Food insecurity and atherosclerotic cardiovascular disease risk in adults with diabetes

Tony Dong, Kristen Harris, Darcy Freedman, Scott Janus, Stephanie Griggs, Yasaswini Iyer, Khurram Nasir, Ian J. Neeland, Sanjay Rajagopalan, Sadeer G. Al-Kindi

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


OBJECTIVES: Adults with diabetes are at an increased risk of atherosclerotic cardiovascular disease (ASCVD), and food insecurity may be a major and underappreciated risk compounder in this population. We sought to analyze the prevalence of food insecurity and its association with ASCVD in adults with diabetes.

METHODS: A total of 6424 participants with diabetes were included from the 2019 and 2020 National Health Interview Survey. Food insecurity was determined with a 10-question U.S. Adult Food Security Survey Module, and classified as high, marginal, low, and very low. ASCVD was defined as a self-reported history of coronary artery disease, myocardial infarction, or stroke.

RESULTS: Of the 6424 included participants (weighted: n = 21 690 217), 5 405 543 (24.4%) reported a history of ASCVD and 2 946 061 (13.3%) were identified as food insecure (low or very low food security). Adults with food insecurity were more likely to have ASCVD than adults who were food secure (28.9% vs 23.7%; P = 0.008). In the multivariate analyses adjusted for traditional cardiovascular risk factors, all levels of food insecurity were associated with ASCVD compared with food-secure adults (marginal security: odds ratio [OR]: 1.60; 95% confidence interval [CI], 1.18-2.18]; P = 0.003; low security: OR: 2.09; 95% CI, 1.58-2.74]; P < 0.001; very low security: OR: 1.69; 95% CI, 1.22-2.34]; P = 0.001). The association persisted when adjusted for income, location, education, and insurance status. In adults with diabetes and ASCVD, income was a negative factor for food insecurity (OR: 0.71; 95% CI, 0.62-0.80; P < 0.001), but female sex and smoking were positive factors (OR: 1.90; 95% CI, 1.29-2.80; P = 0.001; and OR: 1.97; 95% CI, 1.23-3.18; P = 0.005; respectively). At younger ages, the prevalence of food insecurity increased, especially in adults with ASCVD.

CONCLUSIONS: We showed that 13% of U.S. adults with diabetes are food insecure, which was associated with ASCVD independent of traditional and socioeconomic risk factors. Our findings emphasize the importance of recognizing food insecurity as a driver of ASCVD in adults with diabetes, and encourage future efforts at reducing this disparity.

Original languageEnglish (US)
Article number111865
StatePublished - Feb 2023


  • Diabetes
  • Food insecurity
  • Social determinants of health
  • Food Supply
  • Diabetes Mellitus/epidemiology
  • Humans
  • Cardiovascular Diseases/epidemiology
  • Socioeconomic Factors
  • Atherosclerosis/epidemiology
  • Food Insecurity
  • Adult
  • Female

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Endocrinology, Diabetes and Metabolism


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