Moderate and severe food insecurity increases 'wear and tear' on the body

Food insecurity was associated with higher allostatic load among adults in the U.S. aged 50 years or older, according to findings published in JAMA Network Open.

“Allostatic load refers to the physiologic wear and tear that the body experiences due to chronic stress exposure and repeated activation of the adaptive stress response,” Tae-Young Pak, PhD, an assistant professor in the department of consumer science and convergence program for social innovation at Sungkyunkwan University in South Korea, and GwanSeon Kim, PhD, assistant professor in the College of Agriculture at Arkansas State University, wrote. “An emerging body of literature has documented associations between food insecurity and chronic disease in individuals at older ages, including diabetes, heart disease, hypertension, kidney disease, obesity and pulmonary disease.”

Pak and Kim assessed the association between moderate or severe food insecurity and allostatic load in a multiwave longitudinal cohort study. They used data from 2006 to 2014 from the Health and Retirement Study, which included 26,509 person-years observations among 14,394 individuals aged 50 years or older. The median age of the participants was 60 years; 56.5% were women; 66.5% of the participants were white, 17.5% were Black and 12.6% were Hispanic. They provided information on biomarkers, food insecurity, Supplemental Nutrition Assistance Program (SNAP) enrollment and covariates.

The researchers determined allostatic load by evaluating nine biomarkers that indicate dysregulation of the inflammatory, cardiovascular and metabolic systems. Allostatic load scores ranged from zero to nine, with higher scores indicating a greater risk for physiologic dysregulation. Participants were considered moderately food insecure if they reported that they did not always have enough money to buy food in the past 2 years, while those with severe food insecurity reported the same experience in addition to eating less than they felt they should in the past year due to financial struggles.

Overall, 3.6% of participants were moderately food insecure and 5.6% were severely food insecure during the study period, according to Pak and Kim. Also, 7.2% were SNAP beneficiaries.

The incidence rate of allostatic load was 1.05 (95% CI, 1.00-1.09) times higher among participants with moderate food insecurity and 1.11 (95% CI, 1.07-1.15) times higher among participants with severe food insecurity compared with those who were food secure. Specifically, allostatic load was associated with a 5% and 11% increase among moderately and severely food insecure participants.

However, the results further showed that the association between a higher allostatic load and food insecurity was attenuated if the participants were SNAP beneficiaries. The researchers estimated that SNAP enrollment decreased the incidence rate of allostatic load by 0.09 (95% CI, -0.17 to -0.01) among severe food insecure participants and 0.18 (95% CI, -0.29 to -0.07) among moderately food insecure participants. However, the increased incidence rate of allostatic load among severely food insecure participants was associated with C-reactive protein level (OR = 1.22; 95% CI, 1.04-1.44), cystatin C level (OR = 1.23; 95% CI, 1.01-1.51), hemoglobin A1c level (OR = 1.27; 95% CI, 1.01-1.59), BMI (OR = 1.84; 95% CI, 1.41-2.40), waist-to-height ratio (OR = 1.54; 95% CI, 1.26-1.88) and total to high-density lipoprotein cholesterol ratio (OR = 1.32; 95% CI, 1.10-1.59) that were “inflated to the high-risk range,” according to Pak and Kim. The higher level of C-reactive protein indicates that food insecurity is associated with inflammation and reduced immune function, they noted.

The researchers added that the significant interaction between SNAP enrollment and food insecurity suggests “that SNAP may protect against the adverse health outcomes noted with food insecurity increasing allostatic load.”