The Intersection between Food Insecurity and Diabetes: A Review

Explainable machine learning model incorporating social determinants of health to predict chronic kidney disease in type 2 diabetes patients

Background and objectives

Social determinants of health (SDOH) play a critical role in the onset and progression of chronic kidney disease (CKD). Despite the well-established role of SDOH, previous studies have not fully incorporated these factors in predicting CKD in Type 2 diabetes patients. To bridge this gap, this study aimed to develop and evaluate the machine learning (ML) models that incorporate SDOH to enhance CKD risk prediction in Type 2 diabetes patients.

Methods

Data were obtained from the 2023 Behavioral Risk Factor Surveillance System (BRFSS), a national survey that collects comprehensive health-related data from adults across the United States. Missing data were addressed using the K-nearest neighbor imputation method, and the Synthetic Minority Oversampling Technique (SMOTE) was applied to balance class distributions. Potential predictive features were selected using correlation coefficient analysis. The dataset was partitioned into training (80%) and testing (20%) subsets, with a 3-fold cross-validation strategy applied to the training data. Seven ML models were developed for CKD risk prediction, including logistic regression (LR), decision tree (DT), K-nearest neighbor (KNN), random forest (RF), eXtreme Gradient Boosting (XGBoost), and an artificial neural network (ANN). Model performance was evaluated using multiple metrics, including the area under the receiver operating characteristic curve (AUROC), precision, recall, F1 score, accuracy, and false positive rate.

Results

The study included 19,912 Type 2 diabetes patients (weighted sample size: 818,878), among whom 2,924 (weighted 13.92%) had CKD, and 16,988 (weighted 86.08%) did not. Over half of the CKD group (50.4%) were aged 65 or older. The proportion of female patients was higher in both groups, comprising 53.8% of the CKD group and 50.5% of the non-CKD group. Among the ML models evaluated, the RF model demonstrated the highest predictive performance for CKD, with an AUROC of 0.89 (95% CI: 0.88 - 0.90), followed by the DT model (0.84, 95% CI: 0.83 - 0.85) and XGBoost (0.83, 95% CI: 0.82 - 0.84). The RF model achieved an accuracy of 0.81 (95%CI: 0.81 - 0.81), a precision of 0.79 (95%CI: 0.79 - 0.79), a recall of 0.85 (95%CI: 0.85 - 0.85), and an F1 score of 0.82 (95%CI: 0.82 - 0.82). Additionally, the RF model exhibited strong calibration, reinforcing its reliability as a predictive tool for CKD risk in individuals with Type 2 diabetes.

Conclusion

The study findings underscore the potential of ML models, particularly the RF model, in accurately predicting CKD among individuals with Type 2 diabetes. This approach not only enhances the precision of CKD prediction but also highlights the importance of addressing social and environmental disparities in disease prevention and management. Leveraging ML models with SDOH can lead to earlier interventions, more personalized treatment plans, and improved health outcomes for vulnerable populations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01621-9.

MetALD: New Perspectives on an Old Overlooked Disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-associated liver disease (ALD) are the major contributors to the liver disease burden globally. The rise in these conditions is linked to obesity, type 2 diabetes, metabolic syndrome and increased alcohol consumption. MASLD and ALD share risk factors, pathophysiology and histological features but differ in their thresholds for alcohol use, and the ALD definition does not require the presence of metabolic dysfunction. A recent multi-society consensus overhauled the nomenclature of liver steatosis and introduced the term MetALD to describe patients with metabolic dysfunction who drink more than those with MASLD and less than those with ALD. This new terminology aims to enhance the understanding and management of liver disease but poses challenges, such as the need to accurately measure alcohol consumption in research and clinical practice settings. Recent studies show that MetALD has significant implications for patient management, as it is associated with increased mortality risks and more severe liver outcomes compared to MASLD alone. MetALD patients face increased risks of liver disease progression, cancer and cardiovascular disease. The diagnosis of MetALD involves the adequate quantification of alcohol use through standardised questionnaires and/or biomarkers as well as proper assessment of liver disease stage and progression risk using non-invasive tools including serologic markers, imaging, elastography techniques and genetic testing. Effective management requires addressing both metabolic and alcohol-related factors to improve outcomes. This review intends to provide a comprehensive overview of MetALD, covering pathogenesis, potential diagnostic approaches, management strategies and emerging therapies.

The association between multimorbidity and food insecurity among US parents, guardians, and caregivers

BACKGROUND

Multimorbidity among parents, guardians, and caregivers may increase the risk of household food insecurity, which would negatively impact both parents and children. However, limited research has been done to evaluate this relationship among this population. To fill this gap, we examined the association between multimorbidity and food insecurity among U.S. parents.

METHODS

Cross-sectional data from 2019 to 2022 of the National Health Interview Survey were analyzed. Parents, guardians, and caregivers with complete data (N = 26,579) were included. Multimorbidity is defined as having 2 or more conditions. In this study, multimorbidity was categorized as 2 or 3 + conditions from a sum of 11 chronic conditions: hypertension, hyperlipidemia, diabetes, arthritis, stroke, cancer, asthma, depression, anxiety, chronic obstructive pulmonary disease, and heart disease. The presence of food insecurity was defined in four nominal categories (secure, marginal food security, low food security, very low food security). Survey-weighted multinomial regression was used to assess the association of multimorbidity with food insecurity categories, controlling for sociodemographic characteristics. The association between physical versus physical-mental comorbidities and food insecurity was also analyzed.

RESULTS

The mean study sample age was 38.8 years, 51% were women and 53% were non-Hispanic White race/ethnicity. Nearly half (49%) had ≥ 1 chronic condition; 23% had 1, 14% had 2, and 13% had 3+. The most common pair of chronic conditions among parents was depression and anxiety, and most common triad was depression, anxiety, and hypertension. After controlling for potential confounders, we found that parents with 3 + conditions had a higher risk of marginal (OR 1.75, 95% CI 1.47-2.10), low (OR 2.20, 95% CI 1.75-2.75), and very low food security (OR 4.1, 95% CI 3.2-5.2) compared to parents with no conditions. Differences were seen in the odds of food insecurity among parents with mental and physical conditions, as opposed to physical comorbidities alone.

CONCLUSIONS

Our findings suggest a higher risk of food insecurity in parents with multimorbidity. Parents with multimorbidity (especially those with comorbid depression and anxiety disorders) may be a key population to identify and intervene on food insecurity to improve health and well-being among US families.

Prevalence and underdiagnosis of diabetes mellitus in a food insecure population

Food insecurity is a public health issue and a major risk factor for overall worse health outcomes including hypertension, diabetes, coronary heart disease, congestive heart failure, stroke, chronic kidney disease and obesity. Food-insecure patients are more likely to have both diagnosed and undiagnosed prediabetes and diabetes. This study examines the prevalence and self-awareness of diabetes and prediabetes in an at-risk, food-insecure population. The Cardiometabolic Health Initiative (CHI) is a community service organization that provides comprehensive cardiometabolic screenings at food pantries in West Chicago. Between August 2023 and December 2024, 191 patients were screened using point-of-care A1c tests. The average A1c of the population was 6.04%. Ninety-six patients had a normal A1c (< 5.7%), 66 had a prediabetic A1c (5.7-6.4) and 29 had a diabetic A1c (> 6.4). Forty-two patients self-reported a history of DM. The average A1c for the self-reported DM group was 7.58% and the average A1c for the non-reported group was 5.60%. Among the self-reported DM group, 24 patients had controlled DM (A1c < 7%) and 18 had uncontrolled DM (A1c > 7%). Among the non-reported group, 56 had a prediabetic A1c and 3 had a diabetic A1c. The presented findings suggest a high prevalence of diabetes and prediabetes within a food-insecure population in West Chicago. Further, this study suggests that many diabetic patients struggle to control their A1c levels. Our findings reflect many barriers presented to food insecure patients that can hinder diabetes diagnosis, education, and management.

Food insecurity among adult females with a history of breast cancer compared to adult females without cancer in the USA

PURPOSE

To determine the prevalence of food insecurity (FI) among females with a history of breast cancer compared to females without cancer in the USA and the sociodemographic characteristics that may explain their FI.

METHODS

Using the 2019 National Health Interview (NHIS) survey that included the US Department of Agriculture's (USDA's) 10-item Household Food Security Survey Module, participants with high/moderate food security were considered food secure and low/very low food security were considered food insecure. Analyses accounted for complex survey design and included descriptive statistics, bivariate analyses, and multivariate regression analyses.

RESULTS

Eligible females (40+ years old) included 557 with a history of breast cancer and 9678 without a cancer history. FI was experienced by an estimated 4.4% of females with breast cancer, compared to 9.3% of females without cancer. Controlling for age, race/ethnicity, education level, general health status, and body mass index, the prevalence ratio between the two study groups was 0.50 (95% CI 0.33-0.78).

CONCLUSIONS

In this national sample, the prevalence of FI among females with a history breast cancer was lower than females without a history of cancer.

IMPLICATIONS FOR CANCER SURVIVORS

FI is low among breast cancer survivors, and routine FI screening among breast cancer survivors may not be warranted for all patients. Healthcare providers, however, should be aware of FI as a social determinant of health and consider it when there are known financial issues among cancer survivors.

