Lack of healthy food may increase the risk of death from heart failure

A new study published in the Journal of the American Heart Association Circulation: heart failure reviewed data from nearly 3,000 counties in the United States and found that living in neighborhoods with easy access to grocery stores and affordable, healthy food was associated with
lower heart failure mortality.

Food insecurity occurs when healthy food is not available at any time every day due to poverty or socio-economic challenges, leading people to go hungry or eat foods
of reduced quality, variety or desirability.
While previous studies have linked food insecurity to adverse cardiovascular outcomes, there is little
research on the local food environment and its potential relationship to heart failure deaths.
A 2019 paper published in the Journal of the American Heart Association found that poverty was the strongest socioeconomic factor associated with heart failure and coronary heart disease at the county level in the United States, and that it was more strongly associated with heart failure than coronary heart disease
.

"Heart failure mortality is on the rise among people living in socioeconomic poverty, and, importantly, we believe that nutrition plays a role in heart failure mortality, and that food insecurity may be particularly harmful to this population," said Keerthi T.
Gondi, M.
D
.
, lead author of the study, an internal medicine resident at the University of Michigan Health System in Ann Arbor, Michigan.
"We know that there is an important relationship
between food access, food affordability and heart health.
This issue must be addressed in order to change the burden
of cardiovascular disease among people living in socio-economic poverty.
”

The study is one of
the first to investigate the relationship between local food environments and heart failure mortality.
Heart failure is a chronic, progressive disease in which the heart muscle becomes very weak and unable to pump blood
properly.
According to Gondi, he and his colleagues studied the mortality rate from heart failure because it is a consistent metric reported by all counties in the United States, providing the ability to
comprehensively assess heart failure outcomes at the population level.
According to the association's 2022 heart disease and stroke statistics update, heart failure deaths accounted for nearly 86,000 deaths
in the United States in 2019.

The researchers sought to determine whether the food environment at the county level was associated
with heart failure mortality.
They reviewed data from the 2018 National Vital Statistics System (a database of all births and deaths in the United States) and looked at potential associations
between each county's heart failure mortality rate and that county's 2018 food insecurity percentage score and food environment index score.

The researchers collected each county's food insecurity percentage score — the percentage of the population lacking adequate, consistent access to healthy food — and the Food Environment Index score, which ranks from 0 (worst) to 10 (best), based on a combination of metrics including affordability of nutritious foods, food insecurity, distance to grocery stores, transportation, and socioeconomic factors — from the USDA's Food Environment Atlas and the Robert Woods Johnson Foundation's County Health Rankings
。 The Food Environment Atlas brings together statistics on food environmental indicators and provides a spatial overview of
a community's ability to access healthy food.

Integrated assessments, food insecurity percentages and food environment indicators provide a clear picture of
a population's food environment.

Of the 2,956 counties that participated in the study, the analysis found:

• The average food insecurity rate for all counties is 13 per cent and the average Food Environment Index is 7.
  8 points
  .
  

• Counties with a food insecurity percentage above the national median of 13.
  7 percent had a higher heart failure death rate than the food insecurity percentage (30.
  7 deaths per 100,000 people and 26.
  7 deaths per 100,000 people).
  
  

• After adjusting for a range of socioeconomic and health factors, including poverty rates, income inequality, rural versus urban location, type 2 diabetes, obesity and smoking, for every 1 percent reduction in the percentage of food insecurity by county, heart failure mortality was reduced by 1.
  3 percent
  .
  Similarly, for every increase in the Food Environment Index score by county, heart failure mortality decreased by 3.
  6 percent
  .
  

• At the county level, reductions in the food environment index and increases in the percentage of food insecurity were more strongly associated with heart failure mortality than with other subtypes of cardiovascular disease and with all-cause mortality
  .
  

• The association between food environment and heart failure mortality was most pronounced
  in counties with the highest income inequality and poverty rates.
  

"The results of this study are unfortunate, but not surprising
.
These results are consistent with previous studies that have shown a relationship between cardiovascular disease and food insecurity," said Anne Thorndike, MD, M.
P.
S.
A.
, the Federal Health Association, who was not involved in the study, director of the Heart Lifestyle Program at Massachusetts General Hospital in Boston, past chair of the Association's Nutrition Committee and a member of
the Association's Lifestyle Committee.
"This study provides a robust assessment of food environments in U.
S.
states and shows that the characteristics of the food environment are strongly associated
with heart failure deaths.
"

One limitation of the study is that it only collected data from the year before the COVID-19 pandemic, so it may have limited generalization capacity
at this time.
More research is needed to examine these links
over a longer period of time.

The study also showed counties with higher heart failure mortality rates had fewer food stocks, poorer access to healthy food for seniors over 65, and lower
participation in the Supplemental Nutrition Assistance Program (SNAP).
SNAP is a U.
S.
government food budget supplement program designed to help families and individuals earning 130 percent or less of the federal poverty standard reduce food insecurity (for families of three, earning less than $29,940 a year).

According to the association's Essentials of Life 8, dietary intake affected by food insecurity is one of the major factors in cardiovascular disease risk, and the low prevalence of an ideal diet contributes to the overall low prevalence of ideal cardiovascular health in the United States
.
Better cardiovascular health can help reduce the risk of
heart disease, stroke, and other major health problems.

"Food insecurity and lack of access to healthy food are the main causes of
poor diet quality and so-called 'nutritional insecurity'," Thorndike said.
"The American Heart Association and other organizations now acknowledge that to help Americans achieve ideal cardiovascular health, especially the ideal diet, we need to step up our efforts to address the psychological and social determinants
of our healthy behaviors and well-being.
" These efforts need to include policies, health care and community interventions to improve access to
nutritious food at all stages of life.
”

Co-author is John Larson, MD; Aaron Sifuentes, MD; Neil B.
Alexander, M.
D.
, M.
S.
; Matthew C.
Konerman, M.
D.
; Kali S.
Thomas, Ph.
D.
, M.
A.
and Scott L.
Hummel, M.
D.
author disclosures are listed in the
manuscript.

The authors report that there were no funding sources for
the study.

Journal Reference:

1. Keerthi T.
   Gondi, John Larson, Aaron Sifuentes, Neil B.
   Alexander, Matthew C.
   Konerman, Kali S.
   Thomas, Scott L.
   Hummel.
   Health of the Food Environment Is Associated With Heart Failure Mortality in the United States.
   Circulation: Heart Failure, 2022; DOI: 10.
   1161/CIRCHEARTFAILURE.
   122.
   009651ober 25, 2022).