Can Participation in SNAP During Early Childhood Protect Against the Long-Term Cardiovascular Risks of Food Insecurity?

This study asked whether food insecurity in early childhood is linked to poorer cardiovascular health in young adulthood and whether participation in the Supplemental Nutrition Assistance Program (SNAP) can reduce these risks. Researchers analyzed data from 1,071 children in the Future of Families–Cardiovascular Health Among Young Adults study, following them from ages 3–5 to about age 22. Early childhood food insecurity was associated with a 2.2-point lower overall Life’s Essential 8 cardiovascular health score and a 1.4 times higher likelihood of obesity (BMI ≥30). Among children in SNAP households, these negative effects were largely mitigated.

The Policy Scientist’s Perspective

The topic of early childhood food insecurity has broad significance because it addresses how social and economic deprivation can shape long-term health outcomes—a central concern in both public health and social policy. As rising food prices and child poverty threaten population health, understanding the life-course implications of early deprivation is particularly timely. While this JAMA Cardiology study relies on multivariate regression rather than causal inference or randomized designs, the longitudinal dataset (tracking 1,071 individuals from early childhood to adulthood) provides unusually rich, policy-relevant evidence. The findings, showing that SNAP participation moderates the link between food insecurity and poor cardiovascular health, have high external validity for U.S. urban populations, though less so cross-nationally. This paper stands as one of the most substantively important contributions in recent months for understanding how early-life policy interventions may influence adult health trajectories.

Full Citation and Link to Article

Lam, E. L., Gauen, A. M., Kandula, N. R., Notterman, D. A., Goldman, N., Lloyd-Jones, D. M., Allen, N. B., & Shah, N. S. (2025). Early childhood food insecurity and cardiovascular health in young adulthood. JAMA Cardiology, 10(8), 762–769. https://doi.org/10.1001/jamacardio.2025.1062

Extended Summary

Central Research Question

This study investigates whether exposure to food insecurity in early childhood is associated with worse cardiovascular health in young adulthood and whether participation in the Supplemental Nutrition Assistance Program (SNAP) during childhood mitigates these long-term effects. The authors hypothesize that early-life food insecurity—defined as inconsistent access to adequate and nutritious food—negatively affects later-life health outcomes, particularly body mass index (BMI) and overall cardiovascular health as measured by the American Heart Association’s (AHA) Life’s Essential 8 (LE8) score. A secondary question explores whether SNAP participation modifies these associations by reducing or offsetting the adverse impact of food insecurity on young adult cardiovascular health.

Previous Literature

Previous studies have consistently shown that food insecurity is a key social determinant of health, associated with higher rates of obesity, diabetes, hypertension, and cardiovascular disease (CVD) in adults. Adults experiencing food insecurity have been found to have approximately 1.3 times higher odds of obesity, 1.4 times higher odds of prediabetes or diabetes, and a higher risk of cardiovascular mortality compared with food-secure adults. Yet much of this evidence has been cross-sectional or focused on adult populations, leaving a significant gap in understanding how early-life food insecurity may shape cardiovascular trajectories across the life course.

A small but growing literature identifies early childhood as a critical developmental window for the establishment of long-term health behaviors and physiological patterns. Exposure to nutritional deprivation, stress, or inconsistent access to food during early life can influence metabolic programming, emotional regulation, and long-term disease risk. Prior work suggests that food insecurity may alter eating patterns through stress-induced mechanisms, encouraging higher intake of calorie-dense and nutrient-poor foods while constraining dietary diversity. Research also links food insecurity to reduced physical activity and increased stress hormones, both of which contribute to elevated cardiometabolic risk.

