Food Insecurity, Memory, and Dementia Among US Adults Aged 50 Years and Older

Author:

Qian Haobing1,Khadka Aayush1,Martinez Suzanna M.2,Singh Sonali2,Brenowitz Willa D.3,Zeki Al Hazzouri Adina4,Hill-Jarrett Tanisha G.5,Glymour M. Maria6,Vable Anusha M.1

Affiliation:

1. Department of Family and Community Medicine, University of California, San Francisco

2. Department of Epidemiology and Biostatistics, University of California, San Francisco

3. Kaiser Permanente Center for Health Research, Portland, Oregon

4. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York

5. Global Brain Health Institute, University of California, San Francisco

6. Department of Epidemiology, Boston University, Boston, Massachusetts

Abstract

ImportanceDespite existing federal programs to increase access to food, food insecurity is common among US older adults. Food insecurity may affect Alzheimer disease and Alzheimer disease–related dementias via multiple mechanisms, yet there is almost no quantitative research evaluating this association.ObjectiveTo examine whether food insecurity in older adults is associated with later-life cognitive outcomes.Design, Setting, and ParticipantsThis cohort study of US residents aged 50 years and older from the US Health and Retirement Study was restricted to respondents with food insecurity data in 2013 and cognitive outcome data between calendar years 2014 and 2018. Analyses were conducted from June 1 to September 22, 2023.ExposureFood insecurity status in 2013 was assessed using the validated US Department of Agriculture 6-item Household Food Security Module. Respondents were classified as being food secure, low food secure, and very low food secure.Main Outcomes and MeasuresOutcomes were dementia probability and memory score (standardized to 1998 units), estimated biennially between 2014 and 2018 using a previously validated algorithm. Generalized estimation equations were fit for dementia risk and linear mixed-effects models for memory score, taking selective attrition into account through inverse probability of censoring weights.ResultsThe sample consisted of 7012 participants (18 356 person-waves); mean (SD) age was 67.7 (10.0) years, 4131 (58.9%) were women, 1136 (16.2%) were non-Hispanic Black, 4849 (69.2%) were non-Hispanic White, and mean (SD) duration of schooling was 13.0 (3.0) years. Compared with food-secure older adults, experiencing low food security was associated with higher odds of dementia (odds ratio, 1.38; 95% CI, 1.15-1.67) as was experiencing very low food security (odds ratio, 1.37; 95% CI, 1.11-1.59). Low and very low food security was also associated with lower memory levels and faster age-related memory decline.Conclusions and RelevanceIn this cohort study of older US residents, food insecurity was associated with increased dementia risk, poorer memory function, and faster memory decline. Future studies are needed to examine whether addressing food insecurity may benefit brain health.

Publisher

American Medical Association (AMA)

Subject

General Medicine

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