(P19-027-24) U.S. Household Food Security Survey Module Questions Predict Dietary and Nutrient Quality Among Low-Income Adults to Inform Measures of Nutrition Security-NHANES 2007–2018

Objectives: Food security, or enough food to support an active and healthy life, is assessed using the U.S. Household Food Security Survey Module (HFSSM). Nutrition security is related, as reliable, fair access to nutritious, safe, and affordable foods for optimal health and well-being. Despite no official nutrition security metric, diet, nutrient quality and food security contribute conceptually to its dimensions. The relationship of affirming questions (indicating food insecurity) within the U.S. HFSSM to diet quality, using the Healthy Eating Index-2015 (HEI-2015), and nutrient quality using the Food Nutrient Index (FNI), was evaluated in U.S. adults of households without children to inform their inclusion in a nutrition security measure.

Methods: Backward regression (adjusted for NHANES survey factors and diet weights) was applied to individual responses on the U.S. HFSSM from 59,842 low-income adults (≥18y) of the U.S. National Health and Nutrition Examination Survey (NHANES) 2007-2018 in separate models against the total and component HEI-2015 and FNI, derived from ≤2 24-hour dietary recalls.

Results: Worrying about food (Question (Q) 2) was associated with lower HEI, 2.8 point, and FNI, 7.6 point, total scores and not eating for a whole day frequently (Q12a) was related to lower HEI, 3 point, and FNI, 10.7 point, total scores (all p< 0.0001). Yet, affirming that food did not last (Q3) was linked to higher HEI, 2.7 point, and FNI, 5 point, total scores and not eating for a whole day (Q12) linked to higher HEI, 1.8 point, and FNI, 7.4 point, total scores (all p≤0.0001). All four questions were similarly related to their consistent respective increases or decreases in ≥5 HEI and FNI component scores (p≤0.05) always including greens and beans, seafood and plant proteins, magnesium, vitamins D and E.

Conclusions: Affirming questions indicating limited food access on the U.S. HFSSM is significantly related to diet and nutrient quality among low-income U.S. adults from households of adults. Both questions where affirmative results indicate early (Q2, Q3) and later stages (Q12, Q12a) of food insecurity are linked to lower and higher diet and nutrient quality revealing the complexity of classifying nutrition insecurity. U.S. HFSSM questions should be further evaluated as components of a measure of nutrition security.

Funding Sources: Supported by the U.S. Department of Agriculture