SNAP participants	0.5 ± 0.3	−0.2 ± 0.3	0.75f	0.02, 1.49	17 (7.9)	12 (4.8)	1.59	0.67, 3.77

Note: Boldface indicates statistical significance (p<0.05).

^aZ scores derived from analytic sample

^bInternational Diabetes Federation criteria used to define age-appropriate clinical cutpoints for cardiometabolic risk factors: Waist circumference ≥90th percentile or BMI-for-age ≥95th percentile and the presence of ≥2 risk factors: elevated triglycerides (≥150 mg/dL), low HDL-cholesterol (<40 mg/dL in boys, <50 mg/dL in girls), elevated blood pressure (≥130/ ≥85 mmHg), and elevated fasting glucose (≥100 mg/dL).

^cMultivariate linear regression models were fit for continuous measures converted to Z scores and adjusted for adolescent’s age, adolescent’s gender, adolescent’s race/ethnicity, parental birth place, parental educational attainment, parental marital status, household size, household income, household WIC participation, and household food insecurity.

^dMultivariate logistic regression models adjusted for adolescent’s age, adolescent’s gender, adolescent’s race/ethnicity, parental birth place, parental educational attainment, parental marital status, household size, household income, household WIC participation, and household food insecurity.

^eAs a continuous outcome, cardiometabolic risk was defined as the summation of the systolic blood pressure, fasting triglycerides, HDL cholesterol (inverse), and fasting glucose Z scores, with a higher score denoting higher cardiometabolic risk. As a dichotomous outcome, the metabolic syndrome was defined as waist circumference ≥90th percentile or BMI-for-age ≥95th percentile, and the presence of adverse levels of ≥2 risk factors.

^fp<0.05 comparing SNAP participants to income-eligible nonparticipants.

SNAP, Supplemental Nutrition Assistance Program, NHANES, National Health and Nutrition Examination Survey; HDL, high-density lipoprotein; WIC, Special Supplemental Nutrition Program for Women, Infants and Children