Food Insecurity and Depression among US Adults: NHANES 2005–2016

A growing body of evidence suggests that food insecurity is associated with adverse mental health outcomes such as depression and anxiety. In this study, the relationship between food insecurity and depression was examined using data from the 2005–2016 National Health and Nutrition Examination Survey (NHANES). Food insecurity was assessed with the 18-item United States Food Security Survey Module with zero affirmative responses indicating high food security, 1 or 2 affirmative responses indicating marginal food security, and ≥3 affirmative responses indicating food insecurity. Depression was assessed with the Patient Health Questionnaire-9 with scores ≥10 indicating depression. Data were analyzed from 28,448 adult participants aged 20 or older. Food insecurity was present in 19.2% of the sample population (n = 5452). Food security status was significantly associated with gender, race, education level, marital status, smoking status, and BMI (Rao-Scott chi-square, p < 0.05). Fully food secure and very low food security adults experienced depression at a rate of 5.1% and 25.8%, respectively (Rao-Scott chi-square, p < 0.0001). Participants with very low food security had a significantly greater odds of depression than food secure adults, OR = 3.50 (95% CI: 2.98, 4.12). These findings suggest that food insecurity is a significant risk factors for depression in US adults over 20 years of age. To address this issue in our citizenry, police initiatives and public health interventions addressing both food access and mental health should be prioritized.     

Household Food Insecurity Is Associated with Symptoms of Emotional Dysregulation in Children with Attention Deficit Hyperactivity Disorder: The MADDY Study

The association of household food insecurity with symptoms of attention deficit hyperactivity disorder (ADHD) and emotional dysregulation in children was examined in this study. We utilized baseline data from 134 children aged 6–12 years who were enrolled in a clinical trial investigating multinutrient supplementation as a treatment for ADHD and emotional dysregulation. Household food security status was assessed using the 18-item US Household Food Security Survey Module. The symptoms of ADHD and emotional dysregulation disorders (oppositional defiant disorder (ODD) and disruptive mood dysregulation disorder (DMDD)) were assessed using the Child and Adolescent Symptom Inventory-5 and other comorbid emotional dysregulation symptoms were assessed using the Strengths and Difficulties Questionnaire (SDQ). Multiple linear regression determined associations between household food security status and symptoms of ADHD, ODD and DMDD, emotional symptoms and conduct problems. Household food insecurity was associated with more severe emotional symptoms (β = 2.30; 95% CI = 0.87–3.73; p = 0.002), conduct problems (β = 1.15; 95% CI = 0.01–2.30; p = 0.049) and total difficulties scores (β = 4.59; 95% CI = 1.82–7.37; p = 0.001) after adjusting for covariates (child’s sex, parent marital status, household income, parental anxiety and other parental psychopathology). In unadjusted analyses, household food insecurity was also associated with increased ODD (β = 0.58; 95% CI = 0.21–0.95; p = 0.003) and DMDD symptoms (β = 0.69; 95% CI = 0.20–1.19; p = 0.006), but these associations attenuated to non-significance after adjusting for all covariates. Household food insecurity was associated with more severe emotional dysregulation symptoms. Discussing and addressing food insecurity may be appropriate initial steps for youths with ADHD and emotional dysregulation.     

Effects of Perceived Food Store Environment on Malnutrition and Frailty among the Food-Insecure Elderly in a Metropolitan City

