Food insecurity and cognitive impairment in older adults in rural areas of Ecuador

Food insecurity in older adults constitutes a growing public health challenge, especially in rural settings where access to nutritious and culturally appropriate foods is limited. This condition is associated with changes in diet quality, emotional state, body composition and cardiometabolic risk, creating a vulnerability profile that requires interdisciplinary approaches. Scientific evidence has shown associations between food insecurity, depression, obesity, hypertension, dyslipidemias and lower adherence to healthy dietary patterns. Understanding the interaction between food insecurity, the food environment, diet quality and clinical and emotional indicators is key to designing effective interventions. To investigate the association between food insecurity and cognitive impairment in older adults in rural areas of Azuay Province, Ecuador, and to identify potential mediators of this relationship. A cross-sectional study with 316 older adults (≥65 years) from the parishes of Sinincay, Ricaurte and El Valle. Food security was assessed using the Latin American and Caribbean Food Security Scale (ELCSA); cognitive status with the Tinetti Scale; depression with the Yesavage Geriatric Depression Scale; and social risk with the Lawton and Brody scale. Multivariable linear regressions and mediation analyses were performed. Data from 312 older adults were analyzed [mean (SD) age 74.3 (7.6) years; 68.3% women]. The prevalence of severe food insecurity was 5.8%. Severe food insecurity (versus food security) was associated with 6.87 (95% CI=0.38–13.36) points greater cognitive impairment on the Tinetti scale. Depression (23.7%; p=0.035), difficulty sleeping (34.2%; p=0.014) and social risk (14.3%) partially mediated this association. Together, the mediators explained 54.3% of the association. Food insecurity was associated with greater cognitive impairment in older adults in rural areas of Ecuador. Interventions aimed at improving food security could additionally benefit the cognitive health of this population.