Food Insecurity Linked With Lower Dietary Guideline Adherence Among Youth With T1D

Food insecurity is linked with lower adherence to fiber and sodium guidelines in youth and young Americans (YYA) with type 1 diabetes (T1D), which could lead to diabetes complications and other chronic diseases, according to new results from the SEARCH for Diabetes in Youth study.

Findings were published in the Journal of the Academy of Nutrition and Dietetics. 

Previous research has shown household food insecurity is associated with poor dietary intake in the general population. However, “little is known about this association in persons with diabetes,” authors wrote.

It’s also been shown that in general, children and adults consume excess sodium and saturated fat. Moreover, in 2020 approximately 10.5% percent of all US households and nearly 15% of households with children were food insecure at some point, authors noted.

To better understand the association between food insecurity with dietary intake among YYA with youth-onset diabetes, researchers assessed 10 key nutrients and dietary components. They also analyzed adherence to the Dietary Reference Intakes (DRIs) and the 2020-2025 Dietary Guidelines for Americans (DGA).

A total of 1197 YYA with T1D and 319 YYA with type 2 diabetes (T2D) were included in the study. Average age of the first cohort was around 21 and average age of the second cohort was around 25. All participants completed the US Department of Agriculture Household Food Security Survey Module, where 3 or more affirmations indicate food insecurity.

The age range of all YYA was 10 to 35 years, while most participants were female. Individuals with T1D had an average duration of diabetes of 11.2 years. Individuals with T2D had an average duration of 10.4 years. Individuals with T1D were mostly white and those with T2D were predominantly Black.

Analyses revealed:

• Less than 40% of participants met guideline recommendations for 8 of 10 nutrients and dietary components
• Higher adherence greater than 47% was found for vitamin C and added sugars
• YYA with T1D who were food insecure were more likely to meet recommendations for calcium, magnesium, and vitamin E (P < .05), and less likely for sodium (P < .05) than those with food security
• In adjusted models, YYA with T1D who were food secure had closer median adherence to sodium (P = .002) and fiber (P = .042) guidelines than those who were food insecure
• No associations were observed in YYA with T2D

In addition, data showed “among all participants, 20.3% were living in a food-insecure household, affecting a larger proportion of those with T2D (T1D: 17.5%, T2D: 30.7%). Those who were food insecure had a greater energy intake than those who were food secure (T1D: 235.1 more kilocalories per day; T2D: 179.3 more kilocalories per day).”

Researchers noted results of the current study are consistent with prior findings in a population with diabetes. “Adherence to guidelines was very low across the board for fiber, magnesium, vitamin D, vitamin E, and saturated fat, but moderate overall for vitamin C,” they said.

They also found more than half of YYA with diabetes were adherent to sugar consumption guidelines compared with 32.6 % of the general population. This higher adherence is potentially due to individuals with diabetes needing to be more attentive to their sugar intake, authors wrote.

“There is remarkable nutritional inadequacy among YYA with diabetes in the United States, with small differences between having a food secure/insecure status, except for pronounced differences among racial/ethnic minorities and by socioeconomic status,” researchers concluded.

“Further investigations that highlight the social context contributing to the nutritional inadequacy among YYA with diabetes are needed to inform effective support for disproportionately influenced populations; for example, based on socioeconomic status or race/ethnicity,” they said.

Reference

Bercaw H, Reid LA, Mendoza JA, et al. Food insecurity and adequacy of dietary intake in youth and young adults with youth-onset type 1 and type 2 diabetes. J AcadNutr Diet. Published online March 27, 2023. doi:10.1016/j.jand.2023.03.013