@article {13852, title = {Food insecurity, inflammation, and immune function among older US adults: Findings from the health and Retirement study.}, journal = {Brain, Behavior, and Immunity}, volume = {119}, year = {Forthcoming}, pages = {28-35}, abstract = {

BACKGROUND: Food insecurity (FI) is a pressing public health concern among older adults and has been associated with adverse cardiovascular outcomes. Greater systemic inflammation may provide a pathway to explain these associations, but few studies have examined the link between FI and markers of inflammation. Thus, the objective of the present study was to evaluate the associations between FI and multiple inflammatory and immune functioning biomarkers using a nationally representative study of US adults aged~>~50~years.

METHOD: Participants (n~=~3,924) were drawn from the longitudinal Health and Retirement Study (HRS). Household FI was assessed using the six-item Short Form Food Security Survey Module from the 2013 HRS Health Care and Nutrition Study. Markers of inflammation (neutrophil-lymphocyte ratio, albumin, hs-CRP, IL6, IL10, IL-1Ra, sTNFR-1, and TGFβ-1) and immune functioning (CMV) were collected during the 2016 HRS Venous Blood Study. Multivariate logistic and linear regression models were used to evaluate associations between household FI and inflammatory and immune functioning biomarkers, adjusting for individual and household sociodemographic characteristics.

RESULTS: The weighted prevalence of FI was 18.8~\%. Age and sex-adjusted mean showed that FI was associated with higher levels of inflammation and impaired immune functioning (Ps-value~<~0.05). Older adults with FI had higher mean levels of albumin, hs-CRP, IL6, IL10, IL-1Ra, TGF{\ss}-1, and CMV seronegative and borderline (Ps-value~<~0.05). Multivariate-adjusted regression model showed that FI was associated with high-risk categories of hs-CRP (OR 1.34, 95~\% CI 1.06, 1.68), IL-6 (OR 1.66, 95~\% CI 1.28, 2.14), IL-1Ra (OR 0.67, 95~\% CI 0.48, 0.93), TGF{\ss}-1 (OR 1.87, 95~\% CI 1.45, 2.42), seronegativity for CMV (OR 0.48, 95~\% CI 0.35, 0.64).

CONCLUSION: In this nationally representative sample of older adults, FI was positively associated with multiple markers of systemic inflammation and impaired immune functioning. Public health efforts that directly work to reduce FI among older adults are warranted and may result in further improvements in their health and well-being.

}, keywords = {chronic inflammation, Food insecurity, Health and Retirement Study, immune functioning, Inflammation, Inflammatory cytokines, Older Adults}, issn = {1090-2139}, doi = {10.1016/j.bbi.2024.03.034}, author = {Aljahdali, Abeer A and Ludwig-Borycz, Elizabeth and Leung, Cindy W} } @article {13699, title = {Food Insecurity, Race and Ethnicity, and Cognitive Function Among United States Older Adults.}, journal = {The Journal of Nutrition}, volume = {154}, year = {2024}, pages = {233-242}, abstract = {

BACKGROUND: Cognitive impairment and dementia are severe public health issues in aging populations, which can be exacerbated by insufficient or unhealthy dietary intake. Food (in)security status is linked to cognitive function among older adults, but the relationship is complex and can vary by sociodemographic characteristics.

OBJECTIVE: This article aimed to investigate the association between food insecurity and cognitive function among United States older adults and explore potential variations by race and ethnicity groups.

METHODS: We prospectively examined changes in cognitive function and incidence of cognitive impairment alongside the presence of self-reported food insecurity among older adults of different racial and ethnic groups. Data were from the 2012-2018 Health and Retirement Study (HRS) and the 2013 Health Care and Nutrition Study (HCNS), including N = 6,638 United States adults aged 50 years and older. Food insecurity was measured by a self-reported United States Household Food Security Survey Module, and cognitive function was assessed by the modified version of the Telephone Interview for Cognitive Status.

RESULTS: Results showed that 17\% of United States older adults reported food insecurity in the 2013 HCNS. Compared with food secure older adults, those reporting food insecurity experienced worsened cognitive functioning over time (B = -0.63, p < .001), and they were more likely to have onset of cognitive impairment (OR= 1.46, p < .001) in the 6-y observation. Compared with non-Hispanic White older adults, being non-Hispanic Black, non-Hispanic Other, or Hispanic was associated with 2.96, 2.09, or 1.26 odds (p < .001) of cognitive impairment (2012-2018), respectively. Older adults of racial and ethnic minority groups also had higher risks of experiencing the double burden of cognitive impairment alongside food insecurity compared with non-Hispanic White older adults.

CONCLUSION: Findings underscore racial and ethnic structural disparities in food security and cognitive health in the United States aging population.

}, keywords = {Aged, Cognition, Cognitive Dysfunction, ethnicity, Food insecurity, Food Supply, Humans, Middle Aged, Minority Groups, Racial Groups, United States}, issn = {1541-6100}, doi = {10.1016/j.tjnut.2023.11.015}, author = {Wang, Haowei and El-Abbadi, Naglaa} } @article {13416, title = {Associations of Food Insecurity and Memory Function Among Middle to Older-Aged Adults in the Health and Retirement Study.}, journal = {JAMA Netw Open}, volume = {6}, year = {2023}, pages = {e2321474}, abstract = {

IMPORTANCE: Food insecurity is a leading public health issue in the US. Research on food insecurity and cognitive aging is scarce, and is mostly cross-sectional. Food insecurity status and cognition both can change over the life course, but their longitudinal relationship remains unexplored.

OBJECTIVE: To examine the longitudinal association between food insecurity and changes in memory function during a period of 18 years among middle to older-aged adults in the US.

