Food insecurity and cognitive function in Puerto Rican adults

Abstract

Background: Food insecurity is associated with nutrient inadequacy and a variety of unfavorable health outcomes. However, little is known about whether food security is associated with lower cognitive function in the elderly.

Objective: We investigated the prevalence of food insecurity in a representative sample of 1358 Puerto Ricans aged 45-75 y living in Massachusetts in relation to cognitive function performances.

Design: Food security was assessed with the US Household Food Security Scale. Cognitive function was measured to capture general cognition with a battery of 7 tests: Mini-Mental State Examination (MMSE), word list learning (verbal memory), digit span (attention), clock drawing and figure copying (visual-spatial ability), and Stroop and verbal fluency tests (fluency executive functioning).

Results: The overall prevalence of food insecurity during the past 12 mo was 12.1%; 6.1% of the subjects reported very low food security. Food insecurity was inversely associated with global cognitive performance, as assessed by the MMSE score. The adjusted difference in the MMSE score was -0.90 (95% CI: -1.6, -0.19; P for trend = 0.003) for a comparison of participants with very low food security with those who were food secure, after adjustment for age, smoking, education, poverty status, income, acculturation, plasma homocysteine, alcohol, diabetes, and hypertension. Food insecurity was significantly associated with lower scores for word-list learning, percentage retention, letter fluency, and digit span backward tests.

Conclusions: Very low food security was prevalent among the study subjects and was associated with lower cognitive performance. Further studies, both observational and experimental, are warranted to clarify the direction of causality in this association.

Figures

FIGURE 1

Prevalence of food insecurity and very low food security in Puerto Rican adults according to sex (A), poverty (B), and education level (C). *P < 0.05 and **P < 0.01, adjusted for age and sex (men, poverty, and education <5th grade were used as references). Logistic regression was used to test differences in prevalence across categories.

FIGURE 2

Multivariate-adjusted odds ratios (ORs) and 95% CIs for cognitive impairment according to status of food security. Cognitive impairment was defined as a Mini-Mental State Examination score 2; <25, 25–29.9, or ≥30), education (<5th grade, 5th–8th grade, 9th–12th grade, college, or graduate school), poverty (yes or no), acculturation score, smoking (never, past, or current), use of alcohol (never, past, or current), presence of diabetes and hypertension (each, yes or no), and plasma homocysteine (μmol/L).