Food Insecurity Associated with the Quality of Life of Older People

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The leading cause of death in people aged > 60 years in Mexico is deprivation-related conditions, including pneumonia, energy-protein malnutrition, and anemia, with an increasing prevalence of chronic noncommunicable diseases, mental illnesses, and abuse. This study aimed to comprehensively analyze the association between quality of life (QoL) and food insecurity among older adults who reside in Guanajuato and have some degree of marginalization. Methods This cross-sectional study included 2,031 people aged > 60 years as participants. Food insecurity, sociodemographic conditions, housing, functional status, health, nutrition, and QoL were all assessed. Measures of central tendency and dispersion were used for the statistical analysis of quantitative data, frequency tables and percentages for categorical variables. As well as the chi-square χ 2 test to identify differences between low and high Qol. Cramér's V was applied when the variable was polytomous, and when significant differences were found, it was categorized as dichotomous to identify OR risk and 95% confidence intervals (95%CI), Multiple regression test were used to assess the strength of the association between the studied variables, and those that were statistically significant were analyzed with logistic regression test. P-values of p < 0.05 were considered statistically significant. Results Food insecurity in older adults living in highly marginalized areas of Guanajuato, Mexico, characterized by insufficient income, low educational level, and precarious housing, was statistically associated with a negative impact on QoL. The factors positively associated with the quality of life of older adults were physical and financial independence. Conclusions Individuals with insufficient food and nutrient intake, specifically older adults, had less energy available for daily activities. Therefore, the lower the physical movement, the lower the appetite, leading to a greater loss of muscle mass and strength, frailty, physical and cognitive deterioration, risk of falls, and risk of disease and death. Food insecurity quality of life prevalence risk factors malnutrition older adults. Introduction Over the past two decades, the percentage of the older population in Mexico has considerably increased owing to the declining birth rate and increasing life expectancy. Currently, adults aged ≥ 60 years account for 14% of the population (approximately 17.9 million people), with an annual growth rate of 3%. By 2050, 24.7% of the population is estimated to be over 60 years of age ( 1 ). Guanajuato is the sixth most populous state with a moderate aging index ( 2 , 3 ). In 2018, 92.6% of older people in Guanajuato were impoverished, with 59.1% having scholastic backwardness ( 4 ). According to Juárez-Ramírez et al., the leading cause of death in people aged > 60 years in Mexico is deprivation-related conditions, including pneumonia, energy-protein malnutrition, and anemia, with an increasing prevalence of chronic noncommunicable diseases, mental illnesses, and abuse. These factors contribute to a 10.9% reduction in life expectancy associated with socioeconomic inequality ( 5 ). According to Wang and Geng ( 6 ), socioeconomic factors, including economic income, buying capacity, educational level, housing conditions, connectivity, technology use, access to health services, and employment opportunities, are considered determinants of health. These factors influence healthy lifestyles, such as selecting nutritious quality foods, engaging in physical exercise and self-care, maintaining social networks, managing stress, and fostering spiritual growth. Alternatively, risky behaviors, including a sedentary lifestyle, substance use disorders (e.g., smoking, alcohol consumption), development of physical and mental deterioration, disease burden, and life expectancy, influence the lifestyles of older adults. Nutritional deficiencies can result from socioeconomic issues (poverty, food insecurity, and poor education), health-related conditions (chronic diseases, polypharmacy, and decreased mobility), psychological factors (loneliness, isolation, and depression), and factors associated with eating habits (decreased appetite, changes in taste and smell, and difficulties in chewing and swallowing). Food and nutrition insecurity is defined as limited or uncertain access to sufficient food for an active and healthy lifestyle. In Mexico, reports show a prevalence of food insecurity of 69.5%, with no appreciable changes over time. However, in recent years, the incidence of moderate food insecurity has increased from 30.5–35.5%, whereas the incidence of severe food insecurity has increased from 33.9–41%, representing an increase of 7% without considering the food crisis caused by the COVID-19 pandemic ( 7 , 8 ). Adequate food and nutrient intake determines the health status and function of older adults. Conversely, malnutrition is directly associated with the quality of life (QoL). Milte et al. defined QoL as a “multidimensional term of social policies that means having good ‘objective’ living conditions and a high degree of ‘subjective’ “well-being” ( 9 ) QoL also “includes the collective satisfaction of needs through social policies in addition to individual needs" ( 10 ) and encompasses physical health, psychological state, level of independence, social relationships, personal beliefs, and interaction with the environment ( 11 ). The current study aimed to comprehensively analyze the association between QoL and food insecurity in older adults with some degree of marginalization. Methodology This study is part of an evaluation of factors associated with QoL in older adults in Guanajuato. A cross-sectional, epidemiological, and analytical study was conducted using a convergent design. Considering that 10% of the population in the State of Guanajuato is older, a sample size of 2,025 representative people in the state was calculated. Localities with more than 500 inhabitants were randomly selected. Based on INEGI ( 12 ), 126 localities located across 33 municipalities were stratified by the degree of marginalization; 82 were classified as having a high degree of marginalization, and the rest were classified as having a medium or low degree of marginalization, reflecting similar trends at the state level. Participants This study included people aged ≥ 60 years who could respond to the evaluation instruments, were Mexican by birth, and had resided in Guanajuato for at least the past decade. Assessment Direct face-to-face interviews were conducted with each participant in their locality, and demographic data (age and sex) were obtained. Their cognitive status was evaluated using the Mini-Mental State Examination ( 13 ); one point was awarded for each correct answer, and participants scoring ≤ 13 points were classified as having severe cognitive impairment. In such cases, the caregivers were requested to respond. The physical functionality of the participants was evaluated using the Katz index and the Lawton and Brody index ( 14 , 15 ), with one point awarded for each positive response. A score of 6 (6/6) points indicated that participants were independent in performing basic activities of daily living, whereas a score of > 6 (6/8) points signified that participants were independent in performing instrumental activities of daily living. QoL was measured using the WHOQOL-BREF ( 16 ), with an unweighted score of > 87 points indicating high QoL. To comprehensively assess food insecurity, the Latin American and Caribbean Scale of Food Security (ELCSA) harmonized for Mexico was used to classify people living without children in households, with > 4 points indicating food insecurity; those with children in households with > 5 points were considered to have experienced food insecurity ( 17 ). Because the ELCSA measures access to food and dietary sufficiency, but not quality, 10% of the study population was evaluated for dietary variables to measure the quantity and