New Research Calls for Greater Focus on Food Security in YYA Patients with Diabetes

Investigators say that dietary habits in youth and young adult patients with diabetes can be impacted by income, employment, ethnicity, and a variety of other factors.

New research presented at the 2021 American Diabetes Association (ADA) Virtual Meeting found an association between food security dietary intake in youth and young adult populations with type 1 diabetes (T1D) and type 2 diabetes (T2D).

The study, led by Hope Bercaw, assessed how household food security (HFS) status impacted nutritional adequacy of 11 key nutrients in a population of YYA with T1D and T2D. Differences in intake quality and adherence to guideline recommendations were examined.

Household food security is impacted by a variety of socioeconomic trends and values.

“Socioeconomic position clearly impacts our health, as well as our food consumption,” Bercaw said in an interview with HCPLive.”Food insecurity is defined as ‘limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways’, and according to the Healthy People 2020 initiative, can be influenced by many factors including income, employment, race/ethnicity, and disability status, all of which impact socioeconomic position.”

The participant group for the study was comprised of 1464 people, all of whom belonged to youth and young adult populations. The participants were then divided between two groups, people with type 1 diabetes (1166) and people with type 2 diabetes (298). The study noted that a majority of those with T1D were White (57%) and those with T2D were Black (44%).

Participants were tasked with completing the USDA Household FS Survey model. Diet was also assessed with a food frequency questionnaire and compared to age and sex specific goals form the DGA.

Goals were presented for daily energy, added sugar, saturdated fat, calcium, fiber, iron, magnesium, potassium, sodium, and vitamina C, D, and E.

Overall, the average daily nutrient consumption and adherence to guidelones did not differ by HFS, with the exception with sodium and saturated fat consumption in female participants with T1D and vitamin E in male participants with T2D.

“On average, females with T1D between the ages of 10 and 35 consumed 162 mg more sodium and 0.6% more kilocalories from saturated fat per day if they live in a food insecure household compared to those who live in a food secure household,” Bercaw said. “To put this amount of sodium in perspective, a snack bag of Lays potato chips contains 170 mg of sodium.”

Additionally, food insecure males consumed more vitamin E (+1.9 mg), which was closer to guidelines than food secure males with T2D.

Bercaw spoke on some of the findings and limitations of the study.

“We would expect that food security is associated with a more healthful diet; however, this is not the case, except for in females with T1D for sodium and saturated fat, and for males with T2D with vitamin E,” Bercaw said. “We must consider the limitation of our data collection tool, the food frequency questionnaire, is not the most accurate tool for estimating nutrient consumption.”

While the study showed that food security did result in better dietary habits among some participants, all groups within the population consumed more sodium and saturated fats tham recommended by the DGA.

Investigators urged for moderation in regard to intake of saturated fats and sodium for all participants regardless of T1D or T2D, as well as transparency on dietary habits and socioeconomic conditions with patients.

“I would encourage health professionals to screen for food insecurity. The American Diabetes Association recommends that healthcare providers screen all patients with diabetes for food insecurity, however, there is currently an enormous barrier to food security screening during visits,” Bercaw said. “This is partially due to time constraints during visits, but mostly because of the stigma that comes with discussing hunger and poverty, especially for parents. To overcome these barriers, public health professionals should try to normalize screening for food insecurity and have a plan for discussing diet quality and food access in a judgement-free manner. The key to improving diet quality for youth and young adults with diabetes is tailoring dietary recommendations to the patient’s needs.Health care providers would then be able to link families to community resources as needed.”

The study, “Food Insecurity and Dietary Intake Adequacy in Youth and Young Adults with Type 1 and Type 2 Diabetes,” was published online in ADA.