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Food Insecurity and Diabetes in Developed Societies


Food insecurity is an important issue in public health even in developed societies, particularly for vulnerable populations. Food insecurity refers to the uncertain or limited access to adequate and safe foods. Emerging evidence shows an association between food insecurity, type 2 diabetes risk factors, and management of type 1 and type 2 diabetes. A review of the current literature describing the association between food insecurity and diabetes reveals possible mechanisms and pathophysiologic pathways. There is less evidence for effective interventions, and much of the current literature is limited to cross-sectional studies. Future work should evaluate longitudinal associations and ways to help vulnerable patients with diabetes access adequate food for effective diabetes management.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Seligman HK, Bindman AB, Vittinghoff E, Kanaya AM, Kushel MB. Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999–2002. J Gen Intern Med. 2007;22(7):1018–23.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr. 2010;140(2):304–10.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Seligman HK, Jacobs EA, Lopez A, Tschann J, Fernandez A. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes Care. 2012;35(2):233–8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Berkowitz SA, Baggett TP, Wexler DJ, Huskey KW, Wee CC. Food insecurity and metabolic control among U.S. adults with diabetes. Diabetes Care. 2013;36(10):3093–9.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Agriculture USDA. Food Security in the U.S. Available from: Accessed 20 February 2016.

  6. 6.

    Sattler EL, Lee JS, Bhargava V. Food insecurity and medication adherence in low-income older Medicare beneficiaries with type 2 diabetes. J Nutr Gerontol Geriatr. 2014;33(4):401–17.

    Article  PubMed  Google Scholar 

  7. 7.

    Coleman-Jensen AG C, Singh A. Household food security in the United States in 2014. 2015.

    Google Scholar 

  8. 8.

    United States Department of Agriculture. Food security in the U.S.: survey tools. 2015.

    Google Scholar 

  9. 9.

    Depa J, Hilzendegen C, Tinnemann P, Stroebele-Benschop N. IAn explorative cross-sectional study examining self-reported health and nutritional status of disadvantaged people using food banks in Germany. Int J Equity Health. 2015;14(1):141.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Weinfield NS, Mills G, Borger C, Gearing M, Macaluso T, Montaquila J, et al. Hunger in America 2014 National Report. Prepared for: Feeding America 35 East Wacker Drive, Suite 2000 Chicago, IL 60601. 2014. Accessed 14 Jul 2016.

  11. 11.

    Service UER. Nearly one-third of SNAP recipients obtain food from a food pantry. 2014.

    Google Scholar 

  12. 12.

    Alley DE, Asomugha CN, Conway PH, Sanghavi DM. Accountable health communities—addressing social needs through Medicare and Medicaid. N Engl J Med. 2016;374(1):8–11.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Seligman HK, Schillinger D. Hunger and socioeconomic disparities in chronic disease. N Engl J Med. 2010;363(1):6–9.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Lyles CR, Seligman HK, Parker MM, Moffet HH, Adler N, Schillinger D, et al. Financial strain and medication adherence among diabetes patients in an integrated health care delivery system: the diabetes study of Northern California (DISTANCE). Health Serv Res. 2015;51:610–24.

    Article  PubMed  Google Scholar 

  15. 15.

    Morales ME. Berkowitz SA. Dietary Patterns, and Obesity. Current Nutrition Reports: The relationship between food insecurity; 2016.

    Google Scholar 

  16. 16.

    Bruening M, MacLehose R, Loth K, Story M, Neumark-Sztainer D. Feeding a family in a recession: food insecurity among Minnesota parents. Am J Public Health. 2012;102(3):520–6.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Dinour LM, Bergen D, Yeh MC. The food insecurity-obesity paradox: a review of the literature and the role food stamps may play. J Am Diet Assoc. 2007;107(11):1952–61.

    Article  PubMed  Google Scholar 

  18. 18.