quality of food and nutrients. Two or three 24-hour dietary recalls were obtained (two on weekdays and one on weekends) to calculate the average nutritional intake analyzed using ESHA's software Food Processor, a semi-quantitative frequency of food consumption validated by the National Institute of Public Health ( 18 ). Nutritional deficiency was established when nutritional values were lower than those recommended by the International Organization for Migration ( 19 ), and the Mini Nutritional Assessment ( 20 ) classified malnutrition as a score of ≤ 7. Anthropometric measurements, including weight, height, knee height, medium wingspan, mid-arm muscle circumference, calf circumference, and waist circumference, were evaluated by certified personnel (ISAK level 1). Women with waist circumference > 80 cm and men with waist circumference > 90 cm were classified as having central obesity ( 21 ). The grip strength of the right and left hands was measured in triplicate in kilograms using a TAKEY A5401 dynamometer. Data on sociodemographic variables, such as marital status, educational level, sources and amount of economic income, family and/or government economic support, occupation, housing conditions (construction materials and services), household occupants, availability of technological equipment in the home (car and telephone), access to health services, and presence of any disease or disability, were collected. Statistical Analysis Statistical analyses were performed using IBM SPSS Statistics for Windows version 25 (IBM Corp., Armonk, NY, USA). Measures of central tendency and dispersion were used for quantitative data, whereas frequency tables and percentages were used for categorical variables. Differences between low and high QoL scores were identified using the chi-squared (χ 2 ) test. Cramér V was applied to polytomous variables. When significant differences were found, the variables were categorized as dichotomous to identify odds ratios (OR) and 95% confidence intervals (CIs). Multiple regression tests were performed to assess the strength of associations among the studied variables, and statistically significant variables were analyzed using logistic regression. Differences were considered statistically significant at P 60 years (average age: 73.1 ± 8.1 for women, 74.6 ± 8.4 for men) were evaluated, with no statistical difference between them. Women and men accounted for 64.4% and 35.6% of the study population, respectively. Supplementary Table 1 presents the sociodemographic characteristics of the participants according to their QoL scores. Marital status, occupation, and health problems were not significantly associated with QoL. However, educational level exhibited a positive association with high QoL, indicating that the higher the educational level, the more satisfactory the QoL of older adults. Conversely, the lower the educational level (complete or incomplete primary education), the unsatisfactory the QoL (OR: 2.6, 95% CI: 1.4–4.68). With respect to personal income or assistance, older people who depended on economic support, such as domestic work, unemployment benefits, or assistance from family, friends, or the government, perceived their QoL as unsatisfactory compared to those who had a source of income, whether from continued employment, retirement, or disability pensions (OR: 1.7, 95% CI: 1.4–2.09). Additionally, those with some disability reported lower QoL (OR: 1.8, 95% CI: 1.49–2.21) As for food insecurity, particularly regarding access to safe food, the housing conditions where older individuals live had a negative influence on their QoL. As shown in Supplementary Table 2, a lack of basic services such as drinking water and electricity (which affects the ability to refrigerate food) had a significant impact on QoL, followed by the availability of a gas stove, solid roof, drainage, and amenities such as a cell phone, car, landline telephone, or color television. Similarly, malnutrition (OR: 4.03, 95% CI: 2.9–5.57) and central obesity (OR: 1.38, 95% CI: 1.1–1.7) negatively influenced QoL (Supplementary Table 3). Financial and physical independence in performing basic (OR: 0.6, 95% CI: 0.5–0.8) and instrumental activities of daily living and adequate nutritional status to maintain strength and mobility were identified as factors positively associated with high QoL in older adults (Supplementary Table 4). A decline in muscle mass (OR: 1.5, 95% CI: IC 1.2–1.87) and strength (OR: 1.93, 95% CI: 1.5–2.4) hindered the ability to perform instrumental activities of daily living (OR: 2.64, 95% CI: 2.1–3.28), including shopping, using public transportation, cooking, washing clothes, and using the telephone. Mobility loss generated dependence and negatively affected appetite, food preferences, and food insecurity (65.8%), leading to increased malnutrition and weakness, which could explain the high consumption of soft drinks (92%, cola; 2.7%, canned juices; 1.2%, natural juices; 3.5%, freshwater sweetened with cane sugar; and 0.6%, chocolate prepared in water). Daily consumption of sugary drinks accounted for 20% of the total energy intake in older people with low QoL, as compared with 5% in older people with a high QoL (OR: 3.47, 95% CI: 2.88–4.1). Such consumption was paradoxical because older adults experiencing malnutrition due to food insecurity tended to consume non-nutritious foods. This practice was a consequence of the consumption culture that promoted marketing, which disrupted the daily life of impoverished sectors and encouraged the consumption of unhealthy foods, as evidenced in southern Mexico ( 22 – 24 ). No significant differences in food and nutrient consumption were observed between the groups. Nevertheless, it is important to mention that people dependent on assistance in performing basic and instrumental activities of daily living tended to consume two to three meals per day, as compared with three to five meals daily in those who were independent ( P = 0.054). People with high QoL consumed dairy products (milk, yogurt, and cheese) more frequently ( P = 0.02). Significant deficiencies were observed in the consumption of vitamins A (96.9%), B6 (98%), C (93.4%), E (99.6%), D (99.2%), and K (98.4%), as well as biotin (98.8%), thiamine (98%), folic acid (98%), riboflavin (93%), cyanocobalamin (85.9%), and niacin (64.1%). Deficient intake of inorganic nutrients was also noted, with 100% deficiency in iodine, fluoride, magnesium, manganese, chromium, and copper, along with 78.9% and 45.3% deficiency in calcium and iron, respectively. Discussion The older population in Guanajuato faces sociocultural and nutritional situations, with QoL issues associated with them, similar to those reported in previous studies. The observed trend of a higher proportion of older women compared to men is associated with a greater mortality rate among men (56.4%), attributed to cardiovascular diseases, complications from diabetes, and neoplasms ( 25 ). This trend is consistent with the findings reported in the United States ( 26 ) and Europe (( 27 ). Additionally, men reported a higher percentage of migration (56%) than women ( 28 ). Similarly, our data on the determinants of health revealed that educational level is positively associated with QoL, consistent with the findings of Olsen et al., who suggested that educational level contributes 29–40% of healthy behaviors, promoting better QoL ( 29 ). This positive effect is associated with the probability of having formal jobs and higher incomes, which guarantees access to social security benefits, including nutritious quality food, medical care, housing, pensions, and retirement benefits. This situation explains why people with income have a better QoL than those in dependent situations. Similar findings were reported by Ellina et al. who noted that older women employed full-time with a stable economic income demonstrated better QoL ( 30 ). Economic income remains insufficient, and thus, economic transfers have become increasingly important. However, as noted by Montes De Oca et al. older adults typically receive less formal economic income, with