Updated recommendations for the management of metabolic dysfunction-associated steatotic liver disease (MASLD) by the Latin American working group

Metabolic dysfunction-associated steatotic liver disease (MASLD) is one of the leading causes of chronic liver disease globally. Based on the 2023 definition, MASLD is characterized by the presence of metabolic dysfunction and limited alcohol consumption (<140 grams/week for women, <210 grams/week for men). Given the significant burden of MASLD in Latin America, this guidance was developed by the Latin American Association for the Study of the Liver (ALEH) Working Group to address key aspects of its clinical assessment and therapeutic strategies. In Latin America, ultrasonography is recommended as the initial screening tool for hepatic steatosis due to its accessibility, while Fibrosis-4 (FIB-4) is preferred for fibrosis risk stratification, with further evaluation using more specific techniques (i.e., vibration-controlled transient elastography or Enhanced Liver Fibrosis [ELF] test). A Mediterranean diet is advised for all MASLD patients, with a target of 7-10% weight loss for those with excess weight. Complete alcohol abstinence is recommended for patients with significant fibrosis, and smoking cessation is encouraged regardless of fibrosis stage. Pharmacological options should be tailored based on the presence of steatohepatitis, liver fibrosis, excess weight, and diabetes, including resmetirom, incretin-based therapies, pioglitazone, and sodium-glucose cotransporter-2 inhibitors. Bariatric surgery may be considered for MASLD patients with obesity unresponsive to lifestyle and medical interventions. Hepatocellular carcinoma screening is advised for all cirrhotic patients, with consideration given to those with advanced fibrosis based on individual risk. Finally, routine cardiovascular risk assessment and proper diabetes prevention and management remain crucial for all patients with MASLD.

Glycemic control is worse in rural compared to urban type 2 diabetes in Bangladesh, irrespective of food security status

BACKGROUND

Food insecurity (FIS) affects around 25% of Bangladesh's population, and data from developed nations report higher FIS rates among individuals with type 2 diabetes (T2D), potentially worsening glycemic control. The importance of FIS to T2D has not been studied in developing countries such as Bangladesh, with substantial disparities in healthcare access, especially between rural and urban areas. We evaluated the relationships between food insecurity and glycemic control in the context of area of residence among individuals with T2D in Bangladesh.

METHODS

A total of 849 individuals with T2D attending diabetes clinics in four districts of Bangladesh completed a validated questionnaire to assess the FIS (a score ≥ 3 is indicative of FIS), which was compared with their sociodemographic and biochemical data. Two-way anova and multiple linear and binary logistic regression analyses were performed.

RESULTS

Both HbA1c levels (10.8% vs 9.5, P < 0.001) and the prevalence of FIS (45.8% vs 31.4%, P < 0.001) were higher in rural areas. According to two-way anova (0.87-1.78% mean difference, P < 0.05) and multiple linear regression model (β = 1.4, P < 0.001), HbA1c levels were also higher among rural than urban dwellers, irrespective of their FIS status. Rural dwellers were also more than twice as likely to have suboptimal glycemic control (HbA1c ≥7%; AOR: 2.26 (1.35-3.97), P < 0.05), irrespective of their food security status (AOR: 1.19 (0.78-1.84, P > 0.05)).

CONCLUSIONS

In Bangladesh, rural residence is associated with poor glycemic control, irrespective of food security status, and thus is an important social determinant of diabetes care that warrants further exploration.

Investigating health professionals' perspectives and experiences of food security-related conversations in diabetes care

AIMS

Household food insecurity (FI) is a serious public health concern and disproportionately affects people living with chronic health conditions, undermining diabetes self-management. Little is known about healthcare professionals' (HCPs) experiences of supporting people affected by diabetes and FI, and no national guidelines incorporate consideration of FI within UK diabetes care. A qualitative study of NHS HCPs' consideration of FI within diabetes care, and the extent to which it informs their clinical practice, was undertaken.

METHODS

Fifteen HCPs providing self-management support to people with Type 1 or Type 2 diabetes in a Scottish Health Board took part in semi-structured interviews. Data were analysed using a thematic framework approach informed by the Capability, Opportunity, Motivation and Behaviour (COM-B) model of behaviour change.

RESULTS

Although the potential impact of FI on diabetes self-management was recognised, this important consideration was not currently core to their clinical practice. Enablers and barriers identified included: personal feelings about raising the issue, lack of knowledge of available resources, the patient-practitioner relationship, and the wider socioeconomic environment. Practical suggestions to support HCPs included: specific training on communication, access to patient support information, use of a screening tool to assess FI, and building NHS-third sector links.

CONCLUSIONS

Our findings provide insight into cognitive factors, emotional processes and environmental systems impacting on HCPs' practice supporting individuals with diabetes and FI. Research with affected patients is needed to gain a better understanding of how to provide support within NHS settings.

The syndemic nature of food insecurity among U.S. college students: Findings from national samples

Objective: This study explores the concept of food insecurity as a syndemic among U.S. college students, examining its connections with mental health issues and socioeconomic determinants. Participants: The data came from two national surveys of U.S. college students (N = 63,680) before and after the 2020 campus shutdown. Methods: Our analysis assess the prevalence of food insecurity among U.S. college students during the Covid outbreak and its impact on their mental well-being, academic performance, and various socioeconomic factors. Results: Food insecurity affected 40.8% of U.S. college students before the Covid pandemic and 35.0% of them after it. Viewing food insecurity as a syndemic reveals its links to diminished academic performance, increased obesity rates, mental health issues, and parents' educational background. Conclusions: These findings help identify at-risk students and develop interventions to alleviate food insecurity like expanding on-campus support systems, delivering emergency food aid, and reconfiguring residential dining programs.

Firearm Homicide Mortality is Linked to Food Insecurity in Major US Metropolitan Cities

BACKGROUND

Gun violence disproportionately affects metropolitan areas of the United States (US). There is limited information regarding the influence of social determinants of health, such as food insecurity (FI) on firearm homicide mortality (FHM) in major metropolitan cities in the US. We sought to examine the relationship between FI and FHM.

MATERIALS AND METHODS

This was a cross-sectional analysis examining the largest 51 US major metropolitan statistical areas (MSAs) using data from 2018. Demographic data, markers of social inequities, and firearm homicide data were obtained from the US Census Bureau, US Department of Education, and the Frey and Brookings Institute. Food insecurity prevalence was obtained from Feeding America. Spearman ρ and linear regression were performed.

RESULTS

Using Spearman rho analysis, higher FI (r = 0.55, P < 0.001) was associated with FHM. Other variables associated with FHM included percent Black/African American (AA) (r = 0.77, P < 0.001), poverty rate (r = 0.53, P < 0.001), and percent of children living in single parent households (r = 0.58, P < 0.001). In linear regression analyses, FI was associated with increased FHM, with 1.3 additional FHM events for each unit increase in FI (β = 1.33, 95% CI 0.27-2.39, P = 0.02). The percent of a population that is Black/AA was also associated with FHM, with more than 4 additional cases for each 1% increase in the population (β = 4.32, 95% CI 3.26-5.38, P < 0.001).

CONCLUSION

Food insecurity may influence FHM in major US metropolitan cities. Community- and hospital-based programs that target FI may help combat the gun violence epidemic and decrease gun violence.

Health-Related Social Needs Intervention for Adolescents and Young Adults With Type 2 Diabetes and Their Caregivers: An Exploratory Study Using Human-Centered Design

Youth-onset type 2 diabetes (T2D) is increasingly common and projected to impact over 200,000 adolescents and young adults by 2060. Youth with T2D frequently experience health-related social needs (HRSN) that increase their risk for poor outcomes. Using human-centered design methodology, we explored how best to address HRSN in pediatric endocrinology clinics. We conducted two parallel, six-session group meetings with youth (n = 4) and caregivers of youth (n = 6), as well as individual interviews with 12 pediatric endocrinology clinicians. An inductive thematic data analysis approach was used. Participants described that HRSN are pervasive for youth with T2D and are especially impactful after diagnosis. Participants thought that addressing HRSN in healthcare settings was important but emphasized that interventions need to be affirming and provide tangible, relevant resources. Engagement with community health workers trained around diabetes management is needed, as is structural change to disrupt health disparities. Future research and clinical transformation are discussed.

Contextualization of Diabetes: A Review of Reviews from Organisation for Economic Co-operation and Development (OECD) Countries

PURPOSE OF REVIEW

The prevalence of diabetes is rising around the world and represents an important public health concern. Unlike individual-level risk and protective factors related to the etiology of diabetes, contextual risk factors have been much less studied. Identification of contextual factors related to the risk of type 1 and type 2 diabetes in Organisation for Economic Co-operation and Development (OECD) countries may help health professionals, researchers, and policymakers to improve surveillance, develop policies and programs, and allocate funding.

RECENT FINDINGS

Among 4,470 potential articles, 48 were included in this review. All reviews were published in English between 2005 and 2023 and were conducted in over 20 different countries. This review identified ten upstream contextual risk factors related to type 1 and type 2 diabetes risk, including income, employment, education, immigration, race/ethnicity, geography, rural/urban status, built environment, environmental pollution, and food security/environment. The ten upstream contextual risk factors identified this review may be integrated into diabetes research, surveillance and prevention activities to help promote better outcomes for people at risk or living with diabetes in OECD countries. Additional research is needed to better quantify the measures of associations between emerging key contextual factors and diabetes outcomes.

