Relationship between food security, nutrition security, and diabetes: The role of Supplemental Nutrition Assistance Program participation

Authors: ALMOHAMAD, MAHA - University Of Texas Health Science Center; DAVE, JAYNA - Children'S Nutrition Research Center (CNRC); CALLOWAY, ERIC - Gretchen Swanson Center For Nutrition; LI, RUOSHA - University Of Texas Health Science Center; SHARMA, SHREELA - University Of Texas Health Science Center

Submitted to: Current Developments in Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/28/2024
Publication Date: 3/29/2024
Citation: Almohamad, M., Dave, J.M., Calloway, E.E., Li, R., Sharma, S. 2024. Relationship between food security, nutrition security, and diabetes: The role of Supplemental Nutrition Assistance Program participation. Current Developments in Nutrition. 5(8):Article 102153. https://doi.org/10.1016/j.cdnut.2024.102153.
DOI: https://doi.org/10.1016/j.cdnut.2024.102153

Interpretive Summary: Inadequate nutrition and poor diet quality have long been linked to an increased risk of diabetes. While it's known that programs like the Supplemental Nutrition Assistance Program (SNAP) help reduce food insecurity, how newly developed nutrition security measures, which focus on acquiring healthy foods to prevent diseases, relate to diabetes and SNAP participation remains unclear. This study aimed to investigate this relationship, looking at both food security and nutrition security concerning diabetes risk, particularly considering SNAP participation as a potential factor. Using data from a cross-sectional pilot study involving 517 adults from five US states, the researchers employed statistical models to analyze the data, adjusting for various factors. They found that higher scores on the nutrition security measure were associated with a lower risk of diabetes, even after accounting for other variables. Interestingly, the overall link between food security and diabetes risk wasn't significant, but it did vary depending on SNAP participation. Additionally, there wasn't a clear interaction between reported diabetes/prediabetes and the combined effects of food and nutrition security. These findings suggest a complex interplay between nutrition security and diabetes risk. While SNAP appears to play a role in mitigating diabetes risk, further research is needed to fully understand these relationships.

Technical Abstract: Inadequate nutrition and poor diet quality are associated with a heightened risk of diabetes. The connection between food insecurity measures and diabetes has been established, with evidence indicating that Supplemental Nutrition Assistance Program (SNAP) participation contributes to reductions in food insecurity. Recently developed nutrition security measures, defined as the ability to acquire healthful foods to prevent diseases, and their association with diabetes and SNAP participation are not yet understood. This study aimed to assess the relationship between food security and nutrition security in relation to diabetes overall and by SNAP participation and nutrition security as potential modifiers. Secondary data analysis of cross-sectional pilot study data collected from adults in 5 US states (N=517). Logistic regression mixed models included moderation analysis and clustering effects by state to address site-level confounding. Higher nutrition security scores among adults, after adjusting for confounders, were significantly associated with lower odds of diabetes risk (adjusted odds ratio=0.59; 95% confidence interval: 0.40, 0.87; P value=0.008). Statistically significant interaction effect of differences according to SNAP participation was observed for nutrition security (P homogeneity/interaction=0.021), adjusting for age, gender, race/ethnicity, education, employment, National School Lunch Program, Special Supplemental Nutrition Program for Women, Infants, and Children, food pantry use, household with children, survey mode, and food security. The association between food security and diabetes was not statistically significant overall. However, statistically significant interaction effect of differences according to SNAP participation was observed for food security (P homogeneity/interaction=0.047). Further, no interaction effect of differences in nutrition security was found between food security and self-reported diabetes/prediabetes (P homogeneity/interaction=0.250). This study sheds light on the early exploration of the intricate relationship between nutrition security and diabetes. The findings suggest that a higher nutrition security score, after adjusting for confounders, was significantly associated with lower odds of diabetes risk. Notably, there were statistically significant interaction effects in these associations based on SNAP participation.