Longitudinal Mechanisms of Food and Nutrition Security and Cardiometabolic Health in PROSPECT - PROJECT SUMMARY Access to sufficient, high-quality, and safe food and nutrition is a fundamental human right. Lacking this denotes food insecurity (FI), becoming a significant societal and public health crisis. FI increases the risk of type 2 diabetes and cardiovascular disease. Yet, there is insufficient evidence on the causal link and potential mediating mechanisms between FI and cardiometabolic disease (CMD). Posited pathways are neuroendocrine factors, dietary factors, such as dysfunctional eating or specific fats like trans fats or ceramides, and positive or negative psychological factors. But few studies have investigated these pathways. It is also unclear how persistent vs. transient FI influences CMD. Moreover, the impact of food procurement decisions on FI and diet quality has been barely studied. These gaps are largely due to scant comprehensive longitudinal studies, leading key agencies to call for rigorous research on the mechanisms linking FI and CMD in vulnerable groups. Due to social and cardiovascular-related inequities, compounded by vulnerability to climate-change events, FI prevalence in the US territory of Puerto Rico (PR) is 33.2%, three times the US prevalence. This makes PR a pressing case and an ideal setting to study contributors to - and health consequences of - FI. With the goal of elucidating the complex pathways connecting FI and CMD, in 2018 we established PROSPECT: Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic disease Trends (R01-HL143792), a longitudinal cohort of adults aged 30-75 y. PROSPECT includes a thorough clinical examination and collects blood, urine, saliva, and hair samples to assess CMD, and validated psychosocial measures, a food frequency questionnaire, geocoded food access metrics, and the USDA Food Security Survey Module. Our reports show that 73% of participants have abdominal obesity, 61% have high blood pressure, 33% have FI, and 53% receive the Nutrition Assistance Program. We propose to renew PROSPECT to assess CMD at 4y and 6y post-baseline, screen for transient FI between visits, and analyze circulating fatty acids and novel biomarkers. We will enrich representation from rural areas and men, key CVD factors, with 500 new participants. Over 6y, we aim to determine associations between persistent and transient FI and CMD, directly or via neuroendocrine markers; identify dietary and psychosocial mechanisms linking FI and CMD; and identify food procurement factors associated with FI and diet. Exploratory analysis will georeference climate change indicators with FI. PROSPECT leverages an established interdisciplinary team, a thorough dataset, multiple timepoints to examine complex pathways, novel biomarkers, and original analysis of FI and climate-change events. We have already produced pivotal publications, action-oriented initiatives, ancillary studies, and a biorepository and research infrastructure in PR. This renewal will enhance our unique cohort and generate compelling results that will advance science by elucidating mechanisms between FI and CMD, serving as model for other groups, and will inform food-related and psychosocial programs to alleviate FI and CMD inequities in PR and beyond.
