Relationship between Food Security, Nutrition Security, and Diabetes: The Role of SNAP Participation

Background Inadequate nutrition and poor diet quality are associated with heightened risk for diabetes. The connection between food insecurity measures and diabetes has been established, with evidence indicating that SNAP participation contributes to reductions in food insecurity. Recently developed nutrition security measures, defined as the ability to acquire healthful foods to prevent diseases, and its association with diabetes and SNAP participation is not yet understood. Objective The purpose of this study is to assess the relationship between nutrition security and food security in relation to diabetes overall, and by SNAP participation and nutrition security as potential modifiers. Methods Secondary data analysis of cross-sectional pilot study data collected from adults in five US states [N= 517]. Logistic regression mixed models included moderation analysis and clustering effects by state to address site level confounding. Results Higher nutrition security scores among adults, after adjusting for confounders, were significantly associated with lower odds of diabetes risk (AOR= 0.59; 95% CI: 0.40, 0.87; P value=0.008). Statistically significant interaction effect of differences according to SNAP participation was observed for nutrition security (Phomogeneity/interaction =0.021), adjusting for age, gender, race/ethnicity, education, employment, NSLP, WIC, food pantry use, household with children, survey mode, and food security. The association between food security and diabetes was not statistically significant overall. However, statistically significant interaction effect of differences according to SNAP participation was observed for food security (Phomogeneity/interaction=0.047). Further, no interaction effect of differences by nutrition security was found between food security and self-reported diabetes/pre-diabetes (Phomogeneity/interaction=0.250). Conclusions This study sheds light on the early exploration of the intricate relationship between nutrition security and diabetes. The findings suggest that a higher nutrition security score, after adjusting for confounders, is significantly associated with lower odds of diabetes risk. Notably, there is statistically significant interaction effects in these associations based on SNAP participation.