Prospective associations of food insecurity and ultra-processed food consumption with diabetes risk in older adults

Background Food insecurity and ultra-processed foods have been linked to an increased risk of disease. However, insufficient research has been conducted on the association between food insecurity, ultra-processed foods, and the risk of developing diabetes. This study aims to examine whether food insecurity and consumption of ultra-processed foods in older adults are associated with later-life diabetes. Methods This cohort study analyzed data from a nationally representative longitudinal study of older U.S. adults. The analysis included respondents aged 50 years and older who had complete data on food insecurity and ultra-processed food consumption in 2013 and were free from diabetes at baseline. New-onset diabetes was assessed during 7 years of follow-up, from 2013 through 2020.Food insecurity status was assessed using the validated 6-item Household Food Security Module. Respondents were classified as food secure, having low food security, or having very low food security.Dietary intake was assessed using a food frequency questionnaire. Ultra-processed foods were identified based on the NOVA food classification system, and the percentage of total daily energy intake derived from ultra-processed foods was calculated for each participant. The primary outcome was new-onset diabetes. Cox proportional hazards regression models were used to examine the associations of food insecurity status and the dietary share of ultra-processed foods with incident diabetes. Results A total of 5331 participants without diabetes at baseline were included in the analysis. The mean (SD) age was 67.6 (10.0) years, and 3163 (59.3%) were women. During 7 years of follow-up, [number] participants developed new-onset diabetes. In multivariable Cox regression models adjusted for age, sex, marital status, educational attainment, physical activity, current smoking, body mass index, and total caloric intake, food insecurity was associated with a higher risk of new-onset diabetes. Compared with food-secure older adults, those experiencing low food security had a hazard ratio for new-onset diabetes of 1.24 (95% CI, 0.98-1.58), and those experiencing very low food security had a hazard ratio of 1.43 (95% CI, 1.04-1.98). The percentage of energy from ultra-processed foods was not significantly associated with new-onset diabetes (hazard ratio, 0.69; 95% CI, 0.39-1.20). Conclusions In this cohort study of older U.S. residents without diabetes at baseline and with 7 years of follow-up, food insecurity was associated with an increased risk of developing new-onset diabetes. Future studies are needed to examine whether addressing food insecurity may help reduce the risk of diabetes.