SNAP Participation and Diet-Sensitive Cardiometabolic Risk Factors in Adolescents

Previous research suggests participation in the Supplemental Nutrition Assistance Program (SNAP) is associated with poorer adult cardiometabolic health; the extent to which these associations extend to adolescents is unknown. Differences in diet quality, obesity, and cardiometabolic risk factors were examined among SNAP participants, income-eligible nonparticipants, and higher-income adolescents.

The study population comprised 4,450 adolescents ≤300% federal poverty level from the 2003-2010 National Health and Nutrition Examination Survey. Generalized linear models were used to examine associations between SNAP participation and the Alternate Healthy Eating Index-2010. Linear and logistic regression models were used to examine associations between SNAP participation, obesity, and risk factors comprising the metabolic syndrome. Data were analyzed in 2015.

All surveyed adolescents consumed inadequate amounts of vegetables, fruits, whole grains, and long-chain fatty acids, while exceeding limits for sugary beverages, processed meats, and sodium. Although there were few dietary differences, SNAP participants had 5% lower Alternate Healthy Eating Index-2010 scores versus income-eligible nonparticipants (95% CI=-9%, -1%). SNAP participants also had higher BMI-for-age Z scores (β=0.21, 95% CI=0.01, 0.41), waist circumference Z scores (β=0.21, 95% CI=0.03, 0.39), and waist-to-height ratios (β=0.02, 95% CI=0.00, 0.03) than higher-income nonparticipants. SNAP participation was not associated with most cardiometabolic risk factors; however, SNAP participants did have higher overall cardiometabolic risk Z scores than higher-income nonparticipants (β=0.75, 95% CI=0.02, 1.49) and income-eligible nonparticipants (β=0.55, 95% CI=0.03, 1.08).

Adolescent SNAP participants have higher levels of obesity, and some poorer markers of cardiometabolic health compared with their low-income and higher-income counterparts.