significant gender differences: older women receive 13.7% of the total pensions, while men receive 24% ( 31 ). In this context, informal economic transfers play a vital role, with women showing greater ease in establishing support networks and contact to obtain food vouchers, medicines, or various forms of support (15.8%) than men (11.8%). Conversely, the lower the personal income, the lower the QoL, as emphasized by Alaazi et al. ( 32 ) and Siqeca et al. ( 33 ), who reported that older women without regular income and with health issues had lower QoL scores. As previously mentioned, food insecurity is the most significant and sensitive indicator of poverty, as it directly identifies families experiencing hunger ( 34 ), and its prevalence varies globally, with social disparities evident even in developed countries. Since 2006, Mexico has consistently reported a prevalence of approximately 69% for moderate and severe food insecurity. We found a prevalence of 65.8% with an impact on QoL in Guanajuato, with an OR of 1.86 (95% CI: 1.52–2.25). This finding aligns with existing reports in the literature indicating that food insecurity increases the risk of poor QoL by 2.5 times and is associated with depression, stress, malnutrition, dependence, cognitive impairment ( 35 , 36 ), insomnia, deterioration of physical health, increased complications in the face of any disease, and death ( 37 , 38 ). Food insecurity is related to housing conditions, which are very important for older people because that is where they spend most of their day. Therefore, the lack of basic services, such as electricity and refrigerators, drinking water, or cooking facilities, decreases access to fresh food due to rapid decomposition, leading to the selection of ultra-processed foods with preservatives and lower nutritional quality. A deficient intake of nutrients in sufficient quantity and quality contributes to the loss of muscle mass and strength, which affects nutritional status along with physical, functional, immunological, mental, and emotional health, thereby compromising QoL ( 39 ). Nutritional status is closely associated with QoL; when nutritional status is adequate, it acts as a protective factor ( 40 ). Our results indicate that malnutrition increases the risk of poor QoL by an OR of 4 (95% CI: 2.9–5.6), as evidenced in the literature ( 41 , 42 ). When older people experience a loss of strength and function, they lose the ability to perform basic activities of daily living, such as using the toilet. This occurs because they cannot reach the toilet (as in some marginalized communities where bathrooms are located outside the home) or because of their inability to maintain posture and get up from it, which negatively influences their QoL ( 43 ). Food insecurity caused by a lack of access to food due to economic incapacity is more strongly affected by the high costs of basic necessities, as observed during the financial crisis of 2008–2009 and post-pandemic times following COVID-19. As reported by Mundo-Rosas et al. the food expenditure of people with moderate and severe food insecurity averages 55% of their total income, of which 20% is spent on fruits and vegetables, 22.8% on cereals and legumes, 19.3% on meat products, 15.5% on dairy, 7.5% on eggs, 7.4% on soft drinks, and 3.9% on fast food ( 7 ). Similarly, our results indicate that people with food security, higher QoL, and higher educational level spend 3% less on soft drinks (4%) and fast food (2%) ( 44 ). Food consumption among older people worldwide has been shown to be often insufficient with respect to energy and protein, with little variation across regions ( 45 , 46 ). Insufficient protein intake is associated with cognitive decline, loss of muscle mass, and increased risk of death ( 47 ). Lin et al. reported that dairy, fruit, and fats/oils were the primary food groups insufficiently consumed ( 47 ). This result aligns with our findings for the entire population because a significant difference was observed only in the higher consumption of dairy products among people with high QoL. Additionally, while the number of mealtimes ranged from three to five, a higher frequency of snack consumption was observed among those with high QoL. This finding is significant because snacks can provide greater energy and protein to perform daily activities.Chan et al. (2015) proposed that snacks, including dairy, could reduce the risk of frailty ( 48 ). Lin et al. reported that the consumption of dairy products decreases the loss of bone mineral density by 40%, and consumption of 200 mL of low-fat milk is associated with a reduced risk of heart attack. The consumption of 25 g cheese or 80 g natural yogurt decreases the risk of developing type 2 diabetes by 16%. Our results reveal very low fat consumption. According to the literature, low fat or oil intake is associated with a 2.4-fold relative risk (RR) of developing dementia and 1.07 times the likelihood of developing lung cancer, likely due to vitamin D deficiency ( 47 ). The analysis conducted by the National Health and Nutrition Survey 2006 and 2012 ( 49 ) reported that macronutrient consumption among the older population is similar to that in most Western countries ( 50 , 51 ), with a higher proportion of simple carbohydrates and saturated fats and a lower proportion of proteins and fiber. Although our results align with this trend, no reports have indicated such a high carbohydrate intake (70–75% of the total calories consumed), as revealed in the present study. We did not find significant differences between participants with high and low QoL in terms of macronutrient intake; however, we did observe significant differences in the quality of food consumed. People with low QoL reported excessive consumption of sugary drinks, specifically cola, also called “fantasy drinks” (also known as “energy drinks”), because they generate temporary feelings of energy and well-being, increasing the risk of cardiometabolic diseases. Siqueira et al. reported that the consumption of sugary drinks at 250 mL/day creates an RR for developing Metabolic Syndrome of 1.2 (95% CI: 1.04–1.45), increases fasting glucose (RR: 1.23; 95% CI: 1.01–1.48), systemic arterial hypertension (RR: 1.23; 95% CI: 1.0–1.54), and increased waist circumference (OR: 1.21; 95% CI: 1.02–1.42) ( 52 ). Consuming soft drinks during breakfast increases the probability of excluding dairy products, as revealed in our results ( 53 ). Our findings indicate that the dietary pattern of older adults is generally unhealthy, with insufficient intake of energy, mono- and polyunsaturated fats, fiber, natural water, vitamins, and inorganic nutrients, which increases disease risk and impairs the immune system due to deficiencies in vitamins A, D, C, E, B6, B12, folate, zinc, iron, copper, chromium, selenium, and iodine intake. As described above ( 54 ), deficiencies in natural antioxidants present in fruits and vegetables increase the probability of developing cancer and decrease muscle and cognitive capacity, which is detrimental to the QoL ( 54 – 56 ). Overall, the data collected in this research indicate a strong relationship between food security and QoL of older adults, with the number of years in education positively influencing both factors. Food choices in older adults are complex because the traditional Mexican plant-based diet has been altered by the industrialization of food ( 57 ), leading to a preference for hyperpalatable foods ( 58 ). Food insecurity, depression, anxiety, and stress influence food consumption through physiological mechanisms, including signals from the hypothalamic-pituitary axis, gastrointestinal, endocrine, thyroid systems, and gut microbiota, as well as cultural and genetic influences ( 59 – 61 ). Finally, purchasing power determines what can be bought merely to satisfy hunger and cravings, often without considering healthy diet ( 62 , 63 ). This study has some limitations. This study did not consider the physical activities performed by older adults. Physical activity and moderate exercise have a significant positive influence on