|GAO, XIANG - Harvard School Of Public Health|
|SCOTT, TAMMY - Tufts - New England Medical Center|
|FALCON, LUIS - Northeastern University|
|WILDE, PARKE - Friedman School At Tufts|
|TUCKER, KATHERINE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University|
Submitted to: American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/20/2009
Publication Date: 2/18/2009
Citation: Gao, X., Scott, T., Falcon, L.M., Wilde, P.E., Tucker, K. 2009. Food insecurity and cognitive function in Puerto Rican adults. American Journal of Clinical Nutrition. 89:1197-1203.
Interpretive Summary: Food insecurity, defined as "limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways," was reported by 10.9% of US households in 2006 and, among them, 4% were in the category of "very low food security." The prevalence of food insecurity was particularly high among low-income populations, ethnic minorities, and households with elders. Food insecurity is associated with nutrient inadequacy and a variety of unfavorable health outcomes including obesity, anxiety, depression, and suicide. Little is known, however, about whether food security is associated with lower cognitive function in the elderly. Examining the relation between food insecurity and cognitive function could be particularly important for Hispanic elders, because this population is more likely to develop Alzheimer disease than are non-Hispanic whites. We investigated the prevalence of food insecurity in older Puerto Ricans aged 45–75 living in Massachusetts in relation to cognitive function performances. 12.1% of subjects reported food insecurity during the past 12 months, and 6.1% reported very low food security. The presence of food insecurity, especially of very low food security, was associated with lower cognition and a greater likelihood of cognitive impairment. Further studies, both observational and experimental, are warranted to clarify the direction of causality in this association. In either case, the association may have public policy implications. If food insecurity contributes to limitations in cognitive function through a biological mechanism, it provides another reason to recommend ensuring that this population has full access to nutrition program benefits. If cognitive function influences food security through economic mechanisms, then targeting food assistance benefits to the particularly high level of need in this population remains a significant issue.
Technical Abstract: Food insecurity is associated with nutrient inadequacy and a variety of unfavorable health outcomes. However, little is known about whether food security is associated with lower cognitive function in the elderly. We investigated the prevalence of food insecurity in a representative sample of 1358 Puerto Ricans aged 45–75 y living in Massachusetts in relation to cognitive function performances. Food security was assessed with the US Household Food Security Scale. Cognitive function was measured to capture general cognition with a battery of 7 tests: Mini-Mental State Examination (MMSE), word list learning (verbal memory), digit span (attention), clock drawing and figure copying (visual-spatial ability), and Stroop and verbal fluency tests (fluency executive functioning). The overall prevalence of food insecurity during the past 12 mo was 12.1%; 6.1% of the subjects reported very low food security. Food insecurity was inversely associated with global cognitive performance, as assessed by the MMSE score. The adjusted difference in the MMSE score was –0.90 (95% CI: –1.6, –0.19; P for trend 1/4 0.003) for a comparison of participants with very low food security with those who were food secure, after adjustment for age, smoking, education, poverty status, income, acculturation, plasma homocysteine, alcohol, diabetes, and hypertension. Food insecurity was significantly associated with lower scores for word-list learning, percentage retention, letter fluency, and digit span backward tests. Very low food security was prevalent among the study subjects and was associated with lower cognitive performance. Further studies, both observational and experimental, are warranted to clarify the direction of causality in this association.