Depressive symptoms mediate the relationship between sustained food insecurity and cognition: a causal mediation analysis

Purpose: This study aimed to investigate the association of change in food insecurity over time with cog-nitive function in midlife, and whether depressive symptoms mediated that relationship. Methods: We used longitudinal data from the Coronary Artery Risk Development in Young Adults study. Change in food insecurity in 2000-2005 was coded as "persistently food-secure," "persistently food -in-secure," "became food-insecure," and "became food-secure." Depressive symptoms were measured in 2010, and cognitive function was measured in 2015. Multivariable linear regression controlled for socio-demographic and cardiovascular health factors was used. We also conducted causal mediation analysis. Results: Our study population included 2448 participants (57.23% female and 43.18% Black, mean age = 40.31 in 2000). Compared with persistent food security, persistently and became food -insecure were associated with worse cognition, particularly with processing speed (beta persistent = -0.20 standard unit, 95% CI = -0.36, -0.04; beta became = -0.17, 95% CI = -0.31, -0.03), and these associations appeared mediated by depressive symptoms (proportion-mediated = 14% for persistently food-insecure and 18% for became food -insecure). Conclusions: Persistent and transition to food insecurity were associated with worse cognition, both directly and indirectly through increasing depressive symptoms. Targeting food insecurity or depressive symptoms among persistently or became food-insecure individuals may have the potential to slow premature cog-nitive aging.(c) 2023 Elsevier Inc. All rights reserved.