Clinical features associated with self-reported food insecurity in people with cystic fibrosis

Heather Boas; Jesse Y Hsu; Allen Koshy; Semret Seyoum; Marsha Regenstein; Gina Hong; Olivia Dieni; Anne Willis; Clement L Ren

doi:10.1016/j.jcf.2024.12.005

Clinical features associated with self-reported food insecurity in people with cystic fibrosis

J Cyst Fibros. 2025 Jan 9:S1569-1993(24)01855-1. doi: 10.1016/j.jcf.2024.12.005. Online ahead of print.

Authors

Heather Boas¹, Jesse Y Hsu², Allen Koshy³, Semret Seyoum⁴, Marsha Regenstein⁵, Gina Hong⁶, Olivia Dieni⁷, Anne Willis⁷, Clement L Ren⁸

Affiliations

¹ Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. Electronic address: boash@chop.edu.
² Division of Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA.
³ Clinical Research Collaboration Unit Penn Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Center for Medicare and Medicaid Innovation (Innovation Center) at the Centers for Medicare and Medicaid Services, USA.
⁵ Milken Institute School of Public Health, George Washington University, USA.
⁶ University of Pennsylvania Perelman School of Medicine, Department of Medicine, Pulmonary, Allergy and Critical Care Division, Philadelphia, PA, USA.
⁷ Cystic Fibrosis Foundation, Bethesda, MD, USA.
⁸ Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.

PMID: 39794182
DOI: 10.1016/j.jcf.2024.12.005

Abstract

Background: Food insecurity (FI) is more prevalent in people with cystic fibrosis (PwCF) than the reported national prevalence, but there are limited data on the relationship between FI and health outcomes in PwCF. The objective of this study was to analyze the relationship between FI in PwCF and pulmonary and nutritional status.

Methods: We leveraged an electronic cross-sectional survey that ascertained FI status and gave participants the option to link their survey data to their records in the Cystic Fibrosis Foundation Patient Registry (CFFPR). Linear regression and negative binomial models were used to estimate the associations in mean differences between FI and percent predicted FEV1 (ppFEV1), nutritional indices, and hospitalizations.

Results: There were 1,856 respondents, 1,234 (66.5 %) of whom granted permission to link to the CFFPR. FI was present in 352 (28 %) of the respondents. FI was associated with lower ppFEV1 (-6.5; 95 % CI -9.9, -3.1); however, this was no longer statistically significant after adjusting for confounders. FI was independently associated with increased hospitalizations. Higher weight for age was significantly associated with FI in the adjusted model, but there were no significant associations between height for age or absolute weight and body mass index (BMI) in adults.

Conclusions: FI in PwCF is associated with adverse health outcomes. These results support screening for FI during routine visits. Further studies are needed to investigate causal relationships between FI and adverse clinical outcomes.

Keywords: Epidemiology; Health equity; Health-related social need; Nutrition; Pulmonary exacerbation; Social determinants of health.