This study aimed to identify food environment factors in the local community that could affect the levels of nutritional status and frailty in 372 older adults (at least 65 years old) experiencing food insecurity and enrolled in the integrated Community Health Promotion Program (CHPP) in two districts of Seoul. The local food environment was assessed using perceived food store accessibility questionnaires. In order to quantify nutrient intake, the 24-h recall method was applied. Malnutrition was measured using the Mini Nutritional Assessment tool, while frailty was assessed using the Frailty Measurement Questionnaire developed for the CHPP. Malnourished or frail elderly adults commonly had a lower intake of cereals and potatoes, meats, and vegetables than those who were not, and their resulting intake levels of energy, protein, iron, and vitamin groups were also significantly lower (all p-values < 0.05). Among the local community food store environment factors, the sufficiency of food stores (odds ratio (OR) = 1.988, 95% confidence interval (CI] = 1.211–3.262), freshness of foods (OR = 1.767, 95% CI = 1.075–2.886), and variety in foods (OR = 1.961, 95% CI = 1.197–3.212) were significant factors affecting the risk of malnutrition. For frailty, the freshness of foods (OR = 1.997, 95% CI = 1.053–3.788), variety in foods (OR = 2.440, 95% CI = 1.277–4.661), and small purchase of foods (OR = 2.645, 95% CI = 1.362–5.139) were significant environmental factors. In conclusion, we found that the perceived food store environment in the local community can influence the occurrence of malnutrition and frailty in vulnerable, urban older adults.     

The relationship between sleep quality and psychological distress and job burnout among Chinese psychiatric nurses

This cross-sectional study aimed to investigate the sleep quality of psychiatric nurses in China and explore the risk factors affecting it. This study used the stratified random sampling method. The general data questionnaire was conducted using the 10-item Kessler Psychological Distress Scale (K10), the Maslach Burnout Inventory (MBI), and the Pittsburgh Sleep Quality Index (PSQI) were used to investigate the prevalence and risk factors of sleep quality among 812 psychiatric nurses in China. There were statistically significant differences in sleep quality among different shift frequency. Surveys demonstrated that sleep quality among psychiatric nurses was positively correlated with psychological distress and job burnout. Multiple logistics regression analysis showed that high psychological distress (odds ratio, OR=0.907, p<0.001, 95% confidence interval, CI=0.885–0.931), high emotional exhaustion (OR=0.946, p<0.001, 95% CI=0.921–0.972), low depersonalization (OR=1.061, p=0.004, 95% CI=1.019–1.104), and low personal accomplishment (OR=0.972, p=0.018, 95% CI=0.949–0.995) were the contributing factors of sleep quality. Future studies should investigate effective measures to relieve psychological distress and alleviate burnout, particularly for psychiatric nurses with poor sleep quality.     

Food Insecurity,Dietary Diversity,and Coping Strategies in Jordan during the COVID-19 Pandemic: A Cross-Sectional Study

The 2019 coronavirus disease (COVID-19) is an emerging respiratory infection with severe impacts on the nutritional status of the worldwide population. This cross-sectional study was conducted to assess the food insecurity, dietary diversity, and food-related coping strategies in Jordan during the pandemic using an online, self-administered questionnaire. Among the 740 adults who completed the survey, the prevalence of food security was 84.1%, whereas 2% and 13.9% were moderately and severely food-insecure, respectively. The determinants of food insecurity were educational level, monthly income, marital status, availability of health insurance, and type of residence. In addition, food insecurity was significantly higher among the participants who consumed two or fewer meals per day (p = 0.015). Moreover, an acceptable food consumption score was shown among 76.2% of the participants, and the remaining participants were at borderline (14.1%) or had poor scores (9.7%), with a significant association between food insecurity and food consumption scores (p < 0.001). The food-related coping strategies studied were significantly associated with food insecurity at both levels (p < 0.001) and were more evident in the severely food-insecure group. These findings highlight the adverse effects of COVID-19 restrictions on nutritional status, especially among food-insecure households, which might reduce food accessibility due to economic difficulties.     