    Seligman HK, Davis TC, Schillinger D, Wolf MS. Food insecurity is associated with hypoglycemia and poor diabetes self-management in a low-income sample with diabetes. J Health Care Poor Underserved. 2010;21(4):1227–33.

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Pan L, Sherry B, Njai R, Blanck HM. Food insecurity is associated with obesity among US adults in 12 states. J Acad Nutr Diet. 2012;112(9):1403–9.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Sirotin N, Hoover DR, Shi Q, Anastos K, Weiser SD. Food insecurity with hunger is associated with obesity among HIV-infected and at risk women in Bronx, NY. PLoS One. 2014;9(8):e105957.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Mohammadi F, Omidvar N, Harrison GG, Ghazi-Tabatabaei M, Abdollahi M, Houshiar-Rad A, et al. Is household food insecurity associated with overweight/obesity in women? Iran J Public Health. 2013;42(4):380–90.

    PubMed  PubMed Central  Google Scholar 

  22. 22.

    Cheung HC, Shen A, Oo S, Tilahun H, Cohen MJ, Berkowitz SA. Food insecurity and body mass index: a longitudinal mixed methods study, Chelsea, Massachusetts, 2009–2013. Prev Chronic Dis. 2015;12:E125.

    PubMed  Google Scholar 

  23. 23.

    Burns C, Bentley R, Thornton L, Kavanagh A. Associations between the purchase of healthy and fast foods and restrictions to food access: a cross-sectional study in Melbourne, Australia. Public Health Nutr. 2015;18(1):143–50.

    Article  PubMed  Google Scholar 

  24. 24.

    Esser N, Legrand-Poels S, Piette J, Scheen AJ, Paquot N. Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes. Diabetes Res Clin Pract. 2014;105(2):141–50.

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Fronczyk A, Moleda P, Safranow K, Piechota W, Majkowska L. Increased concentration of C-reactive protein in obese patients with type 2 diabetes is associated with obesity and presence of diabetes but not with macrovascular and microvascular complications or glycemic control. Inflammation. 2014;37(2):349–57.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Hernandez-Aguilera A, Rull A, Rodriguez-Gallego E, Riera-Borrull M, Luciano-Mateo F, Camps J, et al. Mitochondrial dysfunction: a basic mechanism in inflammation-related non-communicable diseases and therapeutic opportunities. Mediators Inflamm. 2013;2013:135698.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.••

    Gowda C, Hadley C, Aiello AE. The association between food insecurity and inflammation in the US adult population. Am J Public Health. 2012;102(8):1579–86. One of the only studies describing inflammations as a potential mechanism for the relationship between food insecurity and inflammation.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Despres JP. Intra-abdominal obesity: an untreated risk factor for type 2 diabetes and cardiovascular disease. J Endocrinol Invest. 2006;29(3 Suppl):77–82.

    CAS  PubMed  Google Scholar 

  29. 29.

    Sahakyan KR, Somers VK, Rodriguez-Escudero JP, Hodge DO, Carter RE, Sochor O, et al. Normal-weight central obesity: implications for total and cardiovascular mortality. Ann Intern Med. 2015;163(11):827–35.

    Article  PubMed  Google Scholar 

  30. 30.

    Willows N, Veugelers P, Raine K, Kuhle S. Associations between household food insecurity and health outcomes in the Aboriginal population (excluding reserves). Health Rep. 2011;22(2):15–20.

    PubMed  Google Scholar 

  31. 31.

    Shariff ZM, Sulaiman N, Jalil RA, Yen WC, Yaw YH, Taib MN, et al. Food insecurity and the metabolic syndrome among women from low income communities in Malaysia. Asia Pac J Clin Nutr. 2014;23(1):138–47.

    CAS  PubMed  Google Scholar 

  32. 32.

    Kimani-Murage EW, Kahn K, Pettifor JM, Tollman SM, Klipstein-Grobusch K, Norris SA. Predictors of adolescent weight status and central obesity in rural South Africa. Public Health Nutr. 2011;14(6):1114–22.