County-Level Food Insecurity and Hepatocellular Carcinoma Risk: A Cross-Sectional Analysis

Food insecurity (FI) is associated with several known hepatocellular carcinoma (HCC) risk factors, but few studies have directly examined FI in association with HCC risk. We aimed to investigate whether county-level FI is associated with HCC risk. We used data from 21 registries in the Surveillance Epidemiology and End Results database to obtain county-level counts of HCC cases from 2018 to 2021. We obtained the county-level FI rates for 2018-2021 from Feeding America's Map the Meal Gap. We used multi-level Poisson regression models with robust standard errors to calculate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Overall, a one-standard-deviation (SD) increase in county-level FI was associated with an 8% increase in HCC risk in the fully adjusted model (IRR = 1.08, 95% CI = 1.06, 1.10). When stratified by age at diagnosis, a one-SD increase in county-level FI was associated with a 2% higher risk of HCC in the ≥65 age group (IRR = 1.02, 95% CI = 1.00, 1.05) and a 15% higher risk in the <65 age group (IRR = 1.15, 95% CI = 1.11, 1.19; interaction p-value < 0.001). If confirmed in other studies, these findings support the need for interventions and policies addressing FI in populations at increased risk for HCC.

Development of a statewide network hub for screening, referral, and enrollment into food as medicine programs across Kentucky

Widespread recognition of food as medicine interventions' role in reducing food insecurity and improving health outcomes has recently emerged. Several states have released In Lieu of Services, state-approved alternative services that may be offered by managed care organizations in place of covered benefits, or 1,115 Medicaid waivers, which may allow for expanded nutrition services to reduce food insecurity and improve health outcomes. However, there are significant gaps in understanding how to create a statewide system for delivering "healthcare by food" interventions. The University of Kentucky Food as Health Alliance first piloted the development of a statewide hub facilitating referral to, enrollment in, and evaluation of food as medicine programs across two healthcare providers (one urban and one rural). We then used a quasi experimental study design to examine effects on systolic and diastolic blood pressure in a target population of Medicaid eligible individuals aged 18-64 with high blood pressure and/or type 2 diabetes in rural and urban areas. Participant allocation was based on geographic location for each program arm with no control group. This feasibility case study aims to: (1) outline the development of a referral system between healthcare and food as medicine providers; (2) describe gaps in referral and enrollment; (3) summarize lessons learned from a statewide network as a blueprint for other states; and (4) present clinical outcomes across three food as medicine programs. Ninety-two referrals were received from UK HealthCare with 21 enrolled in medically tailored meals and 28 enrolled in a grocery prescription (53% enrollment rate). Thirty-two referrals were received from Appalachian Regional Healthcare with 26 enrolled in meal kits (81% enrollment rate). On average, the reduction in systolic blood pressure was 9.67 mmHg among medically tailored meals participants and 6.89 mmHg among grocery prescription participants. Creating a statewide system to address food insecurity and clinical outcomes requires key support from a host of stakeholders. Policy steps moving forward need to consider funding and infrastructure for screening, referral, enrollment and engagement hubs for improved health outcomes.

Clinical trial registration

ClinicalTrials.gov, NCT06033664.

Supplemental Nutrition Assistance Program Work Requirements and Safety-Net Program Participation

Importance

Work requirements are a controversial feature of US safety-net programs, with some policymakers seeking to expand their use. Little is known about the demographic, clinical, and socioeconomic characteristics of individuals most likely to be negatively impacted by work requirements.

Objective

To examine the association between work requirements and safety-net program enrollment.

Design, Setting, and Participants

This cohort study included Medicaid and Supplemental Nutrition Assistance Program (SNAP) enrollees in Connecticut. The impact of SNAP work requirements for able-bodied adults without dependents-the target population-was estimated using a triple-differences research design comparing outcomes before and after the policy (first difference) in affected and exempted towns (second difference) between the targeted population and untargeted parents and caregivers (third difference). SNAP and Medicaid enrollment trends were assessed for a 24-month period, and the characteristics of individuals most likely to lose coverage were examined. Data were collected from August 2015 to April 2018, and data were analyzed from August 2022 to September 2024.

Exposures

The reintroduction of SNAP work requirements in 2016.

Main Outcomes and Measures

Proportion of enrollees disenrolled from SNAP and Medicaid.

Results

Of 81 888 Medicaid enrollees in Connecticut, 46 872 (57.2%) were female, and the mean (SD) age was 36.6 (7.0) years. Of these, 38 344 were able-bodied adults without dependents, of which 19 172 were exposed to SNAP work requirements, and 43 544 were parents or caregivers exempted from SNAP work requirements. SNAP coverage declined 5.9 percentage points (95% CI, 5.1-6.7), or 25%, following work requirements. There were no statistically significant changes in Medicaid coverage (0.2 percentage points; 95% CI, -1.4 to 1.0). Work requirements disproportionately affected individuals with more chronic illnesses, targeted beneficiaries who were older, and beneficiaries with lower incomes. Individuals with diabetes were 5 percentage points (95% CI, 0.8-9.3), or 91%, likelier to lose SNAP coverage than those with no chronic conditions; older SNAP beneficiaries (aged 40 to 49 years) with multiple comorbidities were 7.3 percentage points (95% CI, 4.3-11.3), or 553%, likelier to disenroll than younger beneficiaries (aged 25 to 29 years) without chronic conditions; and households with the lowest incomes were 18.6 percentage points (95% CI, 11.8-25.4), or 204%, likelier to lose coverage than the highest income SNAP beneficiaries.

Conclusions and Relevance

In this cohort study, SNAP work requirements led to substantial reductions in SNAP coverage, especially for the most clinically and socioeconomically vulnerable. Work requirements had little effect on Medicaid coverage, suggesting they did not lead to sufficient increases in employment to transition beneficiaries off the broader safety net.

Personal and Social-Built Environmental Factors of Glucose Variability Among Multiethnic Groups of Adults With Type 2 Diabetes: Research Protocol Using Ecological Momentary Assessment, Continuous Glucose Monitoring, and Actigraphy

Glucose variability (GV)-the degree of fluctuation in glucose levels over a certain period of time-is emerging as an important parameter of dynamic glycemic control. Repeated glycemic oscillations have been reported to be the link to diabetes complications. This prospective observational study aims to: (1) identify multilevel risk factors (personal and social-built environmental factors) associated with high GV; (2) identify "within-person predictors" of high GV leveraging the intra-person data to inform future personalized diabetes interventions; and (3) examine which lifestyle factors either mediate or moderate the relationship between emotional well-being and GV among diverse adults with type 2 diabetes (T2D). We will recruit 200 adults with T2D from the community. All participants will complete baseline surveys assessing demographics, lifestyle, social-built environmental, and clinical factors. Real-time dynamic glucose levels will be measured using continuous glucose monitoring (CGM). Sleep, physical activity, diet/eating, and emotional well-being will be measured with an actigraphy device and a real-time self-report tool (ecological momentary assessment [EMA]) across 14 days. Two 24-h dietary recall data will be collected by online video calls. Generalized linear models, multilevel models, and structural equation models will be developed to achieve the study aims. The findings from the study will identify high-risk groups of high GV who would benefit from CGM to improve diabetes outcomes and inform the future development of personalized just-in-time interventions targeting lifestyle behaviors with an increased understanding of GV and by supporting healthcare providers' clinical decisions.

Patients with diabetes struggling to afford food and control their HbA1c in food-insecure areas in Bronx, NY

OBJECTIVE

To characterise the association between risk of poor glycaemic control and self-reported and area-level food insecurity among adult patients with type 2 diabetes.

DESIGN

We performed a retrospective, observational analysis of cross-sectional data routinely collected within a health system. Logistic regressions estimated the association between glycaemic control and the dual effect of self-reported and area-level measures of food insecurity.

SETTING

The health system included a network of ambulatory primary and speciality care sites and hospitals in Bronx County, NY.

PARTICIPANTS

Patients diagnosed with type 2 diabetes who completed a health-related social need (HRSN) assessment between April 2018 and December 2019.

RESULTS

5500 patients with type 2 diabetes were assessed for HRSN with 7·1 % reporting an unmet food need. Patients with self-reported food needs demonstrated higher odds of having poor glycaemic control compared with those without food needs (adjusted OR (aOR): 1·59, 95 % CI: 1·26, 2·00). However, there was no conclusive evidence that area-level food insecurity alone was a significant predictor of glycaemic control (aOR: 1·15, 95 % CI: 0·96, 1·39). Patients with self-reported food needs residing in food-secure (aOR: 1·83, 95 % CI: 1·22, 2·74) and food-insecure (aOR: 1·72, 95 % CI: 1·25, 2·37) areas showed higher odds of poor glycaemic control than those without self-reported food needs residing in food-secure areas.

CONCLUSIONS

These findings highlight the importance of utilising patient- and area-level social needs data to identify individuals for targeted interventions with increased risk of adverse health outcomes.

Food insecurity and diabetes management among adults of African descent: A systematic review

AIMS

This systematic review explores the established causal link between food insecurity and cardiometabolic conditions among adults of African descent. Specifically, this study examined the relationship between food insecurity and the management of type 2 diabetes, highlighting the prevalence of food insecurity among individuals of African descent with type 2 diabetes.

METHODS

Original English papers were meticulously searched in databases including PubMed, CINAHL, PsycINFO, Medline, Cochrane, Embase and Web of Science. The Cochrane Risk of Bias Tool for quantitative studies and COReQ for qualitative studies were employed to assess biases. Three independent reviewers meticulously evaluated and synthesized results, reaching a consensus.

RESULTS

Among the 198 studies identified, 14 met the inclusion criteria for data extraction and analysis, which were conducted independently by three reviewers. The findings indicate that individuals of African descent are more likely to experience food insecurity compared to their White counterparts and are also more prone to diabetes risk factors or the presence of diabetes.