Food Insecurity Prevalence,Severity and Determinants in Australian Households during the COVID-19 Pandemic from the Perspective of Women

This study aimed to describe the prevalence, severity and socio-demographic predictors of food insecurity in Australian households during the COVID-19 pandemic in 2020, from the perspective of women. A cross-sectional online survey of Australian (18–50 years) women was conducted. The survey collected demographic information and utilised the 18-item US Department of Agriculture Household Food Security Survey Module and the Kessler Psychological Distress Scale (K10). A multivariable regression was used to identify predictors of food security status. In this cohort (n = 1005), 19.6% were living in households experiencing food insecurity; with 11.8% experiencing low food-security and 7.8% very low food-security. A further 13.7% of households reported marginal food-security. Poor mental health status (K10 score ≥ 20) predicted household food insecurity at all levels. The presence of more than three children in the household was associated with low food-security (OR 6.24, 95% CI: 2.59–15.03). Those who were renting were 2.10 (95% CI: 1.09–4.05) times likely to experience very low food-security than those owning their own home. The COVID-19 pandemic may have contributed to an increased prevalence of household food insecurity. This study supports the need for a range of responses that address mental health, financial, employment and housing support to food security in Australia.     

Is It What They Eat or How Much They Eat That Matters More in Adults with Food Insecurity in a Wealthy-Country Context?

This study aimed to investigate whether dietary quantity and/or quality differ according to food security levels in the Korean adult population. Dietary adequacy and quality were evaluated by the Korean Dietary Reference Intake and the Korean Healthy Eating Index (KHEI) for adults, respectively, according to three food security levels, i.e., food security, low food security, and very low food security. A total of 7144 Korean adults (aged 19 to 64 years) were selected from cross-sectional data from the 2013–2015 Korean National Health and Nutrition Examination Surveys. The risk of inadequate nutrient intakes of protein (p trend = 0.021) and phosphorus (p trend = 0.002) increased according to food insecurity levels after adjustment for putative risk factors. The total KHEI scores (p < 0.001) as well as scores of having breakfast (p < 0.001) were lowest in the very low food security group. Among KHEI components, adults with food insecurity were less likely to get full scores from intakes of mixed grains (p trend = 0.016), total fruit (p trend = 0.039), fresh fruit (p trend = 0.043), and breakfast (p trend < 0.001). In addition, food-insecure adults were more likely to get zero score from intakes of fresh fruit (p trend = 0.020), milk and dairy products (p trend = 0.049), breakfast (p trend < 0.001), % of energy from sweets and beverages (p trend = 0.002), and total energy (p trend = 0.033). In conclusion, food security levels were associated with how much they ate, as well what they ate, in adults in South Korea. These results implied that the diet adequacy as well as moderation and balance could be carefully treated with food assistance or nutrition intervention once nutritional adequacy has mostly been met. In addition, targeted intervention programs tailored to diverse contexts for improving food insecurity may prevent unintended consequences due to easy access to inexpensive obesogenic foods in adults with food insecurity.     

Food Insecurity Reduces the Chance of Following a Nutrient-Dense Dietary Pattern by Brazilian Adults: Insights from a Nationwide Cross-Sectional Survey

Dietary patterns derived by data-driven techniques are still scarce in the food security context and may be a useful tool to inform policymakers to promote adequate and healthy diets for vulnerable populations. We investigated the association between food security status and dietary patterns among 28,127 Brazilian adults using data from the 2017–2018 Household Budget Survey. Food security status was measured by the Brazilian Food Insecurity Scale. Food items reported in two 24 h dietary recalls were combined into food groups. Dietary patterns were derived from exploratory factor analysis, and participants were grouped according to their factor scores by K-means cluster analysis. Multiple logistic regression models were fitted to investigate the association between food security status and clusters of adherence to dietary patterns. Four dietary patterns were derived: ‘Brazilian breakfast style’ (cluster 3), ‘Brazilian Traditional staple foods’ (cluster 2), ‘Beverages, ready-to-eat and convenience foods’ (cluster 4), and ‘Fruits, vegetables, and whole grains’ (cluster 1). After adjustments, food insecurity was inversely associated with adherence to the ‘Fruits vegetables, and whole grains’ pattern (OR = 0.75, 95% CI: 0.63–0.89). Findings suggest food insecurity negatively impact the adoption of a nutrient-dense dietary pattern and highlight the critical role of policy actions in a scenario of increasing food insecurity.     

Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample

Objectives. We investigated whether nonelderly US adults (aged 18–64 years) in food-insecure households are more likely to report cost-related medication underuse than the food-secure, and whether the relationship between food insecurity and cost-related medication underuse differs by gender, chronic disease, and health insurance status.Methods. We analyzed data from the 2011 and 2012 National Health Interview Survey (n = 67 539). We examined the relationship between food insecurity and cost-related medication underuse with the χ² test and multivariate logistic regression with interaction terms.Results. Bivariate and multivariate analyses showed a dose–response relationship between food insecurity and cost-related medication underuse, with an increasing likelihood of cost-related medication underuse with increasing severity of food insecurity (P < .001). This association was conditional on health insurance status, but not substantially different by gender or chronic disease status. Being female, low-income, having no or partial health insurance, chronic conditions, functional limitations, or severe mental illness were positively associated with cost-related medication underuse.Conclusions. Using food insecurity as a risk factor to assess cost-related medication underuse could help increase identification of individuals who may need assistance purchasing medications and improve health for those in food-insecure households.Food insecurity refers to “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.”1^(p6) Food insecurity is associated with poor health status and risk factors such as obesity, metabolic conditions, and chronic diseases, potentially attributable to intake of poor-quality diets, which increase the risk for obesity and cardiometabolic diseases.2–5 Studies of diabetic patients living in food-insecure households have shown poor outcomes such as poor glycemic control and increased physician use.6,7 Moreover, there is evidence that people living in food-insecure households are more likely to have poor mental health outcomes,8,9 use alcohol,10 and smoke cigarettes11—factors also associated with poor health status.Recent research suggests that people living in food-insecure households may adjust their behaviors in ways that are potentially detrimental to their health. Ivers and Cullen suggest that the vulnerability of food insecurity puts individuals at risk for engaging in coping strategies (e.g., withdrawal of children from school, theft, and risky sexual behaviors), particularly among women who tend to be children’s primary caregivers.12 One set of behaviors that has received relatively little attention as a potential coping mechanism for food insecurity until recently is reducing, skipping, delaying, or using lower-cost medications to compensate for lack of household resources to purchase food. These behaviors have been described as cost-related medication underuse.13,14Studies have demonstrated the relationship between cost-related medication underuse and poor health outcomes,15–19 but, to our knowledge, only 1 study has examined the relationship between food insecurity and cost-related medication underuse in the United States in a nationally representative sample.13 This study, which was restricted to individuals with chronic diseases, found that those living in food-insecure households were more likely to report cost-related medication underuse. Similar findings have been demonstrated from smaller studies in different parts of the country among people with diabetes, people with HIV/AIDS, and patients presenting at emergency departments.20–24We extend the literature on behaviors individuals living in food-insecure households may adopt to save money for food by examining the relationships between food insecurity and cost-related medication underuse in a nationally representative sample of nonelderly adults living in the United States. The objective of this analysis was to determine whether nonelderly adults (aged 18–64 years) living in food-insecure households in the United States are more likely to report cost-related medication underuse. We also examined whether the relationship between food insecurity and cost-related medication underuse differs by gender, chronic disease status, and health insurance status.     

