Report on the Link Between Food Security and Health Outcomes in the Context of Sustainable Development Goals

Introduction: Aligning Research with Global Development Priorities

This report details the methodology of a cross-sectional study investigating the relationship between food security and muscle mass. The research framework is critically aligned with several United Nations Sustainable Development Goals (SDGs), primarily focusing on SDG 2 (Zero Hunger) and SDG 3 (Good Health and Well-being). By examining how food insecurity, a direct challenge to SDG 2, impacts a key health indicator like muscle mass, the study provides crucial data for achieving SDG 3. Furthermore, the analysis incorporates socioeconomic factors, reflecting a commitment to understanding and addressing the issues outlined in SDG 1 (No Poverty) and SDG 10 (Reduced Inequalities).

Research Methodology and SDG Alignment

Study Design and Population: Monitoring Health Equity

The study utilized a cross-sectional design, analyzing public data from the 2011–2018 National Health and Nutrition Examination Survey (NHANES). This nationally representative survey is an essential tool for monitoring progress towards national health and nutrition targets, directly supporting the evidence-based policy-making required to achieve SDG 3.

• Data Source: National Health and Nutrition Examination Survey (NHANES) 2011–2018.
• Population: Non-institutionalized U.S. adults aged 18 and older.
• Ethical Standards: The study adhered to high ethical standards, with protocols approved by the NCHS Research Ethics Review Board and informed consent obtained from all participants, reflecting the principles of responsible research that underpin the SDGs.

Inclusion criteria were established to ensure data integrity for the core analysis of food security and muscle mass. Exclusion criteria were applied to remove confounding factors and enhance the precision of the findings, including:

1. Pregnancy or lactation.
2. Body mass index (BMI) ≥ 50, which could affect the accuracy of muscle mass assessment.
3. Self-reported active malignancy.
4. Missing data for key variables.

Assessment of Food Security: A Direct Measure of SDG 2

Household food security was evaluated using the 10-item Adult Food Security Survey Module from the USDA. This assessment is fundamental to tracking progress on SDG 2, Target 2.1, which aims to end hunger and ensure access for all people, in particular the poor and people in vulnerable situations, to safe, nutritious, and sufficient food all year round.

• Instrument: 10-item USDA Adult Food Security Survey Module.
• Scope: Captured food-related experiences over the preceding 12 months, including concerns about food insufficiency and the inability to afford a balanced diet.
• Classification for Analysis: To investigate the impact on health, participants were grouped into two primary categories:
  • Food Secure: Combining full and marginal food security (0-2 affirmative responses).
  • Food Insecure: Combining low and very low food security (3-10 affirmative responses).

Assessment of Muscle Mass: An Indicator for SDG 3

Muscle mass was assessed using Dual-energy X-ray Absorptiometry (DXA), a precise method for evaluating body composition. Low muscle mass is a significant health concern related to malnutrition and non-communicable diseases, making its study vital for SDG 3 (Good Health and Well-being) and SDG 2, Target 2.2 (end all forms of malnutrition).

• Primary Metric: Appendicular lean mass (ALM), calculated as the lean tissue mass in the arms and legs.
• Standardized Index: The ALM index (ALMI), defined as ALM/height², was used to standardize for body size.
• Definition of Low Muscle Mass: The study adopted the European Working Group on Sarcopenia in Older People (EWGSOP) criteria to classify participants, contributing to a standardized global understanding of this health condition.
  • Males: ALMI
  • Females: ALMI

Dietary Intake Assessment: Understanding Nutritional Pathways for SDG 2

To understand the mechanisms linking food insecurity to poor health, the study analyzed detailed dietary intake data. This analysis is crucial for addressing SDG 2, Target 2.2, by identifying the nutritional deficiencies associated with food insecurity. Data was collected via two 24-hour dietary recalls and averaged to estimate usual intake of key nutrients like protein, vitamin D, and calcium from both food and supplements.

Analytical Framework for Sustainable Development Insights

Covariate Analysis: Addressing the Drivers of Inequality (SDG 1 & SDG 10)

The study controlled for a range of sociodemographic and health-related variables. This approach is essential for understanding the complex interplay of factors that drive inequality, a core focus of SDG 10 (Reduced Inequalities) and SDG 1 (No Poverty).

• Sociodemographic Variables:
  • Sex, age, and ethnicity.
  • Education level (low, medium, high).
  • Family income-to-poverty ratio, a direct measure related to SDG 1.
• Health-Related Variables:
  • BMI, hypertension, and diabetes status.
  • Smoking and alcohol consumption status.

By including these covariates, the analysis aimed to isolate the effect of food insecurity on muscle mass, providing clearer evidence for targeted interventions that address vulnerable populations.

