{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T12:20:44Z","timestamp":1770639644659,"version":"3.49.0"},"reference-count":40,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2019,6,19]],"date-time":"2019-06-19T00:00:00Z","timestamp":1560902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["OB-1402-10977"],"award-info":[{"award-number":["OB-1402-10977"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["1U54GM104940"],"award-info":[{"award-number":["1U54GM104940"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["#P30DK072476"],"award-info":[{"award-number":["#P30DK072476"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>This study investigated associations between cardiovascular health (CVH), adiposity, and food insecurity by race, sex, and health literacy in a sample of 800 underserved patients with obesity (body mass index [BMI] \u2265 30 kg\/m2). CVH was assessed using American Heart Association Life\u2019s Simple 7 (LS7) and adiposity was estimated using BMI and waist circumference (WC). Mixed models including interaction terms between food insecurity and sex, race, and health literacy were analyzed for LS7, BMI, and WC. Stratified models were analyzed as indicated by significant interactions. Mean BMI and WC were 37.3 kg\/m2 (4.6 SD) and 113.5 cm (12.4 SD), respectively. Among patients, 31% were food insecure and 31% had low health literacy. There were significant positive associations between food insecurity and BMI (p = 0.03) and WC (p = 0.03) in the overall sample. In sex-stratified models, women who were food insecure had higher BMI (p = 0.02) and WC (p = 0.007) than their food secure counterparts. Further, food insecure patients with better health literacy had greater BMI (p = 0.004) and WC (p = 0.007) than their food secure counterparts. Results suggest that adiposity is a greater burden in food insecure patients, which may be an important consideration for obesity treatment in underserved populations.<\/jats:p>","DOI":"10.3390\/nu11061376","type":"journal-article","created":{"date-parts":[[2019,6,19]],"date-time":"2019-06-19T10:43:32Z","timestamp":1560941012000},"page":"1376","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Cardiovascular Health, Adiposity, and Food Insecurity in an Underserved Population"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1923-3448","authenticated-orcid":false,"given":"Candice A.","family":"Myers","sequence":"first","affiliation":[{"name":"Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8125-4015","authenticated-orcid":false,"given":"Corby K.","family":"Martin","sequence":"additional","affiliation":[{"name":"Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr.","given":"Robert L.","family":"Newton","sequence":"additional","affiliation":[{"name":"Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8492-7820","authenticated-orcid":false,"given":"John W.","family":"Apolzan","sequence":"additional","affiliation":[{"name":"Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Connie L.","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71103, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terry C.","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71103, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2901-3852","authenticated-orcid":false,"given":"Eboni G.","family":"Price-Haywood","sequence":"additional","affiliation":[{"name":"Ochsner Clinic Foundation, Center for Outcomes and Health Services Research, 1514 Jefferson Highway, New Orleans, LA 70121, USA"},{"name":"Ochsner Clinical School, University of Queensland, 1401 Jefferson Highway, New Orleans, LA 70121, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter T.","family":"Katzmarzyk","sequence":"additional","affiliation":[{"name":"Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,6,19]]},"reference":[{"key":"ref_1","unstructured":"Murphy, S.L., Xu, J., Kochanek, K.D., and Arias, E. (2018). Mortality in the United States, 2017, National Center for Health Statistics."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1161\/CIRCRESAHA.115.306883","article-title":"Obesity and Cardiovascular Disease","volume":"118","author":"Ortega","year":"2016","journal-title":"Circ. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1353\/hpu.2011.0166","article-title":"Relationships between obesity and cardiovascular diseases in four southern states and Colorado","volume":"22","author":"Akil","year":"2011","journal-title":"J. Health Care Poor Underserv."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2284","DOI":"10.1001\/jama.2016.6458","article-title":"Trends in Obesity Among Adults in the United States, 2005 to 2014","volume":"315","author":"Flegal","year":"2016","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1002\/oby.20502","article-title":"The geographic concentration of US adult obesity prevalence and associated social, economic, and environmental factors","volume":"22","author":"Slack","year":"2014","journal-title":"Obesity"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2419","DOI":"10.1001\/jama.2018.7270","article-title":"Differences in Obesity Prevalence by Demographic Characteristics and Urbanization Level Among Adults in the United States, 2013\u20132016","volume":"319","author":"Hales","year":"2018","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"238","DOI":"10.2174\/1573403X11666141122220003","article-title":"Disparities in cardiovascular disease risk in the United States","volume":"11","author":"Graham","year":"2015","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1161\/CIR.0000000000000228","article-title":"Social Determinants of Risk and Outcomes for Cardiovascular Disease: A Scientific Statement from the American Heart Association","volume":"132","author":"Havranek","year":"2015","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","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."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.foodpol.2019.01.003","article-title":"What explains gender differences in food insecurity?","volume":"83","author":"Broussard","year":"2019","journal-title":"Food Policy"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1007\/s12571-017-0733-8","article-title":"Food insecurity in the United States of America: An examination of race\/ethnicity and nativity","volume":"9","author":"Myers","year":"2017","journal-title":"Food Secur."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"304","DOI":"10.3945\/jn.109.112573","article-title":"Food insecurity is associated with chronic disease among low-income NHANES participants","volume":"140","author":"Seligman","year":"2010","journal-title":"J. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"203","DOI":"10.3945\/an.112.003277","article-title":"Food insecurity and chronic disease","volume":"4","author":"Laraia","year":"2013","journal-title":"Adv. