Longitudinal Analysis of Food Insufficiency and Cardiovascular Disease Risk Factors in the CARDIA study

Kelsey A. Vercammen, Alyssa J. Moran, Mercedes R. Carnethon, Amanda C. McClain, Lindsay R. Pool, Catarina I. Kiefe, April P. Carson, Penny Gordon-Larsen, Lyn M. Steffen, Matthew M. Lee, Jessica G. Young, Eric B. Rimm

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Introduction: Most previous studies on food insecurity and cardiovascular disease risk factors are cross-sectional. Without longitudinal data, it is unclear whether food insecurity precedes poor health and how exposure timing impacts these relationships. Methods: Data from 2000 to 2001, 2005 to 2006, and 2010 to 2011 of the Coronary Artery Risk Development in Young Adults study were used. Food insufficiency—a screener measure related to food insecurity—was assessed in 2000–2001 and 2005–2006 using a single item. Cardiovascular disease risk factors were objectively assessed in 2010–2011. Impacts of food insufficiency patterns (food sufficient, food insufficient in 2000–2001 only, food insufficient in 2005–2006 only, food insufficient in both 2000–2001 and 2005–2006) on cardiovascular disease risk factors were estimated using inverse probability weighting of marginal structural models. Covariates that change over time were adjusted for using stabilized weights; baseline covariates were adjusted for in the marginal structural models. Analyses were conducted in 2020–2021. Results: The baseline sample included 2,596 participants (56% women, 47% White). In unadjusted analyses, all food insufficiency patterns were associated with higher BMI, waist circumference, and blood pressure than food sufficiency. After accounting for covariates, estimates were attenuated but still consistent with adverse effects of food insufficiency, particularly among women. Conclusions: After covariate adjustment, food insufficiency was associated with several cardiovascular disease risk factors. Findings from this study should be replicated in other settings and populations. If verified, this evidence could provide justification for intervening in food insecurity to reduce future cardiovascular disease risk.

Original languageEnglish (US)
Pages (from-to)65-76
Number of pages12
JournalAmerican journal of preventive medicine
Issue number1
Early online dateOct 9 2021
StatePublished - Jan 2022

Bibliographical note

Funding Information:
The CARDIA study is conducted and supported by the National Heart, Lung, and Blood Institute in collaboration with the University of Alabama at Birmingham (HHSN268201800005I and HHSN268201800007I), Northwestern University (HHSN268201800003I), University of Minnesota (HHSN268201800006I), and Kaiser Foundation Research Institute (HHSN268201800004I). This manuscript has been reviewed by CARDIA for scientific content.

Funding Information:
KV was supported by a Canadian Institute of Health Research doctoral foreign study award (#0492002603). PGL is supported by R01HL143885. ACM was supported by a National Heart, Lung, and Blood Institute Mentored Research Scientist Development K01 Award (HL150406). APC has received investigator-initiated funding from Amgen, Inc. for unrelated work. No other financial disclosures were reported.

Publisher Copyright:
© 2021 American Journal of Preventive Medicine

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't


Dive into the research topics of 'Longitudinal Analysis of Food Insufficiency and Cardiovascular Disease Risk Factors in the CARDIA study'. Together they form a unique fingerprint.

Cite this