CONCLUSIONS

This study underscores a higher prevalence of food insecurity and type 2 diabetes among adults of African descent, suggesting that ethnicity and food insecurity play significant roles in diabetes management. Future research should prioritize interventions aimed at reducing these disparities.

Focusing attention on the important association between food insecurity and psychological distress: a systematic review and meta-analysis

BACKGROUND

Food insecurity has involved more than 750 million individuals worldwide. The association of food insecurity with socio-economic factors is also undeniable demand more consideration. Food insecurity will become a global priority by 2030. This systematic review and meta-analysis examined current literature concerning the association between food insecurity and psychological distress.

METHODS

Relevant researches were identified by searching databases including PubMed, EMBASE, Scopus, and Web of Science, ProQuest, and Cochrane Library up to June 2024 without language limitation. Then a snowball search was conducted in the eligible studies. The quality assessment was made through Newcastle-Ottawa Scale.

RESULTS

Data were available from 44 cross-sectional articles for systematic review and 17 eligible articles for meta-analysis with 2,267,012 and 1,953,636 participants, respectively. Findings support the growing segment of literature on the association between food insecurity and psychological distress. The highly represented groups were households with low income. Psychological and diabetic distress was directly associated with food insecurity as it increased the odds of distress to 329% (OR: 3.29; 95% CI: 2.46-4.40). Sleep problems, anxiety, depression, lower life satisfaction, obesity, and a higher rate of smoking were among the secondary outcomes.

CONCLUSION

Food insecurity was a common stressor that can have a negative impact on psychological well-being and even physical health. The findings should be considered in the public health and making policy-making process.

Food insecurity and glycemic goals among Medicare beneficiaries with type 2 diabetes

OBJECTIVE

To examine the association between food insecurity and achieving glycemic goals among Medicare beneficiaries with type 2 diabetes.

METHODS

This study analyzed the nationally representative 2019 Medicare Current Beneficiary Survey of 1340 beneficiaries aged ≥65 years with type 2 diabetes. The binary dependent variable was whether beneficiaries' blood glucose was at target (A1C ≤ 7.5% or average fasting blood glucose of ≤140 mg/dL, all/most of the time). Food insecurity, a binary variable, was adapted based on the USDA's food security questions. A survey-weighted multivariable logistic model, adjusted for sociodemographics and comorbidities, was conducted to estimate predictive margins for comparing prevalence of having above-target blood glucose levels across groups.

RESULTS

Of study beneficiaries, 20.9% reported not achieving glycemic targets. The predictive marginal prevalence of having higher than target blood glucose levels was significantly greater in females over males (23.8% [95% confidence interval [CI], 20.1-27.4] vs 17.6% [14.3-20.9]); those with less than high school education over those with college education (31.0% [23.6-38.3] vs 18.6% [14.8-22.3]); and those reporting food insecurity over their counterparts (33.4% [24.5-42.3] vs 19.1% [16.6-21.7]).

CONCLUSIONS

Sociodemographic disparities related to achieving blood glucose goals were observed. Screening for food insecurity and related interventions should be considered for at-risk beneficiaries with diabetes.

Predictive Modelling of Diabetes Risk in Population Groups Defined by Socioeconomic and Lifestyle Factors in Canada: A Cross-Sectional Study

Objectives

This study modelled diabetes risk for population groups in Canada defined by socioeconomic and lifestyle characteristics and investigated inequities in diabetes risk using a validated population risk prediction algorithm.

Methods

We defined population groups, informed by determinants of health frameworks. We applied the Diabetes Population Risk Tool (DPoRT) to 2017/2018 Canadian Community Health Survey data to predict 10-year diabetes risk and cases across population groups. We modelled a preventive intervention scenario to estimate reductions in diabetes for population groups and impacts on the inequity in diabetes risk across income and education.

Results

The population group with at least one lifestyle and at least one socioeconomic/structural risk factor had the highest estimated 10-year diabetes risk and number of new cases. When an intervention with a 5% relative risk reduction was modelled for this population group, diabetes risk decreased by 0.5% (females) and 0.7% (males) and the inequity in diabetes risk across income and education levels was reduced.

Conclusion

Preventative interventions that address socioeconomic and structural risk factors have potential to reduce inequities in diabetes risk and overall diabetes burden.

Food and Nutrition Insecurity: Experiences That Differ for Some and Independently Predict Diet-Related Disease, Los Angeles County, 2022

BACKGROUND

National surveillance shows that food insecurity affects ∼1 in 10 Americans each year. Recently, experts have advocated for surveillance of nutrition insecurity alongside food insecurity. Nutrition security refers to the nutritional adequacy of accessible food and factors that impact one's ability to meet food preferences.

OBJECTIVES

This study presents representative estimates of food insecurity and nutrition insecurity for Los Angeles County, CA, United States; compares predictors of these constructs; and examines whether they independently predict diet-related health outcomes.

METHODS

In December 2022, a representative sample of Los Angeles County adults participating in the Understanding America Study (N = 1071) was surveyed about household food insecurity and nutrition insecurity over the past 12 months. Data were analyzed in 2023.

RESULTS

Reported rates were similar for food insecurity (24%) and nutrition insecurity (25%), but the overlap of these subgroups was less than 60%. Logistic regression models indicated that non-Hispanic Asian individuals had higher odds of nutrition insecurity but not food insecurity. Moreover, nutrition insecurity was a stronger predictor of diabetes compared with food insecurity, and both constructs independently predicted poor mental health.

CONCLUSIONS

Food and nutrition insecurity affect somewhat different populations. Both constructs are valuable predictors of diet-related health outcomes. Monitoring nutrition insecurity in addition to food insecurity can provide new information about populations with barriers to healthy diets.

Food insecurity is related to eating disorder psychopathology beyond psychological distress in rural Chinese adolescents

OBJECTIVE

This study aimed to examine the relationship between food insecurity (FI) and eating disorder psychopathology in a large sample of rural Chinese adolescents.

METHODS

Analyses included 1654 adolescents (55.4% girls; Mage = 16.54 years, SD = 1.45) from a rural high school in southwestern China. FI, eating disorder psychopathology, and psychological distress (i.e., symptoms of depression, anxiety, and stress) were assessed. Data were analyzed by sex. Pearson correlation analysis was performed to investigate the zero-order association between FI and eating disorder psychopathology. Hierarchical linear regressions were used to explore whether FI could explain meaningful variance in eating disorder psychopathology beyond psychological distress and demographic covariates (e.g., socioeconomic status).

RESULTS

FI was significantly associated with higher eating disorder psychopathology for boys (r = 0.44, p < 0.001) and girls (r = 0.43, p < 0.001), with medium-to-large effect sizes. FI accounted for significant unique variance in eating disorder psychopathology beyond psychological distress and demographic covariates for boys (ΔR2 = 0.14, p < 0.001) and girls (ΔR2 = 0.10, p < 0.001).

DISCUSSION

Using a large sample of rural Chinese adolescents, this study extends the connection between FI and eating disorder pathology in adolescents beyond the Western context. Future investigations on the mechanisms underlying FI and eating disorder psychopathology are warranted for developing prevention strategies for eating disorders among rural Chinese adolescents.

PUBLIC SIGNIFICANCE

This is the first investigation that examined the link between FI and eating disorder psychopathology among rural Chinese adolescents. Our findings highlight the importance of incorporating FI as a potential risk factor to screen for the prevention and intervention of eating disorders among rural Chinese adolescents.

Rationale and design of the KP ENRICH trial: A food is medicine intervention in low-income high-risk adults with diabetes within Kaiser Permanente

BACKGROUND

Food insecurity is associated with poor glycemic control and increased risk for diabetes-related complications. The clinical benefit of addressing these challenges through a medically supportive grocery prescription (GRx) program in patients with type 2 diabetes mellitus (T2D) remains unclear. We report the aims and design of a randomized clinical trial to evaluate the effectiveness of a 6-month GRx intervention on hemoglobin A1c (HbA1c) levels among low-income adults with T2D.

METHODS

The Kaiser Permanente Evaluating Nutritional Interventions in Food-Insecure High-Risk Adults (KP ENRICH) Study is a pragmatic randomized trial enrolling 1100 participants within Kaiser Permanente Northern California and Southern California, two integrated health care delivery systems serving >9 million members. Medicaid-insured adults with T2D and baseline HbA1c ≥7.5% will be randomized at a 1:1 ratio to either GRx, delivered as $100 per month for select items from among a curated list of healthful food groups in an online grocery ordering and home-delivery platform along with biweekly digital nutrition educational materials, or control, consisting of free membership and deliveries from the online grocery platform but without curated food groups or purchasing dollars. The primary outcome is 6-month change in HbA1c. Secondary outcomes include 12-month change in HbA1c, and 6- and 12-month change in medical resource utilization, food security, nutrition security, dietary habits, diabetes-related quality of life, and dietary self-efficacy.

CONCLUSIONS

The results of this large randomized clinical trial of GRx will help inform future policy and health system-based initiatives to improve food and nutrition security, disease management, and health equity among patients with T2D.

