Food insecurity and muscle health: exploring the role of protein, vitamin D, and calcium intake in low muscle mass

Abstract

Background: Empirical evidence concerning the association between household food insecurity and objectively quantified low muscle mass, together with the nutritional mechanisms underlying this link, remains limited. The present study aimed to examine the relation between food insecurity and the odds of low muscle mass in a nationally representative sample of U.S. adults and to determine whether total intakes of protein, vitamin D, and calcium mediate this relation.

Methods: A cross-sectional analysis was conducted using data from 6 292 adults (≥ 18 years) enrolled in the 2011-2018 National Health and Nutrition Examination Survey. Household food security was assessed with the 10-item USDA Adult Food Security Survey Module (12-month reference period). Habitual nutrient intakes were estimated from two non-consecutive 24-h dietary recalls obtained with the Automated Multiple-Pass Method and analysed with the Food and Nutrient Database for Dietary Studies, thereby capturing both food- and supplement-derived nutrients. Low muscle mass was defined by dual-energy X-ray absorptiometry as an appendicular lean-mass index < 7.0 kg m^-2 in men or < 5.5 kg m^-2 in women (EWGSOP criteria). Survey-weighted generalised linear models yielded adjusted odds ratios (ORs), and non-parametric bootstrap procedures (5 000 iterations) were applied to quantify mediation.

Results: Food insecurity was identified in 22.6 % of participants. After adjustment for socio-demographic and health-related covariates, food insecurity was associated with higher odds of low muscle mass (OR = 1.38; 95 % CI 1.01-1.88). Lower total protein intake accounted for 6.3 % of this association (average causal mediation effect =-0.00093; p = 0.048), whereas intakes of vitamin D and calcium did not exert significant indirect effects. Age, body-mass index, sex and ethnicity were additional independent correlates of low muscle mass.

Conclusions: Household food insecurity is independently associated with increased odds of low muscle mass in U.S. adults, and inadequate protein intake constitutes a significant-albeit partial-mediating pathway. Prospective and interventional investigations are warranted to establish temporal directionality and to evaluate whether improving dietary protein adequacy can modify this relationship.

Keywords: Body composition; Cross-Sectional studies; Nutrition surveys.

Fig. 1

Selection of 6,292 participants from the NHANES 2011–2018 dataset (n = 39,156) after excluding individuals with missing data for key variables

Fig. 2

Stacked bar chart illustrating the percentage distribution of muscle mass status (Non-Low Muscle Mass: blue; Low Muscle Mass: yellow) across food security categories (Secure vs. Insecure)

Fig. 3

Violin plots showing the distribution of daily protein, vitamin D, and calcium intake by food security status (Secure vs. Insecure). The secure group (purple/orange) generally exhibits higher protein and calcium intake, while vitamin D intake shows minimal variation. Boxplots indicate the median and interquartile range, with violin widths representing data density

Fig. 4

Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) are shown on a logarithmic scale. The dashed black line at OR = 1 indicates no association. Age and diabetes increased risk, while higher BMI was protective. Significant variables: purple (P < 0.001), blue (P < 0.05), gray (P ≥ 0.05)