cognitive, physical, and emotional states, probably influencing QoL. Therefore, it is important to consider this aspect in future research. Conclusion Our findings indicate that food insecurity among older adults in Guanajuato, Mexico, particularly those living in high-marginality areas with insufficient economic income and a low educational level with precarious housing, has a statistically negative relationship on QoL. In other words, food insecurity due to lack of access to food in terms of quality and quantity, conditioned by insufficient income and increased dependence that comes with aging, is the primary risk factor for low QoL in older adults. Individuals with insufficient food and nutrient intake, specifically older adults, have less energy for daily activities. Therefore, the lower the physical movement, the lower the appetite, leading to the greater loss of muscle mass and strength, frailty, physical and cognitive deterioration, risk of falls, and risk of disease and death. This finding highlights the need for public policy focusing on this sector of the population, given the demographic changes and projections for the country. It is crucial to raise awareness among social workers and the population regarding the importance of food quality to achieve satisfactory QoL. Emphasis should be placed on nutrition, including a balanced diet, proper food selection, nutritional quality, and adequate hydration, to ensure optimal functioning of the body. However, any awareness-raising initiative will yield optimal results if it is not planned comprehensively. Ensuring a good diet for the older population also requires improving economic income, housing conditions, and access to quality basic services, which remain inadequate in these marginal areas. Declarations Ethical considerations The study adhered to the international code of ethics, the Helsinki Code and was approved by the Institutional Research and Ethics Committee of the University of Guanajuato number CIBIUG-P402015. Consent to participate Those interested in participating voluntarily received information about the study and its risks and benefits, once their doubts were resolved, they signed a written letter of informed consent affirming their participation and acceptance of the publication of results, always safeguarding their identity. Data availability and materials Data and materials can be shared upon reasonable request and sent to the corresponding author. Declaration of competing interest The authors declare that they have no competing interest regarding the research, authorship, or publication of this article. Funding Statement The research was funded by the Government of the State of Guanajuato and the University of Guanajuato during the 2015-2018 administration, agreement DRF-1473/2015. Author contributions All the authors contributed substantially to the conception or design of the work, acquisition, analysis, interpretation of data for the work, and final approval. All authors read and approved the final manuscript. Acknowledgments To Mrs. María Eugenia Carreño de Márquez for the support provided in the realization of this work, Mr. Alfonso Borja Pimentel for his support in the administrative logistics, Silvia Quintana Vargas, MD for the support in the logistics of the fieldwork, to the postgraduate students Priscyla Zenteno Castillo and Berenice Vidales Núñez for their support in the application of evaluation instruments to the participants. References Scobie J, Amos S, Beales S, Dobbing C, Gillam S, Knox-Vydmanov C, et al. Global AgeWatch Index 2015 Insight report. 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Association between circulating vitamin E and ten common cancers: evidence from large-scale Mendelian randomization analysis and a longitudinal cohort study. BMC Med [Internet]. 2022 Dec 1 [cited 2024 Jun 22];20(1):168. Available from: https://pubmed.ncbi.nlm.nih.gov/35538486/ Moreno-Altamirano L, Hernández-Montoya D, Silberman M, Capraro S, García-García JJ, Soto-Estrada G, et al. La transición alimentaria y la doble carga de malnutrición: cambios en los patrones alimentarios de 1961 a 2009 en el contexto socioeconómico mexicano. Arch Latinoam Nutr [Internet]. 2014 [cited 2024 Oct 25];64(4):231–40. Available from: http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0004-06222014000400002&lng=es&nrm=iso&tlng=es Leng G, Adan RAH, Belot M, Brunstrom JM, De Graaf K, Dickson SL, et al. The determinants of food choice. Proc Nutr Soc [Internet]. 2017 Aug 1 [cited 2024 Oct 24];76(3):316–27. Available from: https://pubmed.ncbi.nlm.nih.gov/27903310/ Dicu AM, Cuc LD, Rad D, Rusu AI, Feher A, Isac FL, et al. Exploration of Food Attitudes and Management of Eating Behavior from a Psycho-Nutritional Perspective. Healthcare (Basel) [Internet]. 2024 Sep 27 [cited 2024 Oct 24];12(19):1–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/39408115 Shafiee NH, Razalli NH, Muhammad Nawawi KN, Mohd Mokhtar N, Affendi Raja Ali R, Malaysia K, et al. Implication of food insecurity on the gut microbiota and its potential relevance to a multi-ethnic population in Malaysia. JGH Open [Internet]. 2022 Feb 1 [cited 2024 Oct 24];6(2):112–9. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/jgh3.12709 Chiu DT, Parker JE, Wiley CR, Epel ES, Laraia BA, Leung CW, et al. Food insecurity, poor diet, and metabolic measures: The roles of stress and cortisol. Appetite [Internet]. 2024 Jun 1 [cited 2024 Oct 24];197:107294. 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Currently, adults aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years account for 14% of the population (approximately 17.9\u0026nbsp;million people), with an annual growth rate of 3%. By 2050, 24.7% of the population is estimated to be over 60 years of age (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Guanajuato is the sixth most populous state with a moderate aging index (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In 2018, 92.6% of older people in Guanajuato were impoverished, with 59.1% having scholastic backwardness (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to Ju\u0026aacute;rez-Ram\u0026iacute;rez et al., the leading cause of death in people aged\u0026thinsp;\u0026gt;\u0026thinsp;60 years in Mexico is deprivation-related conditions, including pneumonia, energy-protein malnutrition, and anemia, with an increasing prevalence of chronic noncommunicable diseases, mental illnesses, and abuse. These factors contribute to a 10.9% reduction in life expectancy associated with socioeconomic inequality (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). According to Wang and Geng (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), socioeconomic factors, including economic income, buying capacity, educational level, housing conditions, connectivity, technology use, access to health services, and employment opportunities, are considered determinants of health. These factors influence healthy lifestyles, such as selecting nutritious quality foods, engaging in physical exercise and self-care, maintaining social networks, managing stress, and fostering spiritual growth. Alternatively, risky behaviors, including a sedentary lifestyle, substance use disorders (e.g., smoking, alcohol consumption), development of physical and mental deterioration, disease burden, and life expectancy, influence the lifestyles of older adults.