DESIGN, SETTING, AND PARTICIPANTS: The Health and Retirement Study is an ongoing population-based cohort study of individuals aged 50 years or older. Participants with nonmissing information on their food insecurity in 1998 who contributed information on memory function at least once over the study period (1998-2016) were included. To account for time-varying confounding and censoring, marginal structural models were created, using inverse probability weighting. Data analyses were conducted between May 9 and November 30, 2022.

MAIN OUTCOMES AND MEASURES: In each biennial interview, food insecurity status (yes/no) was assessed by asking respondents whether they had enough money to buy food or ate less than they felt they should. Memory function was a composite score based on self-completed immediate and delayed word recall task of a 10-word list and proxy-assessed validated instruments.

RESULTS: The analytic sample included 12 609 respondents (mean [SD] age, 67.7 [11.0] years, 8146 [64.60\%] women, 10 277 [81.51\%] non-Hispanic White), including 11 951 food-secure and 658 food-insecure individuals in 1998. Over time, the memory function of the food-secure respondents decreased by 0.045 SD units annually (β for time, -0.045; 95\% CI, -0.046 to -0.045 SD units). The memory decline rate was faster among food-insecure respondents than food-secure respondents, although the magnitude of the coefficient was small (β for food insecurity {\texttimes} time, -0.0030; 95\% CI, -0.0062 to -0.00018 SD units), which translates to an estimated 0.67 additional (ie, excess) years of memory aging over a 10-year period for food-insecure respondents compared with food-secure respondents.

CONCLUSIONS AND RELEVANCE: In this cohort study of middle to older-aged individuals, food insecurity was associated with slightly faster memory decline, suggesting possible long-term negative cognitive function outcomes associated with exposure to food insecurity in older age.

}, keywords = {Adult, Aged, Cohort Studies, Cross-Sectional Studies, Female, Food insecurity, Food Supply, Humans, Male, Memory Disorders, Middle Aged, Retirement}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2023.21474}, author = {Lu, Peiyi and Kezios, Katrina and Jawadekar, Neal and Swift, Samuel and Vable, Anusha and Zeki Al Hazzouri, Adina} } @article {13661, title = {Food Insecurity a Dementia Risk Factor?}, year = {2023}, publisher = {Medscape}, keywords = {dementia risk, Food insecurity}, url = {https://www.medscape.com/viewarticle/998912?form=fpf}, author = {Brooks, Megan} } @article {Jordan2022.02.08.22270608, title = {Food Insecurity Among Older Adults with a History of Incarceration}, journal = {Journal of Applied Gerontology}, volume = {42}, year = {2023}, pages = {1035-1044}, abstract = {Objectives To examine the association between history of incarceration (HOI) and food insecurity (FI) among older adults.Methods This is a secondary analysis utilizing data from 12,702 respondents aged 51+ who participated in the 2012 and 2014 waves of The Health and Retirement Study. Multiple logistic regression was used to estimate the association between HOI and FI, adjusting for demographic variables using odds ratios (OR) and 95\% confidence intervals (CI).Results In our sample, 12.8\% of participants reported FI. Having a HOI increased odds of FI (OR 1.83; 95\% CI 1.52-2.21), especially among Blacks (OR 1.78; 95\% CI 1.29-2.46) and Whites (OR 2.27; 95\% CI 1.74-2.97), but not Hispanics (OR 1.11; 95\% CI 0.69-1.77) or other racial/ethnic groups (OR 1.79; 95\% CI 0.71-4.52).Discussion FI is an important issue among older adults with a HOI. Stronger linkages between formerly incarcerated older adults and existing food assistance programs are needed.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis project was funded by Michigan Center for Urban African-American Aging Center through a grant from the National Institutes of Health (grant number P30 AG015281). This analysis uses data from the Health and Retirement Study (2012 HRS Core, 2014 HRS Core, and RAND HRS Longitudinal File 2018), sponsored by the National Institute on Aging (grant number NIA U01AG009740) and conducted by the University of Michigan.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:This current study was exempt from Michigan State University IRB review (STUDY00006614).I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesAll data are available online at: https://hrsdata.isr.umich.edu/data-products/2012-hrs-core, https://hrsdata.isr.umich.edu/data-products/2014-hrs-core, and https://hrsdata.isr.umich.edu/data-products/rand-hrs-longitudinal-file-2018}, keywords = {Food insecurity, incarceration, justice involvement}, doi = {10.1177/07334648231152152}, author = {Jordan, Tamara and Rodlescia S. Sneed} } @article {13662, title = {Food Insecurity, Memory, and Dementia Among US Adults Aged 50 Years and Older.}, journal = {JAMA Network Open}, volume = {6}, year = {2023}, pages = {e2344186}, abstract = {

IMPORTANCE: Despite existing federal programs to increase access to food, food insecurity is common among US older adults. Food insecurity may affect Alzheimer disease and Alzheimer disease-related dementias via multiple mechanisms, yet there is almost no quantitative research evaluating this association.

OBJECTIVE: To examine whether food insecurity in older adults is associated with later-life cognitive outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study of US residents aged 50 years and older from the US Health and Retirement Study was restricted to respondents with food insecurity data in 2013 and cognitive outcome data between calendar years 2014 and 2018. Analyses were conducted from June 1 to September 22, 2023.

EXPOSURE: Food insecurity status in 2013 was assessed using the validated US Department of Agriculture 6-item Household Food Security Module. Respondents were classified as being food secure, low food secure, and very low food secure.

MAIN OUTCOMES AND MEASURES: Outcomes were dementia probability and memory score (standardized to 1998 units), estimated biennially between 2014 and 2018 using a previously validated algorithm. Generalized estimation equations were fit for dementia risk and linear mixed-effects models for memory score, taking selective attrition into account through inverse probability of censoring weights.

