| 摘要: | Background: Cardiovascular disease (CVD) has been increased astonishingly in a low middle-income country, such as Indonesia. Previous studies suggested the association between CVD and overweight and obesity, hypertension, diabetes, or dyslipidemia. The prior studies reported that food insecurity importantly contributes to the development of CVD risk factors and the incidence of CVD. The concept of food security and its association with chronic diseases are both well established. During the years within the scope of the study, there was a significant increase in the body shape index (ABSI) of Indonesian adults. Available prospective studies of food insecurity and cardiovascular diseases (CVD) have included obesity and hypertension as the modifiable risk factors. Studies using the physical activity and depressive symptoms measurements are lacking. For example, where the physical activity to contribute to counterbalance the risk associated with food insecurity and CVD remains unclear. This study tested the hypotheses that the association between food insecurity and chronic diseases and aimed to use structural equation modeling (SEM) to explore the complex direct and indirect factor variables influencing cardiovascular disease (CVD) during a seven-year follow-up study.
Methods: Data was obtained from Indonesian adults using the Indonesia Family Life Survey (IFLS) in 2007 and 2014. Longitudinal study participants were interviewed face-to-face for dietary intake data using the food frequency questionnaire (FFQ). Food security, a concept developed by the World Food Programme (WFP), was calculated based on a food consumption score analysis using the FFQ. A generalized estimating equation (GEE) and a Sobel–Goodman test were used to test some part of the hypotheses in this study. Further, we used SEM to examine the direct and indirect relationships of food consumption score, body shape index, physical activity volume, and blood pressures on CVD.
Results: The food consumption score was negatively associated with ABSI, depression, diabetes, and CVD. It was also negatively associated with systolic blood pressure (p < 0.001). In a formal mediation analysis, ABSI significantly mediated the pathway between the food consumption score and systolic blood pressure (p < 0.001). Based on the beta coefficients from a regression analysis, the significant direct effects (p < 0.001) for CVD were food consumption score (FCS), a body shape index (ABSI), vigorous physical activity volume (VPAV), and systolic blood pressure (SBP). Indirect (p = 0.004 – p < 0.001) effects for CVD were FCS, ABSI, moderate physical activity volume (MPAV), and VPAV. Food-insecure people are more likely to consume high-calorie diets that lead to obesity, which, together with a lack of vigorous physical activity, leads to hypertension and CVD.
Conclusions: The effect of food security on hypertension is mediated through body shape. Strategies to improve the prevention of hypertension among adults may need to take the ABSI and food security, along with nutrition education, into account. In addition, the effect of food security on diabetes and CVD is partly mediated through depression. Moreover, further work is required to determine the in-depth causality among the variables. Of the multiple factors influencing the incidence of CVD, the modifiable risk factors were FCS, ABSI, and VPAV. Hence, the recommendations for CVD prevention should include targeting food insecurity, body shape index, and vigorous physical activity besides the measurement of blood pressure. |
