Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT03243136 |
| Other study ID # |
PROTOCOL REFERENCE # 32143 |
| Secondary ID |
|
| Status |
Completed |
| Phase |
N/A
|
| First received |
August 4, 2017 |
| Last updated |
August 7, 2017 |
| Start date |
January 1, 2004 |
| Est. completion date |
March 31, 2016 |
Study information
| Verified date |
August 2017 |
| Source |
University of Toronto |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational
|
Clinical Trial Summary
A pervasive and persistent finding is the health disadvantage experienced by those in food
insecure households. While clear associations have been identified between food insecurity
and diabetes risk factors, less is known about the relationship between food insecurity and
incident type 2 diabetes.
The objective of this study is to investigate the association between household food
insecurity and the future development of type 2 diabetes.
The investigators used data from Ontario adult respondents to the 2004 Canadian Community
Health Survey, linked to health administrative data (n = 4,739). Food insecurity was assessed
with the Household Food Security Survey Module and incident type 2 diabetes cases were
identified by the Ontario Diabetes Database. Multivariable adjusted Cox proportional hazards
models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for type
2 diabetes as a function of food insecurity.
Description:
Globally, there are over 200 million people living with type 2 diabetes. Aging populations,
steadily increasing obesity rates, increases in sedentary behaviours, and decreases in
diabetes-related mortality signal that the global prevalence of type 2 diabetes will continue
to grow.
In Canada, type 2 diabetes is one of the most prevalent chronic conditions and is the 7th
leading cause of mortality. Over the last decade, the prevalence of type 2 diabetes in Canada
has increased by 72%, with 11 million Canadians currently living with diabetes or
pre-diabetes. This number is expected to rise to 13.9 million (33% of Canadians) by 2026.
Much of the body of literature concerning type 2 diabetes focuses on management and control.
Research that is geared towards prevention focuses heavily on the modification of individual
risk behaviours, while less attention is given to the broader social determinants of
increased type 2 diabetes risk.
Household food security is a broad measure of socioeconomic status that is not traditionally
included in health research. Household food insecurity is experienced when there is
uncertainty regarding, or disruption in, food intake or eating patterns by at least one
member of a household due to financial constraints, resulting in inadequate or insecure
access to food.
Food insecurity has been identified as a significant social and health problem in Canada . It
was first measured in 2004, where it was estimated that 9.2% of Canadian households were food
insecure. The most recent estimate from 2014 indicates that this number has risen to 12%,
representing 3.2 million Canadians.
While there exists the perception that food insecurity leads to caloric restriction, food
insecurity has been associated with lower nutrient intakes and consumption of a less healthy
diet compared to those who are food secure. Prior evidence from cross-sectional studies has
demonstrated that there is an association between food insecurity and chronic disease risk
including hypertension, cardiovascular disease, and type 2 diabetes.
Though clear associations have been identified between food insecurity and diabetes risk
factors such as dietary consumption, weight gain, and obesity, less is known about the direct
relationship between food insecurity and incident type 2 diabetes. Moreover, limited studies
have investigated this association longitudinally in a population-based sample.
Prospective, longitudinal assessment is critical as cross-sectional studies lack the ability
to infer the direction of the relationship between food insecurity and type 2 diabetes. For
example, the 'health selection' hypothesis has been studied, positing that a decline in
health status may precede and ultimately cause downward social mobility and a decrease in
income leading to food insecurity. Consequently, this theory presents evidence for reverse
causation, by which poor health may precede financial difficulties, especially in cases where
early age of diagnosis, and thus longer duration of disease, might predispose individuals to
being in a food insecure household.
Current estimates of the future health consequences associated with food insecurity are
needed to inform health decision-makers of potential areas for upstream intervention to
alleviate the burden type 2 diabetes places on the Canadian healthcare system. Data linkages
provide a novel opportunity to study this relationship in a prospective, population-based
sample. Accordingly, the objectives of this study are to estimate the risk of type 2 diabetes
as a function of food insecurity in the Canadian population, and to investigate the extent to
which this association may be mediated by obesity.
