Journal of General Internal Medicine

, Volume 22, Issue 7, pp 1018–1023 | Cite as

Food Insecurity is Associated with Diabetes Mellitus: Results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999–2002

  • Hilary K. SeligmanEmail author
  • Andrew B. Bindman
  • Eric Vittinghoff
  • Alka M. Kanaya
  • Margot B. Kushel
Populations at Risk



Food insecurity refers to limited or uncertain access to food resulting from inadequate financial resources. There is a clear association between food insecurity and obesity among women, but little is known about the relationship between food insecurity and type 2 diabetes.


To evaluate whether there is an independent association between food insecurity and diabetes.


Cross-sectional analysis of the nationally representative, population-based National Health and Nutrition Examination Survey (1999–2002 waves).


Four thousand four hundred twenty-three adults >20 years of age with household incomes ≤300% of the federal poverty level.


We categorized respondents as food secure, mildly food insecure, or severely food insecure using a well-validated food insecurity scale. Diabetes was determined by self-report or a fasting serum glucose ≥126 mg/dl.


Diabetes prevalence in the food secure, mildly food insecure, and severely food insecure categories was 11.7%, 10.0%, and 16.1%. After adjusting for sociodemographic factors and physical activity level, participants with severe food insecurity were more likely to have diabetes than those without food insecurity (adjusted odds ratio [AOR] 2.1, 95% CI 1.1–4.0, p = .02). This association persisted after further adjusting for body mass index (AOR 2.2, 95% CI 1.2–3.9, p = .01).


Food insecurity may act as a risk factor for diabetes. Among adults with food insecurity, increased consumption of inexpensive food alternatives, which are often calorically dense and nutritionally poor, may play a role in this relationship. Future work should address how primary care clinicians can most effectively assist patients with food insecurity to make healthy dietary changes.


diabetes mellitus type 2 hunger poverty obesity NHANES 



The authors would like to express their gratitude to Dr. Umesh Masharani for his helpful comments on the manuscript. Dr. Seligman was funded by a DHHS-HRSA Primary Care Faculty Development Grant 5 D14HP00178-03-00. Dr. Kushel’s work was supported by the Agency for Healthcare Research and Quality grant K08 HS011415-03. The funders did not participate in any part of the study. Portions of this work were presented in abstract form at the 2006 Society of General Medicine Meeting.

Conflicts of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Hilary K. Seligman
    • 1
    • 3
    Email author
  • Andrew B. Bindman
    • 1
    • 2
  • Eric Vittinghoff
    • 2
  • Alka M. Kanaya
    • 1
    • 2
  • Margot B. Kushel
    • 1
  1. 1.Division of General Internal Medicine, Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoUSA
  3. 3.University of CaliforniaSan FranciscoUSA

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