Nutritional Value Key Factor in Food Security’s Impact on Outcomes

Healthcare has zeroed in on food deserts for their impact on health, but what about food swamps? Food swamps—areas with a higher density of fast-food and junk food establishments—can also have an adverse effect on health outcomes, researchers said at American Stroke Association’s International Stroke Conference 2023.

Living in a food swamp can increase the odds of stroke for individuals aged 50 and older, prompting researchers to call for community-based interventions and dietary guidance.

Food security is a leading social determinant of health, getting attention from healthcare professionals. Individuals without enough to eat, like those who live in food deserts, are at increased risk for adverse health outcomes and may have difficulty managing certain diet-related illnesses, like heart disease or diabetes.

That’s prompted some provider organizations to set up social determinants of health interventions helping to connect individuals and families to affordable food options.

But the quality or nutritional value of that food is also of utmost importance, experts have said, and this latest data confirms that notion.

 “An unhealthy diet negatively impacts blood pressure, blood glucose and cholesterol levels that increases the risk of stroke,” Dixon Lang, MD, the lead author of the study and a postdoctoral fellow at Columbia University Irving Medical Center, said in a statement. “Independent of one’s own demographics or socioeconomic status, living in a neighborhood with an abundance of poor food choices may be an important factor to consider for many people.”

Food swamps are regions that are filled with food establishments that sell food with little nutritional value, like fast food restaurants. These regions tend to coincide with food deserts, the researchers said, which are regions that have a dearth of grocery stores that sell fresh produce.

And when people live in these areas, they face increased risks for adverse health events. In the case of this study, the researchers found that those living in food swamps face an increased risk for stroke.

The researchers looked at data from the Health and Retirement Study (HRS) from between 2010 and 2016 and analyzed it against what they called a retail food environment index. Essentially, the researchers calculated the proportion of convenience stores and fast-food and full-service restaurants with unhealthy food options to specialized food stores or grocery stores with nutritious food options.

Using a patient sample of over 17,000 individuals with an average age of 64 years old, the researchers looked at outcomes based on the retail food environment index. They compared the risk of stroke for those living in high-ratio areas (places deemed food swamps) and low-ratio areas (places with nutritious food options).

“The two categories were chosen for comparison because prior research has shown that a retail food environment index ratio of 5 or higher may predict the prevalence of people with obesity in a neighborhood,” Yang said.

Around three-quarters of study participants lived in food swamps, while the remainder lived in areas with more nutritious food options. The mean retail food environment index was 6, which Yang pointed out means most people live in areas with six times the amount of unhealthy food sellers than healthy vendors.

Moreover, Yang and team found that those living in food swamps had a higher risk for worse health outcomes. Across the entire study population, 3.8 percent of participants said they’d previously had a stroke. The odds of stroke in a food swamp were about 13 times higher than in areas with more nutritious food sellers.

“Our research highlights the potential importance of an area’s retail food options as a structural factor affecting stroke, especially since most participants resided in areas with 6 times the amount of relative unhealthy to healthy food choices,” Yang said.

Yang and team conceded that this research is in its earliest stages, and it may be difficult to pinpoint feasible solutions to this food desert and food swamp problem. Community-based interventions promoting a more nutritious diet may be helpful, he indicated.

“At this early stage of our research, it’s important to raise awareness that a person's neighborhood and food environment are potentially important factors affecting their health, especially among people who may have difficulty in reaching optimal cardiovascular health targets,” Yang said. “In the future, it may help to focus on community-based interventions or dietary guidance to improve cardiovascular health, thereby, hopefully reducing the risk of stroke.”

However, it will be prudent that healthcare experts approach social determinants of health interventions—especially those surrounding food security—with cultural competence. Offering free meal vouchers for foods that do not align with communities’ cultural norms may not be effective.

By designing interventions with input from community leaders will be essential to ameliorating food security problems.