SNAP Participation as a Moderator of Food and Nutrition Security and Combined Cardiometabolic Conditions: A Mixed Regression Approach.

Objectives: To examine the relationships between food security, nutrition security, Supplemental Nutrition Assistance Program (SNAP) participation, and cardiometabolic outcomes, including hypertension, hyperlipidemia, or diabetes, among low-income U.S. individuals. Methods: A cross-sectional survey of 486 participants (April-June 2021) assessed food and nutrition security and cardiometabolic outcomes. Mixed-effects logistic regression models adjusted for covariates and included a random effect for state of residence. Moderation analyses evaluated SNAP participation's impact. Results: Very low food security was associated with higher odds of having at least one cardiometabolic condition, such as hypertension, hyperlipidemia, or diabetes (AOR = 1.96; 95% CI: 1.04-3.69; p = 0.04). SNAP moderated this relationship (p-interaction = 0.007), with non-participants experiencing significantly higher risk. Non-SNAP participants with very low food security had 3.17 (95% CI = 1.17-8.61) times higher odds of having a cardiometabolic condition. Among SNAP participants, very low food security was not significantly associated with having a cardiometabolic condition (OR = 1.62; 95% CI = 0.64-4.13). Higher nutrition security was associated with lower odds of having at least one cardiometabolic condition (AOR = 0.59; 95% CI: 0.41-0.83; p = 0.002). Conclusions: Nutrition security and SNAP participation mitigate cardiometabolic risks, underscoring their importance in public health interventions.