Food insecurity among Canadian youth and young adults: insights from the Canada Food Study

ObjectiveThis study explored associations between socio-demographic characteristics, self-reported health, and household food security among young adults.MethodsNational cohort study participants from Toronto, Montreal, Vancouver, Edmonton, and Halifax, Canada, aged 16–30 years (n = 2149) completed online surveys. Multinomial logistic regression, weighted to reflect age and sex proportions from the 2016 census, was conducted to examine associations between food security status and covariates.ResultsAlmost 30% of respondents lived in food-insecure households, with 19% in “moderately” food-insecure and 10% in “severely” food-insecure households. Respondents identifying as Black or Indigenous were more likely to live in moderately (AOR = 1.96, CI: 1.10, 3.50; AOR = 3.15, CI: 1.60, 6.20) and severely (AOR = 4.25, CI: 2.07, 8.74; AOR = 6.34, CI: 2.81, 14.30) food-insecure households compared with those identifying as mixed/other ethnicity. Respondents who found it “very difficult” to make ends meet were more likely to be moderately (AOR = 20.37, CI: 11.07, 37.46) and severely (AOR = 101.33, CI: 41.11, 249.77) food insecure. Respondents classified as “normal” weight (AOR = 0.64, CI: 0.43, 0.96) or overweight (AOR = 0.53, CI: 0.34, 0.83) were less likely to be moderately food insecure compared with those affected by obesity. Compared with “very good or excellent,” “poor” health, diet quality, and mental health were each positively associated with severe food insecurity (AOR = 7.09, CI: 2.44, 20.61; AOR = 2.63, CI: 1.08, 6.41; AOR = 2.09, CI: 1.03, 4.23, respectively).ConclusionThe high prevalence of correlates of food insecurity among young adults suggests the need for policies that consider the unique challenges (e.g., precarious income) and vulnerability associated with this life stage.     

Relationship between Dietary Habits,Food Attitudes and Food Security Status among Adults Living within the United States Three Months Post-Mandated Quarantine: A Cross-Sectional Study

COVID-19 has disrupted the lives of many and may have influenced dietary habits through factors such as food security status and attitudes. The purpose of this study was to identify dietary habits and their associations with food insecurity and attitudes among adults living in the United States within three months post-mandated quarantine. An online cross-sectional study was conducted from April to June 2020. Participants (n = 3133) responded to a 71-item questionnaire regarding demographics (n = 7), health information (n = 5), lifestyle habits (n = 8), dietary habits (n = 37), food attitudes (n = 8), and food security status (n = 6). Frequency counts and percentages were tabulated, and multivariate linear regression was conducted to examine associations using STATA v14 at a statistical significance level of p < 0.05. Results showed that most participants indicated no change in dietary habits (43.6–87.4%), yet participants reported increased consumption of sweets (43.8%) and salty snacks (37.4%). A significant positive association for food attitude scores (1.59, 95% CI 1.48 to 1.70; p < 0.001) and food security scores (1.19, 95% CI 0.93 to 1.45; p < 0.001) on total dietary habit scores was found. Future extensive population studies are recommended to help public health authorities frame actions to alleviate the impact that mandated quarantine has on dietary habits.     

Food Insecurity,Neighborhood Food Access,and Food Assistance in Philadelphia

An estimated 17.6 million American households were food insecure in 2012, meaning they were unable to obtain enough food for an active and healthy life. Programs to augment local access to healthy foods are increasingly widespread, with unclear effects on food security. At the same time, the US government has recently enacted major cuts to federal food assistance programs. In this study, we examined the association between food insecurity (skipping or reducing meal size because of budget), neighborhood food access (self-reported access to fruits and vegetables and quality of grocery stores), and receipt of food assistance using the 2008, 2010, and 2012 waves of the Southeastern Pennsylvania Household Health Survey. Of 11,599 respondents, 16.7 % reported food insecurity; 79.4 % of the food insecure found it easy or very easy to find fruits and vegetables, and 60.6 % reported excellent or good quality neighborhood grocery stores. In our regression models adjusting for individual- and neighborhood-level covariates, compared to those who reported very difficult access to fruits and vegetables, those who reported difficult, easy or very easy access were less likely to report food insecurity (OR 0.62: 95 % CI 0.43–0.90, 0.33: 95 % CI 0.23–0.47, and 0.28: 95 % CI 0.20–0.40). Compared to those who reported poor stores, those who reported fair, good, and excellent quality stores were also less likely to report food insecurity (OR 0.81: 95 % CI 0.60–1.08, 0.58: 95 % CI 0.43–0.78, and 0.43: 95 % CI 0.31–0.59). Compared to individuals not receiving food assistance, those receiving Supplemental Nutrition Assistance Program (SNAP) benefits were significantly more likely to be food insecure (OR 1.36: 95 % CI 1.11–1.67), while those receiving benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (OR 1.17: 95 % CI 0.77–1.78) and those receiving both SNAP and WIC (OR 0.84: 95 % CI 0.61–1.17) did not have significantly different odds of food insecurity. In conclusion, better neighborhood food access is associated with lower risk of food insecurity. However, most food insecure individuals reported good access. Improving diet in communities with high rates of food insecurity likely requires not only improved access but also greater affordability.     

