Abstract Body (Do not enter title and authors here): Background: Food insecurity is associated with adverse cardiometabolic health in adults. To understand the early, long-term impact of food insecurity, we examined the associations of food insecurity in childhood with young adult cardiovascular-kidney-metabolic (CKM) syndrome stage and suboptimal cardiovascular health (CVH), and the modifying effects of participation during childhood in the Supplemental Nutrition Assistance Program (SNAP).

Methods: In the Future of Families and Child Wellbeing Study of individuals enrolled at birth (1998-2000) and followed through age 22 years (2020-24) across 20 US cities, the associations of household food insecurity during childhood (age 3-5 years; score ≥1 on the US Household Food Security Survey) with CKM stage (0 [reference], 1, 2, or 3/4) and Life’s Essential 8 CVH score (high 80-100 [reference], intermediate 50-79, low 0-49) at age 22 years were evaluated with adjusted multinomial logistic regression. The interactions of food insecurity and SNAP participation, and food insecurity and race, were evaluated.

Results: Among 1,071 participants, 53% were female; 53% non-Hispanic Black, 25% non-Hispanic White, 18% Hispanic; 39% lived in households with food insecurity, and 44% participated in SNAP. Food insecurity was associated with higher odds of being in CKM Stage 1 (aOR 1.41 [95% CI: 1.02-1.93]) and Stage 3/4 (aOR 1.78 [95% CI 1.11-2.83]) compared with Stage 0 at year 22 (Table). Food insecurity was also associated with having intermediate vs. high CVH in young adulthood (aOR 1.46 [95% CI 1.04-2.06]). SNAP participation modified the association of food insecurity and CVH; ffood insecurity was more strongly associated with intermediate vs. high CVH among those who did not participate in SNAP (aOR 2.37 [95% CI 1.39-4.04]) compared to those who were SNAP participants (aOR 0.79 [95% CI 0.46-1.35]) in childhood. There was no significant interaction of food insecurity and race for either outcome.

Conclusions: Childhood food insecurity is associated with worse cardiometabolic health in young adulthood, especially among children whose families did not participate in SNAP. Policies to promote food security in children may promote cardiometabolic health across the life course.