Food insecurity now, heart disease later

Struggling to afford food today could mean heart problems tomorrow. Young adults experiencing food insecurity have a 41% greater risk of developing heart disease in midlife, even after accounting for demographic and socioeconomic factors, according to a new Northwestern Medicine study in JAMA Cardiology. Food insecurity — struggling to get enough nutritious food to stay healthy — affects one in eight households in the U.S. each year. 

“We’ve known that food insecurity and heart disease often go hand in hand, but this study shows, for the first time, that food insecurity comes first,” said Dr. Jenny Jia, an instructor of general internal medicine and preventive medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine internist. “That makes it a clear target for prevention — if we address food insecurity early, we may be able to reduce the burden of heart disease later.”

How the study was conducted

Jia and her colleagues analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a long-term cohort study that has followed Black and white U.S. adults since the mid-1980s. The scientists identified participants who reported food insecurity in 2000-2001, when they were in their early 30s to mid-40s, and compared their health outcomes over the next 20 years to those who were food secure.

We’ve known that food insecurity and heart disease often go hand in hand, but this study shows, for the first time, that food insecurity comes first”

Among the 3,616 study participants, those experiencing food insecurity were 41% more likely to develop cardiovascular disease than their food-secure counterparts. Over the study period, 11% of food-insecure individuals developed heart disease, compared to 6% of those with adequate food access.

“For a long time, there was this chicken-or-the-egg question — does food insecurity cause heart disease, or does heart disease make food insecurity worse because of the high cost of health care?” Jia said. “By following people over two decades, we were able to show that food insecurity, on its own, significantly increases the risk of developing cardiovascular disease.”

At baseline, participants with food insecurity were more likely to identify as Black and had lower educational attainment than those who were food secure.

Screening for food insecurity

Jia says the findings highlight the need for health care providers to be savvy in how to best screen for food insecurity and connect patients with community resources.

She says primary care settings, such as with internists, pediatricians and family doctors, are ideal for screening for food insecurity, “because there tends to be a lot of trust between primary care providers and patients.”

Jia also stresses that food security screenings could extend to emergency rooms and specialties like cardiology, and can be done by nurses, medical assistants or even patients themselves filling out forms.

“The more we screen for it, the better,” Jia said, adding that “we need better strategies to help people once they screen positive. Do we connect them to social workers who can refer them to existing community programs? Should health care systems develop their own interventions? These are the next big questions.”

Next steps

Jia and her team plan to continue tracking this group to understand the long-term effects of food insecurity. “It’s surprising to see heart disease in this group, which doesn’t include those 65 or older,” Jia said. “As they near 80, we plan to revisit the study to explore the evolving link to heart disease.”