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1056\/NEJMp1000072","article-title":"Hunger and socioeconomic disparities in chronic disease","volume":"363","author":"Seligman","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1952","DOI":"10.1016\/j.jada.2007.08.006","article-title":"The food insecurity-obesity paradox: A review of the literature and the role food stamps may play","volume":"107","author":"Dinour","year":"2007","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e105","DOI":"10.1017\/S0140525X16000947","article-title":"Food insecurity as a driver of obesity in humans: The insurance hypothesis","volume":"40","author":"Nettle","year":"2016","journal-title":"Behav. Brain Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/s10900-011-9420-4","article-title":"Exploring mediators of food insecurity and obesity: A review of recent literature","volume":"37","author":"Franklin","year":"2012","journal-title":"J. Commun. Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s13668-016-0153-y","article-title":"The Relationship Between Food Insecurity, Dietary Patterns, and Obesity","volume":"5","author":"Morales","year":"2016","journal-title":"Curr. Nutr. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ypmed.2016.09.002","article-title":"Food insecurity and cardiovascular health: Findings from a statewide population health survey in Wisconsin","volume":"93","author":"Saiz","year":"2016","journal-title":"Prev. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1161\/CIRCULATIONAHA.109.192703","article-title":"Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association\u2019s strategic Impact Goal through 2020 and beyond","volume":"121","author":"Hong","year":"2010","journal-title":"Circulation"},{"key":"ref_21","first-page":"E202","article-title":"Food security and cardiovascular disease risk among adults in the United States: Findings from the National Health and Nutrition Examination Survey, 2003\u20132008","volume":"10","author":"Ford","year":"2013","journal-title":"Prev. Chron. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Vercammen, K.A., Moran, A.J., McClain, A.C., Thorndike, A.N., Fulay, A.P., and Rimm, E.B. (2019). Food Security and 10-Year Cardiovascular Disease Risk Among U.S. Adults. Am. J. Prev. Med., in press.","DOI":"10.1016\/j.amepre.2018.11.016"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"457","DOI":"10.2147\/vhrm.2006.2.4.457","article-title":"The impact of health literacy on cardiovascular disease","volume":"2","author":"Safeer","year":"2006","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1880","DOI":"10.1177\/2047487317729538","article-title":"Health literacy is associated with health behaviour and self-reported health: A large population-based study in individuals with cardiovascular disease","volume":"24","author":"Aaby","year":"2017","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1007\/s12471-017-0963-6","article-title":"Cardiovascular disease risk and secondary prevention of cardiovascular disease among patients with low health literacy","volume":"25","author":"Jorstad","year":"2017","journal-title":"Neth. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Nielsen-Bohlman, L., Panzer, A.M., and Kindig, D.A. (2004). Health Literacy: A Prescription to End Confusion, The National Academies Press.","DOI":"10.17226\/10883"},{"key":"ref_27","unstructured":"United States (2000). Department of Health, Healthy People 2010: Understanding and Improving Health."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e48","DOI":"10.1161\/CIR.0000000000000579","article-title":"Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement from the American Heart Association","volume":"138","author":"Magnani","year":"2018","journal-title":"Circulation"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Cheng, Y.L., Shu, J.H., Hsu, H.C., Liang, Y., Chou, R.H., Hsu, P.F., Wang, Y.J., Ding, Y.Z., Liou, T.L., and Wang, Y.W. (2018). High health literacy is associated with less obesity and lower Framingham risk score: Sub-study of the VGH-HEALTHCARE trial. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0194813"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cct.2018.02.002","article-title":"Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL): Rationale, design and baseline characteristics","volume":"67","author":"Katzmarzyk","year":"2018","journal-title":"Contemp. Clin. Trials"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.atherosclerosis.2018.05.050","article-title":"Life\u2019s Simple 7 and the risk of atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis","volume":"275","author":"Ogunmoroti","year":"2018","journal-title":"Atherosclerosis"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1249\/01.MSS.0000078924.61453.FB","article-title":"International physical activity questionnaire: 12-country reliability and validity","volume":"35","author":"Craig","year":"2003","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1353\/hpu.2010.0921","article-title":"Food insecurity is associated with hypoglycemia and poor diabetes self-management in a low-income sample with diabetes","volume":"21","author":"Seligman","year":"2010","journal-title":"J. Health Care Poor Underserv."},{"key":"ref_34","unstructured":"Bickel, G., Nord, M., Price, C., Hamilton, W., and Cook, J. (2000). Guide to Measuring Household Food Insecurity, United States Department of Agriculture."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1097\/MLR.0b013e3180616c1b","article-title":"Development and validation of a short-form, rapid estimate of adult literacy in medicine","volume":"45","author":"Arozullah","year":"2007","journal-title":"Med. Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"500","DOI":"10.3945\/ajcn.2008.26847","article-title":"Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults","volume":"89","author":"Flegal","year":"2009","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_37","first-page":"149","article-title":"Food Insecurity, Not Stress is Associated with Three Measures of Obesity in Low-Income, Mexican-American Women in South Texas","volume":"6","author":"Salinas","year":"2016","journal-title":"Food Pub. Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"234","DOI":"10.21101\/cejph.a5172","article-title":"Low health literacy and excess body weight: A systematic review","volume":"26","author":"Michou","year":"2018","journal-title":"Cent. Eur. J. Pub. Health"},{"key":"ref_39","unstructured":"Coleman-Jensen, A., Rabbitt, M.P., Gregory, C.A., and Singh, A. (2018). Household Food Security in the United States in 2017, United States Department of Agriculture."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1080\/19312458.2013.789839","article-title":"On the validity of the rapid estimate of adult literacy in medicine (REALM) scale as a measure of health literacy","volume":"7","author":"Dumenci","year":"2013","journal-title":"Commun. Methods Meas."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/6\/1376\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:59:34Z","timestamp":1760187574000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/6\/1376"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,19]]},"references-count":40,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,6]]}},"alternative-id":["nu11061376"],"URL":"https:\/\/doi.org\/10.3390\/nu11061376","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,19]]}}}