|Wong, Janice - Massachusetts General Hospital|
|Scott, Tammy - Jean Mayer Human Nutrition Research Center On Aging At Tufts University|
|Wilde, Parke - Tufts University|
|Li, Yin-ge - Harvard University|
|Tucker, Katherine - University Of Massachusetts|
|Gao, Ziang - Harvard University|
Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/22/2016
Publication Date: 7/27/2016
Citation: Wong, J.C., Scott, T., Wilde, P., Li, Y., Tucker, K., Gao, Z. 2016. Food insecurity is associated with subsequent cognitive decline in the Boston Puerto Rican Health Study. Journal of Nutrition. doi: 10.3945/jn.115.228700.
Interpretive Summary: Food insecurity - living with hunger and fear of not having enough food - is a growing worldwide concern, due to an imbalance between rapidly increasing demand for food and limited access to good quality foods. In this Study, we investigated whether food insecurity was associated with subsequent cognitive decline in approximately 600 individuals, ages 40-75, who were participants in the Boston Puerto Rican Health study. Participants had Mini-Mental State Exam scores of 24 or higher at baseline. Food insecurity was assessed with the US Household Food Security Scale, and cognitive tests were given at the start of the study and at a two-year follow-up. We found that food insecurity was associated with faster two-year decline in cognitive function, especially in executive function (i.e. the ability to plan, organize, and shift attention). This association was more pronounced in participants whose incomes were below the poverty line. Our results emphasize the importance of developing interventions for food insecurity that take into account the impact of food insecurity on cognition.
Technical Abstract: Background: Living with hunger and fear of not having enough food is a growing worldwide concern. In our previous cross-sectional study, we found that food insecurity was associated with poor cognitive function, but the direction of this relation remains unclear. Objective: We investigated whether food insecurity is associated with subsequent cognitive decline. Methods: This was a longitudinal study of 597 participants aged 40–75 y from the Boston Puerto Rican Health Study cohort, with a Mini-Mental State Examination score of >/= 24 at baseline. Food security was assessed at baseline with the US Household Food Security Scale. Participants completed cognitive batteries, which included 7 cognitive tests, twice—at baseline and again at a 2-y follow-up. The primary outcome was the change in global cognitive function over 2-y. Multiple linear regression was used to obtain adjusted mean differences and 95% CIs in cognitive decline across baseline food security status. Results: Food insecurity at baseline was associated with a 2-y decline in global cognitive function (P-trend = 0.03) after adjusting for relevant potential confounders, including age, sex, baseline cognitive score, body mass index, education, poverty, acculturation score, depression score, smoking status, use of alcohol, physical activity score, presence of diabetes and hypertension, apolipoprotein E status, plasma homocysteine, healthy eating index, and time between baseline and follow-up measures. Compared with the food-secure group, the decline in the very low food security group was greater [mean difference: -0.26 (95% CI: -0.41, -0.10)]. Baseline food insecurity was significantly associated with a faster decline in executive function (P-trend = 0.02) but not memory function (P-trend = 0.66). Conclusions: Food insecurity was associated with faster cognitive decline in this cohort of Puerto Rican adults. Our study emphasizes the importance of developing interventions for food insecurity that take into account the impact of food insecurity on cognition.