Background: Food insecurity is a critical public health issue and an important social determinant of health among older adults in the US. Food insecurity has increased in recent years, and similarly, the prevalence of related health conditions, including metabolic syndrome (MetS) and depression remains high. This study aimed to 1) examine trends in food insecurity, MetS, and depression from 2007-2018 and 2) determine the association between food insecurity and MetS, including whether this association differs by depression status among adults aged 60 years and older.

Method: Secondary data analysis of 2007 to 2018 waves of National Health and Nutrition Examination Survey was conducted. Food security was assessed using the USDA Food Security Survey Module, MetS based on ATP III criteria, and depression using PHQ-9. Chi-square tests and multivariable regression models were used to assess associations between food security, MetS, and depression. Interaction terms were included to evaluate whether depression modified the association between food insecurity and MetS.

Result: The prevalence of food insecurity exceeded 10% overall and increased to over 20% in the most recent cycle. More than half of older adults had MetS across all cycles, while depression prevalence ranged from 5% to 10%. In adjusted models, low food security was associated with higher odds of MetS compared to full food security (OR: 1.46, 95% CI: 1.06, 2.01). Food insecurity was also strongly associated with depression; individuals in the low food security had twice the odds of depression (OR: 2.03, 95% CI: 1.23, 3.35), and those with very low food security had over three times the odds of depression (OR: 3.1, 95% CI: 1.84, 5.24), compared to those with full food security. The interaction between food security status and depression was not statistically significant.

Discussion: Food insecurity remains highly prevalent among older U.S. adults and is associated with increased odds of both MetS and depression. Addressing food insecurity may be an important strategy for improving cardiometabolic and mental health outcomes in aging populations.