Food Insecurity and Cardiovascular Risk Factors in U.S. Adolescents

Introduction: Disparities in cardiovascular diseases are one of today’s most important public health challenges. Pathological processes related to modifiable cardiovascular risk factors have shown to begin in childhood and disparities in these risk factors have been reported in adolescence. Food insecurity is significantly associated with cardiovascular risk factors in adults; however, little is known about cardiovascular risk in food insecure adolescents. Objective: The objective of this study was to examine the relationship between food insecurity and cardiovascular risk factors in U.S. adolescents aged 12-17 years. Methods: Using cross-sectional data on 1,853 adolescents aged 12-17 years from the National Health and Nutrition Examination Survey 2007-2012, we examined the association between food insecurity and cardiovascular risk factors. Food security status was measured using the validated 18-item Household Food Security Survey Module. Cardiovascular risk was measured based on American Heart Association’s Life’s Simple 7 factors (LS7; tobacco smoke exposure, diet quality, physical activity, body mass index, blood pressure, total cholesterol, blood glucose levels). Results: Nearly 10.0% of U.S. adolescents were food insecure. A total of 26.1% of adolescents failed to attain ideal scores on more than 5 LS7 components. In bivariate analyses, food secure, in comparison to food insecure adolescents, were more likely to have ideal scores on 5-7 LS7 components (75.1% vs. 63.0%, p = 0.0089). In multivariate models adjusted for demographic, socioeconomic, health, and health care access factors, food insecurity was not significantly associated with cardiovascular risk in adolescents. However, food insecure adolescents had significantly lower odds of attaining ideal levels of tobacco smoke exposure ([OR] = 0.54 [95% CI 0.31, 0. 94]) than food secure adolescents. Adolescents living in families with incomes below the Federal Poverty Level (Odds Ratio [OR] = 0.59 [95% CI 0.40,0.86]) had significantly lower odds of having ideal LS7 scores and lower odds of attaining ideal scores on tobacco smoke exposure ([OR] = 0.25 [95% CI 0.13, 0.49]) and physical activity ([OR] = 0.60 [95% CI 0.38, 0.95]). Conclusion: Although cardiovascular risk is not more pronounced in food insecure adolescents than their counterparts, adolescents from low SES households may be at particular risk of developing cardiovascular diseases. Multifaceted and tailored strategies inclusive of nutrition assistance are needed to facilitate effective cardiovascular risk prevention as these vulnerable populations transition into early adulthood