Household Food Security Status and Allostatic Load among United States Adults: National Health and Nutrition Examination Survey 2015-2020

Background: Household food insecurity has been linked to adverse health outcomes, but the pathways driving these associations are not well understood. The stress experienced by those in food-insecure households and having to prioritize between food and other essential needs could lead to physiologic dysregulations [i.e., allostatic load (AL)] and, as a result, adversely impact their health. Objective: To assess the association between household food security status and AL and differences by gender, race and ethnicity, and Supplemental Nutrition Assistance Program (SNAP) participation. Methods: We used data from 7640 United States adults in the 2015-2016 and 2017-March 2020 National Health and Nutrition Examination Survey to estimate means and prevalence ratios (PR) for AL scores (based on cardiovascular, metabolic, and immune biomarkers) associated with self-reported household food security status from multivariable linear and logistic regression models. Results: Adults in marginally food-secure [mean = 3.09, standard error (SE) = 0.10] and food-insecure households (mean = 3.05; SE = 0.08) had higher mean AL than those in food-secure households (mean = 2.70; SE = 0.05). Compared with adults in food-secure households in the same category, those more likely to have an elevated AL included: SNAP participants [PR= 1.12; 95% confidence interval (CI): 1.03, 1.22] and Hispanic women (PR= 1.20; 95% CI: 1.05, 1.37) in marginally food-secure households; and non-Hispanic Black women (PR= 1.14; 95% CI: 1.03, 1.26), men (PR= 1.13; 95% CI: 1.02, 1.26), and non-SNAP non-Hispanic White adults (PR =1.22; 95% CI: 1.08, 1.39) in food-insecure households. Conclusions: AL may be one pathway by which household food insecurity affects health and may vary by gender, race and ethnicity, and SNAP participation.