RESULTS: The sample consisted of 7012 participants (18 356 person-waves); mean (SD) age was 67.7 (10.0) years, 4131 (58.9\%) were women, 1136 (16.2\%) were non-Hispanic Black, 4849 (69.2\%) were non-Hispanic White, and mean (SD) duration of schooling was 13.0 (3.0) years. Compared with food-secure older adults, experiencing low food security was associated with higher odds of dementia (odds ratio, 1.38; 95\% CI, 1.15-1.67) as was experiencing very low food security (odds ratio, 1.37; 95\% CI, 1.11-1.59). Low and very low food security was also associated with lower memory levels and faster age-related memory decline.

CONCLUSIONS AND RELEVANCE: In this cohort study of older US residents, food insecurity was associated with increased dementia risk, poorer memory function, and faster memory decline. Future studies are needed to examine whether addressing food insecurity may benefit brain health.

}, keywords = {agriculture, Algorithms, Alzheimer disease, Food insecurity, Memory Disorders}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2023.44186}, author = {Qian, Haobing and Khadka, Aayush and Martinez, Suzanna M and Singh, Sonali and Brenowitz, Willa D and Zeki Al Hazzouri, Adina and Hill-Jarrett, Tanisha G and Glymour, M Maria and Vable, Anusha M} } @article {13669, title = {Food Insecurity Tied to Dementia Risk, Memory Decline in Older Adults}, year = {2023}, publisher = {Neurology Advisor}, keywords = {Cognition, dementia risk, Food insecurity}, url = {https://www.neurologyadvisor.com/topics/alzheimers-disease-and-dementia/food-insecurity-dementia-risk-memory-decline-older-adults/}, author = {Khaja, Hibah} } @article {13319, title = {Predictors of food insecurity among older adults before and during COVID-19 in the United States.}, journal = {Front Public Health}, volume = {11}, year = {2023}, month = {=}, pages = {1112575}, abstract = {

BACKGROUND: The COVID-19 pandemic has strained the health and wellbeing of older adult populations through increased morbidity, mortality, and social exclusion. However, the impact of COVID-19 on the health of older adults through food security has received relatively little attention, despite the strong impact of diet quality on the health and longevity of older adults.

OBJECTIVE: The objective of this study was to identify sociodemographic and socioeconomic predictors of self-reported food insecurity before and early in the COVID-19 pandemic among community-dwelling older adults in the United States.

METHODS: Using longitudinal data from the Health and Retirement Study, a nationally representative sample of middle-aged and older adults in the United States, we examined the associations between sociodemographic and socioeconomic predictors of self-reported food insecurity between 2018 ( = 2,413) and June 2020 ( = 2,216) using population-weighted multivariate logistic regression models.

RESULTS: The prevalence of food insecurity doubled among participants from 2018 (4.83\%) to June 2020 (9.54\%). In 2018, non-Hispanic Black and rural residents were more likely to report food insecurity, while individuals with higher education and greater wealth were less likely to report food insecurity in adjusted models. In June 2020, those who were relatively younger, not working due to a disability, and renting were more likely to report food insecurity. Those with an increased number of functional limitations, a recent onset of a work-limiting disability, and those who were no longer homeowners experienced an elevated longitudinal risk for food insecurity.

CONCLUSION: Future research should examine effective policies and interventions to address the disproportionate impacts of COVID-19 on populations at a heightened risk of experiencing food insecurity.

}, keywords = {Aged, COVID-19, diet, Food insecurity, Food Supply, Humans, Middle Aged, Pandemics, United States}, issn = {2296-2565}, doi = {10.3389/fpubh.2023.1112575}, author = {Nicklett, Emily Joy and Cheng, Greta Jianjia and Morris, Zachary A} } @article {13634, title = {Study: Food Insecurity Associated With Increased Risk of Dementia}, year = {2023}, publisher = {Pharmacy Times}, keywords = {Dementia, Food insecurity}, url = {https://www.pharmacytimes.com/view/study-food-insecurity-associated-with-increased-risk-of-dementia}, author = {Gallagher, Ashley} } @article {https://doi.org/10.1002/aepp.13329, title = {The dynamic nature of poverty and food insecurity among older adults: Evidence from the Health and Retirement Study}, journal = {Applied Economic Perspectives and Policy}, year = {2022}, abstract = {Using data from the Health and Retirement Study, this paper examines the dynamics of food insecurity for older adults over the past two decades and how it relates to different poverty measures. The results show that the Supplemental Poverty Measure predicts the likelihood of food insecurity better than the official poverty measure. Although there is no evidence that the impact of poverty on food insecurity declines with age, we find that the discrepancy between food insecurity and poverty is greater for more recent cohorts. Beyond poverty, various demographic, economic, and health characteristics also determine food insecurity among older adults.}, keywords = {Food insecurity, Poverty}, doi = {https://doi.org/10.1002/aepp.13329}, author = {Mudrazija, Stipica and Butrica, Barbara A.} } @article {https://doi.org/10.1002/aepp.13219, title = {Food insecurity among older adults in the U.S.: The role of mortgage borrowing}, journal = {Applied Economic Perspectives and Policy}, volume = {44}, year = {2022}, pages = {549-574}, abstract = {Housing wealth is the main source of wealth for many older adults. Using the Health and Retirement Study, we assess the impact of new mortgage borrowing on food insecurity among homeowners aged 65 and older. We find a substantial short-term effect, with each additional \$10,000 borrowed, lowering food insecurity by 2.2 percentage points. In a simulation of the impact of relaxing the debt-to-income borrowing constraint, food insecurity is reduced by 2.1 percentage points for previous nonborrowers and by 1.6 percentage points for borrowers. Results support the importance of access to mortgage borrowing to reduce material hardship in older age.}, keywords = {Food insecurity, Housing wealth, mortgage borrowing}, doi = {https://doi.org/10.1002/aepp.13219}, author = {C{\"a}zilia Loibl and Rhodes, Alec P. and Stephanie Moulton and Donald Haurin and Edmunds, Chrisse} } @article {https://doi.org/10.1002/aepp.13229, title = {The long-run prevalence of food insufficiency among older Americans}, journal = {Applied Economic Perspectives and Policy}, volume = {44}, year = {2022}, pages = {575-590}, abstract = {The prevalence of food insufficiency among seniors in any given year is well-documented, but the prevalence of this hardship over a longer time period in later life is unknown. Using panel data from the Health and Retirement Study, I find that about 8\% of seniors report food insufficiency over a 2-year recall window, while 22\% experience it at some point over the two decades of their 60s and 70s. Food insufficiency is not concentrated among a small group of persistently disadvantaged elderly, but is instead a surprisingly common feature of the later life course.}, keywords = {Aging, Food insecurity, food insufficiency, hardship}, doi = {https://doi.org/10.1002/aepp.13229}, author = {Helen G Levy} } @article {13507, title = {The Long-Run Prevalence of Food Insufficiency among Older Americans.}, journal = {Applied Economic Perspectives and Policy}, volume = {44}, year = {2022}, pages = {575-590}, abstract = {

