NEJM Editorial cites toll of disparity on chronic disease

By Lauren Hammit on July 13, 2010

The heavy burden of hunger in the United States helps explain why the poor are at higher risk for obesity, high blood pressure and diabetes, according to an editorial in the July 1 New England Journal of Medicine co-authored by two UCSF faculty members.

Health care providers urge patients with obesity, high blood pressure and diabetes to modify their diet to include fruits, vegetables and healthy protein, and to exclude sugar, fats and excess sodium. However, the researchers said, the price of healthy fresh fruit and vegetables has increased 118 percent since 1985, compared to the modest 35 percent increase for foods with fats and oils, and fresh and nutritious food choices are often not available in low-income areas.

“This widening cost differential between pricey healthy foods and cheap nutritionally poor foods, in combination with the global economic crisis, has profound implications in terms of increasing socioeconomic disparities in the incidence and management of obesity, hypertension, diabetes and other diet-sensitive chronic diseases,” the authors wrote.

Authors Hilary Kessler Seligman, MD, MAS, assistant professor of medicine at UCSF and San Francisco General Hospital, and Dean Schillinger, MD, professor of Medicine in Residence and director of the UCSF Center for Vulnerable Populations at San Francisco General Hospital, cited U.S. Department of Agriculture findings that 14 percent of U.S. households, comprising more than 49 million people, are at risk for going hungry because of an inability to afford food.

More than a quarter of all African-American and Hispanic households are at risk of going hungry in this country, as are about 21 percent of households with children and 42 percent of households with incomes below the federal poverty level, according to the USDA statistics.

The editorial cites diabetes as an example, noting that research conducted at the UCSF Center for Vulnerable Populations showed that adults living with the most severe levels of food insecurity have more than twice the risk of diabetes as adults who have ready access to healthy foods. Once diagnosed with diabetes, food-insecure individuals have many more hospitalizations and doctor’s visits each year than do patients with adequate access to healthy food, according to the research.

The study authors also explored the link between food insecurity and diabetes in a policy brief released by the California Pan Ethnic Health Network and the California Diabetes Program. http://www.caldiabetes.org/content_display.cfm?contentID=1249.

 

article: http://content.nejm.org/cgi/content/short/363/1/6

Journal of Nutrition article: http://jn.nutrition.org/cgi/content/abstract/140/2/304

UCSF Center for Vulnerable Populations at SFGH: http://cvp.ucsf.edu