Obesity as a potential mediator of the association between food insecurity and diabetes among participants of the HRS survey in the USA, 2013-2016.

Introduction: Prior studies have shown that food insecurity is associated with diabetes. The underlying mechanisms for this relationship are complicated. Though obesity is a risk factor for both food insecurity and diabetes, there is a paucity of data on its role as a potential mediator of the relationship between food insecurity and diabetes. This study examined the association between food insecurity and diabetes with obesity as a potential mediator using data from the Health and Retirement Survey.
Methods: This study included 2,253 adults aged 51 years and older from the Health and Retirement Study. The outcome of interest was diabetes, the exposure was food insecurity, and the mediating variable was obesity. Causal mediation analysis was performed to evaluate the mediating effect of obesity in the association between food insecurity and diabetes. All models were adjusted for age, race, gender, alcohol consumption, health insurance, and the total years of education.

Results: The mean age of the participants was 65.78 years. The majority were females (59.92%) and white people (72.30%). After adjusting for potential confounders, food insecurity was significantly associated with diabetes (aOR: 1.68, 95% CI: 1.14-2.49). The association between food insecurity and diabetes was significantly mediated by obesity (ORNIE: 1.05, 95% CI: 1.01,1.10), and the proportion mediated was 10.57%. The natural direct effect of food insecurity on diabetes was 1.81 (95% CI: 1.11, 2.51)

Conclusion: Obesity mediates some part of the association between food insecurity and diabetes and is important in establishing the mechanism that links food insecurity to diabetes.