Household Food Insecurity and Cognition in Youth and Young Adults with Youth-Onset Diabetes

Andrea D Brown; Angela D Liese; Allison L B Shapiro; Edward A Frongillo; Greta Wilkening; Julius Fridriksson; Anwar T Merchant; Leora Henkin; Elizabeth T Jensen; Beth A Reboussin; Amy S Shah; Santica Marcovina; Lawrence M Dolan; Dana Dabelea; Catherine Pihoker; Jason A Mendoza

doi:10.1155/2023/6382663

Household Food Insecurity and Cognition in Youth and Young Adults with Youth-Onset Diabetes

Pediatr Diabetes. 2023:2023:6382663. doi: 10.1155/2023/6382663. Epub 2023 Sep 14.

Authors

Andrea D Brown¹, Angela D Liese¹, Allison L B Shapiro², Edward A Frongillo³, Greta Wilkening², Julius Fridriksson⁴, Anwar T Merchant¹, Leora Henkin⁵, Elizabeth T Jensen⁶, Beth A Reboussin⁵, Amy S Shah⁷, Santica Marcovina⁸, Lawrence M Dolan⁷, Dana Dabelea^{2

9}, Catherine Pihoker¹⁰, Jason A Mendoza^{10

11}

Affiliations

¹ Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, USA 29208.
² Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO, USA 80045.
³ Department of Health Promotion, Education, and Behavior, University of South Carolina, 915 Greene Street Columbia, SC, USA 29208.
⁴ Department of Communication Sciences & Disorders, University of South Carolina, 1705 College Street Columbia, SC, USA 29208.
⁵ Department of Biostatistics and Data Science, Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC, USA 27101.
⁶ Department of Epidemiology and Prevention, Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC USA 27101.
⁷ Department of Pediatrics, Division of Endocrinology, Cincinnati Children's Hospital Medical Center and The University of Cincinnati, 3333 Burnet Avenue, MLC 4002 Cincinnati, OH, USA 45229.
⁸ Medpace Reference Laboratories, 5365 Medpace Way, Cincinnati, OH, USA 45227.
⁹ Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B119, Aurora, CO, USA 80045.
¹⁰ Department of Pediatrics, University of Washington, Box 356320, Seattle WA, USA 98115-8160.
¹¹ Seattle Children's Research Institute, PO Box 5371, Seattle, WA, USA 98145-5005.

Abstract

Objective: We evaluated the association of household food insecurity (FI) with cognition in youth and young adults with type 1 diabetes (T1D) or type 2 diabetes (T2D).

Design: In this cross-sectional study, age-adjusted scores for composite Fluid Cognition, and sub-domain scores for Receptive Language and Inhibitory Control and Attention, were modeled stratified by diabetes-type using linear regression, with FI in the past year as the predictor, controlling for covariates. Tests for processing speed, inhibitory control/attention, working memory, episodic memory, and cognitive flexibility were administered to measure composite Fluid Cognition score. The NIHT-CB Picture Vocabulary Test was used to assess Crystallized Cognition score and rapid identification of congruent versus noncongruent items were used to assess Inhibitory Control and Attention score.

Setting: The SEARCH for Diabetes in Youth study, representative of 5 U.S. states.

Participants: Included 1574 youth and young adults with T1D or T2D, mean age of 21 years, mean diabetes duration of 11 years, 51% non-Hispanic white, and 47% had higher HbA1c levels (>9% HbA1c).

Results: Approximately 18% of the 1,240 participants with T1D and 31% of the 334 with T2D experienced FI. The food-insecure group with T1D had a lower composite Fluid Cognition score (β= -2.5, 95% confidence interval (CI)= -4.8, -0.1) and a lower Crystallized Cognition score (β= -3.4, CI= -5.6, -1.3) than food-secure peers. Findings were attenuated to non-significance after adjustment for demographics. Among T2D participants, no associations were observed. In participants with T1D effect modification by glycemic levels were found in the association between FI and composite Fluid Cognition score but adjustment for socioeconomic characteristics attenuated the interaction (p=0.0531).

Conclusions: Food-insecure youth and young adults with T1D or T2D did not have different cognition compared to those who were food-secure after adjustment for confounders. Longitudinal research is needed to further understand relations amongst these factors.

Keywords: Cognition; Crystallized Cognition; Diabetes; Fluid Cognition; Food Insecurity.

MeSH terms

Adolescent
Adult
Child
Cognition* / physiology
Cross-Sectional Studies
Diabetes Mellitus, Type 1* / epidemiology
Diabetes Mellitus, Type 1* / psychology
Diabetes Mellitus, Type 2* / epidemiology
Diabetes Mellitus, Type 2* / psychology
Family Characteristics
Female
Food Insecurity*
Humans
Male
Young Adult

Abstract

MeSH terms

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