Food Insecurity, Poor Diet, and Metabolic Syndrome: Cortisol’s Amplifying Role

PROJECT SUMMARY Food insecurity is highly prevalent in the U.S., affecting 11.1% of households. This high prevalence is significant because food insecurity is associated with metabolic consequences such as obesity, metabolic syndrome (MetS), and chronic diseases such as diabetes. One solution for relieving the health burden of food insecurity is to target those most at risk for its poor outcomes. Therefore, the overarching goal of this project is to use a multidisciplinary, multimethod approach to identify such individuals. The central hypothesis of this project is that those with food insecurity and high levels of the stress hormone cortisol are most at risk for the negative behavioral and health consequences of food insecurity. This hypothesis is based on literature and preliminary data showing that (a) food insecurity can be stressful for many; (b) cortisol is a causal driver of high-fat, -sodium, -sugar, and - carbohydrate (“hyperpalatable”) food consumption and (b) cortisol is associated with poor metabolic outcomes like diabetes and MetS. Further, preliminary data for this project show that cortisol modulates the relationship between experimentally manipulated stressful states and consumption of hyperpalatable foods. Two patterns of cortisol levels can potentially index higher risk: (1) chronically high levels of cortisol and/or (2) high cortisol reactivity to acute in-the-moment stressors. This project examines both by pursuing the following specific aims: AIM 1. Determine the modulating effect of chronic high cortisol levels on associations between food insecurity and (a) hyperpalatable food intake and (b) MetS—Recently collected data from the study team’s NHLBI Growth and Health Study (N = 624; R01 HD073568 ) will test the hypothesis that those with higher chronic cortisol levels indexed in hair will show a stronger relationship between food insecurity with hyperpalatable food intake and MetS, respectively. AIM 2. Determine the modulating effect of experimentally manipulated high cortisol reactivity on the association between food insecurity and objectively measured hyperpalatable food intake—In a laboratory paradigm using within-subjects design, 400 individuals with food insecurity will be exposed to a gold-standard laboratory stressor to measure cortisol reactivity compared to a no-stress session. The hypothesis tested will be that those with greater cortisol reactivity to stress (vs. control) will engage in greater hyperpalatable food intake, measured objectively. In an EXPLORATORY AIM, the project will examine potential roles of perceived stress and psychosocial resilience factors. By successfully achieving these aims and demonstrating the strong biobehavioral drivers of unhealthy diet, federal food programs (updated every 5 years) will have stronger rationale to prioritize nutritious foods over hyperpalatable ones. With screening for food insecurity becoming commonplace in clinical settings, additional resources for stress screening and management could be disseminated. Discovering factors that confer resilience in the face of food insecurity will allow future work testing them as intervention targets. This project, therefore, could ultimately reduce the consequences of food insecurity and improve the nation’s health.