{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T03:11:30Z","timestamp":1784257890872,"version":"3.55.0"},"reference-count":68,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi250090-4\"><jats:title>Importance<\/jats:title><jats:p>Evidence from diverse global populations suggests that household food insecurity (HFI) is associated with adult disability, but the association between household water insecurity (HWI) and disability remains understudied. Examinations of the joint association of dual HFI and HWI with disability are lacking.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250090-5\"><jats:title>Objective<\/jats:title><jats:p>To explore independent and joint associations of HFI and HWI with functional disability in Ecuadorian adults.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250090-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cross-sectional study used data from the 2018 Ecuadorian National Health and Nutrition Survey, a nationally representative, population-based survey conducted in Ecuador. The study included adults (aged 18-99 years) with information on sociodemographic characteristics, household food and water security, and functional disability status. Data were collected in 2 waves of the survey, from November 2018 to January 2019 and June to July 2019. Statistical analysis was performed from May to December 2024.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250090-7\"><jats:title>Exposures<\/jats:title><jats:p>HFI, WFI, or both.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250090-8\"><jats:title>Main outcomes and Measures<\/jats:title><jats:p>The primary outcome was self-reported functional disability, assessed using the Washington Group Short Set on Functioning, a tool that uses a set of 6 questions to measure activity limitations.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250090-9\"><jats:title>Results<\/jats:title><jats:p>Among 42\u202f071 participants (mean [SE] age, 48.0 [0.1] years; 31\u202f683 male [75.3%]; 1840 African descendant [4.4%], 5184 Indigenous [12.3%], and 35\u202f047 Mestizo ethnic majority group [83.3%]), most lived in urban areas (26\u202f164 participants [62.2%]). Exposure to HFI only was associated with an increased risk for any functional disability (adjusted relative risk [aRR], 1.44; 95% CI, 1.37-1.52), as well as sensory (aRR, 1.43; 95% CI, 1.35-1.52), physical (aRR, 1.56, 95% CI, 1.42-1.72), and cognitive (aRR, 1.78; 95% CI, 1.61-1.98) disabilities. HWI exposure only was associated with increased risk for any functional disability (aRR, 1.12; 95% CI, 1.06-1.20), as well as sensory (aRR, 1.17; 95% CI, 1.09-1.25), physical (aRR, 1.15; 95% CI, 1.05-1.26), and cognitive (aRR, 1.17; 95% CI, 1.03-1.34) disabilities. Exposure to dual HFI and HWI was associated with a greater increase in risk than HFI or HWI alone of any functional disability (aRR, 1.61; 95% CI, 1.50-1.72), as well as sensory (aRR, 1.65; 95% CI, 1.52-1.79), physical (aRR, 1.72; 95% CI, 1.59-1.87), and cognitive (aRR, 2.01; 95% CI, 1.76-2.29) disabilities.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250090-10\"><jats:title>Conclusion and Relevance<\/jats:title><jats:p>In this study, dual exposure to HFI and HWI was associated with a greater increase in risk of any and specific functional disabilities compared with independent contributions of HFI and HWI alone. These findings highlight the importance of addressing HFI and HWI jointly rather than independently when conducting research on disability and other health outcomes and in designing policies and programs to protect at-risk adults and their households.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.1271","type":"journal-article","created":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T20:59:15Z","timestamp":1742504355000},"page":"e251271","source":"Crossref","is-referenced-by-count":2,"title":["Food and Water Insecurity and Functional Disability in Adults"],"prefix":"10.1001","volume":"8","author":[{"given":"Yankun","family":"Wang","sequence":"first","affiliation":[{"name":"Women and Children\u2019s Hospital of Chongqing Medical University, Chongqing, China"},{"name":"Chongqing Health Center for Women and Children, Chongqing, China"},{"name":"Chongqing Research Center for Prevention and Control of Maternal and Child Diseases and Public Health, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo X.","family":"Armijos","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, Bloomington"},{"name":"Global Environmental Health Research Lab, Indiana University-Bloomington School of Public Health, Bloomington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Commodore","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, Bloomington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurelian","family":"Bidulescu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Indiana University-Bloomington School of Public Health, Bloomington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Margaret","family":"Weigel","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health, Indiana University-Bloomington School of Public Health, Bloomington"},{"name":"Global Environmental Health Research Lab, Indiana University-Bloomington School of Public Health, Bloomington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,3,20]]},"reference":[{"key":"zoi250090r3","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.1093\/jn\/120.suppl_11.1555","article-title":"Core indicators of nutritional state for difficult-to-sample populations.","volume":"120","author":"Anderson","year":"1990","journal-title":"J Nutr"},{"issue":"3","key":"zoi250090r5","doi-asserted-by":"publisher","DOI":"10.1002\/wat2.1214","article-title":"Progress in household water insecurity metrics: a cross-disciplinary approach.","volume":"4","author":"Jepson","year":"2017","journal-title":"WIREs 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