Households' Food Insecurity and Its Association with Demographic and Socioeconomic Factors in Gaza Strip,Palestine: A Cross-Sectional Study

BackgroundThis sudy aimed to identify the prevalence of household''s food insecurity and its association with demographic and socioeconomic factors.MethodsA cross-sectional study was conducted in September 2021 among a representative sample of households in the Gaza strip governorates. A total of 1167 households randomly selected from all five governorates and were included in the study. The Radimer/Cornell food security scale was used to determine the prevalence and levels of household food insecurity. The household''s demographic and socioeconomic characteristics were obtained using an interview-based questionnaire. Statistical analysis was performed using SPSS version 25.ResultsThe overall prevalence of household''s food insecurity was 71.5%. The prevalence by governorates was highest in Gaza (30.8%), followed by Khanyounis (23.0%), North-Gaza (18.6%), Middle-Area (15.2%) and Rafah (12.4%). Regarding the food insecurity levels, 333 (28.5%) of the households were food secure, 422 (36.2%) had mild food insecurity, 161 (13.8%) had moderate food insecurity, and 251 (21.5%) had severe food insecurity. Significant associations were found between governorates, monthly income, homeownership, work status with the household''s food insecurity, (Crude OR [COR] = 2.02, 95% CI = [1.02–3.98], P value < 0.05), (COR = 2.00, 95% CI = [1.04–2.75], P value < 0.05), (COR = 2.36, 95% CI = [1.39–3.99], P value < 0.05), and (COR = 1.14, 95% CI = [0.66–1.97], P value < 0.05), respectively.ConclusionsOur study demonstrates that food insecurity is highly prevalent in the Gaza strip and is associated with poor living conditions. Therefore, this high prevalence should be seriously discussed and urgently considered.     

Black–white racial disparities in household food insecurity from 2005 to 2014, Canada

ObjectivesTo understand the differential vulnerability to household food insecurity of the Black population as compared with white counterparts in Canada.MethodsUsing data for households with Black and white respondents in pooled Canadian Community Health Survey cycles from 2005 to 2014, the 18-question Household Food Security Survey Module was analyzed (N = 491,400). Bivariate and multivariate logistic and multinomial regression models were run using respondent’s race, immigration status, and six well-established predictors of household food insecurity in the general population. Additional multivariable logistic regression models were run, with race interacted with each predictor individually to yield predicted probabilities.ResultsThe weighted prevalence of household food insecurity was 10.0% for white respondents and 28.4% for Black respondents. The odds of Black households being food-insecure as compared with white households fell from 3.56 (95% CI: 3.30–3.85) to 1.88 (95% CI: 1.70–2.08) with adjustment for household socio-demographic characteristics. In contrast with white households, there was relative homogeneity of risk of food insecurity among Black subgroups defined by immigration status, household composition, education, and province of residence. Homeownership was associated with lower probabilities of food insecurity for Black and white households, but the probability among Black owners was similar to that for white renters (14.7% vs. 14.3%). Black households had significantly higher predicted probabilities of food insecurity than their white counterparts across all main sources of household income except child benefits and social assistance.ConclusionBeing racialized as Black appears to be an overriding factor shaping vulnerability to food insecurity for the Black population in Canada. Future research and public policy on food insecurity should seriously consider the role of racism at the systemic and institutional levels.     