The prevalence of food insufficiency among seniors in any given year is well-documented, but the prevalence of this hardship over a longer time period in later life is unknown. Using panel data from the Health and Retirement Study, I find that about 8\% of seniors report food insufficiency over a two-year recall window, while 22\% experience it at some point over the two decades of their sixties and seventies. Food insufficiency is not concentrated among a small group of persistently disadvantaged elderly, but is instead a surprisingly common feature of the later life course.

}, keywords = {Food insecurity, food insufficiency, hardship}, issn = {2040-5790}, doi = {10.1002/aepp.13229}, author = {Helen G Levy} } @article {11834, title = {Physical Disability and Older Adults{\textquoteright} Perceived Food and Economic Insecurity During the COVID-19 Pandemic.}, journal = {The Journals of Gerontology, Series B }, volume = {77}, year = {2022}, pages = {e123-e133}, abstract = {

OBJECTIVES: We examined whether older adults with physical disability were vulnerable to three types of perceived economic insecurity (difficulty paying regular bills, difficulty paying medical bills, income loss) and two types of perceived food insecurity (economic obstacles, logistical obstacles) during the early months of the COVID-19 pandemic. We evaluated the extent to which associations are moderated by three personal characteristics (age, sex, race/ethnicity) and two pandemic-specific risk factors (job loss, COVID-19 diagnosis).

METHODS: Data are from a random 25 percent subsample of Health and Retirement Study (HRS) participants who completed a COVID-19 module introduced in June 2020. We estimated logistic regression models to predict each of five self-reported hardships during the pandemic.

RESULTS: Bivariate analyses showed that persons with three or more functional limitations were more likely to report both types of food insecurity, and difficulty paying regular and medical bills since the start of the pandemic, relative to those with no limitations. After controlling for health conditions, effects were no longer significant for paying medical bills, and attenuated yet remained statistically significant for other outcomes. Patterns did not differ significantly on the basis of the moderator variables. Job loss substantially increased the risk of economic insecurity but not food insecurity.

DISCUSSION: Older adults with more functional limitations were vulnerable to economic and food insecurity during the pandemic, potentially exacerbating the physical and emotional health threats imposed by COVID-19. Supports for older adults with disability should focus on logistical as well as financial support for ensuring their food security.

}, keywords = {COVID-19, Disability, Financial hardship, Food insecurity, Job insecurity}, issn = {1758-5368}, doi = {10.1093/geronb/gbab162}, author = {Choi, Shinae L and Deborah Carr and Namkung, Eun Ha} } @article {12295, title = {Rural-urban differences in food insecurity and associated cognitive impairment among older adults: findings from a nationally representative survey.}, journal = {BMC Geriatrics}, volume = {22}, year = {2022}, pages = {287}, abstract = {

INTRODUCTION: Due to rapid urbanization, Covid-19 pandemic and increasing food prices, a higher rate of food insecurity has been observed in recent years in India. Thus, we aim to study the prevalence of food insecurity among older Indian adults and the association of food insecurity as a modifiable risk factor with late-life cognitive impairment.

METHOD: Data for this study were obtained from the recent release of the Longitudinal Ageing Study in India (2017-18). The total sample size for the study was 31,464 older adults aged 60 years and above. Cognitive functioning was measured through five broad domains (memory, orientation, arithmetic function, executive function, and object naming) adapted from the cognitive module of the US Health and Retirement Study (HRS). Descriptive statistics along with cross-tabulation were presented in the study. Additionally, multivariable logistic regression analysis was used to fulfil the objectives of the study.

RESULTS: It was found that 7.7\% of older adults in rural areas reduced their size of meals due to unavailability (urban, 3.2\%), 41.2\% of them did not eat enough food of their choice (urban, 38.3\%), 6.9\% were hungry but did not eat food (urban, 2.6\%), 5.0\% did not eat for whole day (urban, 2.2\%), and 6.9\% lost weight due to lack of food in their household (urban, 2.9\%). It was found that older adults who did not have enough food of their choice had significantly higher odds [AOR: 1.24; CI: 1.14, 1.35] of suffering from cognitive impairment in reference to their counterparts. Similarly, the older adults who were hungry but did not eat were 30\% [AOR: 1.30; CI: 1.02, 1.73] more likely to suffer from cognitive impairment in reference to their counterparts. Interaction model revealed that older adults who had food insecurity in rural areas had higher odds of cognitive impairment than older adults who had food insecurity in urban areas.

