Submitted to: Nutrients
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/16/2025
Publication Date: 6/18/2025
Citation: Almohamad, M., Li, R., Heredia, N.I., Dave, J.M., Calloway, E.E., Sharrief, A.Z., Sharma, S.V. 2025. When access isn't enough: The role of utilization barriers in nutrition security and cardiometabolic risk. Nutrients. 17(12):Article 2031. https://doi.org/10.3390/nu17122031.
DOI: https://doi.org/10.3390/nu17122031

Interpretive Summary: Food security means having enough food, while nutrition security focuses on consistent access to healthy, nourishing food. In this study, 486 low-income adults from five U.S. states were surveyed. Researchers examined how barriers to using food, like lack of storage or cooking equipment, affect the link between food and nutrition security and chronic diseases such as high blood pressure and diabetes. They found that better nutrition security was linked to fewer reported health conditions. However, this benefit weakened when participants faced tangible barriers to food use, such as equipment and storage. Intangible barriers such as lack of time or cooking skills didn't strongly affect health outcomes, and food security wasn't linked to better health either. The study suggests food programs should offer more than just food, such as kitchen tools or cooking education. These supports could make initiatives like food boxes or meal prescriptions more effective. Addressing both access and usability is key to improving health. Public health strategies must ensure people can not only get healthy food but also use it.

Technical Abstract: Food and nutrition security are key social determinants of cardiometabolic health. While food security reflects access to sufficient food, nutrition security incorporates the quality, consistency, and usability of food that supports long-term health. However, few studies have examined how household-level barriers to food utilization shape these relationships. This study assessed whether tangible (e.g., equipment, storage) and intangible (e.g., time, knowledge) food utilization barriers modify the associations between food and nutrition security and cardiometabolic outcomes in low-income adults. A cross-sectional survey was conducted among 486 low-income adults across five U.S. states. Participants reported household food security (USDA 18-item module), nutrition security (four-item scale), and utilization barriers (eight-item scale, categorized into tangible and intangible subscales). Self-reported diagnoses of hypertension, hyperlipidemia, and diabetes were combined into a cardiometabolic outcome. Mixed-effects logistic regression models, adjusted for sociodemographic and program participation factors, were used to assess associations and effect modification. Higher nutrition security was associated with lower odds of cardiometabolic conditions (AOR=0.59; 95% CI: 0.41–0.83). Tangible barriers significantly modified the relationship between nutrition security and hypertension (p-interaction=0.04), with stronger protective effects observed in households without such barriers. No significant moderation effects were found for intangible barriers or for food security. Tangible household barriers influence the protective association between nutrition security and cardiometabolic outcomes. Public health strategies should address not only food access but also the practical resources required to store, prepare, and consume healthy foods effectively.