Associations between cross-sectional and long-term food insecurity with dietary quality among middle-aged and older United Study adults: A Cohort Study from the Health and Retirement Study.

Background: Food insecurity impedes healthy diet adherence, but few studies, particularly longitudinal studies, have examined these associations in middle-aged and older adults.

Objectives: Using the longitudinal Health and Retirement Study (HRS), we examined the associations between cross-sectional and long-term food insecurity and diet quality among United States middle-aged and older adults.

Methods: Participants aged ≥50 at the time of initial food insecurity assessment and who completed the 2013 Health Care and Nutrition Study (HCNS) were included (cross-sectional food insecurity: n = 6783; long-term food insecurity: n = 4923). Food insecurity was assessed using the 6-item United States Department of Agriculture Food Security Survey Module in 2013. Long-term food insecurity was estimated by averaging 2 items from the 18-item Household Food Security Survey Module assessed biennially (2002-2012). Dietary intake was assessed using a food frequency questionnaire in 2013 to create 5 diet quality indices: the plant-based diet index (PDI), healthful PDI, unhealthful PDI (uPDI), Mediterranean diet index, and Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegeneration Delay (MIND) diet index. Weighted multivariate linear regression models examined the associations between food insecurity and diet quality indices.

Results: In cross-sectional analyses, very low food security was associated with higher scores on the uPDI (1.46; 95% CI: 0.45, 2.48) and low food security was associated with lower Mediterranean diet index scores (-0.69; 95% CI: -1.30, -0.09). In long-term analyses, very low food security was associated with lower scores on overall PDI (-1.15; 95% CI: -2.37, 0.08; P-trend = 0.03), Mediterranean diet index (MIND diet index) (-1.33; 95% CI: -2.24, -0.42; P-trend < 0.01), and Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegeneration Delay diet index (-0.58; 95% CI: -1.00, -0.17; P-trend < 0.01), and higher scores on the uPDI (1.92; 95% CI: 0.15, 3.69; P-trend = 0.01). Associations with health PDI (hPDI) were not significant.

Conclusions: Among adults aged 50 y or older, food insecurity, especially long-term very low food security, is adversely associated with diet quality, highlighting the need for policies to reduce food insecurity and facilitate healthy eating habits.