    Article  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Rezazadeh A, Omidvar N, Eini-Zinab H, Ghazi-Tabatabaie M, Majdzadeh R, Ghavamzadeh S, et al. Food insecurity, socio-economic factors and weight status in two Iranian ethnic groups. Ethn Health. 2015:1–18.

  34. 34.

    Weigel MM, Armijos RX, Hall YP, Ramirez Y, Orozco R. The household food insecurity and health outcomes of U.S.-Mexico border migrant and seasonal farmworkers. J Immigr Minor Health. 2007;9(3):157–69.

    Article  PubMed  Google Scholar 

  35. 35.

    Parker ED, Widome R, Nettleton JA, Pereira MA. Food security and metabolic syndrome in U.S. adults and adolescents: findings from the National Health and Nutrition Examination Survey, 1999–2006. Ann Epidemiol. 2010;20(5):364–70.

    Article  PubMed  Google Scholar 

  36. 36.

    Liu J, Park YM, Berkowitz SA, Hu Q, Han K, Ortaglia A, et al. Gender differences in the association between food insecurity and insulin resistance among U.S. adults: National Health and Nutrition Examination Survey, 2005–2010. Ann Epidemiol. 2015;25(9):643–8.

    Article  PubMed  Google Scholar 

  37. 37.••

    Holben DH, Taylor CA. Food insecurity and its association with central obesity and other markers of metabolic syndrome among persons aged 12 to 18 years in the United States. J Am Osteopath Assoc. 2015;115(9):536–43. One of the only studies describing the relationship between central adiposity and food insecurity as potential mechanisms for the development of metabolic syndrome.

    Article  PubMed  Google Scholar 

  38. 38.••

    Ding M, Wilson NL, Garza KB, Zizza CA. Undiagnosed prediabetes among food insecure adults. Am J Health Behav. 2014;38(2):225–33. Key examination of food insecurity and prediabetes.

    Article  PubMed  Google Scholar 

  39. 39.

    James C, Bullard KM, Rolka DB, Geiss LS, Williams DE, Cowie CC, et al. Implications of alternative definitions of prediabetes for prevalence in U.S. adults. Diabetes Care. 2011;34(2):387–91.

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Ardisson Korat AV, Willett WC, Hu FB. Diet, lifestyle, and genetic risk factors for type 2 diabetes: a review from the Nurses’ Health Study, Nurses’ Health Study 2, and Health Professionals’ follow-up study. Curr Nutr Rep. 2014;3(4):345–54.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Berkowitz SA, Gao X, Tucker KL. Food-insecure dietary patterns are associated with poor longitudinal glycemic control in diabetes: results from the Boston Puerto Rican Health study. Diabetes Care. 2014;37(9):2587–92.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Heerman WJ, Wallston KA, Osborn CY, Bian A, Schlundt DG, Barto SD, et al. Food insecurity is associated with diabetes self-care behaviours and glycaemic control. Diabet Med. 2015.

  43. 43.•

    Wang EA, McGinnis KA, Goulet J, Bryant K, Gibert C, Leaf DA, et al. Food insecurity and health: data from the Veterans Aging Cohort Study. Public Health Rep. 2015;130(3):261–8. This study describes the impact of food insecurity on a number of different health outcomes including diabetes in the veteran population.

    PubMed  PubMed Central  Google Scholar 

  44. 44.

    Mayer VL, McDonough K, Seligman H, Mitra N, Long JA. Food insecurity, coping strategies and glucose control in low-income patients with diabetes. Public Health Nutr. 2015:1–9.

  45. 45.

    Berkowitz SA, Meigs JB, DeWalt D, Seligman HK, Barnard LS, Bright OJ, et al. Material need insecurities, control of diabetes mellitus, and use of health care resources: results of the Measuring Economic Insecurity in Diabetes study. JAMA Intern Med. 2015;175(2):257–65.

