Food Insecurity and Vision Impairment Among Adults Age 50 and Older in the United States

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Highlights

  • In US adults 50 years and older, food insecurity is associated with greater odds of prevalent vision impairment, as assessed by both self-report and objective measurement.

  • In a dose–response manner, prevalence of vision impairment increased with increasing severe food insecurity.

  • The association between food insecurity and objectively measured poor vision was more prominent in those 65 years and older compared with those aged 50 through 64 years.

Purpose

To test the hypothesis that food insecurity is associated with greater prevalence of vision impairment (VI).

Design

Cross-sectional, nationally representative survey of US adults.

Methods

Adults 50 years and older were included. Food security category (ie, full, marginal, low, or very low) was assessed by the US Household Food Security Survey Module. Objective presenting VI (PVI) and self-reported VI (SRVI) were assessed by examination and survey, respectively. Separate logistic regression models were constructed with food insecurity category as a predictor of PVI or SRVI. Models were adjusted for age, gender, race, education, income, cigarette use, alcohol use, body mass index, and physical activity. Age-stratified analyses (age 50 through 64 years vs 65 years and older) were also conducted.

Results

Mean age of participants (n = 10,078) was 63.4 years; 8,518 (89.9%) were fully food secure, 1,033 (7.2%) had PVI, and 2,633 (20.1%) had SRVI. Compared with full food security, adjusting for sociodemographic confounders, those with marginal (adjusted odds ratio [aOR], 1.31; 95% CI, 0.97-1.76), low (aOR, 1.61; 95% CI, 1.17-2.23), and very low (aOR, 2.71; 95% CI, 1.75-4.20) food security had higher odds of PVI. Compared with full food security, those with marginal (aOR, 1.58; 95% CI, 1.23-2.02), low (aOR, 1.46; 95% CI, 1.11-1.92), and very low (aOR, 1.85; 95% CI, 1.41-2.41) food security had higher odds of SRVI. The associations between food insecurity and PVI were greater in magnitude in those 65 years and older compared with those age 50 through 64 years.

Conclusions

In this nationally representative sample of US adults 50 years and older, severe food insecurity was increasingly associated with greater prevalence of VI in a dose–response manner.

Section snippets

STUDY DESIGN AND SAMPLE

The National Health and Nutrition Examination Survey (NHANES) is a nationally representative series of cross-sectional interviews, surveys, and physical examinations conducted in the United States.27,28 The NHANES was designed to assess the health and nutrition status of the US civilian population using a stratified multistage probability design with oversampling of certain subgroups, which has been described in detail.29,30 Use of NHANES sample weights yields data generalizable to the US

RESULTS

Of the 12,781 adults 50 years and older in the NHANES 1999-2008, there were 2126 excluded due to lack of vision data, and an additional 577 were excluded due to lack of food security data, resulting in 10,078 participants included in this analysis. The individuals included in this analysis were statistically significantly older (66 vs 63 years; P < .0001), less likely to engage in regular physical activity (35% vs 45%; P < .0001), less likely to have more than a high school education (66% vs

DISCUSSION

In this nationally representative sample of US adults age 50 years and older, we found compelling evidence to suggest that dietary adequacy as measured by food security is associated with visual health. In this study, those with food insecurity had higher odds of prevalent VI, assessed by both objective measurement and self-report. Compared with those with full food security, those with very low food security had 170% higher odds of PVI and 85% higher odds of SRVI. Furthermore, as severity of

REFERENCES (69)

  • JT. Holladay

    Visual acuity measurements

    J Cataract Refract Surg

    (2004)
  • BA. Laraia

    Food insecurity and chronic disease

    Adv Nutr

    (2013)
  • E Kostyra et al.

    Food shopping, sensory determinants of food choice and meal preparation by visually impaired people. Obstacles and expectations in daily food experiences

    Appetite

    (2017)
  • P Herd et al.

    Health disparities among older adults: life course influences and policy solutions

  • HK Seligman et al.

    Food insecurity is associated with chronic disease among low-income NHANES participants

    J Nutr

    (2010)
  • N Sanjeevi et al.

    Monthly variations in dietary intake of women participating in the Supplemental Nutrition Assistance Program

    J Acad Nutr Diet

    (2019)
  • WS Wolfe et al.

    Understanding the experience of food insecurity by elders suggests ways to improve its measurement

    J Nutr

    (2003)
  • S Vitale et al.

    Prevalence of visual impairment in the United States

    JAMA

    (2006)
  • R Bourne et al.

    Trends in prevalence of blindness and distance and near vision impairment over 30 years and contribution to the Global Burden of Disease in 2020

    SSRN J

    (2020)
  • CM. Mangione

    Psychometric Properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ)

    Arch Ophthalmol

    (1998)
  • J Wittenborn et al.

    The Future of Vision: Forecasting the Prevalence and Costs of Vision Problems

    (June 11, 2014)
  • GK Broadhead et al.

    Diet and risk of visual impairment: a review of dietary factors and risk of common causes of visual impairment

    Nutr Rev

    (2021)
  • C Dow et al.

    Diet and risk of diabetic retinopathy: a systematic review

    Eur J Epidemiol

    (2018)
  • JA Mares et al.

    Healthy diets and the subsequent prevalence of nuclear cataract in women

    Arch Ophthalmol

    (2010)
  • JA Mares et al.

    Healthy lifestyles related to subsequent prevalence of age-related macular degeneration

    Arch Ophthalmol

    (2011)
  • US Department of Agriculture, Economic Research Service

    (2021)
  • SA. Anderson

    Core indicators of nutritional state for difficult-to-sample populations

    J Nutr

    (1990)
  • AJ.U.S. Coleman-Jensen

    food insecurity status: toward a refined definition

    Soc Indicators Res

    (2010)
  • HK Seligman et al.

    Hunger and socioeconomic disparities in chronic disease

    N Engl J Med

    (2010)
  • DJ Arenas et al.

    A systematic review and meta-analysis of depression, anxiety, and sleep disorders in US adults with food insecurity

    J Gen Intern Med

    (2019)
  • M Dinu et al.

    Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials

    Eur J Clin Nutr

    (2018)
  • C Gundersen et al.

    Food insecurity and health outcomes

    Health Aff (Millwood)

    (2015)
  • S Fraser-Bell et al.

    Hypertensive eye disease: a review

    Clin Exp Ophthalmol

    (2017)
  • Center for Disease Control and Prevention

    (2020)
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    Accepted for publication Oct 6, 2021.

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