Determinants of food insecurity among adults residing in peri-urban municipal settings in Flanders, Belgium

Food insecurity is a global public health issue associated with noncommunicable diseases. Individual factors are strongly associated with food insecurity, but there is limited literature on the broader impact of both the social and food environments on food insecurity in non-English speaking European countries, given that the research was predominantly conducted in Anglophone settings. In addition, these studies have mostly been conducted in urban areas. Therefore, this study aimed to identify the main determinants of food insecurity among adults living in peri-urban areas in Flanders, Belgium. Data on socio-demographics, neighborhood social cohesion, social isolation, and perceived food environments were collected from 567 adults through a self-administered questionnaire, and objective data on the food environment were obtained through (commercial) databases on food outlets. Food insecurity was measured using the USDA Household Food Security Survey Module. Multivariable logistic regression models revealed that lower socioeconomic status (OR14.11,95%CI:4.72;61.11), reasonable (OR4.16,95%CI: 2.11;8.47) to poor and very poor (OR6.54,95%CI: 2.11;8.47) subjective health status, and living in private (OR7.01, 95% CI:3.0;17.0) or government-assisted (OR6.32,95%CI: 3.13;13.26) rental housing significantly increased the odds of food insecurity. Additionally, residing in a neighborhood with low (OR2.64, 95% CI:1.13;6.26) to medium (OR2.45,95% CI:1.21;5.11) social cohesion, having a neutral opinion (OR4.12,95%CI:1.51;11.54) about the availability of fruit and vegetables in one's neighborhood, and having an opinion that fruit and vegetable prices are too expensive (OR5.43,95% CI 2.26;14.4) significantly increased the odds of experiencing food insecurity. This study underscores the need for policies that consider factors related to social and food environments, in addition to individual factors, to effectively address food insecurity.

The Association Between Hospital-Based Food Pantry Use and Subsequent Emergency Department Utilization Among Medicaid Patients With Diabetes

We explored the association between the use of a hospital-based food pantry and subsequent emergency department (ED) utilization among Medicaid patients with diabetes in a large safety-net health system. Leveraging 2015-2019 electronic health record data, we used a staggered difference-in-differences approach to measure changes in ED use before vs after food pantry use. Food pantry use was associated with a 7.3 percentage point decrease per patient per quarter (95% confidence interval, -13.8 to -0.8) in the probability of subsequent ED utilization ( P = .03). Addressing food insecurity through hospital-based food pantries may be one mechanism for reducing ED use among low-income patients with diabetes.

Food Insecurity and Diabetes Insulin Adherence Among Older Adults

Older adults in the United States continue to be impacted by food insecurity. Diabetes is on the rise in older adults and insulin therapy is often recommended as treatment. However, less is known about the relationship between food insecurity and insulin adherence among older adults. The current study utilized secondary data analysis methods to examine the 2021 National Health Interview Survey to explore the relationship between food insecurity and insulin adherence among adults aged 55 and older who are living with diabetes. Results of multivariable logistic regression suggest that participants experiencing food insecurity were more likely to take less insulin than needed and delay buying insulin in the past 12 months compared to participants who were food secure. Homeownership was inversely associated with taking less insulin than needed. Higher income-to-poverty ratio was also inversely associated with skipping insulin doses, taking less insulin than needed, and delaying the purchase of insulin. Our results showed that other racialized/ethnic groups (i.e., American Indian, Alaskan Native, Asian, biracial, and multiracial persons) compared to White were less likely to skip an insulin dose and take less insulin than needed. Suggesting food insecurity should be considered when insulin therapy is recommended for older adults with diabetes.

Household food security and dietary diversity in south-eastern Nigeria

The aim of this study was to investigate household food security (access) level and the dietary diversity of households in the Nsukka Local Government Area in South-eastern Nigeria. From 20 local communities of Nsukka, 390 women were randomly sampled from the women's group and asked to complete a survey that determined the Household Food Insecurity Access Scale scores and the Household Dietary Diversity Scores (HDDS). The descriptive results indicated a high level of food insecurity with 82.6% households reporting various degrees of food insecurity. Over half of the sampled population experienced insufficient food quality. They either ate unwanted food (65.9%), limited variety (63.1%), or unpreferred food (64.6%). Some households experienced insufficient food intake by going a whole day without food (38.2%), go to sleep hungry (45.1%), or have no food of any kind (49%). The analysis of variance showed no significant difference (p = 0.428) in the food security level of households headed by males as compared with those headed by females. Approximately 53.6% of households fell at or below the average HDDS; males headed 48% of these households, while females headed 64%. The chi-square test indicated factors associated with household food security including age, education, work status and income, whereas the gender of the household head, household size and marital status were not significantly associated. Public-private partnerships, nutrition orientation and food intervention programs could improve food security in this area.

"We don't separate out these things. Everything is related": Partnerships with Indigenous Communities to Design, Implement, and Evaluate Multilevel Interventions to Reduce Health Disparities

Multilevel interventions (MLIs) are appropriate to reduce health disparities among Indigenous peoples because of their ability to address these communities' diverse histories, dynamics, cultures, politics, and environments. Intervention science has highlighted the importance of context-sensitive MLIs in Indigenous communities that can prioritize Indigenous and local knowledge systems and emphasize the collective versus the individual. This paradigm shift away from individual-level focus interventions to community-level focus interventions underscores the need for community engagement and diverse partnerships in MLI design, implementation, and evaluation. In this paper, we discuss three case studies addressing how Indigenous partners collaborated with researchers in each stage of the design, implementation, and evaluation of MLIs to reduce health disparities impacting their communities. We highlight the following: (1) collaborations with multiple, diverse tribal partners to carry out MLIs which require iterative, consistent conversations over time; (2) inclusion of qualitative and Indigenous research methods in MLIs as a way to honor Indigenous and local knowledge systems as well as a way to understand a health disparity phenomenon in a community; and (3) relationship building, maintenance, and mutual respect among MLI partners to reconcile past research abuses, prevent extractive research practices, decolonize research processes, and generate co-created knowledge between Indigenous and academic communities.

Food insecurity is associated with metabolic syndrome among US adults: NHANES 2005-2016

The primary objective of this study was to examine the association between food security status and metabolic syndrome (MetS) using a nationally representative dataset. We hypothesized that food insecurity would be associated with an increased odds of having MetS. This was a cross-sectional analysis of data from the 2005-2006 to 2015-2016 National Health and Nutrition Examination Survey data collection cycles. Food security was measured using the US Food Security Survey Module. Presence of MetS was determined using the National Cholesterol Education Program Adult Treatment Panel III criteria. The association between food insecurity and MetS was examined using logistic regression models stratified by sex and adjusted for poverty to income ratio, age, race, marital status, educational attainment, smoking status, and body mass index. After adjusting for covariates, men with marginal (odds ratio, 1.64; 95% confidence interval [CI], 1.22-2.20) and low (odds ratio, 1.33; 95% CI, 1.02-1.73) food security had a higher odds of having MetS than men with full food security; however, this association was lost among men with very low food security. For women, very low food security was associated with a 1.61 times greater odds of having MetS (95% CI, 1.16-2.25). These results suggest that food insecurity is generally associated with an increased prevalence of MetS for women, but not necessarily for men. These findings highlight the need to address rising food insecurity rates, while also highlighting the need for further research to fully elucidate the role of gender and sex in food insecurity and chronic disease.

Household food insecurity and associations with hemoglobin A1c and acute diabetes-related complications in youth and young adults with type 1 diabetes: The SEARCH for Diabetes in Youth study

AIMS

To examine, among youth and young adults (YYA) with type 1 diabetes (T1D), the association of household food insecurity (HFI) with: 1) HbA1c and 2) episodes of diabetic ketoacidosis (DKA) and severe hypoglycemia.

METHODS

HFI was assessed using the U.S. Household Food Security Survey Module in SEARCH for Diabetes in Youth participants with T1D between 2016 and 2019. Linear and logistic regression models adjusted for age, diabetes duration, sex, race, ethnicity, clinic site, parent/participant education, household income, health insurance, and diabetes technology use.

RESULTS

Of 1830 participants (mean age 20.8 ± 5.0 years, 70.0 % non-Hispanic White), HbA1c was collected for 1060 individuals (mean HbA1c 9.2 % ± 2.0 %). The prevalence of HFI was 16.4 %. In the past 12 months, 18.2 % and 9.9 % reported an episode of DKA or severe hypoglycemia, respectively. Compared to participants who were food secure, HFI was associated with a 0.33 % (95 % CI 0.003, 0.657) higher HbA1c level. Those with HFI had 1.58 (95 % CI 1.13, 2.21) times the adjusted odds of an episode of DKA and 1.53 (95 % CI 0.99, 2.37) times the adjusted odds of an episode of severe hypoglycemia as those without HFI.

CONCLUSIONS

HFI is associated with higher HbA1c levels and increased odds of DKA in YYA with T1D.

Testing Race Differences in Risk of Gestational Diabetes Mellitus Associated with Household Food Insecurity (Using NHANES 2007-2018)

OBJECTIVE

This study aimed to estimate the association of household food insecurity with gestational diabetes mellitus (GDM) risk by race and ethnic group.

STUDY DESIGN

The study was a secondary analysis from the National Health and Nutrition Examination Survey from 2007 to 2018. A survey-weighted logistic regression model was constructed with self-reported GDM as the response. The primary independent variable was a four-level food security indicator, defined as the inability to obtain food in a socially acceptable way due to the lack of financial resources and controlled for several established risk factors. Analyses were stratified by race (White and Black) and ethnicity (Hispanic) to provide insight into how gestational diabetes risk differs by subpopulation.

RESULTS

Results indicated that family history of diabetes is a risk factor across all races (adjusted odds ratio [aOR]: 4.22-16.26), while household food insecurity is a significant risk factor for only Hispanic women living with a partner (aOR: 8.50 for very low food security).

CONCLUSION

In the United States, Hispanic women's GDM risk may be uniquely impacted by food insecurity.