Association of Frailty Status and Dietary Patterns in a Nationally Representative Sample of United States Adults with Olfactory Dysfunction

Background: Olfactory dysfunction (OD) is a strong, independent predictor of frailty and mortality risk. This study evaluated the association of dietary patterns and frailty status in older adults with OD. Methods: This cross-sectional study utilized the 2013–2014 National Health and Nutrition Examination Survey. Dietary patterns (DPs) characteristic of OD were derived using exploratory factor analysis (EFA). Multiple logistic regressions adjusted for demographics and frailty risk factors assessed the association of DPs with two frailty metrics: the frailty index (FI) and physical frailty (PF). Results: EFA yielded six distinct DPs in persons with OD. The protein/selenium (OR 0.82 [95% CI 0.74–0.92], p = 0.041) and β-carotene/vitamin A DPs (OR 0.76 [95% CI 0.66–0.88], p = 0.028) were independently associated with frailty by FI. Only the protein/selenium DP (OR 0.82 [95% CI 0.74–0.92], p = 0.036) was associated with frailty by PF. No DPs were associated with either frailty measure in normosmic persons. Conclusions: Dietary patterns high in protein/selenium and β-carotene/vitamin A are associated with lower frailty prevalence in adults with OD. While the relationship between OD and frailty is likely multifaceted, these findings suggest that dietary patterns are uniquely associated with frailty in older adults with OD.     

Association between Lebanese Mediterranean Diet and Frailty in Community-Dwelling Lebanese Older Adults—A Preliminary Study

Discrepancies in the characteristics of the food components of a Mediterranean diet exist based on the country of origin. In Lebanon, a traditional Mediterranean diet emphasizes the high intakes of fruits (including dried), vegetables, burghol, and dairy products. Therefore, this cross-sectional study aimed to explore the association between adherence to the Lebanese Mediterranean diet (LMD) and frailty among older adults in Lebanon. A total of 112 community-dwelling older adults aged ≥65 years were recruited. Demographic and clinical characteristics were collected through face-to-face interviews. A 61-item food frequency questionnaire (FFQ) was used to collect dietary intake data, and adherence to LMD was calculated. Physical frailty was defined by the presence of three out of the five criterion: weight loss, weakness, exhaustion, slowness, and low activity. Binary logistic regression was used to examine the relationship between LMD adherence and frailty while adjusting for several confounders. The participants’ mean age was 73 ± 12.8 and 65% were females. Sixteen (14.3%) individuals were identified as frail. Frail individuals were significantly older (p = 0.001), depressed (p < 0.001), at risk of cognitive impairment (p = 0.006), and reported polypharmacy (p = 0.003). No significant association was found between LMD adherence and frailty in fully adjusted models (OR = 0.195; 95% CI: 0.033–1.154; p = 0.071 when categorical and OR = 0.856; 95% CI: 0.668–1.097; p = 0.218 when continuous). We also performed additional analyses with a modified frailty index where house chores were not considered as part of leisure activities of the physical activity criterion. The results showed that a higher LMD adherence was associated with a significantly decreased frailty prevalence (OR = 0.123, 95% CI: 0.022–0.676, p = 0.016 when categorical and OR = 0.773, 95% CI 0.608–0.983, p = 0.036). Larger, longitudinal studies are needed to clarify the relationship between the adherence to the Lebanese Mediterranean diet and frailty in Lebanese older adults.     

