Research Research and Professional Briefs| Volume 114, ISSUE 12, P1943-1953.e2, December 2014

Food Insecurity Is Inversely Associated with Diet Quality of Lower-Income Adults

Published:August 01, 2014DOI:


      Food insecurity acts as a chronic stressor independent of poverty. Food-insecure adults may consume more highly palatable foods as a coping mechanism, leading to poorer diet quality and increased risks of chronic disease over time. Using data from the 1999-2008 National Health and Nutrition Examination Surveys, this study aimed to examine the cross-sectional differences in dietary intake and diet quality by household food security among 8,129 lower-income adults (≤300% of the federal poverty level). Food insecurity was assessed using the 18-item US Household Food Security Survey Module. Dietary intake was assessed from 24-hour recalls and diet quality was measured using the Healthy Eating Index-2005 and the Alternate Healthy Eating Index-2010. Relative mean differences in dietary outcomes by household food security were estimated using linear regression models, adjusting for sociodemographic characteristics. Lower-income food-insecure adults reported higher consumption of some highly palatable foods, including high-fat dairy products (P trend<0.0001) and salty snacks (P trend=0.01) compared with lower-income food-secure adults. Food insecurity was also associated with more sugar-sweetened beverages (P trend=0.003); more red/processed meat (P trend=0.005); more nuts, seeds, and legumes (P trend=0.0006); fewer vegetables (P trend<0.0001); and fewer sweets and bakery desserts (P trend=0.0002). No differences were observed for intakes of total energy and macronutrients. Food insecurity was significantly associated with lower Healthy Eating Index-2005 (P trend<0.0001) and Alternate Healthy Eating Index-2010 scores (P trend<0.0001). Despite no macronutrient differences, food insecurity was associated with characteristics of poor diet quality known to increase chronic disease risk.


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      C. W. Leung is a postdoctoral scholar, Center for Health and Community, School of Medicine, University of California, San Francisco.


      E. S. Epel is associate director, Center for Health and Community, School of Medicine, and associate professor in residence, Department of Psychiatry, University of California, San Francisco.


      L. D. Ritchie is director and cooperative extension specialist, Nutrition Policy Institute, University of California, Berkeley, Division of Agriculture and Natural Resources.


      P. B. Crawford is director, Dr Robert C. and Veronica Atkins Center for Weight and Health, University of California, Berkeley.


      B. A. Laraia is an associate professor, School of Public Health, University of California, Berkeley.