Food Insecurity, telomere length and the potential modifying effects of social support in National Health and Nutrition Examination Survey

Objective: Telomere length (TL) is a posited pathway through which chronic stress results in biological dysregulation and subsequent adverse health outcomes. Food insecurity is associated with shorter TL. Social support, which is defined by the size and function of an individual's social network, is associated with better health outcomes. The present study assesses whether social support modifies the relationship between food security and TL. Design: Cross-sectional study design. Linear regression was used to assess the association between food insecurity and TL, stratified by social support level. A multiplicative interacted model was used to formally test modification. Setting: Data come from the National Health and Nutrition Examination Survey 1999-2000 and 2001-2002 waves. Participants: Adults aged 60 years and older who have measurements for TL. Results: Our sample comprised 2674 participants, and 63·5 % of the total sample had low social support, with 13·3 % being food insecure. In fully adjusted models, food insecurity was negatively though modestly associated (P = 0·13) with TL. Associations between food insecurity and TL were significantly modified by social support (interaction P = 0·026), whereby food insecurity had a stronger effect among individuals with high social support (coefficient = -0·099 (95 % CI: -0·161, -0·038)) compared to low social support (coefficient = -0·001, (95 % CI: -0·033, 0·032)). Conclusion: Food insecurity is modestly associated with shorter TL. Contrary to our hypothesis, food insecurity had more deleterious effects on TL among participants with high social support than low social support. Results may indicate that the food insecure population is a higher needs population, and increased social support reflects these needs rather than providing protective effects.