Departments of Community Medicine and Health Care.
Psychiatry, University of Connecticut School of Medicine.
J Nutr. 2019 Jun 1;149(6):982-988. doi: 10.1093/jn/nxz021.
Household food insecurity (HFI) is a stressor that is associated with type 2 diabetes (T2D). However, little is known about HFI and the insulin resistance (IR) underlying T2D, and the mechanisms involved.
We examined the cross-sectional association between HFI and IR among low-income Latinos with T2D and tested whether inflammation and stress hormones mediated this association.
HFI was measured with the 6-item US Household Food Security Survey module. IR was calculated from fasting plasma blood glucose and serum insulin. Inflammation was indicated by high-sensitivity C-reactive protein (hsCRP), and stress hormones included urinary cortisol, metanephrine, and normetanephrine. To test for an indirect effect of HFI on homeostasis model assessment of IR, a parallel multiple mediation model was run with biological markers that significantly differed between food security status-entered as mediators in the model. We used 95% bias-corrected bootstrap CIs, with 10,000 bootstrap samples, to assess the significance of the indirect effects.
The 121 participants with T2D were primarily Puerto Rican (85.8%), aged mean = 60.7 y, and 74% were female. Eighty-two (68%) were classified as food insecure. Compared with food-secure individuals, food-insecure individuals had a significantly higher IR [mean difference (Δ) = 7.21, P = 0.001], insulin (Δ = 9.7, P = 0.019), glucose (Δ = 41, P < 0.001), hsCRP (Δ = 0.8, P = 0.008), cortisol (Δ = 21, P = 0.045), and total cholesterol (Δ = 29, P = 0.004). Groups did not differ on other lipids, metanephrine, normetanephrine, or A1c. The mediation model showed a significant direct effect of HFI on hsCRP (P = 0.020) and on cortisol (P = 0.011). There was a direct effect of cortisol (P = 0.013), hsCRP (P = 0.044), and HFI on IR (P = 0.015). The total combined indirect effect of HFI through cortisol and hsCRP indicated partial mediation.
Among Latinos with T2D, HFI is associated with IR partially through inflammation and stress hormones. Interventions to ameliorate HFI and mitigate its effects on inflammation, stress, and IR are warranted. This trial was registered at clinicaltrials.gov as NCT01578096.
家庭食物不安全（HFI）是与 2 型糖尿病（T2D）相关的应激源。然而，对于 HFI 与 T2D 相关的胰岛素抵抗（IR）以及涉及的机制，我们知之甚少。
我们检测了低收入拉丁裔 T2D 患者中 HFI 与 IR 之间的横断面关联，并检验了炎症和应激激素是否介导了这种关联。
采用美国家庭食物安全调查模块的 6 项 HFI 进行测量。IR 是根据空腹血糖和血清胰岛素计算得出的。高敏 C 反应蛋白（hsCRP）表示炎症，应激激素包括尿皮质醇、甲氧基肾上腺素和去甲氧基肾上腺素。为了检验 HFI 对稳态模型评估的 IR 存在间接影响，我们采用了平行多重中介模型，将生物标志物（根据食物安全状况显著差异而进入模型的中介物）纳入模型。我们使用了 95%的有偏校正自举置信区间，自举样本数为 10000，以评估间接效应的显著性。
121 例 T2D 患者主要为波多黎各人（85.8%），平均年龄 60.7 岁，74%为女性。82 例（68%）被归类为食物不安全。与食物安全个体相比，食物不安全个体的 IR[均值差（Δ）=7.21，P=0.001]、胰岛素（Δ=9.7，P=0.019）、血糖（Δ=41，P<0.001）、hsCRP（Δ=0.8，P=0.008）、皮质醇（Δ=21，P=0.045）和总胆固醇（Δ=29，P=0.004）均显著更高。两组在其他脂质、甲氧基肾上腺素、去甲氧基肾上腺素或 A1c 方面没有差异。中介模型显示 HFI 对 hsCRP（P=0.020）和皮质醇（P=0.011）有显著的直接影响。皮质醇（P=0.013）、hsCRP（P=0.044）和 HFI 对 IR（P=0.015）有直接影响。通过皮质醇和 hsCRP 对 HFI 的总间接效应表明部分中介作用。
在患有 T2D 的拉丁裔人群中，HFI 与 IR 相关，部分原因是炎症和应激激素。需要采取干预措施来改善 HFI 并减轻其对炎症、应激和 IR 的影响。本研究在 clinicaltrials.gov 上注册为 NCT01578096。
