Food Insecurity and Clinical Biomarkers of Inflammation among Cancer Survivors in the All of Us Research Program

Abstract

Background: Food insecurity is associated with a 40% increase in the prevalence of chronic conditions, including cancer. Stress-evoked inflammation is a hypothesized mechanism driving these associations. This study tested the association between food insecurity and inflammation in cancer survivors.

Methods: Our sample included individuals with a history of lung, breast, prostate, and colorectal cancers from the All of Us Research Program. Food insecurity was measured using validated questions, and inflammatory biomarkers were obtained from electronic health records (EHR). Our primary analysis tested the association between food insecurity and C-reactive protein (CRP; n = 413) using multivariable regression models, controlling for sociodemographics and current cancer treatment.

Results: The primary cohort was 69.8 ± 9.5 years in age, 61.0% female, 89.3% non-Hispanic White, and 9.9% had food insecurity. A higher proportion of racial/ethnic minorities (40.8%) and individuals with lower annual household income (33.3%) and education (29.4%) had food insecurity. The mean CRP was higher among those with food insecurity (14.5 ± 18.5) than among food-secure individuals (10.4 ± 17.8), but it was not significantly associated with CRP in our fully adjusted models.

Conclusions: Lung, breast, prostate, and colorectal cancer survivors had moderate levels of inflammation measured by CRP; however, food insecurity was not associated with CRP in fully adjusted models.

Impact: In this cohort, there was no association between food insecurity and CRP; however, given that food insecurity and inflammation are plausible contributors to chronic disease, future studies should include underrepresented survivors with EHR data and a broader range of cancers.