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Trends in food insecurity for adults with cardiometabolic disease in the United States: 2005-2012

Theodore S. Z. Berkowitz, Seth A. Berkowitz, James B. Meigs, Deborah J. Wexler

by Seth A. Berkowitz, Theodore S. Z. Berkowitz, James B. Meigs, Deborah J. Wexler


Food insecurity, the uncertain ability to access adequate food, can limit adherence to dietary measures needed to prevent and manage cardiometabolic conditions. However, little is known about temporal trends in food insecurity among those with diet-sensitive cardiometabolic conditions.


We used data from the Continuous National Health and Nutrition Examination Survey (NHANES) 2005–2012, analyzed in 2015–2016, to calculate trends in age-standardized rates of food insecurity for those with and without the following diet-sensitive cardiometabolic conditions: diabetes mellitus, hypertension, coronary heart disease, congestive heart failure, and obesity.


21,196 NHANES participants were included from 4 waves (4,408 in 2005–2006, 5,607 in 2007–2008, 5,934 in 2009–2010, and 5,247 in 2011–2012). 56.2% had at least one cardiometabolic condition, 24.4% had 2 or more, and 8.5% had 3 or more. The overall age-standardized rate of food insecurity doubled during the study period, from 9.06% in 2005–2006 to 10.82% in 2007–2008 to 15.22% in 2009–2010 to 18.33% in 2011–2012 (p for trend < .001). The average annual percentage change in food insecurity for those with a cardiometabolic condition during the study period was 13.0% (95% CI 7.5% to 18.6%), compared with 5.8% (95% CI 1.8% to 10.0%) for those without a cardiometabolic condition, (parallelism test p = .13). Comparing those with and without the condition, age-standardized rates of food insecurity were greater in participants with diabetes (19.5% vs. 11.5%, p < .0001), hypertension (14.1% vs. 11.1%, p = .0003), coronary heart disease (20.5% vs. 11.9%, p < .001), congestive heart failure (18.4% vs. 12.1%, p = .004), and obesity (14.3% vs. 11.1%, p < .001).


Food insecurity doubled to historic highs from 2005–2012, particularly affecting those with diet-sensitive cardiometabolic conditions. Since adherence to specific dietary recommendations is a foundation of the prevention and treatment of cardiometabolic disease, these results have important implications for clinical management and public health.

Publisher URL: http://journals.plos.org/plosone/article

DOI: 10.1371/journal.pone.0179172

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