Table 1.
Summary of research on food insecurity and cardiovascular disease among US adults during 2010–2020*
| Reference | Population | Data source | Design | Outcome measures | Key findings |
|---|---|---|---|---|---|
| Ford et al. [29] | 10455 US adults aged ≥ 20 years | NHANES (2003–2008) | Cross-sectional, random sample | Food security (USDA 10-item HFSSM); 10-year CVD risk (calculated based on algorithm derived from Framingham data); diabetes, hypertension, dyslipidemia, C-reactive protein, urinary albumin-creatinine ratio (measured by biomarkers) |
• No significant association between food security status and 10-year CVD risk > 20% (p = 0.14). However, stratified analysis showed increased predicted 10-year CVD risk > 20% among VLFS participants aged 30–59 years compared with FS participants (adjusted prevalence ratio = 2.38, 95% CI 1.31–4.31, p = 0.03), but not among older adults aged 60–74 years (p = 0.43) • Food security status was significantly associated with several risk factors, including hemoglobin A1c ≥ 6.5% (p = 0.01), hypertension (p = 0.004), low high-density lipoprotein cholesterol (p = 0.002), BMI ≥ 30 kg/m2 (p = 0.03), current smoking (p < 0.001), cotinine > 10 ng/ml (p < 0.001), C-reactive protein >3 mg/l (p = 0.002), and urinary albumin-creatinine ratio ≥ 30 mg/g (p = 0.01) • Prevalence of food insecurity: HFS (83.9%), MFS (6.7%), LFS (5.8 %), VLFS (3.6%) |
| Gregory et al. [30••] | 41,854 working-age US adults (age 19-64 years) living ≤200% FPL | National Health Interview Survey (2011–2015) | Cross-sectional, random sample | Food security (10-item questionnaire); hypertension, CHD, hepatitis, stroke, cancer, asthma, diabetes, arthritis, chronic obstructive pulmonary disease, and kidney disease (self-reported) |
• As food insecurity worsens, the likelihood of having hypertension (MFS, β = 0.23, p < 0.01; LFS, β = 0.35, p < 0.01; VLFS, β = 0.64, p < 0.01), CHD (MFS, β = 0.35, p < 0.01; LFS, β = 0.43, p < 0.01; VLFS, β = 0.76, p < 0.01), stroke (LFS, β = 0.52, p < 0.01; VLFS, β = 0.78, p < 0.01), and diabetes (MFS, β = 0.25, p < 0.01; LFS, β = 0.36, p < 0.01; VLFS, β = 0.58, p < 0.01) increased relative to those in HFS households • Tests for difference between MFS and LFS was significant for stroke, number of chronic conditions, and self-assessed health (p < 0.05, respectively). Tests for difference between LFS and VLFS was significant for hypertension, CHD, stroke, diabetes, number of chronic conditions, and self-assessed health (p < 0.05, respectively). Tests for difference between MFS and VLFS were significant for hypertension, CHD, stroke, diabetes, number of chronic conditions, and self-assessed health (p < 0.01, respectively) • Covariates significantly associated with CHD and/or stroke included sex, age, race/ethnicity, education, employment, having insurance, household income-to-poverty ratio • Prevalence of food insecurity was not reported |
| Shiue et al. [35] | 4979 US adults aged ≥ 20 years | NHANES (2005–2006) | Cross-sectional, random sample | Food security (USDA 18-item HFSSM); heart failure, and other health outcomes (self-reported) |
• Household food security was not associated with heart failure, coronary heart disease, angina, heart attack, or stroke (p > 0.05) • Prevalence of food insecurity: HFS (77.9%), MFS (9.5%), LFS and VLFS combined (12.7 %) |
| Vercammen et al. [39] | 13,518 US adults aged 20–64 years | NHANES (2007–2014) | Cross-sectional, random sample | Food security (USDA 18-item HFSSM); calculated 10-year CVD risk (pooled cohort equations); BMI, waist circumference, blood pressure (physical exam); cholesterol, blood glucose (fasting metabolic panel) |
• VLFS adults had significantly greater odds of excess predicted CVD risk (≥ 20%) compared with food secure adults (OR = 2.36, 95% CI 1.25, 4.46) • Adults reduced food security had higher odds of current smoking (MFS, OR = 1.43, 95% CI 1.17, 1.75; LFS, OR = 1.47, 95% CI 1.22, 1.77; VLFS, OR = 1.95, 95% CI 1.60, 2.37) compared with FS adults • Prevalence of food insecurity: HFS (75.4%), MFS (9.9%), LFS (8.2%), VLFS (6.5%) |
