Food insecurity is inversely associated with diet quality of lower-income adults

J Acad Nutr Diet. 2014 Dec;114(12):1943-53.e2. doi: 10.1016/j.jand.2014.06.353. Epub 2014 Aug 1.


Food insecurity acts as a chronic stressor independent of poverty. Food-insecure adults may consume more highly palatable foods as a coping mechanism, leading to poorer diet quality and increased risks of chronic disease over time. Using data from the 1999-2008 National Health and Nutrition Examination Surveys, this study aimed to examine the cross-sectional differences in dietary intake and diet quality by household food security among 8,129 lower-income adults (≤300% of the federal poverty level). Food insecurity was assessed using the 18-item US Household Food Security Survey Module. Dietary intake was assessed from 24-hour recalls and diet quality was measured using the Healthy Eating Index-2005 and the Alternate Healthy Eating Index-2010. Relative mean differences in dietary outcomes by household food security were estimated using linear regression models, adjusting for sociodemographic characteristics. Lower-income food-insecure adults reported higher consumption of some highly palatable foods, including high-fat dairy products (P trend<0.0001) and salty snacks (P trend=0.01) compared with lower-income food-secure adults. Food insecurity was also associated with more sugar-sweetened beverages (P trend=0.003); more red/processed meat (P trend=0.005); more nuts, seeds, and legumes (P trend=0.0006); fewer vegetables (P trend<0.0001); and fewer sweets and bakery desserts (P trend=0.0002). No differences were observed for intakes of total energy and macronutrients. Food insecurity was significantly associated with lower Healthy Eating Index-2005 (P trend<0.0001) and Alternate Healthy Eating Index-2010 scores (P trend<0.0001). Despite no macronutrient differences, food insecurity was associated with characteristics of poor diet quality known to increase chronic disease risk.

Keywords: Alternate Healthy Eating Index-2010; Dietary intake; Food insecurity; Healthy Eating Index-2005.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Dairy Products / analysis
  • Diet*
  • Energy Intake
  • Fabaceae
  • Feeding Behavior*
  • Female
  • Food Supply*
  • Fruit
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Nutrition Assessment
  • Nutrition Surveys
  • Nuts
  • Snacks
  • Socioeconomic Factors
  • Vegetables
  • Young Adult