Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999-2002

J Gen Intern Med. 2007 Jul;22(7):1018-23. doi: 10.1007/s11606-007-0192-6. Epub 2007 Apr 11.


Background: Food insecurity refers to limited or uncertain access to food resulting from inadequate financial resources. There is a clear association between food insecurity and obesity among women, but little is known about the relationship between food insecurity and type 2 diabetes.

Objective: To evaluate whether there is an independent association between food insecurity and diabetes.

Design: Cross-sectional analysis of the nationally representative, population-based National Health and Nutrition Examination Survey (1999-2002 waves).

Participants: Four thousand four hundred twenty-three adults > 20 years of age with household incomes < or = 300% of the federal poverty level.

Measurements: We categorized respondents as food secure, mildly food insecure, or severely food insecure using a well-validated food insecurity scale. Diabetes was determined by self-report or a fasting serum glucose > or = 126 mg/dl.

Results: Diabetes prevalence in the food secure, mildly food insecure, and severely food insecure categories was 11.7%, 10.0%, and 16.1%. After adjusting for sociodemographic factors and physical activity level, participants with severe food insecurity were more likely to have diabetes than those without food insecurity (adjusted odds ratio [AOR] 2.1, 95% CI 1.1-4.0, p = .02). This association persisted after further adjusting for body mass index (AOR 2.2, 95% CI 1.2-3.9, p = .01).

Conclusions: Food insecurity may act as a risk factor for diabetes. Among adults with food insecurity, increased consumption of inexpensive food alternatives, which are often calorically dense and nutritionally poor, may play a role in this relationship. Future work should address how primary care clinicians can most effectively assist patients with food insecurity to make healthy dietary changes.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Body Mass Index
  • Costs and Cost Analysis
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / economics*
  • Diabetes Mellitus, Type 2 / psychology*
  • Feeding Behavior / psychology*
  • Female
  • Food / economics*
  • Health Surveys
  • Humans
  • Hunger
  • Male
  • Middle Aged
  • Nutritional Status
  • Obesity / economics*
  • Obesity / psychology
  • Poverty / economics
  • Poverty / psychology*
  • United States