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Food insecurity and social support in Brazil

was a reduction in the prevalence of Brazilian private households that had the ability to feed their residents adequately
(quantitatively and qualitatively). In 2017 – 2018, 63.3% of households in the country had consistent access to adequate
food, a proportion which was lower than the figures for 2004 (65.1%) and 2013 (18.2%). Conversely, there was a
significant increase in food insecurity, which came under the scenario of reduction. The survey also showed that 27.3%
of older Brazilians had some degree of food insecurity (IBGE, 2020). Nutritional transition in Brazil is still underway,
resulting in a double burden of disease related to nutritional excesses and deficiencies, obesity, and starvation, which are
direct causes of poverty and food insecurity (Ghattas, 2014).
In tandem with the worsening food security is the rapid populational aging. It is projected that people aged 60 or older
will reach 66 million in 2050, rising from 29 million in 2021; and these numbers equal to 28.8% of the population in 2050
and 13.8% in 2021 (United Nations, 2022). The rapid population aging in Brazil is mainly due to persistent low fertility
and improved life expectancy. Data provided by the United Nations (2022) show that total fertility rate has been below the
replacement (2.1 births per woman) for two decades and is project to maintain at the current level 1.6 till 2050. The average
life expectancy at birth is also projected to be 78.9 years for men and 83.7 years for women in 2050, despite some reduction
in 2019 – 2021 due to the COVID-19 pandemic (United Nations, 2022). As older adults are more vulnerable than general
adults in the population, food insecurity among older adults will usually exacerbate their disadvantaged health conditions.
Among older adults, food insecurity was associated with negative impacts on mental, physical, and nutritional health,
making older adults more susceptible to health problems such as frailty (Pérez-Zepeda, Castrejón-Pérez, Wynne-Bannister,
et al., 2016), depression (Jung, Kim, Bishop, et al., 2019), cognitive decline (Portela-Parra and Leung, 2019), lower health-
related quality of life (Fernandes, Rodrigues, Nunes, et al., 2018), and worsening nutritional status (Grammatikopoulou,
Gkiouras, Theodoridis, et al., 2019). Social support has also been identified as an important mediator of food insecurity
during aging (Wang and Bishop, 2019).
Although there is no consensus in the literature regarding the definition of social support, it can be understood as the
perceived availability of interpersonal resources capable of responding to needs caused by stressful events. Social support
can be divided into various dimensions. One common classification is composed of five dimensions: Material (financial
or physical assistance), affective (love and affection), emotional (encouragement and empathy), positive social interaction
(social companionship), and information (having someone to counsel and help them deal with problems) (Cassel, 1976;
Cohen and Wills, 1985). This multiple domain characteristic of social support provides different insights into how social
support could be associated with food insecurity. In the literature, it is hypothesized that social support, especially the
material and emotional dimensions, could act as a protective factor against hunger and food insecurity, because social
support may be decisive in the availability of help when someone has financial difficulties in buying food, for example,
(Wang and Bishop, 2019).
Considering that in low- and middle-income countries (LMICs), the prevalence of food insecurity continues to increase,
and in most of these countries, the population is rapidly aging, it is important to identify the social factors associated with
food insecurity among older adults. Therefore, the aim of this study was to analyze the association between different
dimensions of perceived social support and food insecurity among community-dwelling older adults in Brazil, a prime
example of such LMICs. The main hypothesis of this study was that older adults with higher scores on all dimensions of
social support would have the lowest chance of presenting with food insecurity.

2. Data and Methods
2.1. Data sources

We used data from the cross-sectional study “Evaluation of the prevalence of micronutrient deficiency among community
dwelling older adults in the metropolitan area of Campinas – SP,” conducted in three cities of São Paulo, Brazil in 2018
and 2019. The sample size for the principal study was based on the estimated total number of inhabitants aged ≥60 years
in the municipalities of Campinas, Limeira, and Piracicaba in 2018. The calculation of the sample size considered a
prevalence of 60% of older adults with at least one micronutrient deficiency, and a sampling error of 10%, along with a
95% confidence level. Thus, the minimum sample size was set at 600 older adults, with 170 participants being from the
city of Limeira, 180 from Piracicaba, and 250 from Campinas.
Six hundred and eleven older adults registered in the Family Health Strategy program between 2018 and 2019 were
interviewed. Participants were recruited through an invitation made at the basic health units (UBS) recommended by the
respective health departments of each municipality. More details of the data collection have been previously published
(Rolizola, Freiria, Silva, et al., 2021). The main study eligibility criteria included (1) age of 60 years or older, (2) being a
resident of one of the included cities, (3) being registered in the Family Health Strategy program, and (4) presenting the

42 International Journal of Population Studies | 2021, Volume 7, Issue 1