Understanding the Connection Between Food Insecurity and Type 2 Diabetes

Eating what is available—whether it’s healthy or not—is more common among those living paycheck to paycheck, and it’s a reason why food insecurity is emerging as an independent risk factor for type 2 diabetes (T2D).

Now, a new study finds that living in a food insecure household may more than double a person’s risk of developing T2D. The findings, just published in PLoS ONE, come from researchers who studied responses from 4739 people who took part in a 2004 Canadian Community Health Survey and linked these answers with healthcare records.

Patients were then followed for an average of 11.6 years, and researchers looked for common characteristics of those who reported food insecurity and later developed T2D. There were 577 cases of T2D after 12.1 years of follow-up.

Researchers identified those experiencing food insecurity through a questionnaire that asked if the person routinely skipped meals, could afford a balanced diet, or had gone a full day without eating for lack of money. They also asked about alcohol use, and a smaller group of participants were asked dietary recall questions to gauge the quality of their food.

Those who reported being food insecure tended to be younger, female, and non-white; they had lower incomes and lower quality diets than those who were deemed food secure. Those who were food insecure were more likely to be smokers, less active, and obese.

Overall, the hazard ratio (HR) for someone living in a food insecure household developing T2D was 2.40 (95% CI, 1.17-4.94). When adjusted for body mass index (BMI), the association between food insecurity and T2D dropped slightly (HR = 2.08; 95% CI, 0.99-4.36). The authors noted that the results suggest the mechanism connecting food insecurity and diabetes is “distinctly different” than one associated with obesity.

“Repeated episodes of food inadequacy may exacerbate insulin resistance, independently of the pathway through weight gain,” they write. “Our results also support this finding, given that there is still a large effect of food insecurity on diabetes risk even after adjustment for BMI.”

A sensitivity analysis to exclude those diagnosed with T2D within 1 year and 2 years of the interview did not meaningfully change the results. When 1-year diagnoses were excluded the HR was 2.38 (95% CI, 1.12-5.05); when 2-year diagnoses were excluded the HR was 2.36 (95% CI, 1.03-5.41).

The authors note the food insecurity is a growing problem in developed countries and boils down to the financial picture at the household level. Food supply is affected by any disruption of monthly paychecks or social assistance, or the addition of an unforeseen expense. “This cycle of financial instability often contributes to episodic underconsumption, followed by overconsumption during times of adequacy, resulting in binge-fast cycles that are associated with insulin resistance and progression to type 2 diabetes,” they write.

Interest in social determinants of health like food insecurity and homelessness is growing among health plans, who view investments in these areas as a path to preventing more expensive chronic conditions.

Just last week, the integrated benefit network Solera Health announced a partnership with the California Food is Medicine Coalition. The coalition is a group of nonprofit, medically tailored food and nutrition providers working on a pilot to bring medically appropriate meals to 1000 Medi-Cal members with chronic conditions, like congestive heart failure or T2D. Kaiser Permanente recently announced it will invest $200 million to address homelessness and housing instability.

Reference

Tait CA, Abbe MRL, Smith PM, Rosella LC. The association between food insecurity and incident type 2 diabetes in Canada: a population-based cohort study. PLoS ONE. 2018;13(5):e0195962. doi: 10.1371/journal.pone.0195962.