KEY POINTS

· This study provides a national estimate of the GDM risk from food insecurity by race and ethnicity.. · The results in this study suggest a statistically significant relationship between household food insecurity and an increasing risk of developing GDM for Hispanic individuals.. · White women who live alone (without spouse or partner) were also at elevated risk of GDM.. · Age at delivery, poverty ratio, and family history of diabetes are also risk factors for the disease..

Disparities in Cardiovascular Disease-Related Outcomes Among Cancer Survivors in the United States: A Systematic Review of the Literature

BACKGROUND

Cancer and cardiovascular disease (CVD) are major causes of morbidity and mortality in the United States (US). Cancer survivors have increased risks for CVD and CVD-related mortality due to multiple factors including cancer treatment-related cardiotoxicity. Disparities are rooted in differential exposure to risk factors and social determinants of health (SDOH), including systemic racism. This review aimed to assess SDOH's role in disparities, document CVD-related disparities among US cancer survivors, and identify literature gaps for future research.

METHODS

Following the Peer Review of Electronic Search Strategies (PRESS) guidelines, MEDLINE, PsycINFO, and Scopus were searched on March 15, 2021, with an update conducted on September 26, 2023. Articles screening was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, a pre-defined Population, Exposure, Comparison, Outcomes, and Settings (PECOS) framework, and the Rayyan platform. A modified version of the Newcastle-Ottawa Scale was used to assess the risk of bias, and RAW Graphs for alluvial charts. This review is registered with PROSPERO under ID #CRD42021236460.

RESULTS

Out of 7,719 retrieved articles, 24 were included, and discussed diverse SDOH that contribute to CVD-related disparities among cancer survivors. The 24 included studies had a large combined total sample size (n=7,704,645; median=19,707). While various disparities have been investigated, including rural-urban, sex, socioeconomic status, and age, a notable observation is that non-Hispanic Black cancer survivors experience disproportionately adverse CVD outcomes when compared to non-Hispanic White survivors. This underscores historical racism and discrimination against non-Hispanic Black individuals as fundamental drivers of CVD-related disparities.

CONCLUSIONS

Stakeholders should work to eliminate the root causes of disparities. Clinicians should increase screening for risk factors that exacerbate CVD-related disparities among cancer survivors. Researchers should prioritise the investigation of systemic factors driving disparities in cancer and CVD and develop innovative interventions to mitigate risk in cancer survivors.

The relationship between household food insecurity and overweight or obesity among children and adults in Canada: a population-based, propensity score weighting analysis

Household food insecurity is independently associated with adverse health outcomes among Canadians, but its association with overweight and obesity is poorly understood partly because of limited attention to confounding. This study assessed the relationship between food insecurity status and overweight/obesity in Canada. Cross-sectional data for individuals aged 2-64 years were drawn from the 2004 and 2015 Canadian Community Health Survey-Nutrition. Overweight/obesity was defined using body mass index calculated with measured height and weight. Food insecurity status was assessed with the 18-item Household Food Security Survey Module. The relationship was examined among preschool children (n = 2007), girls (n = 5512), boys (n = 5507), women (n = 8317), and men (n = 7279) using propensity score weighted logistic regressions to control for confounding. Relative to their food-secure counterparts, girls in moderately food-insecure households (39.7% vs. 28.5%), boys in severely food-insecure households (54.4% vs. 35.0%), and women in moderately and severely food-insecure households (58.9% and 73.1% vs. 50.7%) had higher overweight/obesity prevalence; men in moderately food-insecure households had a lower prevalence (48.9% vs. 66.3%). With propensity score weighting, no association existed between food insecurity and overweight/obesity among preschool children, girls, boys, or men. For women, moderate (adjusted odds ratio (AOR): 1.61; 95% confidence interval (95%CI): 1.06-2.47) and severe (AOR: 2.33; 95%CI: 1.22-4.44) food insecurity was positively associated with overweight/obesity; the association was strongest for severe food insecurity and obesity (AOR: 3.38; 95%CI: 1.60-7.16). Additional research is needed to better understand the nature of the relationship among women. Problems of food insecurity and overweight/obesity among Canadian children and men should not be conflated in public health interventions.

Local Food System Approaches to Address Food and Nutrition Security among Low-Income Populations: A Systematic Review

Food and nutrition insecurity disproportionately impact low-income households in the United States, contributing to higher rates of chronic diseases among this population. Addressing this challenge is complex because of various factors affecting the availability and accessibility of nutritious food. Short value chain (SVC) models, informally known as local food systems, offer a systemic approach that aims to optimize resources and align values throughout and beyond the food supply chain. Although specific SVC interventions, such as farmers markets, have been studied individually, a comprehensive review of SVC models was pursued to evaluate their relative impact on food security, fruit and vegetable intake, diet quality, health-related markers, and barriers and facilitators to participation among low-income households. Our systematic literature search identified 37 articles representing 34 studies from 2000-2020. Quantitative, qualitative, and mixed-method studies revealed that farmers market interventions had been evaluated more extensively than other SVC models (i.e., produce prescription programs, community-supported agriculture, mobile markets, food hubs, farm stands, and farm-to-school). Fruit and vegetable intake was the most measured outcome; other outcomes were less explored or not measured at all. Qualitative insights highlighted common barriers to SVC use, such as lack of program awareness, limited accessibility, and cultural incongruence, whereas facilitators included health-promoting environments, community cohesion, financial incentives, and high-quality produce. Social marketing and dynamic nutrition education appeared to yield positive program outcomes. Financial incentives were used in many studies, warranting further investigation into optimal amounts across varying environmental contexts. SVC models are increasingly germane to national goals across the agriculture, social, and health care sectors. This review advances the understanding of key knowledge gaps related to their implementation and impact; it emphasizes the need for research to analyze SVC potential comprehensively across the rural-urban continuum and among diverse communities through long-term studies of measurable health impact and mixed-method studies investigating implementation best practices. This trial was registered at PROSPERO as CRD42020206532.

Association of food insecurity with successful aging among older Indians: study based on LASI

PURPOSE

Whether food insecurity (FI), a social determinant of health, is linked with successful aging (SA) in the older generation remains uncertain. This study explored the association of FI with SA among older Indians.

METHODS

Data were collected from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-2018). Older adults (≥ 60 years) who completed both the FI and the SA surveys were selected. FI was indicated by the lack of access to enough food in the past year. SA was determined by five components: (1) low probability of diseases; (2) low probability of disability; (3) high cognitive functionality; (4) low probability of depression; and (5) active social engagement. The association of FI and SA was assessed using multivariable logistic regression adjusted for potential covariates. Subgroup analyses were performed to evaluate interactions with age, sex, alcohol use, smoking, and place of residence.

RESULTS

27,579 participants met the eligibility criteria. Overall prevalence was 7.13% for FI and 19.41% for SA. Following full adjustment, FI was inversely associated with SA (OR 0.56; 95% CI 0.49-0.65) and with each of SA's five components. No significant interactions of FI and SA were observed in subgroup analyses stratified by age, sex, alcohol use, smoking, or place of residence.

CONCLUSIONS

FI was inversely associated with SA among older Indians. These findings need to be validated by future studies which should also explore potential underlying mechanisms, and whether interventions decreasing FI might increase SA.

Association between adult food insecurity and mortality among adults aged 20-79 years with diabetes: A population-based retrospective cohort study

AIMS

There is limited research on the relationship between food insecurity and mortality among individuals with diabetes. This study aims to investigate the impact of food insecurity on all-cause and cause-specific mortality in adults with diabetes.

RESEARCH DESIGN AND METHODS

This study included 5749 adults with diabetes from the National Health and Nutrition Examination Survey cycles 2003-2018 and followed up until 31 December 2019. Food insecurity was measured by the Food Security Survey Module. Cox proportional hazard models were employed to estimate hazard ratios (HRs) and 95% confidence intervals for both all-cause mortality and cause-specific mortality.

RESULTS

The weighted prevalence of full food security, marginal food security, low food security, and very low food security was 70.8%, 11.0%, 10.4%, and 7.8%, respectively. Food insecurity demonstrated a significant correlation with diminished diet quality and reduced consumption of healthy foods. Over the course of 42,272.0 person-years of follow-up, we documented 1091 deaths, of which 370 were attributed to cardiovascular disease and 180 to cancer. After adjusting for multiple variables, food insecurity scores were significantly and linearly associated with increased all-cause mortality. Comparing to full food security, participants experiencing very low food security had a multivariate-adjusted HR of 1.48 (1.12, 1.95) for all-cause mortality (ptrend  = 0.010).

CONCLUSIONS

Food insecurity was associated with increased all-cause mortality and compromised diet quality, especially in individuals experiencing very low food security. Future strategies may necessitate the monitoring of and interventions for food insecurity among individuals with diabetes.

Understanding Food Insecurity as a Determinant of Health in Pregnancy Within the United States: An Integrative Review

Background

Food insecurity is a major public health concern in the United States, particularly for pregnant and postpartum individuals. In 2020, ∼13.8 million (10.5%) U.S. households experienced food insecurity. However, the association between food security and pregnancy outcomes in the United States is poorly understood.

Purpose

The purpose of this review was to critically appraise the state of the evidence related to food insecurity as a determinant of health within the context of pregnancy in the United States. We also explored the relationship between food insecurity and pregnancy outcomes.

Methods

PubMed, CINAHL, Web of Science, and Food and Nutrition Science databases were used. The inclusion criteria were peer-reviewed studies about food (in)security, position articles from professional organizations, and policy articles about pregnancy outcomes and breastfeeding practices. Studies conducted outside of the United States and those without an adequate definition of food (in)security were excluded. Neonatal health outcomes were also excluded. Included articles were critically appraised with the STROBE and Critical Appraisal Skills Program checklists.