\u003c/p\u003e \u003cp\u003eNutritional deficiencies can result from socioeconomic issues (poverty, food insecurity, and poor education), health-related conditions (chronic diseases, polypharmacy, and decreased mobility), psychological factors (loneliness, isolation, and depression), and factors associated with eating habits (decreased appetite, changes in taste and smell, and difficulties in chewing and swallowing). Food and nutrition insecurity is defined as limited or uncertain access to sufficient food for an active and healthy lifestyle. In Mexico, reports show a prevalence of food insecurity of 69.5%, with no appreciable changes over time. However, in recent years, the incidence of moderate food insecurity has increased from 30.5\u0026ndash;35.5%, whereas the incidence of severe food insecurity has increased from 33.9\u0026ndash;41%, representing an increase of 7% without considering the food crisis caused by the COVID-19 pandemic (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdequate food and nutrient intake determines the health status and function of older adults. Conversely, malnutrition is directly associated with the quality of life (QoL). Milte et al. defined QoL as a \u0026ldquo;multidimensional term of social policies that means having good \u0026lsquo;objective\u0026rsquo; living conditions and a high degree of \u0026lsquo;subjective\u0026rsquo; \u0026ldquo;well-being\u0026rdquo; (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) QoL also \u0026ldquo;includes the collective satisfaction of needs through social policies in addition to individual needs\" (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) and encompasses physical health, psychological state, level of independence, social relationships, personal beliefs, and interaction with the environment (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe current study aimed to comprehensively analyze the association between QoL and food insecurity in older adults with some degree of marginalization.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThis study is part of an evaluation of factors associated with QoL in older adults in Guanajuato. A cross-sectional, epidemiological, and analytical study was conducted using a convergent design. Considering that 10% of the population in the State of Guanajuato is older, a sample size of 2,025 representative people in the state was calculated. Localities with more than 500 inhabitants were randomly selected. Based on INEGI (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), 126 localities located across 33 municipalities were stratified by the degree of marginalization; 82 were classified as having a high degree of marginalization, and the rest were classified as having a medium or low degree of marginalization, reflecting similar trends at the state level.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThis study included people aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years who could respond to the evaluation instruments, were Mexican by birth, and had resided in Guanajuato for at least the past decade.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssessment\u003c/h3\u003e\n\u003cp\u003eDirect face-to-face interviews were conducted with each participant in their locality, and demographic data (age and sex) were obtained. Their cognitive status was evaluated using the Mini-Mental State Examination (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e); one point was awarded for each correct answer, and participants scoring\u0026thinsp;\u0026le;\u0026thinsp;13 points were classified as having severe cognitive impairment. In such cases, the caregivers were requested to respond. The physical functionality of the participants was evaluated using the Katz index and the Lawton and Brody index (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), with one point awarded for each positive response. A score of 6 (6/6) points indicated that participants were independent in performing basic activities of daily living, whereas a score of \u0026gt;\u0026thinsp;6 (6/8) points signified that participants were independent in performing instrumental activities of daily living. QoL was measured using the WHOQOL-BREF (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), with an unweighted score of \u0026gt;\u0026thinsp;87 points indicating high QoL.\u003c/p\u003e \u003cp\u003eTo comprehensively assess food insecurity, the Latin American and Caribbean Scale of Food Security (ELCSA) harmonized for Mexico was used to classify people living without children in households, with \u0026gt;\u0026thinsp;4 points indicating food insecurity; those with children in households with \u0026gt;\u0026thinsp;5 points were considered to have experienced food insecurity (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Because the ELCSA measures access to food and dietary sufficiency, but not quality, 10% of the study population was evaluated for dietary variables to measure the quantity and quality of food and nutrients. Two or three 24-hour dietary recalls were obtained (two on weekdays and one on weekends) to calculate the average nutritional intake analyzed using ESHA's software Food Processor, a semi-quantitative frequency of food consumption validated by the National Institute of Public Health (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Nutritional deficiency was established when nutritional values were lower than those recommended by the International Organization for Migration (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), and the Mini Nutritional Assessment (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) classified malnutrition as a score of \u0026le;\u0026thinsp;7. Anthropometric measurements, including weight, height, knee height, medium wingspan, mid-arm muscle circumference, calf circumference, and waist circumference, were evaluated by certified personnel (ISAK level 1). Women with waist circumference\u0026thinsp;\u0026gt;\u0026thinsp;80 cm and men with waist circumference\u0026thinsp;\u0026gt;\u0026thinsp;90 cm were classified as having central obesity (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The grip strength of the right and left hands was measured in triplicate in kilograms using a TAKEY A5401 dynamometer.\u003c/p\u003e \u003cp\u003eData on sociodemographic variables, such as marital status, educational level, sources and amount of economic income, family and/or government economic support, occupation, housing conditions (construction materials and services), household occupants, availability of technological equipment in the home (car and telephone), access to health services, and presence of any disease or disability, were collected.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using IBM SPSS Statistics for Windows version 25 (IBM Corp., Armonk, NY, USA). Measures of central tendency and dispersion were used for quantitative data, whereas frequency tables and percentages were used for categorical variables. Differences between low and high QoL scores were identified using the chi-squared (χ\u003csup\u003e2\u003c/sup\u003e) test. Cram\u0026eacute;r V was applied to polytomous variables. When significant differences were found, the variables were categorized as dichotomous to identify odds ratios (OR) and 95% confidence intervals (CIs). Multiple regression tests were performed to assess the strength of associations among the studied variables, and statistically significant variables were analyzed using logistic regression. Differences were considered statistically significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOverall, 2,031 people aged\u0026thinsp;\u0026gt;\u0026thinsp;60 years (average age: 73.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1 for women, 74.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4 for men) were evaluated, with no statistical difference between them. Women and men accounted for 64.4% and 35.6% of the study population, respectively.\u003c/p\u003e \u003cp\u003eSupplementary Table\u0026nbsp;1 presents the sociodemographic characteristics of the participants according to their QoL scores. Marital status, occupation, and health problems were not significantly associated with QoL. However, educational level exhibited a positive association with high QoL, indicating that the higher the educational level, the more satisfactory the QoL of older adults. Conversely, the lower the educational level (complete or incomplete primary education), the unsatisfactory the QoL (OR: 2.6, 95% CI: 1.4\u0026ndash;4.68).