Food insecurity increases cardiovascular risk among American adults

By Dr. Liji Thomas, MDReviewed by Lily Ramsey, LLMMar 3 2025

New study reveals how gender and race/ethnicity influence health impacts of food insecurity.

Study: Food insecurity and cardiovascular disease risk factors among U.S. adults. Image Credit: PeopleImages.com - Yuri A/Shutterstock.com

Food insecurity is a major threat to health, even in developed countries like the United States of America.

In fact, 13.5% of American households face this challenge. A recent study addressed this issue in relation to cardiovascular disease (CVD) risk among adults in the USA. The results were published in BMC Public Health.

Introduction

Food insecurity is defined as “limited or uncertain access to sufficient food.” American adults have been facing steadily increasing food insecurity, with childless women being somewhat more impacted than men without children. Whites are relatively spared, at 10%, vs 23% and 22% for Blacks and Hispanics, respectively.

Altogether, about 18 million families in the USA are food insecure. Issues with accessing adequate food supplies include financial and transportation barriers, ignorance of available food assistance programs, and lack of food preparation skills.

The adverse outcomes include irregular meals and food choices that are high in sugar and salt, with a deficit of fresh fruit and vegetables.

Food insecurity has been linked to CVD risk factors (like obesity and diabetes) and prevalence. CVD affects nearly half of American adults. It has been the leading cause of death for over a century, causing 7,02,880 deaths in 2022.

Coronary artery disease (CAD) is the most common form of CVD, accounting for over 3,71,000 deaths in this country. It is due to atherosclerotic plaque buildup within the coronary arteries, which feed the heart, leading to their blockage and consequent injury and death of the heart tissue.

Different studies have thrown up conflicting results on associations between CVD risk factors and food insecurity, leaving a knowledge gap. The current study aimed to bridge this gap by providing better evidence.

The National Health and Nutrition Examination Survey (NHANES) 2017-2018 provided the data for this study.

The aim was to identify between food insecurity and six CVD risk factors, namely, high blood pressure, increased blood cholesterol, diabetes, smoking, time spent sitting, and body mass index (BMI). The target group was adults above 40 years of age when CVD risk began to increase in the USA.

Study findings

The study included 3,676 participants with an average age of 61 years, just over half being women. Whites comprised 36%, while 55% were married. Over 70% had a household income of $20,000 or more.

Food insecurity was reported by 26% of participants. Food insecurity rates were higher among people with diabetes, smoking, and high blood pressure. These comprise three of the six CVD risk factors examined here.

Conversely, sedentary time was lower among food-insecure individuals. Overall, there was no association between food insecurity and blood cholesterol levels or BMI.

Gender differences

Women with food insecurity had a higher mean BMI compared to men. The reasons for this paradoxical observation remain unclear.

These findings largely corroborate the results of earlier studies, emphasizing the risk of CVD with food insecurity.

However, those studies showed gender differences in the risk of high cholesterol, diabetes, and smoking with food insecurity. This might be due to behavioral adjustments and social reasons that altered the association.

Long-term follow-up will help identify whether such associations change over time.

Ethnic differences

Among various ethnic groups with food insecurity, Asians and Blacks were less likely to have high blood pressure compared to food-insecure Whites.

Latinos who were food insecure were more likely to have high blood cholesterol rates compared to food insecure Whites. Smoking was less likely among food-insecure Blacks and Latinos.

Geographic factors might account for the differences in these findings from those of earlier studies, as the current study used data from a national sample rather than only a few US states. If so, food insecurity's impact on CVD risk may vary by geographic location.

Conclusions

The findings of this study show that a higher BMI, smoking, high blood pressure, and diabetes – all four of which increase CVD risk – are more likely among people who are food insecure.

A novel observation was the lack of difference in the association of high cholesterol with food insecurity in either sex. The investigators also revealed ethnic differences in these associations.

The results also highlight the need for long-term investigations on the adverse impact of food insecurity on public health as well as on CVD risk among adult Americans.

They could help shape culturally relevant preventive strategies such as customized healthy meals for food insecure groups at high risk for CVD.