CONCLUSION: The findings of the study highlight that the food security status in older adults may bring about greater challenges due to their limited economic resources. Interventions focusing on food security may have unintended positive impacts on late-life mental wellbeing as the older age is associated with higher cognitive deficits.

}, keywords = {Aged, Cognitive Dysfunction, COVID-19, Cross-Sectional Studies, Food insecurity, Food Supply, Humans, Pandemics}, issn = {1471-2318}, doi = {10.1186/s12877-022-02984-x}, author = {Srivastava, Shobhit and Muhammad, T} } @article {12038, title = {Association of Food Insecurity With Allostatic Load Among Older Adults in the US.}, journal = {JAMA Network Open}, volume = {4}, year = {2021}, pages = {e2137503}, abstract = {

Importance: Allostatic overload, a biomarker of wear and tear, could be the potential pathway through which food insecurity leads to increased morbidity risk.

Objective: To assess the association of food insecurity with allostatic load (AL) among US adults aged 50 years or older.

Design, Setting, and Participants: A multiwave longitudinal cohort study was conducted using data from the 2006 to 2014 waves of the Health and Retirement Study in a national cohort study setting. The data comprise 26 509 person-years observations from 14 394 noninstitutionalized individuals aged 50 years or older during the study period. Data were analyzed from September 1 to December 14, 2020.

Exposures: Moderate food insecurity (not enough money to buy the food needed) and severe food insecurity (reduced food intake due to financial constraints) measured at the household level.

Main Outcomes and Measures: The AL score (0-9, with higher scores indicating a greater risk of physiologic dysregulation) and binary indicators of dysregulated inflammatory (C-reactive protein), cardiovascular (systolic and diastolic blood pressure, pulse rate, and cystatin C), and metabolic (hemoglobin A1c, body mass index, waist-to-height ratio, total cholesterol to high-density lipoprotein cholesterol ratio) systems.

Results: Of 14 394 participants included in the analysis, the median age was 60 (IQR, 56-69) years, 8143 (56.6\%) were women, 517 (3.6\%) were moderately food insecure, and 804 (5.6\%) were severely food insecure. In adjusted models, the incidence rate of AL was 1.05 (95\% CI, 1.00-1.09) times higher for the participants with moderate food insecurity and 1.11 (95\% CI, 1.07-1.15) times higher for the participants with severe food insecurity, compared with those who were food secure. The increased incidence rate of AL among participants with severe food insecurity was associated with C-reactive protein level (odds ratio [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), body mass index (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) inflated to the high-risk range. The interaction between moderate food insecurity and Supplemental Nutrition Assistance Program (SNAP) enrollment (β = -0.18; P = .001) and the interaction between severe food insecurity and SNAP enrollment (β = -0.09; P = .02) were associated with a reduction in AL.

Conclusions and Relevance: In this national cohort study of US adults aged 50 years or older, food insecurity was associated with higher AL, mainly through dysregulation of the inflammatory and metabolic systems. SNAP enrollment may modify this association between food insecurity and AL.

