Food Insecurity Is Associated With Lower Diet Quality Among Hispanic/Latinos at High Risk for Type 2 Diabetes Mellitus

Abstract

Background: Food insecurity has been associated with poor diet quality and increased diet-related chronic disease risk. Among racially and ethnically minoritized populations in the U.S., Hispanic/Latinos experience food insecurity twice as often, have overall lower diet quality, and are more likely to be diagnosed with type 2 diabetes mellitus (T2DM) compared with individuals identifying as non-Hispanic White. Understanding the direction, magnitude, and clinical significance of the association between food insecurity and diet quality will aid in designing culturally-responsive food-based nutrition interventions to improve diet quality, food security, and diabetes management for this population.Objective: To examine the association between diet quality and food insecurity, and the modifying effect of obesity on this association, among Hispanic/Latinos at high risk of, or with, T2DM. Methods: El Banco por Salud is a biobank comprised of predominantly self-reported Hispanic/Latino adults. Eighty-six individuals completed the U.S. Household Food Security Survey (18-item questionnaire) and at least one 24-hour dietary recall. Dietary quality was assessed using Healthy Eating Index (HEI-2015) scores. Linear regression models were used to examine the association between household food insecurity status and HEI-2015 scores. Models were adjusted for sociodemographic and health covariates. Results: Of the 86 participants, 76.7% were female and 44.2% had T2DM. Mean (SD) age and BMI were 47.3 years (13.0) and 33.1 kg/m2 (7.4), respectively. Average HEI-2015 score was 55.7 (14.1) (out of 100). In fully adjusted models, participants from households with food insecurity had significantly lower diet quality compared to participants from food secure households (Coefficient: -7.57, CI: -13.17, -1.97, p=0.009). Individuals from a food insecure household who had a BMI ≥30 experienced a substantially lower diet quality score compared with food secure individuals with a BMI<30 (Coefficient: -12.22, CI: -19.46, -4.99, p-interaction: 0.001). Conclusions: Food insecurity was associated with lower overall diet quality among Hispanic/Latino biobank participants at high risk of, or with, T2DM. Future studies should include food-based nutrition interventions to collectively address diet quality, food insecurity, and T2DM management for this population.