Thursday, June 8, 2023
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Health Sciences Clinical Professor of Family Medicine
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Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
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Health Sciences Clinical Professor of Family Medicine
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Food insecurity has been associated with higher rates of obesity and mental health disorders, but can it promote frailty among older adults? This was the research question assessed by Muhammad and colleagues, who published a retrospective cohort study focused on this issue. Their results were published in the July 5, 2022 issue of the Archives of Gerontology and Geriatrics.[1]
Investigators drew study data from 31,464 participants in the 2017 to 2018 iteration of the Longitudinal Ageing Study in India cohort: 30.65% of participants met criteria for frailty. The prevalence rates of major elements of frailty in comparing the groups with and without food security were as follows:
|
Frailty Measure |
Prevalence With Food Insecurity |
Prevalence Without Food Insecurity |
|---|---|---|
|
Exhaustion |
12.1% |
6.5% |
|
Unintentional weight loss |
65.5% |
5.1% |
|
Weak grip strength |
8.6% |
7.9% |
|
Low physical activity |
8.4% |
9.3% |
|
Slow walking |
8.2% |
8.5% |
Food insecurity was significantly associated with higher risks for exhaustion, unintentional weight loss, and weak grip strength, but it did not significantly affect rates of low physical activity and slow walking. Overall, food insecurity was associated with an adjusted odds ratio (OR) for frailty of 2.68 (95% CI: 2.26, 3.19).
The current study by Kim and colleagues examines the relationship between food insecurity and another important pathological process among older adults: cognitive decline.
Food insecurity is linked to a more rapid decline in executive function in older adults, a new study shows.
The findings were reported just weeks after a pandemic-era expansion in Supplemental Nutrition Assistance Program (SNAP) benefits ended, leading to less food assistance for about 5 million people aged older than 60 years who participate in the program.
"Even though we found only a very small association between food insecurity and executive function, it's still meaningful because food insecurity is something we can prevent," lead investigator Boeun Kim, PhD, MPH, RN, postdoctoral fellow at Johns Hopkins University School of Nursing, Baltimore, Maryland, told Medscape Medical News.
The findings were published online March 24 in JAMA Network Open.[2]
National DataThe number of Americans aged older than 60 years with food insecurity has more than doubled since 2007, with 5.5 million older adults reporting food insecurity in 2021.[3]
Prior studies have linked malnutrition and food insecurity to a decline in cognitive function. Participating in food assistance programs such as SNAP is associated with slower memory decline in older adults.[4]
To date, however, there has been no longitudinal study that has used data from a nationally representative sample of older Americans, which, Kim said, could limit generalizability of the findings.
To address that issue, investigators analyzed data from 3037 participants in the National Health and Aging Trends Study, which includes community dwellers aged 65 years and older who receive Medicare.
Participants reported food insecurity over 7 years from 2012 to 2019. The study included data on immediate memory, delayed memory, and executive function from 2013 to 2020.
Food insecurity was defined as going without groceries because of limited ability or social support; a lack of hot meals related to functional limitation or no help; going without eating because of the inability to feed oneself or no available support; skipping meals due to insufficient food or money; or skipping meals for 5 days or more.
Researchers assessed immediate and delayed recall using a 10-item word-list memory task and measured executive function using a clock drawing test. They linked each year's cognitive functions to the prior year's food insecurity data.
Over 7 years, 417 people, or 12.1%, experienced food insecurity at least once.
Persons with food insecurity were more likely to be older; female; part of racial and ethnic minority groups; living alone; obese; and have a lower income and educational attainment, depressive symptoms, social isolation, and disability compared with persons without food insecurity.
After adjusting for age, sex, race/ethnicity, educational level, income, marital status, body mass index, functional disability, social isolation, and other potential confounders, researchers found that food insecurity was associated with a more rapid decline in executive function (mean difference in annual change in executive function score, −0.04 [95% CI: −0.09, −0.003).
Food insecurity was not associated with baseline cognitive function scores or changes in immediate or delayed recall.
"Clinicians should be aware of the experience of food insecurity and the higher risk of cognitive decline, so maybe they could do universal screening and refer people with food insecurity to programs that can help them access nutritious meals," Kim said.
A Sign of Other Problems?Commenting for Medscape Medical News, Thomas Vidic, MD, said food insecurity often goes hand in hand with lack of medication adherence, lack of regular medical care, and a host of other issues. Vidic is a neurologist at the Elkhart Clinic, Elkhart, Indiana, and an adjunct clinical professor of neurology at Indiana University, Bloomington, Indiana.
"When a person has food insecurity, they likely have other problems and they're going to degenerate faster," said Vidic, who was not part of the study. "This is one important component, and it's one more way of getting a handle on people who are failing."
Vidic, who has dealt with the issue of food insecurity with his own patients, said he suspects the self-report nature of the study may hide the true scale of the problem.
"I suspect the numbers might actually be higher," he said, adding that the study fills a gap in the literature with a large, nationally representative sample.
"We're looking for issues to help with the elderly as far as what can we do to keep dementia from progressing," he said. "There are some things that make sense, but we've never had this kind of data before."
The study was funded by the National Institute on Aging. Kim and Vidic have reported no relevant financial relationships.
