Association between Food Insecurity and Blood Pressure in A Multiethnic Population

ABSTRACT

Hypertension (HTN) is the strongest modifiable risk factor for CVD that is disproportionately higher in racial/ethnic groups, e.g., Native Hawaiians. Native Hawaiians have over a 50% prevalence of HTN (i.e., systolic blood pressure (SBP) of =130mmHg or diastolic blood pressure (DBP) of =80mmHg), placing them at higher risk for CVD. Behavioral/biological risk factors (e.g., BMI, diet, physical activity) are often the focus of epidemiological and intervention research;yet, socioeconomic factors, such as food insecurity, also affect blood pressure.The purpose of this study is to examine the association between food insecurity and SBP and DBP in Native Hawaiians communities, controlling for demographics and behavioral/biological risk factors.Participants in this 2020, cross-sectional study (N = 125) were from six, predominantly Native Hawaiian communities across Hawai'i. Demographic variables included age, sex, education, and race/ethnicity. Potential confounding variables were leisure-time physical activity, daily servings of processed meat, daily servings of red meat, daily servings of fruit and vegetables, resilience, BMI, use of HTN medication, and COVID-19 related mental health. To assess food insecurity participants were asked to indicate how often money for food runs out by the end of the month on a 5-point Likert scale, with higher scores indicating greater frequency. SBP and DBP were measured according to a standardized protocol. All confounding variables with a significant bivariate correlation with SBP or DBP were entered into the respective multiple regression model.Participants were predominantly female (73, 58.4%), had some college or were college graduates (73, 58.4%), a mean age of 39.2yrs (SD=9.9) and mean BMI of 31.6 (SD=8.7). Mean SBP and DBP were in the normotensive range, 122.9+/-17.5 and 79.5+/-11.9, respectively. Female sex (beta=-9.9, SE=2.6, p<0.001), daily servings of fruit and vegetables (beta=-2.35, SE=1.04, p=0.026), BMI (beta=0.76, SE=0.16, p<0.001), use of HTN medication (beta=14.01, SE=4.90, p=0.005), and food insecurity (beta=2.09, SE=0.95, p=0.030) were associated with SBP (R2=0.40, SE=14.05, p<0.001). Male sex, fewer daily servings of fruit and vegetables, greater BMI, use of HTN medication, and more food insecurity were significantly associated with higher DBP. Female sex (beta=-5.03, SE=1.90, p=0.009), BMI (beta=0.51, SE=0.12, p<0.001), and food insecurity (beta=1.36, SE=0.69, p=0.05) were associated with DBP (R2=0.31, SE=10.18, p<0.001). Male sex, greater BMI, and more food insecurity were significantly associated with higher DBP.After controlling for potential confounders, food insecurity retains a significant, independent association with both SBP and DBP such that a greater frequency of food insecurity was related to higher SBP and DBP. This provides additional evidence for the idea that food insecurity may directly impact CVD risk.