The United States has become increasingly diverse in the last century. According to the 2000 U.S. Census, approximately 30% of the population belongs to a racial or ethnic minority group. Disparities in health and disease between various population groups, such as racial and ethnic groups, have increasingly become a major focus of public health research, practice, and policy. Diet and nutrition are key contributors to disparities in many chronic diseases and conditions. Therefore, in order to address these disparities, it is important to understand how various factors, including diet and nutrition, contribute to these disparities.
Bone Health in Gender and Racial Groups
The World Health Organization (WHO) defines low bone mass as a bone mineral density (BMD) of 1–2.5 standard deviations below the mean of a matched reference group. Osteoporosis involves a BMD of 2.5+ standard deviations below the mean of the reference group. Osteoporosis affects a significant number of older Americans. Currently, 4.3% of men and 15.4% of women who are 50 years old or older are living with osteoporosis, with an additional 43.4 million Americans having low bone mass, which is a significant risk factor for osteoporosis.
It is well established that there is a disparity between genders, with women carrying more than double the risk for developing osteoporosis. Non-Hispanic black men and women have the highest BMD and therefore the lowest risk for osteoporosis throughout life compared with non-Hispanic white and Mexican-Americans. Nevertheless, many factors are involved in BMD and the relative risk for the development of fragile bones, including body weight, physical activity, hormonal influences, and dietary intakes of several vitamins and minerals (not just calcium and vitamin D).
Osteoporosis is largely a preventable disease. It is also a costly disease. Coupled with the general trends of an aging population, this bone disease has become a serious national concern. Because BMD reaches a peak mass by the average age of 30 years, the years before this are vital for developing healthy bones and preventing the onset of osteoporosis. A healthy diet following the MyPlate guidelines should provide all of the essential nutrients, and it is imperative during the first three decades of life to establish healthy bones. For more information about osteoporosis, visit the website of the National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center.
Food Insecurity
Food insecurity is defined by the USDA as the limited or uncertain availability of nutritious and adequate food. The Food Assitance and Nutrition Research Program of the USDA reported that 17.6 million households (14.5% of all US households) qualify as having food insecurity. Furthermore, homes with children report almost double the rate of food insecurity as compared to homes without children (20% and 11.9%, respectively). There is widespread hunger and malnutrition among the poor and homeless, leading to physical, psychological, and socio-familial disturbances in all age groups, with a significant negative impact and health status, mental health, and the risk of chronic disease.
Those suffering from chronic disease are also at an increased risk of suffering from food insecurity independent of their sociodemographic status. Essentially, individuals who are otherwise food secure may find themselves in a situation where disease complications create a scenario where food is not readily available, exacerbating their overall decline in health. Also, food insecure patients are faced with tough financial decisions on whether to purchase necessary medications or food. Many of these food insecure individuals are unable to take medications as prescribed due to inadequate funds and the overriding need for food instead of medications.
Feeding America, the nation’s largest organization of emergency food providers, estimated that 14 million children in the US receive emergency food services each year. Malnourished children are at an increased risk for stunted growth and episodes of infection or disease, which often have lasting effects on intellectual development.
The prevalence of food insecurity is substantially higher among households that are headed by single mothers and in African-American and Hispanic households. —Household Food Security in the United States in 2012 (USDA)
