Food insecurity linked to type 2 diabetes risk

(Reuters Health) - Canadians who cannot afford to eat regularly or to eat a healthy diet have more than double the average risk of developing type 2 diabetes, a study suggests.

To reduce the burden of diabetes on individuals and the national healthcare system, policymakers should consider intervening in this pathway early by reducing food insecurity, the study team urges in the journal PLOS ONE.

Household food insecurity is defined as having uncertain or insufficient food access due to limited financial resources. Being on a limited budget may result in having to rely on cheaper, high-calorie foods that contribute to weight gain and the risk of chronic disease, the authors write.

“Increasingly, food insecurity is being recognized as a significant social and health problem in Canada, but there isn’t a great deal of evidence that has linked food insecurity to the risk of future chronic diseases, such as type 2 diabetes,” lead author Christopher Tait told Reuters Health in an email.

Tait, a researcher at the Dalla Lana School of Public Health at the University of Toronto, and colleagues analyzed data from a 2004 national health survey. Survey participants were representative of 98 percent of the Canadian population, and the analysis focused on 4,739 men and women over age 18, including 277 who were classified as food insecure.

The study team also matched these people to a national database of people diagnosed with diabetes through 2016, making for an average of nearly 12 years of follow-up.

People who were food insecure at the time of the original survey tended to be younger, female, non-white, lower in income and had lower-quality diets compared to food-secure individuals. Food-insecure adults were also more likely to be smokers, less physically active and obese.

By the end of the follow-up period, 577 participants had developed type 2 diabetes. Those who were food-insecure had 2.4 times the risk of those who were not. When researchers accounted for obesity, the diabetes risk was still two-fold higher with food insecurity.

The findings speak to the importance of understanding the health burden associated with food insecurity, which has been steadily increasing in Canada over the past decade, Tait said.

“Our findings also emphasize the need to continue to monitor this important marker of economic deprivation. This is particularly relevant given Statistics Canada’s decision to make food insecurity measurement optional at the provincial-level as of 2013, which may be a missed opportunity moving forward, he added.

Testing strategies for reducing rates of household food insecurity will be important, Tait said, citing the Ontario Basic Income Pilot as an example of such a strategy. Also, he said, efforts are needed to meaningfully address the broader systemic factors that shape food environments, access and availability.

It’s well known that high and frequent intake of fast foods and processed foods are related to increased risk of obesity, unhealthy blood fat levels and diabetes type 2, among other diseases, said Sandra Arevalo, director of nutrition services and community outreach at Community Pediatrics, a program of Montefiore and The Children’s Health Fund in New York City.

“What I have seen in my practice in the South Bronx, located in the second poorest congressional district in the U.S. and working with the NYC homeless, is that people who are food insecure consume more foods with low nutritional value, which are more affordable,” said Arevalo, who wasn’t involved in the current study.

“Healthier foods such as fresh fruits and vegetables, low-fat milk, lean cuts of meat and low-sodium foods should be subsidized as a measure to prevent the increasing incidence of diabetes type 2 and to support diabetes control among patients,” she said in an email.

More diabetes prevention programs and diabetes self-management education that includes points for selecting healthier foods, shopping tips to save money, meal planning, and cooking classes are needed, Arevalo added.

SOURCE: PLOS ONE, online May 23, 2018.