}, keywords = {Allostatic load, biomarker, Food insecurity, morbidity risk}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2021.37503}, author = {Tae-Young Pak and GwanSeon Kim} } @mastersthesis {11823, title = {Exploring Food Insecurity Using Exclusion and Food Citizenship Among Adults Aged 50 Years and Older: Vulnerability, Food-related Behaviors, and the Perception of Rights and Responsibilities Around Food}, year = {2021}, school = {University of Iowa}, address = {Iowa City, IA}, keywords = {Food insecurity, food-related behaviors}, author = {Patrick Brady} } @article {CHOI2021, title = {Food Insecurity Associated with Higher COVID-19 Infection in Households with Older Adults}, journal = {Public Health}, volume = {200}, year = {2021}, pages = {7-14}, abstract = {ABSTRACT Objectives As a well-documented social determinant of health, food insecurity may be associated with COVID infection in households with older adults. We examined whether older adults were vulnerable to COVID infection during the early pandemic if they were food insecure versus food secure. Study design Cross-sectional study using a nationally representative population-based survey of US older adults. Methods We used a random subsample of Health and Retirement Study (HRS) drawn in June 2020 (N = 3,212). We compared the odds of reporting COVID infection in a household, COVID infection and mortality among acquaintances, and respondent{\^a}{\texteuro}{\texttrademark}s perceived fair or poor health across household food insecurity status resulted from financial or nonfinancial barriers. Baseline health and socioeconomic circumstances were adjusted in the models. Results Results showed higher COVID infection rate among food-insecure households than among their food-secure counterparts during the pandemic. Food insecurity due to nonfinancial obstacles was associated with greater likelihood of COVID infection both within respondents{\^a}{\texteuro}{\texttrademark} households (adjusted odds ratio [aOR] = 1.73, 95\% confidence interval [CI]: 1.03{\^a}{\texteuro}{\textquotedblleft}2.90) and among their acquaintances (aOR = 1.32, 95\% CI: 1.05{\^a}{\texteuro}{\textquotedblleft}1.65). Food insecurity caused by both nonfinancial and financial constraints was associated with twice the likelihood of knowing someone who died from COVID than their food-secure counterparts (aOR = 2.14, 95\% CI: 1.27{\^a}{\texteuro}{\textquotedblleft}3.61). Conclusions Food insecurity driven by nonfinancial constraints played an important role in the ongoing pandemic among US older adults. Policies addressing COVID need to recognize the vulnerability of food-insecure older adults beyond lack of monetary resources.}, keywords = {COVID-19, Food insecurity, Health Disparities}, issn = {0033-3506}, doi = {10.1016/j.puhe.2021.09.002}, author = {Shinae L. Choi and Fei Men} } @article {11649, title = {Patterns of Material Hardship and Food Insecurity Among Older Adults During the COVID-19 Pandemic.}, journal = {Journal of General Internal Medicine}, volume = {36}, year = {2021}, pages = {3639-3641}, abstract = {The coronavirus (COVID-19) pandemic has major economic consequences across the USA.1 Along with heightened risk for severe COVID-19,2 older adults have less digital access which may be a barrier to mobilizing supports including grocery delivery.3,4 While people with lower incomes and from racial and ethnic minoritized groups have faced high levels of material hardship due to COVID-19,1 little is known about the experience of older adults. We aim to assess the prevalence and risk factors for material hardship and food insecurity among older adults in the USA.}, keywords = {COVID-19, Food insecurity, material hardship, race}, issn = {1525-1497}, doi = {10.1007/s11606-021-06905-3}, author = {Claire K. Ankuda and Fogel, Joyce and Amy Kelley and Byhoff, Elena} } @article {11954, title = {The Relationship between Political, Economic, Social, and Cultural Vulnerability and Food Insecurity among Adults Aged 50 Years and Olde}, journal = {Nutrients}, volume = {13}, year = {2021}, pages = {3896}, abstract = {Individuals experience food insecurity when they worry about or have limited access to nutritious foods. Food insecurity negatively impacts older adults{\textquoteright} health. Social exclusion is a theoretical framework describing how unequal access to rights, resources, and capabilities results in political, economic, social, and cultural vulnerability, which leads to health disparities. We used the Health and Retirement Study to cross-sectionally examine associations between vulnerability and experiencing food insecurity in adults 50 years and older using the social exclusion framework. We tested the association between experiencing food insecurity and indicators of political, economic, social, and cultural vulnerability using logistic regression controlling for demographic and health-related factors. Analyses were performed with all respondents and sub-group of respondents with incomes less than 400\% of the federal poverty level (FPL). Assets (OR = 0.97 in both samples), income (OR = 0.85, 0.80 in 400\% FPL sub-sample), perceived positive social support from other family (OR = 0.86, 0.84 in 400\% FPL sub-sample), and perceived everyday discrimination (OR = 1.68, 1.82 in 400\% FPL sub-sample) were significantly associated with food insecurity. Perceived positive social support from spouses, children, or friends and U.S. citizenship status were not significantly associated with food insecurity. Further research is needed to define and measure each dimension of vulnerability in the social exclusion framework. Interventions and policies designed to prevent food insecurity should address these vulnerabilities}, keywords = {Food insecurity, social exclusion}, doi = {https://doi.org/10.3390/nu13113896}, author = {Patrick Brady and Askelson, Natoshia M and Ashida, Sato and Nothwehr, F. and Janssen, Brandi and Frisvold, David} } @article {BERGMANS2020113033, title = {Examining associations of food insecurity with major depression among older adults in the wake of the Great Recession}, journal = {Social Science \& Medicine}, volume = {258}, year = {2020}, abstract = {Abstract: As a psychosocial stressor, the degree to which food insecurity impacts depression may be dependent on macro-level context, which can be examined in the wake of the Great Recession. The objective of this study was to determine (1) whether food insecurity transition status (i.e. initially food insecure, becoming food insecure, and remaining food insecure vs. not food insecure) was associated with major depression in older adults, and; (2) whether this association was moderated by macrolevel context. Data came from the United States Health and Retirement Study, 2008-2016. Multivariable logistic regression across all years revealed that major depression was associated with any exposure to food insecurity, however; this association was moderated by time period. Remaining food insecure was associated with major depression during all time periods. In contrast, becoming food insecure was associated with major depression in the years during and immediately following the Recession, but not in later time periods. Findings suggest that associations of food insecurity with major depression among older adults are moderated by macro-level context, consistent with theories of social comparison and relative disadvantage. Food insecurity may represent an important risk factor for major depression and mental health disparities across socioeconomic strata among older adults. Thus, policies that increase access to food assistance programs or improve the quality of local food environments may buffer against the impact of food insecurity on depression and associated complications in old age.}, keywords = {depression, Food insecurity, Life transitions, Older Adults, Recession, relative disadvantage, social comparison, stress process}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2020.113033}, author = {Rachel S. Bergmans and Riley Wegryn-Jones} } @article {11241, title = {Food Insecurity among Older Adults in the US: The Role of Mortgage Borrowing}, year = {2019}, institution = {Joint Center for Housing Studies of Harvard University}, abstract = {As of 2016, close to 10 million older adults faced the threat of hunger in the US, constituting an urgent food policy issue. For older adults, heterogeneity in household wealth is even more important than income in predicting whether or not a household is food insecure. Yet not all wealth is equally accessible for households experiencing food hardship. Housing wealth{\textemdash}an illiquid asset{\textemdash}is the primary source of wealth for many older adults, particularly those with lower incomes. We use data for homeowners aged 62 and older from the Health and Retirement Study to identify the mechanism that links housing wealth to food insecurity. The results document the critical role of home equity as a {\textquotedblleft}protective buffer{\textquotedblright} and point to the importance of access to mortgage borrowing to reduce material hardship late in life.}, keywords = {Food insecurity, mortgage, Mortgages}, url = {https://www.jchs.harvard.edu/research-areas/working-papers/food-insecurity-among-older-adults-us-role-mortgage-borrowing}, author = {Stephanie Moulton and C{\"a}zilia Loibl and Donald Haurin and Edmunds, Chrisse} } @article {10138, title = {Food insecurity and geriatric hospitalization.}, journal = {International Journal of Environmental Research and Public Health}, volume = {16}, year = {2019}, pages = {E2294}, abstract = {Food insecurity (FI) has been associated with hospitalization, although the pathways underlying this relationship are poorly understood, in part due to the potential for a bidirectional relationship. This study aimed to determine associations of FI with concurrent and future hospitalization among older adults; mediation by depression and; whether hospitalization increased risk of FI. Participants came from the 2012 and 2014 waves of the Health and Retirement Study (HRS; = 13,664). HRS is a prospective cohort representative of U.S. adults over the age of 50. Primary analyses included those who were not hospitalized in 2012 ( = 11,776). Not having enough money to buy necessary food or eating less than desired defined food insecurity. The Composite International Diagnostic Interview Short Form provided depression symptomology. Logistic and linear regression examined concurrent and longitudinal associations of FI in 2012 and 2014 with hospitalization in 2014. Path analysis tested mediation of FI with hospitalization frequency by depression symptomology. Finally, logistic regression examined whether hospitalization in 2012 was longitudinally associated with FI in 2014. FI was not associated with future hospitalization (odds ratio (OR) = 1.1; 95\% confidence interval (CI) = 0.9-1.4), however; FI was associated with concurrent hospitalization status (OR = 1.4; 95\% CI = 1.1-1.8). Depression symptomology explained 17.4\% (95\% CI = 2.8-32.0\%) the association of FI with concurrent hospitalization frequency. Additionally, hospitalization was associated with becoming food insecure (OR = 1.5; 95\% CI = 1.2-2.0). Findings may inform best practices for hospital discharge among older adults.}, keywords = {Food insecurity, Hospitalization, Risk Factors}, issn = {1660-4601}, doi = {10.3390/ijerph16132294}, author = {Rachel S. Bergmans and Briana Mezuk and Zivin, Kara} } @article {10123, title = {Food insecurity transitions and smoking behavior among older adults who smoke.}, journal = {Preventative Medicine}, year = {2019}, abstract = {Cross-sectional data reveal that smoking cigarettes is highly prevalent among those who are food insecure. However, there is limited and conflicting evidence concerning whether causal factors may influence associations of food insecurity with smoking behavior. Additionally, temporality is a core feature of food insecurity that should be considered when examining linkages between food insecurity and health behaviors like smoking cessation. In 2019, data were extracted from waves 2012 and 2014 of the Health and Retirement Study-a representative sample of U.S. adults >=50. Analyses were limited to those who smoked cigarettes in 2012 (n = 2197). Food insecurity was assessed in 2012 and 2014 to indicate food insecurity transitions: (1) initially food insecure (food insecure in 2012 only); (2) became food insecure (food insecure in 2014 only); (3) remained food insecure (food insecure in 2012 and 2014), and; (4) not food insecure (reference group). Multivariable logistic regression examined odds of smoking cessation in 2014 due to food insecurity transition. Becoming food insecure was associated with a 2.0 (95\% confidence interval = 1.2-3.4) higher odds of smoking cessation. Employment loss or retirement (p <=0.001) and diagnosis of a new chronic condition (p = 0.038) were also associated with higher odds of smoking cessation. In older U.S. adults, smoking cessation was associated with decreased spending power and new health problems. Future studies should examine whether findings of this study may be similar among younger adults and; whether those who quit smoking due to food insecurity are more susceptible to relapse than those who quit due to other factors.}, keywords = {Food insecurity, Health Behavior, Smoking}, issn = {1096-0260}, doi = {10.1016/j.ypmed.2019.105784}, author = {Rachel S. Bergmans} } @article {10072, title = {Mental illness, not obesity status, is associated with food insecurity among the elderly in the Health and Retirement Study.}, journal = {Journal of Nutrition in Gerontology and Geriatrics}, volume = {38}, year = {2019}, pages = {149-172}, abstract = {

