Early Childhood Food Insecurity and Cardiovascular Health in Young Adulthood

IMPORTANCE Food insecurity is a social risk factor that may be associated with cardiovascular health across the life course. OBJECTIVE To evaluate the association of food insecurity in early childhood with cardiovascular health (CVH) in young adulthood and whether associations are modified by participation during childhood in the Supplemental Nutrition Assistance Program (SNAP). DESIGN, SETTING, AND PARTICIPANTS The Future of Families-Cardiovascular Health Among Young Adults cohort study was conducted in 20 US cities among 1071 individuals enrolled at birth (February 1998 to September 2000), evaluated in childhood (age, 3-5 years), and followed up to young adulthood (September 2021 to September 2023; mean [SD] participant age, 22.3 [0.7] years). MAIN OUTCOMES AND MEASURES Household food insecurity (assessed by the US Department of Agriculture Food Insecurity survey) and SNAP participation at ages 3 to 5 years and CVH (assessed by the American Heart Association Life's Essential 8 [LE8] score, component LE8 scores, and clinical CVH risk factors). RESULTS Of the 1071 participants, 570 were female (53%), 422 (39%) lived in households with food insecurity, and 475 (44%) participated in SNAP. Early childhood food insecurity was associated with having a lower LE8 score in young adulthood (β, -2.2 [95% CI, -4.0 to -0.4]). Among component LE8 scores and clinical CVH risk factors, food insecurity was associated with a lower LE8 score for body mass index (BMI; β, -4.9 [95% CI, -9.6 to -0.3]) and higher odds of having a BMI of 30 or more (adjusted odds ratio, 1.40 [95% CI, 1.07-1.84]). Food insecurity was more strongly associated with a lower LE8 score among those whose households did not participate in SNAP (β, -4.9 [95% CI, -7.6 to -2.3]) compared with those whose households participated in SNAP (β, 1.0 [95% CI, -1.6 to 3.7]). CONCLUSIONS AND SIGNIFICANCE This study suggests that early childhood food insecurity is associated with a higher BMI in young adulthood, which is associated with a worse overall LE8 score, especially among children whose families did not participate in SNAP. Policies to promote food security among children may promote healthy BMIs and better CVH across the life course.