Food insecurity, food choices, and body mass index in adults: nutrition transition in Trinidad and Tobago

Background This study evaluated whether food insecurity and obesity were associated in a population sample in Trinidad. Methods A sample was drawn of 15 clusters of households, in north central Trinidad. Resident adults were enumerated. A questionnaire was administered including the short form Household Food Security Scale (HFSS). Heights and weights were measured. Analyses were adjusted for age, sex, and ethnic group. Results Data were analysed for 531/631 (84%) of eligible respondents including 241 men and 290 women with a mean age of 47 (range 24-89) years. Overall, 134 (25%) of subjects were classified as food insecure. Food insecurity was associated with lower household incomes and physical disability. Food insecure subjects were less likely to eat fruit (food insecure 40%, food secure 55%; adjusted odds ratio [OR]=0.60, 95% CI: 0.36-0.99, P=0.045) or green vegetables or salads (food insecure 28%, food secure 51%; adjusted OR=0.46, 95% CI: 0.27-0.79, P=0.005) on greater than or equal to5-6 days per week. Body mass index (BMI) was available for 467 (74%) subjects of whom 41 (9%) had BMI <20 kg/m(2), 157 (34%) had BMI 25-29 kg/m(2), and 120 (26%) had BMI greater than or equal to30 kg/m(2). Underweight (OR=3.21, 95% CI: 1.17-8.81) was associated with food insecurity, but obesity was not (OR=1.08, 95% CI: 0.55-2.12). Conclusions Food insecurity was frequent at all levels of BMI and was associated with lower consumption of fruit and vegetables. Food insecurity was associated with underweight but not with present obesity.