\u003c/p\u003e \u003cp\u003eWith respect to personal income or assistance, older people who depended on economic support, such as domestic work, unemployment benefits, or assistance from family, friends, or the government, perceived their QoL as unsatisfactory compared to those who had a source of income, whether from continued employment, retirement, or disability pensions (OR: 1.7, 95% CI: 1.4\u0026ndash;2.09). Additionally, those with some disability reported lower QoL (OR: 1.8, 95% CI: 1.49\u0026ndash;2.21)\u003c/p\u003e \u003cp\u003eAs for food insecurity, particularly regarding access to safe food, the housing conditions where older individuals live had a negative influence on their QoL. As shown in Supplementary Table\u0026nbsp;2, a lack of basic services such as drinking water and electricity (which affects the ability to refrigerate food) had a significant impact on QoL, followed by the availability of a gas stove, solid roof, drainage, and amenities such as a cell phone, car, landline telephone, or color television. Similarly, malnutrition (OR: 4.03, 95% CI: 2.9\u0026ndash;5.57) and central obesity (OR: 1.38, 95% CI: 1.1\u0026ndash;1.7) negatively influenced QoL (Supplementary Table\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eFinancial and physical independence in performing basic (OR: 0.6, 95% CI: 0.5\u0026ndash;0.8) and instrumental activities of daily living and adequate nutritional status to maintain strength and mobility were identified as factors positively associated with high QoL in older adults (Supplementary Table\u0026nbsp;4). A decline in muscle mass (OR: 1.5, 95% CI: IC 1.2\u0026ndash;1.87) and strength (OR: 1.93, 95% CI: 1.5\u0026ndash;2.4) hindered the ability to perform instrumental activities of daily living (OR: 2.64, 95% CI: 2.1\u0026ndash;3.28), including shopping, using public transportation, cooking, washing clothes, and using the telephone. Mobility loss generated dependence and negatively affected appetite, food preferences, and food insecurity (65.8%), leading to increased malnutrition and weakness, which could explain the high consumption of soft drinks (92%, cola; 2.7%, canned juices; 1.2%, natural juices; 3.5%, freshwater sweetened with cane sugar; and 0.6%, chocolate prepared in water). Daily consumption of sugary drinks accounted for 20% of the total energy intake in older people with low QoL, as compared with 5% in older people with a high QoL (OR: 3.47, 95% CI: 2.88\u0026ndash;4.1). Such consumption was paradoxical because older adults experiencing malnutrition due to food insecurity tended to consume non-nutritious foods. This practice was a consequence of the consumption culture that promoted marketing, which disrupted the daily life of impoverished sectors and encouraged the consumption of unhealthy foods, as evidenced in southern Mexico (\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNo significant differences in food and nutrient consumption were observed between the groups. Nevertheless, it is important to mention that people dependent on assistance in performing basic and instrumental activities of daily living tended to consume two to three meals per day, as compared with three to five meals daily in those who were independent (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.054). People with high QoL consumed dairy products (milk, yogurt, and cheese) more frequently (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02).\u003c/p\u003e \u003cp\u003eSignificant deficiencies were observed in the consumption of vitamins A (96.9%), B6 (98%), C (93.4%), E (99.6%), D (99.2%), and K (98.4%), as well as biotin (98.8%), thiamine (98%), folic acid (98%), riboflavin (93%), cyanocobalamin (85.9%), and niacin (64.1%). Deficient intake of inorganic nutrients was also noted, with 100% deficiency in iodine, fluoride, magnesium, manganese, chromium, and copper, along with 78.9% and 45.3% deficiency in calcium and iron, respectively.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe older population in Guanajuato faces sociocultural and nutritional situations, with QoL issues associated with them, similar to those reported in previous studies. The observed trend of a higher proportion of older women compared to men is associated with a greater mortality rate among men (56.4%), attributed to cardiovascular diseases, complications from diabetes, and neoplasms (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This trend is consistent with the findings reported in the United States (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) and Europe ((\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Additionally, men reported a higher percentage of migration (56%) than women (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilarly, our data on the determinants of health revealed that educational level is positively associated with QoL, consistent with the findings of Olsen et al., who suggested that educational level contributes 29\u0026ndash;40% of healthy behaviors, promoting better QoL (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). This positive effect is associated with the probability of having formal jobs and higher incomes, which guarantees access to social security benefits, including nutritious quality food, medical care, housing, pensions, and retirement benefits. This situation explains why people with income have a better QoL than those in dependent situations. Similar findings were reported by Ellina et al. who noted that older women employed full-time with a stable economic income demonstrated better QoL (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEconomic income remains insufficient, and thus, economic transfers have become increasingly important. However, as noted by Montes De Oca et al. older adults typically receive less formal economic income, with significant gender differences: older women receive 13.7% of the total pensions, while men receive 24% (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). In this context, informal economic transfers play a vital role, with women showing greater ease in establishing support networks and contact to obtain food vouchers, medicines, or various forms of support (15.8%) than men (11.8%). Conversely, the lower the personal income, the lower the QoL, as emphasized by Alaazi et al. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) and Siqeca et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), who reported that older women without regular income and with health issues had lower QoL scores.\u003c/p\u003e \u003cp\u003eAs previously mentioned, food insecurity is the most significant and sensitive indicator of poverty, as it directly identifies families experiencing hunger (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), and its prevalence varies globally, with social disparities evident even in developed countries. Since 2006, Mexico has consistently reported a prevalence of approximately 69% for moderate and severe food insecurity. We found a prevalence of 65.8% with an impact on QoL in Guanajuato, with an OR of 1.86 (95% CI: 1.52\u0026ndash;2.25). This finding aligns with existing reports in the literature indicating that food insecurity increases the risk of poor QoL by 2.5 times and is associated with depression, stress, malnutrition, dependence, cognitive impairment (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), insomnia, deterioration of physical health, increased complications in the face of any disease, and death (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFood insecurity is related to housing conditions, which are very important for older people because that is where they spend most of their day. Therefore, the lack of basic services, such as electricity and refrigerators, drinking water, or cooking facilities, decreases access to fresh food due to rapid decomposition, leading to the selection of ultra-processed foods with preservatives and lower nutritional quality. A deficient intake of nutrients in sufficient quantity and quality contributes to the loss of muscle mass and strength, which affects nutritional status along with physical, functional, immunological, mental, and emotional health, thereby compromising QoL (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Nutritional status is closely associated with QoL; when nutritional status is adequate, it acts as a