This is an application for an R21 award for Dr. Bermdez-Milln, a Public Health Nutritionist and junior faculty at the Department of Community Health and Health Care, School of Medicine at the University of Connecticut Health Center. As compared with non-Latino White women, Latino women are at higher risk of developing type 2 diabetes mellitus. A novel putative risk factor for the development of diabetes that disproportionately affects Latinas is food insecurity, and more specifically, the monthly cycling of food insecurity. Food insecurity has been linked to obesity, diabetes, and cardiovascular disease although the mechanisms are not well elucidated. The proposed research narrows in, specifically, the monthly cycling of food insecurity and its associations with dietary intake/quality, eating disturbance, mental distress and diabetes risk markers. The research plan involves conducting a formative pilot study among 100 food insecure Latinas of childbearing age, to investigate the influence of food insecurity on diabetes risk. Since food insecurity is a long term and episodic experience, our overall hypothesis is that, compared to weeks of food adequacy (food security), weeks of food inadequacy (food insecurity) will be characterized by worsened near-term diabetes risk markers, i.e., fasting glucose, insulin resistance, fructosamine, and glycated albumin and higher long-term metabolic risk markers, i.e. HbA1c, waist circumference, and body mass index. We are also planning to determine if diet, eating disturbance, and psychological distress mediate the relationship between food insecurity and diabetes risk. We hypothesize that, compared to weeks of food adequacy (food security), weeks of food inadequacy (food insecurity) (1) will be characterized by eating disturbance (emotional eating and binge-eating); poorer diet quality (Fat/Sugar/Fruit/Vegetable Screener); and increased psychological distress (depression and anxiety symptoms). Using a repeated measure design, we will collect data at timepoints that will allow us to model mediation effects. Finally, we will develop and collect household food inventory data using an app for smart phones, where subjects can enter foods left in their pantry and refrigerator weekly, as well as uploading photographs. Following completion of the quantitative study, we will conduct 15 in-depth interviews with women having the worse glycemic control, to identify barriers and facilitators to improve Fat/Sugar/Fruit/Vegetable intake among food insecure Latinas using the Health Action Process Approach (HAPA) framework, and inform the design of a larger study for an intervention application. Eventually this line of research will lead to novel interventions and inform policy to decrease the deleterious effects of food insecurity on risk for type 2 diabetes. My established relationships with community agencies in the Latino community make this project highly feasible. 1
The study proposed here will examine a serious limitation in the literature, the impact of food insecurity as it unfolds over the course of the month. It will demonstrate that as household food insecurity increases, dietary quality, emotional eating, binge-eating and mental distress worsens and diabetes markers deteriorate. Findings can also have major intervention and policy implications, such as behavioral interventions, which might include support for emotional distress and implementing food resource management education and modifying the amount and timing of disbursement of monthly SNAP benefits.
