Assessing Food and Nutrition Security in Patients Undergoing Total Joint Arthroplasty

Food insecurity, defined as limited or uncertain access to adequate food and nutrition insecurity (inconsistent access to health-promoting foods), is linked to malnutrition. The purpose of this study was to evaluate the proportion and demographics of total joint arthroplasty (TJA) patients who meet food and nutrition insecurity criteria and examine their association with vitamin D and albumin.

Surveys in total joint arthroplasty patients assessing food and nutrition security were collected from January 2023 to March 2024 at two tertiary care centers. Preoperative albumin and vitamin D levels and demographics, including Area Deprivation Index (ADI), were collected retrospectively. Welch's two-sample t-tests evaluated differences in laboratory values based on food and nutrition security status. Multivariate logistic regressions were used to determine the strongest contributors to food and nutrition insecurity.

In this cross-sectional study of 387 patients, 35 (9.0%) reported food insecurity in the past 12 months. Ninety-two percent "often" or "sometimes" found healthy food too expensive. Age (P = 0.02), race and ethnicity (P < 0.001), body mass index (P = 0.02), and ADI (state, P < 0.001; national, P = 0.02) were associated with food insecurity. Race and ethnicity (P < 0.001) and state ADI (P = 0.02) were associated with nutrition insecurity. Vitamin D levels were lower (P = 0.03) in food-insecure patients (30.8 ng/mL) than in food-secure patients (37.5 ng/mL). There were no differences in albumin levels. Similar lab results were observed in nutrition-insecure patients.

In this study, 9.0 and 9.5% of patients met criteria for food and nutrition insecurity, respectively. These patients had significantly lower vitamin D levels. Food security status was associated with age, body mass index, race and ethnicity, and ADI. Nutrition insecurity was associated with race and ethnicity and state ADI. Future strategies should prioritize identifying at-risk patients and ensuring access to affordable healthy foods.