protective factor (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Our results indicate that malnutrition increases the risk of poor QoL by an OR of 4 (95% CI: 2.9\u0026ndash;5.6), as evidenced in the literature (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). When older people experience a loss of strength and function, they lose the ability to perform basic activities of daily living, such as using the toilet. This occurs because they cannot reach the toilet (as in some marginalized communities where bathrooms are located outside the home) or because of their inability to maintain posture and get up from it, which negatively influences their QoL (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFood insecurity caused by a lack of access to food due to economic incapacity is more strongly affected by the high costs of basic necessities, as observed during the financial crisis of 2008\u0026ndash;2009 and post-pandemic times following COVID-19. As reported by Mundo-Rosas et al. the food expenditure of people with moderate and severe food insecurity averages 55% of their total income, of which 20% is spent on fruits and vegetables, 22.8% on cereals and legumes, 19.3% on meat products, 15.5% on dairy, 7.5% on eggs, 7.4% on soft drinks, and 3.9% on fast food (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Similarly, our results indicate that people with food security, higher QoL, and higher educational level spend 3% less on soft drinks (4%) and fast food (2%) (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFood consumption among older people worldwide has been shown to be often insufficient with respect to energy and protein, with little variation across regions (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Insufficient protein intake is associated with cognitive decline, loss of muscle mass, and increased risk of death (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Lin et al. reported that dairy, fruit, and fats/oils were the primary food groups insufficiently consumed (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). This result aligns with our findings for the entire population because a significant difference was observed only in the higher consumption of dairy products among people with high QoL. Additionally, while the number of mealtimes ranged from three to five, a higher frequency of snack consumption was observed among those with high QoL. This finding is significant because snacks can provide greater energy and protein to perform daily activities.Chan et al. (2015) proposed that snacks, including dairy, could reduce the risk of frailty (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Lin et al. reported that the consumption of dairy products decreases the loss of bone mineral density by 40%, and consumption of 200 mL of low-fat milk is associated with a reduced risk of heart attack. The consumption of 25 g cheese or 80 g natural yogurt decreases the risk of developing type 2 diabetes by 16%. Our results reveal very low fat consumption. According to the literature, low fat or oil intake is associated with a 2.4-fold relative risk (RR) of developing dementia and 1.07 times the likelihood of developing lung cancer, likely due to vitamin D deficiency (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe analysis conducted by the National Health and Nutrition Survey 2006 and 2012 (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e) reported that macronutrient consumption among the older population is similar to that in most Western countries (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e), with a higher proportion of simple carbohydrates and saturated fats and a lower proportion of proteins and fiber. Although our results align with this trend, no reports have indicated such a high carbohydrate intake (70\u0026ndash;75% of the total calories consumed), as revealed in the present study. We did not find significant differences between participants with high and low QoL in terms of macronutrient intake; however, we did observe significant differences in the quality of food consumed. People with low QoL reported excessive consumption of sugary drinks, specifically cola, also called \u0026ldquo;fantasy drinks\u0026rdquo; (also known as \u0026ldquo;energy drinks\u0026rdquo;), because they generate temporary feelings of energy and well-being, increasing the risk of cardiometabolic diseases. Siqueira et al. reported that the consumption of sugary drinks at 250 mL/day creates an RR for developing Metabolic Syndrome of 1.2 (95% CI: 1.04\u0026ndash;1.45), increases fasting glucose (RR: 1.23; 95% CI: 1.01\u0026ndash;1.48), systemic arterial hypertension (RR: 1.23; 95% CI: 1.0\u0026ndash;1.54), and increased waist circumference (OR: 1.21; 95% CI: 1.02\u0026ndash;1.42) (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). Consuming soft drinks during breakfast increases the probability of excluding dairy products, as revealed in our results (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur findings indicate that the dietary pattern of older adults is generally unhealthy, with insufficient intake of energy, mono- and polyunsaturated fats, fiber, natural water, vitamins, and inorganic nutrients, which increases disease risk and impairs the immune system due to deficiencies in vitamins A, D, C, E, B6, B12, folate, zinc, iron, copper, chromium, selenium, and iodine intake. As described above (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e), deficiencies in natural antioxidants present in fruits and vegetables increase the probability of developing cancer and decrease muscle and cognitive capacity, which is detrimental to the QoL (\u003cspan additionalcitationids=\"CR55\" citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOverall, the data collected in this research indicate a strong relationship between food security and QoL of older adults, with the number of years in education positively influencing both factors. Food choices in older adults are complex because the traditional Mexican plant-based diet has been altered by the industrialization of food (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e), leading to a preference for hyperpalatable foods (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). Food insecurity, depression, anxiety, and stress influence food consumption through physiological mechanisms, including signals from the hypothalamic-pituitary axis, gastrointestinal, endocrine, thyroid systems, and gut microbiota, as well as cultural and genetic influences (\u003cspan additionalcitationids=\"CR60\" citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e). Finally, purchasing power determines what can be bought merely to satisfy hunger and cravings, often without considering healthy diet (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study has some limitations. This study did not consider the physical activities performed by older adults. Physical activity and moderate exercise have a significant positive influence on cognitive, physical, and emotional states, probably influencing QoL. Therefore, it is important to consider this aspect in future research.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur findings indicate that food insecurity among older adults in Guanajuato, Mexico, particularly those living in high-marginality areas with insufficient economic income and a low educational level with precarious housing, has a statistically negative relationship on QoL. In other words, food insecurity due to lack of access to food in terms of quality and quantity, conditioned by insufficient income and increased dependence that comes with aging, is the primary risk factor for low QoL in older adults. Individuals with insufficient food and nutrient intake, specifically older adults, have less energy for daily activities. Therefore, the lower the physical movement, the lower the appetite, leading to the greater loss of muscle mass and strength, frailty, physical and cognitive deterioration, risk of falls, and risk of disease and death.