Associations between mid-life and later-life food insecurity on probable dementia in a national sample of United States adults

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BACKGROUND: Growing research suggests that food insecurity, a condition of not having adequate access to healthy foods, is associated with poor cognition; however, prior studies have been limited to the effects of food insecurity in later life. OBJECTIVES: We aimed to examine the associations of mid-life and later-life food insecurity on probable dementia in a large, prospective cohort study of United States adults. METHODS: Data came from 2051 adults from the Panel Study of Income Dynamics, the longest running nationally representative household panel survey. Food insecurity was assessed biennially using the United States Household Food Security Survey Module from 1999 to 2003 and 2015 to 2019. Mid-life food insecurity was defined as food insecurity from 1999 to 2003; later-life food insecurity was defined as food insecurity from 2015 to 2019. Dementia was assessed using the Eight Item Interview to Differentiate Aging and Dementia (AD8) in 2019 and 2021. Probable dementia was defined as an AD8 score ≥2. We examined associations between food insecurity and probable dementia using generalized estimating equations, adjusting for baseline and time-varying sociodemographic and health covariates. RESULTS: In the analytic sample, 3% had mid-life food insecurity only, 5.2% had later-life food insecurity only, and 5.0% had mid-life and later-life food insecurity. After multivariable adjustment, food insecurity in later life only [odds ratio (OR) = 1.85, 95% confidence interval (CI): 1.06, 3.23] and food insecurity in mid-life and later life (OR = 2.18, 95% CI: 1.15, 4.11) were both associated with higher probable dementia. Mid-life food insecurity only was not significantly associated with probable dementia. In subsequent analyses, cumulative episodes of food insecurity (≥2) in later life were associated with probable dementia, but there were no significant associations between cumulative episodes of food insecurity in mid-life and probable dementia. CONCLUSIONS: Findings suggest that the association between food insecurity and dementia is strongest with later life, but not mid-life, exposure to food insecurity.

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