Department of Family and Community Medicine, University of California, San Francisco.
Department of Epidemiology and Biostatistics, University of California, San Francisco.
JAMA Netw Open. 2023 Nov 1;6(11):e2344186. doi: 10.1001/jamanetworkopen.2023.44186.
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.
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.
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.
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.
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.
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.
尽管美国存在增加食品获取的联邦计划，但食品不安全仍然是美国老年人面临的一个普遍问题。食品不安全可能通过多种机制影响阿尔茨海默病和与阿尔茨海默病相关的痴呆症，但几乎没有定量研究评估这种关联。
检验老年人的食品不安全是否与晚年认知结果有关。
设计、地点和参与者：这项在美国健康与退休研究中对年龄在 50 岁及以上的美国居民进行的队列研究，仅限于在 2013 年有食品不安全数据且在 2014 年至 2018 年之间有认知结果数据的应答者。分析于 2023 年 6 月 1 日至 9 月 22 日进行。
2013 年的食品不安全状况使用经过验证的美国农业部 6 项家庭粮食安全模块进行评估。应答者被归类为粮食安全、低粮食安全和极低粮食安全。
使用以前验证过的算法，从 2014 年到 2018 年每两年估计一次痴呆症概率和记忆评分（标准化到 1998 个单位）。考虑到选择性失访，通过逆概率删失权重，使用广义估计方程拟合痴呆风险，使用线性混合效应模型拟合记忆评分。
样本包括 7012 名参与者（18356 人波）；平均（SD）年龄为 67.7（10.0）岁，4131 名（58.9%）为女性，1136 名（16.2%）为非西班牙裔黑人，4849 名（69.2%）为非西班牙裔白人，平均（SD）受教育年限为 13.0（3.0）年。与粮食安全的老年人相比，低粮食安全（优势比，1.38；95%CI，1.15-1.67）和极低收入粮食安全（优势比，1.37；95%CI，1.11-1.59）与更高的痴呆风险相关。低和极低的粮食安全也与较低的记忆水平和更快的与年龄相关的记忆衰退有关。
在这项对美国老年居民的队列研究中，食品不安全与痴呆风险增加、记忆功能下降和记忆衰退速度加快有关。需要进一步研究以检验解决食品不安全问题是否有益于大脑健康。