    Article  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Lyles CR, Wolf MS, Schillinger D, Davis TC, Dewalt D, Dahlke AR, et al. Food insecurity in relation to changes in hemoglobin A1c, self-efficacy, and fruit/vegetable intake during a diabetes educational intervention. Diabetes Care. 2013;36(6):1448–53.

    Article  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Moreno G, Morales LS, Isiordia M, de Jaimes FN, Tseng CH, Noguera C, et al. Latinos with diabetes and food insecurity in an agricultural community. Med Care. 2015;53(5):423–9.

    Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    Berkowitz SA, Seligman HK, Choudhry NK. Treat or eat: food insecurity, cost-related medication underuse, and unmet needs. Am J Med. 2014;127(4):303–10e3.

    Article  PubMed  Google Scholar 

  49. 49.

    Knight CK, Probst JC, Liese AD, Sercye E, Jones SJ. Household food insecurity and medication “scrimping” among US adults with diabetes. Prev Med. 2016;83:41–5.

    Article  PubMed  Google Scholar 

  50. 50.

    Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24(6):1069–78.

    CAS  Article  PubMed  Google Scholar 

  51. 51.

    Berge LI, Riise T. Comorbidity between type 2 diabetes and depression in the adult population: directions of the association and its possible pathophysiological mechanisms. Int J Endocrinol. 2015;2015:164760.

    Article  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Berge LI, Riise T, Tell GS, Iversen MM, Ostbye T, Lund A, et al. Depression in persons with diabetes by age and antidiabetic treatment: a cross-sectional analysis with data from the Hordaland Health Study. PLoS One. 2015;10(5):e0127161.

    Article  PubMed  PubMed Central  Google Scholar 

  53. 53.

    Bajor LA, Gunzler D, Einstadter D, Thomas C, McCormick R, Perzynski AT, et al. Associations between comorbid anxiety, diabetes control, and overall medical burden in patients with serious mental illness and diabetes. Int J Psychiatry Med. 2015;49(4):309–20.

    Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Gonzalez JS, Shreck E, Psaros C, Safren SA. Distress and type 2 diabetes-treatment adherence: a mediating role for perceived control. Health Psychol. 2015;34(5):505–13.

    Article  PubMed  Google Scholar 

  55. 55.

    Becerra BJ, Sis-Medina RC, Reyes A, Becerra MB. Association between food insecurity and serious psychological distress among Hispanic adults living in poverty. Prev Chronic Dis. 2015;12:E206.

    PubMed  PubMed Central  Google Scholar 

  56. 56.•

    Silverman J, Krieger J, Kiefer M, Hebert P, Robinson J, Nelson K. The relationship between food insecurity and depression, diabetes distress and medication adherence among low-income patients with poorly-controlled diabetes. J Gen Intern Med. 2015;30(10):1476–80. This study provides a link between diabetes, food insecurity and mental health, particularly depression.

    Article  PubMed  Google Scholar 

  57. 57.

    Kollannoor-Samuel G, Vega-Lopez S, Chhabra J, Segura-Perez S, Damio G, Perez-Escamilla R. Food insecurity and low self-efficacy are associated with health care access barriers among Puerto-Ricans with type 2 diabetes. J Immigr Minor Health. 2012;14(4):552–62.

    Article  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Gucciardi E, Vahabi M, Norris N, Del Monte JP, Farnum C. The intersection between food insecurity and diabetes: a review. Curr Nutr Rep. 2014;3(4):324–32.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  59. 59.

    Seligman HK, Jacobs EA, Lopez A, Sarkar U, Tschann J, Fernandez A. Food insecurity and hypoglycemia among safety net patients with diabetes. Arch Intern Med. 2011;171(13):1204–6.

    Article  PubMed  PubMed Central  Google Scholar 

  60. 60.

    Berkowitz SA, Aragon K, Hines J, Seligman H, Lee S, Sarkar U. Do clinical standards for diabetes care address excess risk for hypoglycemia in vulnerable patients? A systematic review. Health Serv Res. 2013;48(4):1299–310.

