The relationship between food insecurity, diet quality, and behavioural cardiovascular health among adults

Objective This study examined the association between food insecurity, diet quality, and behavioural cardiovascular health (CVH) risk among adults in Türkiye. Methods Data were collected from 808 adults aged 18 years and older, using an online survey. Diet quality was assessed with the 14-item Mediterranean Diet Adherence Screener (MEDAS), food insecurity with the Household Food Insecurity Access Scale (HFIAS), and behavioural CVH with a composite score (0–100) adapted from the American Heart Association’s Life’s Essential 8 framework. Associations were examined using Spearman correlation, Mann–Whitney U /Kruskal-Wallis H tests with Benjamini-Hochberg correction, hierarchical multiple regression, bootstrapped mediation analysis, and logistic regression. Results Food insecurity was reported by 27.5% ( n = 222) of participants. Mediterranean diet adherence was low in 29.3%, moderate in 67.1%, and high in 3.6% of participants, while cardiovascular health was low in 47.5%, moderate in 49.9%, and high in 2.6%. After adjustment for age, BMI, sex, income, and education, food insecurity was not significantly associated with Mediterranean diet adherence or cardiovascular health in correlation, regression, mediation, or logistic regression analyses. In contrast, Mediterranean diet adherence was strongly and positively associated with cardiovascular health ( β = 0.309, p < 0.001). Male sex was the most consistent predictor of both lower diet quality ( β = −0.229, p < 0.001) and lower cardiovascular health ( β = −0.140, p < 0.001). These findings were unchanged after accounting for age bracket and sex. Discussion In this population, no direct or indirect association was found between food insecurity and either diet quality or cardiovascular health, although diet quality remained a robust, independent predictor of cardiovascular health. Longitudinal research is warranted, as food insecurity may affect cardiovascular health through mechanisms other than nutrition.