Associação da insegurança alimentar com vitaminas e carotenóides plasmáticos em adultos participantes do National Health and Nutrition Examination Survey (NHANES) 2017-2018

Abstract

Introduction: In the United States, food insecurity (FI) predisposes vulnerable populations to the paradox of obesity coexisting with “hidden hunger.” Although the literature points to poor diet quality as a mediator of this relationship, the evidence is based primarily on dietary surveys. To overcome the limitations of self-reporting, the use of serum biomarkers is essential for quantifying the impact of this vulnerability on dietary quality. Objective: To evaluate the relationship between Food Insecurity and the serum biochemical profile of vitamins and carotenoids in U.S. adults and older adults, considering effect modification by sex, age group, and race/ethnicity. Material and methods: A cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018, comprising 3,092 adults (≥20 years). Serum levels of vitamins A, C, D, and E, as well as carotenoids, were evaluated. Survey-weighted linear regression models were used to examine the association between FI and these biomarkers. Food Insecurity was assessed using the Household Food Security Survey Module. Confounding variables for the adjusted models were strictly selected using a Directed Acyclic Graph (DAG). Analyses were performed on the total sample and stratified by sex, age, and race/ethnicity. Results: In the total sample, after adjustments, Food Insecurity maintained a significant inverse association with levels of total carotenoids, cis-, and trans-beta-carotene. In stratified analyses, carotenoid depletion persisted among women and young adults. In contrast, men showed an association with reduced vitamin E and lycopene, and older adults with vitamins D and E. Regarding race/ethnicity, the association lost significance among minorities after socioeconomic adjustments, indicating that structural variables such as income and education absorb the isolated impact of Food Insecurity in these groups. Conclusion: Food Insecurity in the U.S. transcends caloric restriction and constitutes a severe state of hidden hunger. The depletion of carotenoids highlights the restricted access to fresh, unprocessed foods (fruits and vegetables). The use of serum biomarkers underscored how social vulnerability can be reflected in measurable nutritional differences.