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Abstract
Food insecurity among older adults is 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 dietary quality, emotional well-being, body composition, and cardiometabolic risk, creating a vulnerability profile that requires interdisciplinary approaches. Scientific evidence has shown associations between food insecurity, depression, obesity, hypertension, dyslipidemia, and lower adherence to healthy dietary patterns. Understanding the interaction between food insecurity, the food environment, dietary quality, and clinical and emotional indicators is key to designing effective interventions. To investigate the association between food insecurity and cognitive decline in older adults in rural areas of the province of Azuay, Ecuador, and to identify the possible mediators of this relationship. A cross-sectional study involving 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 using the Tinetti Scale; depression using the Yesavage Geriatric Depression Scale; and social risk using the Lawton and Brody Scale. Multivariate 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) more points of 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. Collectively, the mediators explained 54.3% of the association. Food insecurity was associated with greater cognitive decline among older adults in rural areas of Ecuador. Interventions aimed at improving food security could further benefit the cognitive health of this population.
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