Abstract

Objectives: To examine the association between household food insecurity (FI) and cognitive performance among older adults in Lebanon - a country where an ongoing economic crisis has pushed large proportions of the population into poverty, disproportionately affecting older adults. Methods: Data are drawn from the baseline survey of an ongoing population-based cohort study (Lebanon Study on Ageing and Health). Adults aged ≥60years were recruited from a rural district and interviewed between Oct 2023-Jan 2024. Household FI was measured using the Food Insecurity Experience Scale and categorized into food secure (FS; score 0-3), moderately food insecure (MFI; 4-6), and severely food insecure (SFI; 7-8). Cognitive performance was assessed using the Community Screening Instrument for Dementia COGSCORE (CSI-D COGSCORE, 32-item); and the CERAD 10-Word List Memory task where mean z-score of the three immediate recall trials and the z-score of delayed recall were averaged (CERAD z-score). GLM models assessed the association between food insecurity and CERAD z-scores and CSI-D COGSCORE, adjusted for age, gender, education, marital status, employment status, and number of chronic diseases. Results: Of 1,204 older adults (median [IQR] age=68 [63; 75]; men (36.4%), primary education (43.6%), employed (44.6%)), 24.5% were MFI and 19.9% SFI. MFI was only associated with a lower CSI-D COGSCORE in bivariate analysis (unadjusted beta=-0.5 ;95%CI=-0.9; -0.1). In multivariable analysis, SFI was associated with a lower CSI-D COGSCORE (adjusted beta (β)= -0.6, 95%CI=-1.0; -0.2) and CERAD z-score (β=-0.2; 95%CI=-0.3; -0.1). Conclusions: In line with the global literature, we find SFI to be associated with lower cognitive performance. Although we cannot confirm temporality in this cross-sectional analysis, SFI has been hypothesized to adversely affect cognitive and memory function via both nutritional and psychological pathways. It will be important to confirm these findings in longitudinal research and to prioritize older adults in social safety net programs to mitigate the health consequences of food insecurity in the context of the socio-political and economic challenges faced. Funding Sources: National Institutes of Health.