OBJECTIVES: Food insecurity, limited or uncertain access to adequate nutrition, is an increasingly recognized determinant of health outcomes and is often associated with having obesity. It is unclear, however, if this association persists in elderly populations.

METHODS: We conducted a cross-sectional study of 2868 participants{\textquoteright} aged 65+ years from the Health and Retirement Study. Multivariate logistic regression was used to assess associations between food insecurity and body mass index, demographic characteristics, psychiatric history, and medical history.

RESULTS: Participants with overweight/obesity had a higher prevalence of food insecurity than leaner counterparts, however, weight status was not a significant predictor of food insecurity after multivariate adjustment. Instead, mental illness, current smoking status, and non-White race were all independently associated with food insecurity.

DISCUSSION: Beyond financial status, health care providers are encouraged to use these characteristics to identify elderly patients that may be at risk of food insecurity.

}, keywords = {BMI, Depressive symptoms, Food insecurity, Mental Health}, issn = {2155-1200}, doi = {10.1080/21551197.2019.1565901}, author = {Diana P Brostow and Gunzburger, Elise and Lauren M. Abbate and Lisa A Brenner and Kali S Thomas} } @article {10199, title = {Social support and monetary resources as protective factors against food insecurity among older Americans: findings from a health and retirement study}, journal = {Food Security}, volume = {11}, year = {2019}, month = {08/2019}, pages = {929{\textendash}939}, abstract = {We examined the association between social support, monetary resources, and food insecurity among a nationally representative sample of older Americans. Analyses included 1164 Americans aged 65 and above from the 2012 Health and Retirement Study and the 2013 Health Care and Nutrition Study. Logistic regression analyses were used to estimate the likelihood of food insecurity as a function of social support (including social contact, emotional support, and social strain), monetary resources (including household income and household assets), and covariates. We found older adults with greater social strain and lower emotional support were at increased risk of food insecurity. Greater monetary resources were associated with lower risk of food insecurity. Select indicators of social support appeared to moderate the effect of monetary resources on food insecurity, with increasing social strain reducing the protective benefits of greater household assets, and low emotional support reducing the protective effect of increased household income to non-significance. Emotional support and social strain are aspects of social relationships that may play important roles in the relationship between monetary resources and food insecurity. Interventions seeking to reduce the burden of food insecurity should consider the quality and quantity of social relationships as potential risk factors.}, keywords = {Assets, Emotional support, Food insecurity, Income, Social strain}, url = {https://link.springer.com/article/10.1007/s12571-019-00945-8}, author = {Nicholas J Bishop and Wang, Kaipeng} } @article {9512, title = {Chronic disease burden predicts food insecurity among older adults.}, journal = {Public Health Nutrition}, volume = {21}, year = {2018}, pages = {1737-1742}, abstract = {

OBJECTIVE: Increased out-of-pocket health-care expenditures may exert budget pressure on low-income households that leads to food insecurity. The objective of the present study was to examine whether older adults with higher chronic disease burden are at increased risk of food insecurity.

