(P17-039-25) Cross-Sectional and Longitudinal Associations of Food Insecurity and Dietary Quality Among Older US Adults in the Health and Retirement Study

Objectives: Using the nationally representative Health and Retirement Study (HRS), we examined cross-sectional and longitudinal associations between food insecurity and diet quality among U.S. adults aged 50 years and older.

Methods: Food insecurity was assessed cross-sectionally using the 6-item USDA food security survey module in 2013, and longitudinally as the moving average of responses to two items from the USDA Household Food Security Survey Module between 2002 and 2012. Dietary intake was assessed via a food frequency questionnaire (FFQ) in 2013 and used to create five diet quality measures: the plant-based diet index (PDI), unhealthful PDI (uPDI), healthful PDI (hPDI), Mediterranean diet index, and Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegeneration Delay (MIND) diet index. Higher scores on the uPDI reflect lower quality; for all other indices, higher scores reflect higher diet quality. Weighted multivariate linear regression models examined associations between food insecurity and each diet quality indices, adjusting for socioeconomic and lifestyle factors.

Results: In cross-sectional analyses, very low food security was associated with lower scores on the overall PDI (β=-0.51, 95% CI: -1.13, 0.10) (P-trend=0.08), Mediterranean diet (β=-0.66, 95% CI: -1.46, 0.15) (P-trend=0.09), and MIND diet (β=-0.24, 95% CI: -0.49, 0.003) (P-trend=0.04), and higher scores on the uPDI (β=1.46, 95% CI: 0.45 to 2.48) (P-trend < 0.01). In longitudinal analyses. Long-term very low food security was associated with lower scores on the overall PDI (β=−1.15, 95% CI: -2.37, 0.08) (P-trend=0.03), Mediterranean diet (β=-1.33, 95% CI: -2.24, -0.42) (P-trend < 0.01), and MIND diet (β=-0.58, 95% CI: -1.00, -0.17) (P-trend < 0.01), and higher scores on the uPDI (β=1.92, 95% CI: 0.15, 3.69) (P-trend=0.01). Association with hPDI was not significant.

Conclusions: Among older adults, food insecurity was consistently associated with lower diet quality on multiple measures. These associations were more pronounced when considering long-term food insecurity.

Funding Sources: This work was supported by the National Institutes of Health (grant number R01AG0792786, PI: Leung).