Age-Specific Differences in Online Grocery Shopping Behaviors and Attitudes among Adults with Low Income in the United States in 2021

Background: Online grocery shopping has surged in popularity, but we know little about online grocery shopping behaviors and attitudes of adults with low income, including differences by age. Methods: From October to November 2021, we used a survey research firm to recruit a convenience sample of adults who have ever received Supplemental Nutrition Assistance Program (SNAP) benefits (n = 3526). Participants completed an online survey designed to assess diet and online food shopping behaviors. Using logistic regression, we examined the relationship between participant characteristics, including age, and the likelihood of online grocery shopping, and separately examined variation in the reasons for online grocery shopping by age. Results: About 54% of the participants reported shopping online for groceries in the previous 12 months. Odds of online shopping were higher for those aged 18–33 years (OR = 1.95 (95% CI: 1.52, 2.52; p < 0.001)) and 34–44 years (OR = 1.50 (95% CI: 1.19, 1.90; p < 0.001)) than for those aged ≥65 years. Odds were also higher for those who were food insecure and those with income below USD 20,000, higher educational attainment, and higher fruit and vegetable intake. Low prices were the most popular reason for online grocery shopping (57%). Adults aged 18–33 years old had higher odds of reporting low prices as a motivating factor than older adults (OR = 2.34 (95% CI: 1.78, 3.08; p < 0.001)) and lower odds of reporting being discouraged by lack of social interaction (OR = 0.34 (95% CI: 0.25, 0.45; p < 0.001)). Conclusion: Strategies for making online grocery shopping more affordable for adults with lower income may be promising, especially online produce. For older adults, additional support may be needed to make online shopping a suitable replacement for in-store shopping, such as education on technology and combining it with opportunities for social support.     

Associations of Diet Quality and Sleep Quality with Obesity

Short sleep duration or poor sleep quality has been associated with an increased risk of obesity. Although the underlying mechanism remains unclear, one proposed pathway is poor diet quality. This cross-sectional study investigated whether diet quality modifies the association between sleep status and obesity in Korean adults. We used the baseline data and samples of 737 men and 428 women (n = 1165) aged 19–64, who participated in the prospective Ewha–Boramae cohort study. Sleep duration was dichotomized into ≥7 h (adequate) and <7 h (insufficient). Pittsburgh Sleep Quality Index (PSQI) values, reflecting sleep quality, were dichotomized into >5 (poor quality) and ≤5 (good quality). Diet quality was evaluated by the Recommended Food Score (RFS). Obesity was associated with higher rates of insufficient sleep and poor sleep quality in women, but not in men. After adjustment for covariates, women with poor sleep quality had a higher risk of obesity than women with good sleep quality (OR = 2.198; 95% CI = 1.027–4.704); this association occurred only in the group with RFS ≤ median score. Our findings support a significant association between sleep quality and obesity, and this association has been potentially modified by dietary quality in women.     

Addressing Food Insecurity: A Qualitative Study of Undergraduate Students’ Perceptions of Food Access Resources

Food insecurity has emerged as a leading health care problem in the United States, impacting college students’ health, well-being, and academic performance. The aims of this study were: (1) to assess the prevalence of food insecurity, (2) to identify college students’ perceptions about food access resources, and (3) to explore students’ expressed needs from the university in improving food security status. A mixed-methods approach was used to assess the quantitative and qualitative aspects of the study aims. An online survey to gather demographic information and assess food security status using the 6-item version of the US Household Food Security Scale Module (HFSSM) was administered. Next, qualitative focus groups with subsets of participants was conducted to gain further insight into the perceptions, coping mechanisms, and resource utilization issues related to food insecurity. This study found 34.1% of undergraduate college students to be food insecure and demonstrates that students with a meal plan are less likely to be food insecure (p = 0.012; OR = 0.68; 95% CI = 0.489, 0.918). Qualitative data identified key influencers of food insecurity: (1) personal beliefs, (2) life skills, and (3) the university. The results of this study contribute to the literature focused on food insecurity prevalence in college students and presents insight from the college student perspective. Findings may support the development of relevant interventions that are congruent with students’ needs, enhancing resource utilization to increase food security status among college students.