| Palakshappa et al. [32] | 9203 US adults aged ≥ 20 years living with obesity | NHANES (2007–2014) | Cross-sectional, random sample | Food security (USDA 10-item HFSSM); CVD outcomes (self-reported); other disease outcomes (self-reported or measured) |
• Food insecurity (β = 0.09, 95% CI 0.02–0.15, p = 0.01) and VLFS (β = 0.17, 95% CI 0.07–0.28, p = 0.003) were associated with an increased number of obesity-related comorbidities. In secondary analyses, food insecurity was associated with increased odds of coronary artery disease (OR = 1.5, 95% CI 1.1–2.0), and the increased odds was primarily seen among VLFS adults (OR = 2.0, 95% CI 1.3–3.0) • Prevalence of food insecurity: LFS (9%), VLFS (6.6%) |
| Smith et al. [36] | 15499 working-age low-income immigrant adults (aged 18–64 years) living ≤ 300% FPL | NHANES (2011–2015) | Cross-sectional, random sample | Food security (USDA 10-item HFSSM); CHD, angina pectoris, heart attack, obesity (self-reported), self-rated poor health (self-reported) |
• Both food insecurity and acculturation are strongly associated with CHD and related health outcomes. Food insecurity is associated with 57% higher odds of being diagnosed with CHD (p < 0.01), 81% higher odds of angina pectoris (p < 0.01), and more than doubled odds of heart attack (p < 0.01) • For all three heart outcomes, the relationship with food insecurity is stronger for women and not significant for men (p < 0.01) • LFS and VLFS are associated with CHD (β = 1.8, p < 0.01; β = 1.5, p < 0.1), angina pectoris (β = 2.0, p < 0.01; β = 2.5, p < 0.01), heart attack (β = 2.2, p < 0.01; β = 1.8, p < 0.05), self-reported poor health (β = 2.6, p < 0.01; β = 4.8, p < 0.01), and obesity (β = 1.3, p < 0.01; β = 1.3, p < 0.01). Food insecurity is associated more strongly with CHD and related outcomes for immigrants in the USA for < 5 years or those ≥ 15 years, than those for 5–14 years (p = 0.014) • Prevalence of food insecurity: 20.6% |
| Venci et al. [38] | 30,010 US adults aged ≥ 18 years | National Health Interview Survey 2011 | Cross-sectional, random sample | Food security (USDA 10-item HFSSM); functional limitation, coronary heart disease and other chronic diseases (self-reported) |
• VLFS adults had higher odds for coronary heart disease (OR = 1.75, 95% CI 1.37–2.24), heart attack (OR = 1.40, 95% CI 1.08–1.81), hypertension (OR = 1.42, 95% CI 1.22–1.65), inflammatory disease or joint/muscular pain (OR = 1.74; 95% CI 1.49–2.04), and diabetes (OR = 1.23, 95% CI 1.02–1.48) compared with FS adults • LFS adults had higher odds for functional limitation (OR = 1.87, 95% CI 1.63–2.14), hypertension (OR = 1.18, 95% CI 1.04–1.35), inflammatory diseases or joint/muscular pain (OR = 1.42, 95% CI 1.21–1.68), and diabetes (OR = 1.26, 95% CI 1.06–1.51) when compared with FS adults • Prevalence of food insecurity: LFS (7.4%), VLFS (5.8%) |
| Banerjee et al. [27] | 9245 US adults aged ≥ 20 years, living below the 130% FPL | Participants were followed for mortality through 2011 using probabilistic matching between NHANES (1999–2010) and National Death Index death certificate records | Longitudinal, random sample | Food security (USDA 10-item HFSSM); cardiorenal syndrome (CVD was self-reported; chronic kidney disease was confirmed by a glomerular filtration rate < 60 ml/min per 1.73 m2 or a urine albumin-to-creatinine ratio < 30) |
• Food insecurity was associated with 28% higher mortality rate than food secure individuals • The adjusted HR was 2.81 (95% CI 1.57–5.05, p < 0.001) among food insecure individuals with cardiorenal syndrome, while the adjusted HR was 2.48 (95% CI 1.73–3.55, p < 0.001) among food secure individuals with cardiorenal syndrome, after controlling for obesity and diabetes status, gender, age, education level, and ethnicity • Prevalence of food insecurity: 37.8% |
| Fanelli Kuczmarski et al. [28] | 2066 US adults aged 30–64 years from urban Baltimore neighborhoods |
