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Introduction:

Food insecurity has negative effects on health outcomes in underserved communities. Food insecurity has been linked to ophthalmic diseases; however, the relationship between diet quality, nutritional factors, and vision loss has not been thoroughly explored in the general adult population. Using the nationally representative National Health and Nutrition Examination Survey (NHANES) dataset, we examined the association between visual impairment and (1) food insecurity; and (2) diet quality.

Methods:

Analyses were conducted for adults ≥18 years of age using NHANES (2005–2008). Visual impairment was defined as presenting visual acuity worse than 20/40 in the better-seeing eye. For study purposes, food insecurity was based on answers to 3 questions from the US Food Security Survey and modeled as a binary variable; responses of “often true” or “sometimes true” were coded as positive indicators. Participants with ≥2 indicators were classified as food insecure. Diet quality was assessed using the Healthy Eating Index (HEI); quartile values were compared. Survey-weighted logistic regression estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, sex, race, income, and presence of diabetes mellitus.

Results:

Among 11,791 adults, 3,586 had complete data on visual acuity, food insecurity, and HEI. The weighted prevalence of visual impairment was 16.2%. Increasing age was significantly associated with higher odds of visual impairment (OR 1.02 per year [95% CI 1.01–1.03], p<0.001), while higher income was associated with lower odds of visual impairment (OR 0.58 [0.41-0.82], p=0.002).  Prevalence of visual impairment was higher among food-insecure individuals compared to food-secure individuals (20.0% vs. 15.4%, OR 1.19 [0.94-1.76], p=0.116). Visual impairment was similar across HEI quartiles (p=0.72) with no clear trend (p>0.37 for all binary comparisons between quartiles).

Conclusion:

Findings suggest that both socioeconomic and biological factors impact eye health. Visual impairment is associated with older age and lower income levels. Food insecurity may result in visual impairment, independent of age and income.  Diet quality, as measured by HEI, was not associated with visual impairment; a study of specific nutritional factors may provide greater insight into the relationship between food insecurity and vision loss.