Results

Nineteen studies met the inclusion criteria. Inconsistencies exist in defining and measuring household food (in)security. Pregnant and postpartum people experienced several adverse physiological and psychological outcomes that impact pregnancy compared with those who do not. Intersections between neighborhood conditions and other economic hardships were identified. Findings regarding the impact of food insecurity on breastfeeding behaviors were mixed, but generally food insecurity was not associated with poor breastfeeding outcomes in adjusted models.

Conclusion

Inconsistencies in definitions and measures of food security limit definitive conclusions. There is a need for standardizing definitions and measures of food insecurity, as well as a heightened awareness and policy change to alleviate experiences of food insecurity.

Nexus of food waste and climate change framework: Unravelling the links between impacts, projections, and emissions

This communication explores the intricate relationship between food waste and climate change, considering aspects such as impacts, projections, and emissions. It focuses on the pressing issue of waste generation and its potential consequences if current trends persist, and emphasises the importance of efficient solid waste management in improving environmental quality and fostering economic development. It also highlights the challenges faced by developing countries in waste collection and disposal, drawing comparisons with the waste utilisation methods used by developed nations. The review delves into the link between food waste and climate change, noting the paradoxical situation of food wastage against the backdrop of global hunger and malnutrition. It underscores the scientific evidence connecting food waste to climate change and its implications for food security and climate systems. Additionally, it examines the environmental burden imposed by food waste, including its contribution to greenhouse gas emissions and the depletion of resources such as energy, water, and land. Besides environmental concerns, this communication also highlights the ethical and socioeconomic dimensions of food waste, discussing its influence on Sustainable Development Goals, poverty, and social inequality. The communication concludes by advocating for collective action and the development of successful mitigation strategies, technological solutions, and policy interventions to address food waste and its climate impacts. It emphasises the need for collaboration, awareness, and informed decision-making to ensure a more sustainable and equitable future.

Beyond the Body: Using Photovoice to Explore Social Determinants of Diabetes With South Asian Adolescents in the Peel Region of Ontario, Canada

OBJECTIVES

The higher prevalence of diabetes in the South Asian (SA) population living in Canada spans across generations and is often associated with individual risk factors while undermining the social determinants of health (SDOH). There is a scarcity of studies on the perspectives of SA adolescents with a family history of type 2 diabetes mellitus (T2DM). Learning directly from these adolescents can fill a major gap by providing insight on how the SDOH contribute to disproportionate rates of T2DM in SA immigrant communities.

METHODS

In this study, we used Photovoice, which is a community-based participatory research (CBPR) method that involves the use of photography to visually capture the challenges of diabetes prevention from the perspective of those with lived experiences. A group of 15 SA youth were recruited from an adolescent diabetes education program in the Peel Region of Ontario. The youth discussed their images and accompanied written narratives during focus groups.

RESULTS

Four themes emerged from the thematic analysis of the photographs and participant narratives that influence the manifestation of T2DM in SA communities: 1) immigration and resettlement stressors; 2) food insecurity; 3) unhealthy school environments; and 4) academic pressures.

CONCLUSIONS

Findings suggest the need to address T2DM as a response to unjust conditions and environments rather than as an epidemic entrenched in genetic predisposition, culture, and poor lifestyle choices.

Household Food Security Status and Allostatic Load among United States Adults: National Health and Nutrition Examination Survey 2015-2020

BACKGROUND

Household food insecurity has been linked to adverse health outcomes, but the pathways driving these associations are not well understood. The stress experienced by those in food-insecure households and having to prioritize between food and other essential needs could lead to physiologic dysregulations [i.e., allostatic load (AL)] and, as a result, adversely impact their health.

OBJECTIVE

To assess the association between household food security status and AL and differences by gender, race and ethnicity, and Supplemental Nutrition Assistance Program (SNAP) participation.

METHODS

We used data from 7640 United States adults in the 2015-2016 and 2017-March 2020 National Health and Nutrition Examination Survey to estimate means and prevalence ratios (PR) for AL scores (based on cardiovascular, metabolic, and immune biomarkers) associated with self-reported household food security status from multivariable linear and logistic regression models.

RESULTS

Adults in marginally food-secure [mean = 3.09, standard error (SE) = 0.10] and food-insecure households (mean = 3.05; SE = 0.08) had higher mean AL than those in food-secure households (mean = 2.70; SE = 0.05). Compared with adults in food-secure households in the same category, those more likely to have an elevated AL included: SNAP participants [PR = 1.12; 95% confidence interval (CI):  1.03, 1.22] and Hispanic women (PR = 1.20; 95% CI: 1.05, 1.37) in marginally food-secure households; and non-Hispanic Black women (PR = 1.14; 95% CI: 1.03, 1.26), men (PR = 1.13; 95% CI: 1.02, 1.26), and non-SNAP non-Hispanic White adults (PR = 1.22; 95% CI: 1.08, 1.39) in food-insecure households.

CONCLUSIONS

AL may be one pathway by which household food insecurity affects health and may vary by gender, race and ethnicity, and SNAP participation.

Diet and exercise knowledge and practices for diabetes care within families in Senwabarwana

BACKGROUND

Family members (FMs) are a valuable source of support, as the bulk of daily diabetes treatment occurs at home. Family members' insufficient understanding of patient support can lead to poor diabetes outcomes. Lack of knowledge about good diet and exercise can lead to unhealthy food preparation and sedentary lifestyles, affecting patients and increasing the risk of diabetes. This study aims to fill the gap in the level of knowledge of FMs relating to appropriate care for diabetic patients under their care. This will relate specifically to diet and exercise.

METHODS

A cross-sectional survey conducted in Senwabarwana, Limpopo province, involved 200 FMs caring for diabetic patients for at least 6 months. Their experience could offer valuable insights into the competence of their care. Data were collected regarding knowledge and practice using a close-ended questionnaire, with Likert scale responses and SPSS analysis, including descriptive statistics and chi-squared tests. Knowledge was assessed on a scale ranging from poor to excellent: poor (0% - 50%), fair (51% - 60%), good (61% - 74%) and excellent ( 75%). Practice was assessed as poor (0% - 50%), fair (51% - 69%) and good (70% - 100%).

RESULTS

Thirty-one percent of participants demonstrated excellent knowledge and only 9% demonstrated good practice. Unfortunately, 53% stated that obese patients with diabetes should skip meals to lose weight. Only 3.5% and 19%, respectively, are familiar with recommendations for exercise and glucose monitoring. Barely 35.5% of FMs eat breakfast every day, while 87.5% report exercising.

CONCLUSION

Few FMs possess excellent diabetes management knowledge but still indulge in bad practices, increasing their risk of developing diabetes. Additionally, they may potentially cause health problems for patients.Contribution: Family-centred behaviour change intervention is recommended.

Trends and disparities in prevalence of cardiometabolic diseases by food security status in the United States

BACKGROUND

Previous studies have demonstrated the association between food security and cardiometabolic diseases (CMDs), yet none have investigated trends in prevalence of CMDs by food security status in the United States (US).

METHODS

Serial cross-sectional analysis of the US nationally representative data from National Health and Nutrition Examination Survey (1999-2018) was conducted among adults aged 20 years or older. Food security status was defined by the US Household Food Security Survey Module (full, marginal, low, and very low food security). We estimated the age-adjusted prevalence of CMDs including obesity, hypertension, diabetes, and coronary heart disease by food security status. Racial and ethnic disparities in age-adjusted prevalence of CMDs by food security status were also assessed.

RESULTS

A total of 49,738 participants were included in this analysis (weighted mean age 47.3 years; 51.3% women). From 1999 to 2018, the age-adjusted prevalence of CMDs was lower in full food secure group as compared with other groups. For example, trends in hypertension decreased from 49.7% (47.5-51.8%) to 45.9% (43.8-48.0%) (P-trend = 0.002) among the full and from 54.2% (49.9-58.5%) to 49.7% (46.8-52.6%) (P-trend = 0.02) among the marginal but remained stable among the low at 49.7% (47.9-51.6%) and among the very low at 51.1% (48.9-53.3%) (P-interaction = 0.02). Prevalence of diabetes increased from 8.85% (8.15-9.60%) to 12.2% (11.1-13.5%) among the full (P-trend < 0.001), from 16.5% (13.2-20.4%) to 20.9% (18.6-23.5%) (P-trend = 0.045) among the marginal and from 14.6% (11.1-19.0%) to 20.9% (18.8-23.3%) (P-trend = 0.001) among the low but remained stable at 18.8% (17.0-20.9) among the very low (P-trend = 0.35) (P-interaction = 0.03). Racial and ethnic differences in prevalence of CMD by food security status were observed. For example, among individuals with full food secure status, the prevalence of diabetes was 9.08% (95% CI, 8.60-9.59%) for non-Hispanic whites, 17.3% (95% CI, 16.4-18.2%) for non-Hispanic blacks, 16.1% (95% CI, 15.0-17.4%) for Hispanics and 14.9% (95% CI, 13.3-16.7%) for others.

CONCLUSIONS AND RELEVANCE

Prevalence of CMDs was greatest among those experiencing food insecurity, and food insecurity disproportionately affected racial/ethnic minorities. Disparities in CMD prevalence by food security status persisted or worsened, especially among racial/ethnic minorities.

