Household food insecurity (HFI) is the limited or uncertain availability of nutritionally adequate and safe foods and has been associated with decreased cognitive function in persons without diabetes. In persons with diabetes, little is known about the impact of HFI, but cognitive function is known to decline with diabetes duration and poorer glycemic control. We evaluated the cross-sectional association of HFI with cognitive function in youth and young adults (YYA) with type 1 diabetes (T1D), focusing on executive function as measured with the NIH Toolbox Cognition Battery (score range 39-146) and a potential interaction of HFI with glycemic control (high risk >9% vs. optimal/suboptimal ≤9% HbA1c). Age-adjusted composite fluid cognition score was modeled using multivariable linear regression, with HFI (≥3 affirmations on US Household Food Security Survey Module) as the predictor, controlling for covariates. Among 1,272 YYA with T1D (mean age 21, diabetes duration 11 years, 57% non-Hispanic white), 55% had high-risk glycemic control and 18% were food insecure. Food insecure T1D YYA had a 2.7 (SD=1.2) lower fluid cognition score than their food secure peers (93.7 vs. 96.4, p=0.03). Adjustment for sex, race/ethnicity, diabetes duration, site, and glycemic control attenuated this association (β=1.2, p=0.30). However, glycemic control turned out to modify the association of HFI with cognition (multiplicative interaction in adjusted model p<0.01). Among YYA with HbA1c ≤9%, food insecure individuals had a lower mean fluid cognition score than the food secure (99 vs. 104, p<0.02); for YYA with high-risk glycemic control, no association was observed. In this cross-sectional study, food insecurity has a detrimental relationship with cognition among T1D YYA, particularly among those with optimal/suboptimal glycemic control levels. Longitudinal research is needed to further delineate the temporal relationships between household food insecurity, glycemic control, and cognition.
A. D. Liese: None. B. A. Reboussin: None. A. S. Shah: None. S. M. Marcovina: None. L. M. Dolan: None. D. Dabelea: None. C. Pihoker: None. J. A. Mendoza: None. A. D. Brown: None. A. Shapiro: None. E. A. Frongillo: None. G. Wilkening: None. J. Fridriksson: None. A. Merchant: None. L. Henkin: None. E. T. Jensen: None.
National Institutes of Health (1R01DK117461, 1UC4DK108173)