Longitudinal Analysis of Food Insufficiency and Cardiovascular Disease Risk Factors in the CARDIA study

Introduction: Most previous studies on food insecurity and cardiovascular disease risk factors are cross-sectional. Without longitudinal data, it is unclear whether food insecurity precedes poor health and how exposure timing impacts these relationships. Methods: Data from 2000 to 2001, 2005 to 2006, and 2010 to 2011 of the Coronary Artery Risk Development in Young Adults study were used. Food insufficiency—a screener measure related to food insecurity—was assessed in 2000–2001 and 2005–2006 using a single item. Cardiovascular disease risk factors were objectively assessed in 2010–2011. Impacts of food insufficiency patterns (food sufficient, food insufficient in 2000–2001 only, food insufficient in 2005–2006 only, food insufficient in both 2000–2001 and 2005–2006) on cardiovascular disease risk factors were estimated using inverse probability weighting of marginal structural models. Covariates that change over time were adjusted for using stabilized weights; baseline covariates were adjusted for in the marginal structural models. Analyses were conducted in 2020–2021. Results: The baseline sample included 2,596 participants (56% women, 47% White). In unadjusted analyses, all food insufficiency patterns were associated with higher BMI, waist circumference, and blood pressure than food sufficiency. After accounting for covariates, estimates were attenuated but still consistent with adverse effects of food insufficiency, particularly among women. Conclusions: After covariate adjustment, food insufficiency was associated with several cardiovascular disease risk factors. Findings from this study should be replicated in other settings and populations. If verified, this evidence could provide justification for intervening in food insecurity to reduce future cardiovascular disease risk.