Healthy Aging in Neighborhoods of Diversity across the Life Span Study (wave 4) |
Cross-sectional, convenience sample | Food security (1-item question); 10-year atherosclerotic CVD risk (calculated using pooled cohort equations); mean adequacy ratio, DASH score, count, evenness, dissimilarity (calculated using the average of two 24-h recall intakes) |
• Being food secure was associated with higher 10-year atherosclerotic CVD risk (p < 0.001) • A micronutrient-rich diet assessed by the mean adequacy ratio was associated with lower atherosclerotic CVD risk (p < 0.001). Greater dissimilarity among foods (p < 0.04) and lower count (p < 0.03), but not DASH score, were associated with lower atherosclerotic CVD risk • Prevalence of food insecurity: 25.9% |
| Liu et al. [31] | 270 US adults aged 21–80 years recruited from food pantries in central Indiana | Food Finders Food Bank, West Lafayette, Indiana | Cross-sectional, convenience sample | Food security (USDA 18-item HFSSM); CVD and other disease outcomes (self-reported) |
• Household food insecurity was associated with higher odds of reporting heart disease (age- and sex-adjusted OR = 2.65; 95% CI 1.05–6.69) compared with household food security • Prevalence of food insecurity: 79% |
| Redmond et al. [33] | 2027 seniors (aged ≥ 60 years) with peripheral arterial disease | NHANES (1999–2004) | Cross-sectional, random sample | Food security (USDA 10-item HFSSM); peripheral arterial disease (ankle brachial index score ≤ 90); other chronic diseases (self-reported) |
• Food insecure seniors had increased odds of having peripheral arterial disease (OR = 1.50, 95% CI 1.11–2.03) • Prevalence of food insecurity: 22.1% |
| Saiz et al. [34] | 2935 adults aged 21–74 years | Survey of the Health of Wisconsin (2008––2014 wave) | Cross-sectional, representative sample of Wisconsin residents | Food security (1-item question); cardiovascular health (self-reported, American Heart Association Life’s Simple 7 criteria) |
• Food insecurity was associated with a decreased likelihood of good cardiovascular health (OR = 0.53, 95% CI 0.31 to 0.92, p = 0.02) • Prevalence of food insecurity: 12% |
| Vaccaro et al. [37] | 3871 US adults aged ≥ 55 years | NHANES (2011–2014) | Cross-sectional, random sample | Food security (USDA 10-item HFSSM); CVD, cancer, diabetes, lung diseases (self-reported) |
• No significant association was observed between food insecurity and CVD (p = 0.48). But adults living in poverty had greater odds of CVD (OR = 1.56, 95% CI 1.10–2.20) compared with those living above the poverty level • Prevalence of food insecurity: 13% |
| Wang et al. [40] | US adults aged 20–64 years from 3142 counties across 50 states and Washington D.C. (2011–2017) | National Center for Health Statistics; Map the Meal Gap project | Ecological design (county-level longitudinal analysis) | Annual county-level food security rate (estimated by the Map the Meal Gap project using state-level food security data measured by the 18-item USDA HFSSM in the current population survey); annual county-level age-adjusted cardiovascular mortality rate (calculated using data from the National Center for Health Statistics) |
• An estimated 1% point increase in food insecurity was associated with a 0.83% (95% CI 0.43–1.25%, p < 0.001) increase in age-adjusted cardiovascular mortality. In stratified analysis by baseline food insecurity quartiles, this association was only significant in the third (0.92%, 95% CI 0.03–1.82%, p = 0.04) and fourth quartiles (0.76%, 95% CI 0.23–1.31%, p = 0.01) • Prevalence of food insecurity: not reported |
*NHANES National Health and Nutrition Examination Survey, USDA United States Department of Agriculture, HFSSM Household Food Security Survey Module, CVD cardiovascular disease, CHD coronary heart disease, BMI body mass index, HFS high food security, MFS marginal food security, LFS low food security, VLFS very low food security, FPL federal poverty level, DASH Dietary Approaches to Stop Hypertension