Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA 94143, USA.
J Nutr. 2010 Feb;140(2):304-10. doi: 10.3945/jn.109.112573. Epub 2009 Dec 23.
Food insecurity refers to the inability to afford enough food for an active, healthy life. Numerous studies have shown associations between food insecurity and adverse health outcomes among children. Studies of the health effects of food insecurity among adults are more limited and generally focus on the association between food insecurity and self-reported disease. We therefore examined the association between food insecurity and clinical evidence of diet-sensitive chronic disease, including hypertension, hyperlipidemia, and diabetes. Our population-based sample included 5094 poor adults aged 18-65 y participating in the NHANES (1999-2004 waves). We estimated the association between food insecurity (assessed by the Food Security Survey Module) and self-reported or laboratory/examination evidence of diet-sensitive chronic disease using Poisson regression. We adjusted the models to account for differences in age, gender, race, educational attainment, and income. Food insecurity was associated with self-reported hypertension [adjusted relative risk (ARR) 1.20; 95% CI, 1.04-1.38] and hyperlipidemia (ARR 1.30; 95% CI, 1.09-1.55), but not diabetes (ARR 1.19; 95% CI, 0.89-1.58). Food insecurity was associated with laboratory or examination evidence of hypertension (ARR 1.21; 95% CI, 1.04-1.41) and diabetes (ARR 1.48; 95% CI, 0.94-2.32). The association with laboratory evidence of diabetes did not reach significance in the fully adjusted model unless we used a stricter definition of food insecurity (ARR 2.42; 95% CI, 1.44-4.08). These data show that food insecurity is associated with cardiovascular risk factors. Health policy discussions should focus increased attention on ability to afford high-quality foods for adults with or at risk for chronic disease.
食物不安全是指无法负担足够的食物以维持积极、健康的生活。许多研究表明，食物不安全与儿童不良健康结局之间存在关联。关于成年人的食物不安全对健康影响的研究则更为有限，通常集中在食物不安全与自我报告疾病之间的关联。因此，我们研究了食物不安全与饮食敏感的慢性疾病（包括高血压、高血脂和糖尿病）的临床证据之间的关联。我们的基于人群的样本包括参加 NHANES（1999-2004 年波次）的 5094 名年龄在 18-65 岁之间的贫困成年人。我们使用泊松回归估计了食物不安全（通过食物安全调查模块评估）与自我报告或实验室/检查饮食敏感慢性疾病证据之间的关联。我们调整了模型以考虑年龄、性别、种族、教育程度和收入的差异。食物不安全与自我报告的高血压（调整后的相对风险（ARR）1.20；95%置信区间，1.04-1.38）和高血脂（ARR 1.30；95%置信区间，1.09-1.55）有关，但与糖尿病（ARR 1.19；95%置信区间，0.89-1.58）无关。食物不安全与高血压的实验室或检查证据（ARR 1.21；95%置信区间，1.04-1.41）和糖尿病（ARR 1.48；95%置信区间，0.94-2.32）有关。除非我们使用更严格的食物不安全定义（ARR 2.42；95%置信区间，1.44-4.08），否则该关联在完全调整后的模型中未达到统计学意义。这些数据表明，食物不安全与心血管危险因素有关。健康政策讨论应更加关注患有或有慢性疾病风险的成年人负担高质量食物的能力。