DESIGN: Secondary analysis of the 2013 Health and Retirement Study (HRS) Health Care and Nutrition Study (HCNS) linked to the 2012 nationally representative HRS.

SETTING: USA.

SUBJECTS: Respondents of the 2013 HRS HCNS with household incomes <300 \% of the federal poverty line (n 3552). Chronic disease burden was categorized by number of concurrent chronic conditions (0-1, 2-4, >=5 conditions), with multiple chronic conditions (MCC) defined as >=2 conditions.

RESULTS: The prevalence of food insecurity was 27{\textperiodcentered}8 \%. Compared with those having 0-1 conditions, respondents with MCC were significantly more likely to report food insecurity, with the adjusted odds ratio for those with 2-4 conditions being 2{\textperiodcentered}12 (95 \% CI 1{\textperiodcentered}45, 3{\textperiodcentered}09) and for those with >=5 conditions being 3{\textperiodcentered}64 (95 \% CI 2{\textperiodcentered}47, 5{\textperiodcentered}37).

CONCLUSIONS: A heavy chronic disease burden likely exerts substantial pressure on the household budgets of older adults, creating an increased risk for food insecurity. Given the high prevalence of food insecurity among older adults, screening those with MCC for food insecurity in the clinical setting may be warranted in order to refer to community food resources.

}, keywords = {Chronic conditions, Comorbidity, Food insecurity}, issn = {1475-2727}, doi = {10.1017/S1368980017004062}, author = {Jih, Jane and Stijacic-Cenzer, Irena and Hilary K Seligman and W John Boscardin and Thu T Nguyen and Christine S Ritchie} } @article {9816, title = {Food insecurity, comorbidity, and mobility limitations among older U.S. adults: Findings from the Health and Retirement Study and Health Care and Nutrition Study.}, journal = {Preventative Med}, volume = {114}, year = {2018}, month = {09/2018}, pages = {180-187}, abstract = {Both food insecurity and comorbidity have been identified as precursors to functional limitation in older adults, yet whether food insecurity modifies the progression from chronic disease to disability has not been assessed. We examined 5986 respondents age 50 and older drawn from the 2012-2014 Health and Retirement Study (HRS) and 2013 Health Care and Nutrition Study (HCNS). Mobility limitations reported in 2014 and change in mobility limitations from 2012 to 2014 were regressed on measures of food insecurity, number of chronic conditions, and their interaction terms using Poisson regression. Around 17.3\% of the sample was identified as food insecure. In 2012, respondents reported an average of 1.9 (SD = 1.5) chronic conditions and 2.4 mobility limitations (SD = 3.0). In 2014, individuals reported an average of 2.5 (SD = 3.1) mobility limitations. Food insecurity was associated with a greater number of mobility limitations (IRR = 1.20, 95\% CI: 1.11-1.29, p < .001) and more rapid increase in mobility limitations over the two-year observational period (IRR = 1.06, 95\% CI: 1.00-1.11, p = .047). Food security status also modified the association between comorbidity and both mobility limitation outcomes, with the food secure exhibiting a stronger positive association between chronic conditions and mobility limitations than the food insecure. The food insecure tended to have more mobility limitations than the food secure when few chronic conditions were reported. Our results suggest that food insecurity is associated with prevalence and change in mobility limitations among older adults.}, keywords = {Comorbidity, Disabilities, Food insecurity}, issn = {1096-0260}, doi = {10.1016/j.ypmed.2018.07.001}, author = {Nicholas J Bishop and Wang, Kaipeng} } @article {9394, title = {Are older adults who participate in the supplemental nutrition assistance program healthier than eligible nonparticipants? Evidence from the Health and Retirement study}, journal = {Journal of Sociology and Social Welfare}, volume = {44}, year = {2017}, month = {09/2017}, pages = {95-117}, abstract = {This research examined the impact of participation in the Supplemental Nutrition Assistance Program on the health of older adults. The study used panel data from the 2004-2012 Waves of the Rand version of the Health and Retirement Study to estimate regression models of self-reported health and the number of doctor-diagnosed conditions, controlling for individual characteristics and time fixed effects. The findings revealed that program participants did not maintain or improve their health status relative to non-participants during the study period. Thus, the study confirms that program participation confers negligible benefits in maintaining and improving the health status of older adults.}, keywords = {Food insecurity, Self-reported health, SNAP}, issn = {01915096}, author = {Jin H. Kim} } @article {9322, title = {Food insecurity and emotional health in the USA: a systematic narrative review of longitudinal research}, journal = {Public Health Nutrition}, volume = {20}, year = {2017}, pages = {3200-3208}, keywords = {Depressive symptoms, Food insecurity, Literature Review, Stress}, issn = {1368-9800}, doi = {10.1017/S1368980017002221}, url = {https://www.cambridge.org/core/product/identifier/S1368980017002221/type/journal_articlehttps://www.cambridge.org/core/services/aop-cambridge-core/content/view/S1368980017002221}, author = {Bruening, Meg and Dinour, Lauren M. and Chavez, Jose B. Rosales} }