**Food Insecurity Is Associated with Mild Cognitive Impairment among Middle-Aged and Older Adults in South Africa: Findings from a Nationally Representative Survey**

**Ai Koyanagi 1,2,3,\*, Nicola Veronese 4,5, Brendon Stubbs 6,7,8, Davy Vancampfort 9,10, Andrew Stickley 11,12, Hans Oh 13, Jae Il Shin 14,15,16, Sarah Jackson 17, Lee Smith 18 and Elvira Lara 2,19**


Received: 27 February 2019; Accepted: 26 March 2019; Published: 30 March 2019

**Abstract:** There are no studies on the association between food insecurity and mild cognitive impairment (MCI). Thus, cross-sectional, community-based data on individuals aged ≥50 years from the World Health Organization's Study on Global AGEing and Adult Health (SAGE) conducted in South Africa (2007–2008) were analyzed to assess this association. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted. The sample consisted of 3,672 individuals aged ≥50 years [mean (SD) age 61.4 (18.3); 56% females]. The prevalence of MCI was

8.5%, while 11.0% and 20.8% experienced moderate and severe food insecurity, respectively. After adjustment for potential confounders, moderate and severe food insecurity were associated with 2.82 (95%CI = 1.65–4.84) and 2.51 (95%CI = 1.63–3.87) times higher odds for MCI compared with no food insecurity, respectively. The OR for those aged ≥65 years with severe food insecurity was particularly high (OR = 3.87; 95%CI = 2.20–6.81). In conclusion, food insecurity was strongly associated with MCI among South African older adults. Future longitudinal research is required to assess whether addressing food insecurity may reduce risk of MCI and subsequent dementia.

**Keywords:** mild cognitive impairment; food insecurity; South Africa; epidemiology