\u003c/p\u003e \u003cp\u003eThis finding highlights the need for public policy focusing on this sector of the population, given the demographic changes and projections for the country. It is crucial to raise awareness among social workers and the population regarding the importance of food quality to achieve satisfactory QoL. Emphasis should be placed on nutrition, including a balanced diet, proper food selection, nutritional quality, and adequate hydration, to ensure optimal functioning of the body. However, any awareness-raising initiative will yield optimal results if it is not planned comprehensively. Ensuring a good diet for the older population also requires improving economic income, housing conditions, and access to quality basic services, which remain inadequate in these marginal areas.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical considerations\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study adhered to the international code of ethics, the Helsinki Code and was approved by the Institutional Research and Ethics Committee of the University of Guanajuato number CIBIUG-P402015.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent to participate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThose interested in participating voluntarily received information about the study and its risks and benefits, once their doubts were resolved, they signed a written letter of informed consent affirming their participation and acceptance of the publication of results, always safeguarding their identity.\u003c/p\u003e\n\u003cp\u003eData availability and materials\u003c/p\u003e\n\u003cp\u003eData and materials can be shared upon reasonable request and sent to the corresponding author.\u003c/p\u003e\n\u003cp\u003eDeclaration of competing interest\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interest regarding the research, authorship, or publication of this article.\u003c/p\u003e\n\u003cp\u003eFunding Statement\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe research was funded by the Government of the State of Guanajuato and the University of Guanajuato during the 2015-2018 administration, agreement DRF-1473/2015.\u003c/p\u003e\n\u003cp\u003eAuthor contributions\u003c/p\u003e\n\u003cp\u003eAll the authors contributed substantially to the conception or design of the work, acquisition, analysis, interpretation of data for the work, and final approval. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eTo Mrs. Mar\u0026iacute;a Eugenia Carre\u0026ntilde;o de M\u0026aacute;rquez for the support provided in the realization of this work, Mr. Alfonso Borja Pimentel for his support in the administrative logistics, Silvia Quintana Vargas, MD for the support in the logistics of the fieldwork, to the postgraduate students Priscyla Zenteno Castillo and Berenice Vidales N\u0026uacute;\u0026ntilde;ez for their support in the application of evaluation instruments to the participants.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eScobie J, Amos S, Beales S, Dobbing C, Gillam S, Knox-Vydmanov C, et al. Global AgeWatch Index 2015 Insight report. HelpAge International [Internet]. 2015 [cited 2023 Dec 14];1\u0026ndash;28. Available from: www.truedesign.co.uk\u003c/li\u003e\n \u003cli\u003eINEGI. 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Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/jgh3.12709\u003c/li\u003e\n \u003cli\u003eChiu DT, Parker JE, Wiley CR, Epel ES, Laraia BA, Leung CW, et al. Food insecurity, poor diet, and metabolic measures: The roles of stress and cortisol. Appetite [Internet]. 2024 Jun 1 [cited 2024 Oct 24];197:107294. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11149909/\u003c/li\u003e\n \u003cli\u003eFrench SA, Tangney CC, Crane MM, Wang Y, Appelhans BM. Nutrition quality of food purchases varies by household income: The SHoPPER study. BMC Public Health. 2019 Feb 26;19(1):231.\u003c/li\u003e\n \u003cli\u003eMart\u0026iacute;nez-Mart\u0026iacute;nez OA, Gil-Vasquez K, Romero-Gonz\u0026aacute;lez MB. Food insecurity and levels of marginalization: food accessibility, consumption and concern in Mexico. Int J Equity Health [Internet]. 2023 Dec 1 [cited 2024 Oct 24];22(1):178. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10478370/\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Food insecurity, quality of life, prevalence, risk factors, malnutrition, older adults.","lastPublishedDoi":"10.21203/rs.3.rs-6178619/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6178619/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe percentage of older adults in Mexico has considerably increased owing to the declining birth rate and increasing life expectancy. The leading cause of death in people aged\u0026thinsp;\u0026gt;\u0026thinsp;60 years in Mexico is deprivation-related conditions, including pneumonia, energy-protein malnutrition, and anemia, with an increasing prevalence of chronic noncommunicable diseases, mental illnesses, and abuse. This study aimed to comprehensively analyze the association between quality of life (QoL) and food insecurity among older adults who reside in Guanajuato and have some degree of marginalization.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study included 2,031 people aged\u0026thinsp;\u0026gt;\u0026thinsp;60 years as participants. Food insecurity, sociodemographic conditions, housing, functional status, health, nutrition, and QoL were all assessed. Measures of central tendency and dispersion were used for the statistical analysis of quantitative data, frequency tables and percentages for categorical variables. As well as the chi-square χ\u003csup\u003e2\u003c/sup\u003e test to identify differences between low and high Qol. Cram\u0026eacute;r's V was applied when the variable was polytomous, and when significant differences were found, it was categorized as dichotomous to identify OR risk and 95% confidence intervals (95%CI), Multiple regression test were used to assess the strength of the association between the studied variables, and those that were statistically significant were analyzed with logistic regression test. P-values of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFood insecurity in older adults living in highly marginalized areas of Guanajuato, Mexico, characterized by insufficient income, low educational level, and precarious housing, was statistically associated with a negative impact on QoL. The factors positively associated with the quality of life of older adults were physical and financial independence.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIndividuals with insufficient food and nutrient intake, specifically older adults, had less energy available for daily activities. Therefore, the lower the physical movement, the lower the appetite, leading to a greater loss of muscle mass and strength, frailty, physical and cognitive deterioration, risk of falls, and risk of disease and death.\u003c/p\u003e","manuscriptTitle":"Food Insecurity Associated with the Quality of Life of Older People","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-17 07:18:25","doi":"10.21203/rs.3.rs-6178619/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-03-17T14:16:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-13T02:04:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-13T02:02:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-03-07T13:16:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"acc43fbf-2fd1-44bb-99b2-026cae3309cb","owner":[],"postedDate":"March 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T16:02:42+00:00","versionOfRecord":{"articleIdentity":"rs-6178619","link":"https://doi.org/10.1186/s12877-025-06791-y","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2025-12-05 15:57:58","publishedOnDateReadable":"December 5th, 2025"},"versionCreatedAt":"2025-03-17 07:18:25","video":"","vorDoi":"10.1186/s12877-025-06791-y","vorDoiUrl":"https://doi.org/10.1186/s12877-025-06791-y","workflowStages":[]},"version":"v1","identity":"rs-6178619","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6178619","identity":"rs-6178619","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}