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Front. Public Health | doi: 10.3389/fpubh.2018.00038

Food insecurity is associated with low adherence to the Mediterranean diet and adverse health conditions in Portuguese adults

  • 1EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC), Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
  • 2Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Portugal
  • 3Programa Nacional para a Promoção da Alimentação Saudável, Direção Geral da Saúde, Portugal
  • 4Sociedade Portuguesa de Reumatologia, Portugal
  • 5Rheumatology Research Unit, Instituto de Medicina Molecular (IMM), Portugal
  • 6Unidade de Investigação em Saúde (UI), Escola Superior de Saúde - Politécnico de Leiria ESSLEI, Portugal
  • 7Serviço de Reumatologia do Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Portugal
  • 8Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Portugal
  • 9Serviço de Reumatologia do Hospital de Santa Maria, Centro Hospitalar de Lisboa Central, Portugal

Background: Food insecurity is a limited or uncertain access to the adequate food and is a significant public health problem. We aimed to assess determinants of food insecurity and the corresponding health impact in Portugal, a southern European country that faced a severe economic crisis.
Methods: Data were derived from the Epidemiology of Chronic Diseases Cohort Study (EpiDoC), a population-based cohort of 10,661 individuals that were representative of the Portuguese adult population and followed since 2011. A cross-sectional analysis of the third wave of evaluation (EpiDoC 3) was performed between 2015 and 2016. Food insecurity was assessed with the household food insecurity psychometric scale. Socioeconomic, demographic, lifestyle, adherence to Mediterranean diet, self-reported non-communicable disease, health-related quality of life (HRQoL) (EQ-5D-3L), physical function (HAQ score), and health resource consumption information was also collected.
Results: The estimated proportion of food insecurity was 19.3% among a total of 5,653 participants. Food insecure households had low adherence to the Mediterranean diet (OR=0.44; 95%IC 0.31–0.62). In addition, diabetes (OR=1.69; 95% IC 1.20–2.40), rheumatic disease (OR= 1.67; 95% IC 1.07–2.60), and depression symptoms (OR=1.50; 95% IC 1.09–2.06) were independently associated with food insecurity. On average, food insecure households had a lower HRQoL (OR=0.18; 95% IC 0.11–0.31) and a higher disability (OR=2.59; 95% IC 2.04–3.29). A significantly higher proportion of food insecure households reported being hospitalized (OR=1.57; 95% IC 1.18–2.07) and had more public hospital medical appointments (OR=1.48; 95% IC 1.12–1.94) in the previous 12 months.
Conclusions: We found that food insecurity is highly prevalent in Portugal. Food insecurity was associated with low adherence to the Mediterranean diet, non-communicable chronic diseases, lower quality of life, and higher health resource consumption. Therefore, this study provides valuable insight into the relationship between food security and the diet and health of the population during an economic crisis.

Keywords: Food insecurity, mediterranean diet, Non-communicable diseases, health-related quality of life, Health resources consumption, economic crisis

Received: 03 Nov 2017; Accepted: 01 Feb 2018.

Edited by:

Onyebuchi A. Arah, University of California, Los Angeles, United States

Reviewed by:

Terri K. Johnson, Dexcom, United States
Mario U. Pérez-Zepeda, Instituto Nacional de Geriatría, Mexico  

Copyright: © 2018 Gregorio, Rodrigues, Graça, De Sousa, Dias, Branco and Canhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: PhD. Maria Joao Gregorio, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC), Lisbon, Portugal,