(P24-048-24) Water and Food Insecurity Are Differentially Associated With Healthy Diets Among Men and Women in Mexico: Findings From the 2021 National Health and Nutrition Survey

Objectives: Household water insecurity, the inability to reliably access sufficient water for domestic use, has been negatively associated with food security and dietary diversity in settings where undernutrition is common, but these relationships are unknown in countries with a high prevalence of overweight and obesity. We therefore aimed to assess whether water and food insecurity are associated with diets that decrease noncommunicable disease (NCD) risk among adults in Mexico.

Methods: We used data from a random subsample of adults (≥18 years) from the 2021 Mexican National Health and Nutrition Survey (ENSANUT) who reported dietary intake in the prior seven days using a semiquantitative food frequency questionnaire (n=1,009 men, 1,513 women). Consumed foods were assigned to at least one of 29 groups, which were used to generate dietary indicators according to WHO guidelines: NCD-Protect (consume healthy foods, range: 0-9) and NCD-Risk (avoid foods to limit, range: 0-9). Water insecurity was measured using the Household Water Insecurity Experiences Scale and food insecurity using the Latin American and Caribbean Food Security Scale. We developed multilevel models of each diet indicator that included urbanicity as a fixed effect, adjusted for confounders (region, socioeconomic status, household size, education, and ethnicity), and were stratified by gender.

Results: Water and food insecurity scores were positively correlated (r=0.21, p < 0.001). Among men, moderate-to-high water insecurity was associated with 0.26 lower (95% CI: -0.52, -0.01) NCD-Protect scores relative to those with no-to-marginal water insecurity; there was no observed association with food insecurity. Among women, severe food insecurity was associated with 0.38 lower (95% CI: -0.64, -0.12) NCD-Protect scores relative to those with no food insecurity; there was no observed association with water insecurity. Across men and women, neither water nor food insecurity were associated with NCR-Risk scores.

Conclusions: Gender may modify how household water and food insecurity are associated with diet healthfulness. Improving water and food insecurity has the potential to reduce the risk of malnutrition and NCDs.

Funding Sources: NICHD, NIMH. Data are publicly available from the National Institute of Public Health, Mexico.