    Article  PubMed  PubMed Central  Google Scholar 

  61. 61.

    Chan J, DeMelo M, Gingras J, Gucciardi E. Challenges of diabetes self-management in adults affected by food insecurity in a large Urban Centre of Ontario, Canada. Int J Endocrinol. 2015;2015:903468.

    Article  PubMed  PubMed Central  Google Scholar 

  62. 62.

    Seligman HK, Bolger AF, Guzman D, Lopez A, Bibbins-Domingo K. Exhaustion of food budgets at month’s end and hospital admissions for hypoglycemia. Health Aff (Millwood). 2014;33(1):116–23.

    Article  Google Scholar 

  63. 63.

    Barnard LS, Wexler DJ, DeWalt D, Berkowitz SA. Material need support interventions for diabetes prevention and control: a systematic review. Curr Diab Rep. 2015;15(2):574.

    Article  PubMed  Google Scholar 

  64. 64.

    Gao J, Wang J, Zheng P, Haardorfer R, Kegler MC, Zhu Y, et al. Effects of self-care, self-efficacy, social support on glycemic control in adults with type 2 diabetes. BMC Fam Pract. 2013;14:66.

    Article  PubMed  PubMed Central  Google Scholar 

  65. 65.

    Vivian EM, Ejebe IH. Identifying knowledge deficits of food insecure patients with diabetes. Curr Diabetes Rev. 2014;10(6):402–6.

    Article  PubMed  PubMed Central  Google Scholar 

  66. 66.

    Sonik RA. Massachusetts inpatient medicaid cost response to increased supplemental nutrition assistance program benefits. Am J Public Health. 2016;106(3):443–8.

    Article  PubMed  PubMed Central  Google Scholar 

  67. 67.••

    Seligman HK, Lyles C, Marshall MB, Prendergast K, Smith MC, Headings A, et al. A pilot food bank intervention featuring diabetes-appropriate food improved glycemic control among clients in three states. Health Aff (Millwood). 2015;34(11):1956–63. This study is the first known study to describe a food pantry intervention to improve diabetes outcomes.

    Article  Google Scholar 

  68. 68.•

    Goddu AP, Roberson TS, Raffel KE, Chin MH, Peek ME. Food Rx: a community-university partnership to prescribe healthy eating on the South Side of Chicago. J Prev Interv Community. 2015;43(2):148–62. This study describes a novel intervention to impact diabetes care in low socioeconomic populations.

    Article  PubMed  PubMed Central  Google Scholar 

  69. 69.

    Basu S, Seligman HK, Gardner C, Bhattacharya J. Ending SNAP subsidies for sugar-sweetened beverages could reduce obesity and type 2 diabetes. Health Aff (Millwood). 2014;33(6):1032–9.

    Article  Google Scholar 

  70. 70.

    Professional practice committee for the standards of medical care in diabetes—2016. Diabetes Care. 2016;39 Suppl 1:S107-8.

  71. 71.

    Promoting food security for all children. Pediatrics. 2015;136(5):e1431-8.

  72. 72.

    Hager ER, Quigg AM, Black MM, Coleman SM, Heeren T, Rose-Jacobs R, et al. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics. 2010;126(1):e26–32.

    Article  PubMed  Google Scholar 

  73. 73.

    Ellwood M, Downer S, Leib EB, Greenwald R, Farthing-Nichol D, Luk E, et al. Opportunities in public and private health care for supporting nutritional counseling and medically tailored, home-delivered meals. Cambridge, UK: Harvard University; 2014.

    Google Scholar 

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Correspondence to Seth A. Berkowitz.

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Utibe Essien, Naysha Shahid, and Seth A. Berkowitz declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Obesity

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Essien, U.R., Shahid, N.N. & Berkowitz, S.A. Food Insecurity and Diabetes in Developed Societies. Curr Diab Rep 16, 79 (2016).

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  • Food insecurity
  • Diabetes
  • Central Adiposity
  • Prediabetes
  • Nutrition