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Food insecurity and cognitive function in Puerto Rican adults

¹ From the Department of Nutrition, Harvard University School of Public Health, Boston, MA (XG); the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA (XG); the Department of Psychiatry, Tufts–New England Medical Center, Boston, MA (TS); the Department of Sociology and Anthropology, Northeastern University, Boston, MA (LMF); Tufts University Friedman School of Nutrition Science and Policy, Boston, MA (TS, PEW, and KLT); and the Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA (KLT).

² Supported by NIA grant P01AG023394, NIA grant R01AG02708, and US Department of Agriculture Agricultural Research Service contract 58-1950-7-707.

³ Reprints not available. Address correspondence to X Gao, Department of Nutrition, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA 02115. E-mail: xiang.gao{at}channing.harvard.edu, or KL Tucker, Dietary Assessment and Epidemiology Research Program, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111. E-mail: katherine.tucker{at}tufts.edu.

Background: Food insecurity is associated with nutrient inadequacy and a variety of unfavorable health outcomes. However, little is known about whether food security is associated with lower cognitive function in the elderly.

Objective: We investigated the prevalence of food insecurity in a representative sample of 1358 Puerto Ricans aged 45–75 y living in Massachusetts in relation to cognitive function performances.

Design: Food security was assessed with the US Household Food Security Scale. Cognitive function was measured to capture general cognition with a battery of 7 tests: Mini-Mental State Examination (MMSE), word list learning (verbal memory), digit span (attention), clock drawing and figure copying (visual-spatial ability), and Stroop and verbal fluency tests (fluency executive functioning).

Results: The overall prevalence of food insecurity during the past 12 mo was 12.1%; 6.1% of the subjects reported very low food security. Food insecurity was inversely associated with global cognitive performance, as assessed by the MMSE score. The adjusted difference in the MMSE score was –0.90 (95% CI: –1.6, –0.19; P for trend = 0.003) for a comparison of participants with very low food security with those who were food secure, after adjustment for age, smoking, education, poverty status, income, acculturation, plasma homocysteine, alcohol, diabetes, and hypertension. Food insecurity was significantly associated with lower scores for word-list learning, percentage retention, letter fluency, and digit span backward tests.

Conclusions: Very low food security was prevalent among the study subjects and was associated with lower cognitive performance. Further studies, both observational and experimental, are warranted to clarify the direction of causality in this association.