Household Food Insecurity Is Associated With Physical Activity in Youth and Young Adults With Diabetes: A Cross-Sectional Study

BACKGROUND

Physical activity (PA) is essential for optimal diabetes management. Household food insecurity (HFI) may negatively affect diabetes management behaviors. The purpose of this study was to cross-sectionally examine the association between HFI and PA in youth and young adults (YYA) with type 1 (N = 1998) and type 2 (N = 391) diabetes from the SEARCH for Diabetes in Youth Study.

METHODS

HFI was measured with the US Household Food Security Survey Module. PA was measured with the International Physical Activity Questionnaire Short Form. Walking, moderate-intensity PA (excluding walking), vigorous-intensity PA, moderate- to vigorous-intensity PA, and total PA were estimated as minutes per week, while time spent sitting was assessed in minutes per day. All were modeled with median regression. Meeting PA guidelines or not was modeled using logistic regression.

RESULTS

YYA with type 1 diabetes who experienced HFI spent more time walking than those who were food secure. YYA with type 2 diabetes who experienced HFI spent more time sitting than those who were food secure.

CONCLUSIONS

Future research should examine walking for leisure versus other domains of walking in relation to HFI and use objective PA measures to corroborate associations between HFI and PA in YYA with diabetes.

Food Insecurity, Race and Ethnicity, and Cognitive Function Among United States Older Adults

BACKGROUND

Cognitive impairment and dementia are severe public health issues in aging populations, which can be exacerbated by insufficient or unhealthy dietary intake. Food (in)security status is linked to cognitive function among older adults, but the relationship is complex and can vary by sociodemographic characteristics.

OBJECTIVE

This article aimed to investigate the association between food insecurity and cognitive function among United States older adults and explore potential variations by race and ethnicity groups.

METHODS

We prospectively examined changes in cognitive function and incidence of cognitive impairment alongside the presence of self-reported food insecurity among older adults of different racial and ethnic groups. Data were from the 2012-2018 Health and Retirement Study (HRS) and the 2013 Health Care and Nutrition Study (HCNS), including N = 6,638 United States adults aged 50 years and older. Food insecurity was measured by a self-reported United States Household Food Security Survey Module, and cognitive function was assessed by the modified version of the Telephone Interview for Cognitive Status.

RESULTS

Results showed that 17% of United States older adults reported food insecurity in the 2013 HCNS. Compared with food secure older adults, those reporting food insecurity experienced worsened cognitive functioning over time (B = -0.63, p < .001), and they were more likely to have onset of cognitive impairment (OR= 1.46, p < .001) in the 6-y observation. Compared with non-Hispanic White older adults, being non-Hispanic Black, non-Hispanic Other, or Hispanic was associated with 2.96, 2.09, or 1.26 odds (p < .001) of cognitive impairment (2012-2018), respectively. Older adults of racial and ethnic minority groups also had higher risks of experiencing the double burden of cognitive impairment alongside food insecurity compared with non-Hispanic White older adults.

CONCLUSION

Findings underscore racial and ethnic structural disparities in food security and cognitive health in the United States aging population.

Feasibility of a food-based diabetes self-management education intervention for food insecure patients with type 2 diabetes: a convergent mixed methods study

OBJECTIVE

To assess the feasibility of a food-based diabetes self-management education and support (DSMES) intervention delivered to persons with type 2 diabetes (T2DM) and food insecurity.

DESIGN

This single arm pre-/post convergent mixed methods study tested the feasibility of a 3-month intervention using food boxes, recipes, DSMES and dietitian visits. Feasibility benchmarks assessed were acceptability (> 50 % participants satisfied), demand (> 50 % used program components) and implementation (75 % adherence, 80 % retention). Assessments included: self-reported food security, health-related quality of life, diabetes self-efficacy, socio-demographic and dietary intake, height, weight, and HbA1c and one in-depth interview with participants and key staff. Enrollment, recruitment and retention rates were summarised; qualitative data were analysed using structured thematic analysis (participant interviews) and key point summaries (staff interviews). Quantitative/qualitative data integration was conducted using a joint display.

SETTING

Food bank and Federally Qualified Health Center in the Southwestern U.S.

PARTICIPANTS

English- or Spanish-speaking adults with T2DM and food insecurity.

RESULTS

In total, 247 patients with T2DM and food insecurity were recruited, seventy-one expressed interest and twenty-five consented. Twenty-one participants completed study measurements. 71 % (n 15) received six home food deliveries and ≥ 1 dietitian visit. A priori benchmarks were approached or met within each feasibility criterion - most participants found the intervention to be acceptable, used most or all intervention components, and reported some challenges within intervention implementation (e.g. timing of food deliveries). Data integration provided deeper understanding of reported intervention implementation challenges, yet high adherence to the intervention.

CONCLUSIONS

The intervention was feasible. Next steps include a clinical trial to establish intervention efficacy.

Inequalities in Diabetes Mortality Between Microregions in Hungary

Objectives: Regional differences in diabetes mortality are high in Hungary. In our cross-sectional study, we aim to reveal the drivers of the inequalities in diabetes mortality across the 197 microregions of Hungary. To account for the influence of changes in healthcare and social conditions, we compared two periods (2009-12 and 2013-16). Methods: Traditional and re-conceptualized deprivation- and healthcare provison measures were used in OLS regression models. Results: Microregions with a high proportion of population living in "service deserts," especially in regard to the lack of grocery stores, suffer the highest rates of diabetes mortality. Alcohol-related mortality has been proven to be a similarly and surprisingly strong predictor of diabetes mortality. Conclusion: Food provision should be supported in areas characterized by low service density, and alcohol policy should be strengthened and targeted.

Food Insecurity and Diabetes: Overview of Intersections and Potential Dual Solutions

Food insecurity increases the risk of developing diabetes and its complications. In this article, we describe the complex relationship that exists between food insecurity and diabetes and describe potential mechanisms that may underlie this association. We then describe how two different types of interventions, food-is-medicine and federal nutrition assistance programs, may help address both food insecurity and health. Finally, we outline the research, policy, and practice opportunities that exist to address food insecurity and reduce diabetes-related health disparities.

Disparities in Food Security and Glycemic Control Among People with Type 2 Diabetes During the COVID-19 Pandemic

Background

Little is known about the differing impacts of food insecurity on HbA1c by race in type 2 diabetes (T2D). Predictions around increased food insecurity from COVID-19 exacerbating racial disparities led us to estimate its prevalence and associations with HbA1c by race during the COVID-19 pandemic.

Methods

Data came from medical records and surveys among a clinic-based sample of T2D patients. Linear regression models estimated associations between food insecurity and HbA1c and between change in food insecurity and change in HbA1c. Likelihood ratio tests and examination of stratum-specific estimates assessed effect modification by race.

Results

Our sample was 59% White, 59% female, and mean age was 60.8 ± 12.6. During the pandemic, food insecurity prevalence and HbA1c were significantly (p < .05) higher among non-Whites (39%, 8.4% ± 2.1) compared to Whites (15%, 7.8% ±1.6). HbA1c among those who were very food insecure was 1.00% (95% CI: 0.222, 1.762, p = .01) higher than those who were food secure. Those with increased food insecurity had a 0.58% (95% CI: 0.024, 1.128, p = .04) higher HbA1c increase than among those experiencing no change. No effect modification was detected.

Limitations

Convenience sampling in an endocrinology clinic, recall bias, and inadequate power may underlie null effect modification results.

Conclusion

Although effect modification was not detected, racial disparities in HbA1c and food insecurity warrant further investigation. These disparities, combined with the significant impact of food insecurity on HbA1c, suggest that prioritization of resources to high-risk populations should be considered early during public emergencies to minimize short- and long-term health consequences.

The Impact of Providing Material Benefits to Improve Access to Food on Clinical Parameters, Dietary Intake, and Household Food Insecurity in People with Diabetes: A Systematic Review with Narrative Synthesis

The high cost of healthy foods makes maintaining a healthy dietary pattern challenging, particularly among people with diabetes who are experiencing food insecurity. The objectives of this study were to: 1) review evidence on the impact of providing material benefits (e.g., food coupons/vouchers, free food, or financial subsidies/incentives) to improve access to food on clinical parameters, dietary intake, and household food insecurity in people with diabetes, and 2) review relevant economic evidence. Six databases were searched from inception to March 2023 for longitudinal studies with quantitative outcomes. Twenty-one studies were included in the primary review and 2 in the economic analysis. Risk of bias was high in 20 studies and moderate in 1 study. The number of randomized controlled trials and nonrandomized studies reporting statistically significant improvement, alongside Grading of Recommendations Assessment, Development, and Evaluation (GRADE) certainty of the evidence was: HbA1c: 1/6 and 4/12 (very low), systolic blood pressure: 0/3 and 1/8 (very low), diastolic blood pressure: 0/3 and 1/7 (very low), BMI: 0/5 and 2/8 (very low), body weight: 0/0 and 1/3 (very low), hypoglycemia: 1/2 and 1/2 (very low), daily intake of fruits and vegetables: 1/1 and 1/3 (very low), daily intake of whole grains: 0/0 and 0/2 (very low), overall diet quality: 2/2 and 1/1 (low), and household food insecurity: 2/3 and 0/0 (very low). The 2 studies included in the economic analysis showed no difference in Medicare spending from Supplemental Nutrition Assistance Program participation and cost-savings from medically tailored meals in an economic simulation. Overall, providing material benefits to improve access to food for people with diabetes may improve household food insecurity, fruit and vegetable intake, and overall diet quality, but effects on clinical parameters and whole grain intake are unclear. The certainty of evidence was very low to low by GRADE. PROSPERO (CRD42021212951).