OUP accepted manuscript

Studies have demonstrated relationships between food insecurity, the lack of access to enough nutritious food, and greater risk of diet-sensitive chronic diseases. However, most prior evidence relies on cross-sectional studies and self-reported disease.The objective was to assess the longitudinal relationship between risk of food insecurity in young adulthood and changes in diet-sensitive cardiometabolic health outcomes across ten years among non-Hispanic white, non-Hispanic Black, American Indian or Alaska Native, and Hispanic adults.Data from the fourth and fifth waves (n = 3,992) of the National Longitudinal Study of Adolescent to Adult Health were used. Measures included risk of food insecurity, body weight, diabetes, and sociodemographic characteristics. Body weight and diabetes were assessed with direct measures. Mixed-effects models assessed the association of risk of food insecurity with body mass index (BMI), obesity and diabetes, while accounting for sociodemographic characteristics and the complex survey design.Risk of food insecurity was associated with increases in BMI as well as incidence of obesity and diabetes from young to middle adulthood in unadjusted and adjusted models (all P < 0.01). In models stratified by race and ethnicity, the relationships of risk of food insecurity with body weight outcomes and diabetes varied.Risk of food insecurity in young adulthood was related to BMI and obesity during young and middle adulthood, but not in changes over time. Risk of food insecurity was related to an increased incidence of diabetes predicted an increase in body weight and diabetes in middle adulthood. However, the relationships among specific racial and ethnic groups were unclear. Estimates of the relationship between food insecurity and cardiometabolic health outcomes within racial and ethnic groups experiencing highest prevalence of these conditions should be refined.