The Association between Food Insecurity and Diet Quality Varies by Race/Ethnicity: An Analysis of National Health and Nutrition Examination Survey 2011-2014 Results

Background Food insecurity is believed to influence the quality and quantity of foods consumed; however, studies examining food insecurity and diet quality have been inconclusive and few studies have explored variability in these associations by sex and race/ethnicity. Objective This study examined associations between food insecurity and diet quality, and variations by sex and race/ethnicity. Design Cross-sectional analysis of data from the 2011-2014 National Health and Nutrition Examination Surveys. Participants The study population was composed of 4,393 adults (aged 20 to 65 years) with family incomes <= 300% of the federal poverty level with complete data on household food security and dietary intake via two 24-hour dietary recalls. Main outcome measures Diet quality was assessed using the Healthy Eating Index-2015. Statistical analyses performed Associations between food insecurity and Healthy Eating Index-2015 total and component scores were examined using linear regression models and generalized linear models. Models adjusted for sociodemographic and health covariates. Results Compared with food-secure adults, food-insecure adults reported a 2.22-unit lower Healthy Eating Index-2015 score (95% CI -3.35 to -1.08). This association was most pronounced among non-Hispanic whites and adults of Asian or other races/ethnicities. There were no associations among non-Hispanic black or Hispanic adults, and no differences by sex. Among non-Hispanic whites, food insecurity was associated with lower scores for total protein foods, seafood and plant proteins, and added sugar. Among Asians, food insecurity was associated with lower scores for whole fruit. Conclusions Food insecurity was associated with lower diet quality primarily among non-Hispanic whites; Asians; and other adults, a group composed of American Indian or Alaska Natives, Native Hawaiian or Other Pacific Islanders, and multiracial adults. Further research is needed to better understand the nature of this association among understudied racial/ethnic groups.