Statistical Analysis: Quantifying Impacts on Health and Nutrition Goals

A robust statistical plan was implemented to analyze the data and provide evidence relevant to achieving the SDGs.

1. Descriptive Analysis: Baseline characteristics were compared across food security groups to identify existing disparities.
2. Multivariate Analysis: A Generalised Linear Model (GLM) was used to assess the association between food insecurity and low muscle mass while controlling for the socioeconomic and health covariates. This helps quantify the health burden of food insecurity (SDG 2, SDG 3).
3. Causal Mediation Analysis: This advanced analysis was performed to determine if the effect of food insecurity on muscle mass is mediated by dietary factors (protein, vitamin D, calcium). This provides critical insight into the pathways through which food insecurity impacts health, informing the design of effective nutritional interventions to meet SDG 2 targets.

All analyses were conducted with a significance level of p

SDGs Addressed in the Article

SDG 2: Zero Hunger

• The article’s primary focus is on assessing household food security and insecurity using the USDA’s Adult Food Security Survey Module. It directly investigates issues of food insufficiency, financial limitations affecting food availability, and the inability to afford a nutritionally balanced diet, which are central to SDG 2.

SDG 3: Good Health and Well-being

• The study examines the relationship between food security and a specific health outcome: low muscle mass. It also includes other health-related variables such as hypertension, diabetes, and BMI. This analysis of how nutritional status (linked to food security) affects physical health aligns with the goal of ensuring healthy lives.

SDG 1: No Poverty

• The article uses the “family income-to-poverty ratio” as a key covariate, classifying participants as being below or at/above the Federal poverty threshold. This directly links the issue of food insecurity to economic status, which is the core focus of SDG 1.

SDG 10: Reduced Inequalities

• The study’s methodology involves analyzing data disaggregated by sociodemographic variables such as ethnicity, education level, and income-to-poverty ratio. By examining how food security and health outcomes differ across these groups, the article addresses the goal of reducing inequalities within a population.

Specific SDG Targets Identified

SDG 2: Zero Hunger

• Target 2.1: By 2030, end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, to safe, nutritious and sufficient food all year round. The article directly addresses this by evaluating household food security and classifying individuals into “food security status” and “food insecurity status” based on their access to food over the preceding 12 months.
• Target 2.2: By 2030, end all forms of malnutrition. The study investigates the link between food insecurity and “low muscle mass,” a condition related to malnutrition (sarcopenia). It also assesses the intake of key nutrients like protein, vitamin D, and calcium, which are crucial for preventing malnutrition.

SDG 3: Good Health and Well-being

• Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. The article investigates health conditions like hypertension and diabetes, which are non-communicable diseases. It explores how food security, a key determinant of health, is associated with low muscle mass, a condition linked to adverse health outcomes.

SDG 1: No Poverty

• Target 1.2: By 2030, reduce at least by half the proportion of men, women and children of all ages living in poverty in all its dimensions according to national definitions. The study uses the “family income-to-poverty ratio (PIR)” based on the U.S. Federal poverty threshold, a national definition of poverty, to analyze its population.

SDG 10: Reduced Inequalities

• Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, race, ethnicity, or economic or other status. The analysis explicitly includes covariates for ethnicity, education level, and income-to-poverty ratio, allowing for an examination of disparities in food security and health outcomes among different demographic and socioeconomic groups.

Indicators for Measuring Progress

For Target 2.1 (End Hunger)

• Prevalence of food insecurity: The article uses the “10-item Adult Food Security Survey Module” to classify the population into four levels of food security. The study then creates a binary categorization of “food security status” vs. “food insecurity status.” This provides a direct measure of the prevalence of food insecurity.

For Target 2.2 (End Malnutrition)

• Prevalence of low muscle mass: The study measures Appendicular Lean Mass Index (ALMI) and defines “low muscle mass” using established criteria (ALMI
• Nutrient Intake Levels: The article assesses the intake of “protein, vitamin D, and calcium” through 24-h dietary recalls. These specific nutrient intakes are indicators of dietary quality and adequacy.

For Target 1.2 (Reduce Poverty)

• Proportion of population below the poverty line: The article uses the “family income-to-poverty ratio (PIR)” and dichotomizes it as

For Target 3.4 (Reduce NCDs)

• Prevalence of hypertension and diabetes: The study defines and measures the prevalence of hypertension and diabetes based on “a prior diagnosis by a physician or the use of antihypertensive/antidiabetic medications.” These are direct indicators for monitoring these non-communicable diseases.

Summary of Findings

Source: bmcpublichealth.biomedcentral.com