Studies on SNAP—the largest U.S. anti-hunger program—have shown that participation reduces food insecurity among low-income families by as much as 30 percent and may improve certain health outcomes. Longitudinal research by Hoynes, Schanzenbach, and Almond (2016) demonstrated that childhood access to the food stamp program is associated with improved adult metabolic health and longer life expectancy. Yet findings remain mixed regarding dietary quality: SNAP participation has not consistently improved diet composition and in some cases correlates with higher caloric intake from low-cost processed foods. Thus, whether SNAP participation in early childhood moderates long-term cardiovascular outcomes remains an open empirical question.

Data

The study draws on the Future of Families and Child Well-Being Study (FFCWS), a nationally recognized longitudinal cohort originally comprising children born between 1998 and 2000 in 20 large U.S. cities. The FFCWS oversampled children born to unmarried mothers, producing a demographically diverse sample that overrepresents low-income and racial/ethnic minority households. The ancillary Future of Families–Cardiovascular Health Among Young Adults (FF-CHAYA) study followed these participants into young adulthood, collecting detailed cardiovascular health measures between 2021 and 2023, when participants averaged 22.3 years of age.

The analytic sample included 1,071 individuals who had complete data on both early childhood food security (ages 3–5) and cardiovascular health at age 22. Roughly 53 percent of participants were female, 39 percent experienced food insecurity during early childhood, and 44 percent participated in SNAP at some point between ages 3 and 5. The racial and ethnic composition included 43 percent non-Hispanic Black, 26 percent Hispanic, 18 percent non-Hispanic White, and smaller shares of other groups.

Food insecurity was measured using the U.S. Department of Agriculture’s 18-item Food Security Survey, which classifies households into four categories: high, marginal, low, and very low food security. Following prior literature, the authors defined food insecurity as reporting marginal, low, or very low food security at either age 3 or 5. SNAP participation was identified from maternal reports of household benefit receipt at the same time points. Cardiovascular health outcomes were assessed using the American Heart Association’s Life’s Essential 8 (LE8) score, a comprehensive composite (range 0–100) summarizing eight dimensions: diet quality, physical activity, nicotine exposure, BMI, blood lipids, blood glucose, blood pressure, and sleep. Because sleep data were unavailable, the authors used an unweighted mean of the seven remaining components, consistent with AHA guidance for incomplete LE8 data.

Methods

The authors employed multivariable linear and multinomial logistic regression to estimate the associations between early childhood food insecurity and cardiovascular outcomes in young adulthood. The primary dependent variable was the continuous LE8 score. Secondary outcomes included each component LE8 score and clinical cardiovascular risk factors—BMI ≥30, elevated non–HDL cholesterol (≥130 mg/dL), systolic blood pressure ≥130 mm Hg, and hemoglobin A1c ≥5.7 percent.

Model 1 adjusted for the child’s sex, and Model 2 added maternal sociodemographic variables: household income, educational attainment, and maternal age at birth. The authors also tested an interaction term between food insecurity and SNAP participation to examine whether the relationship between early food insecurity and adult cardiovascular health varied by SNAP involvement. When significant, stratified models were estimated separately for SNAP participants and nonparticipants. Secondary analyses assessed categorical cardiovascular health (high, moderate, or low LE8 score) and cardiovascular-kidney-metabolic (CKM) syndrome stages to identify gradations in overall health risk.

All analyses used R (version 4.3.0). Statistical significance was set at a two-sided p-value < .05. Because the study design was observational, the authors did not claim causal inference. Nonetheless, the longitudinal nature of the data and extensive covariate controls enhance the credibility of observed associations.

Findings/Size Effects

The study found that early childhood food insecurity was significantly associated with worse cardiovascular health in young adulthood. Specifically, food-insecure children had an adjusted 2.2-point lower mean LE8 score (95% CI, −4.0 to −0.4) than food-secure peers. Among the individual components of LE8, BMI showed the largest effect: food-insecure children scored 4.9 points lower on the BMI component (95% CI, −9.6 to −0.3) and had 1.4 times higher odds of having a BMI ≥30 (95% CI, 1.07–1.84). Other LE8 dimensions—diet, glucose, cholesterol, blood pressure, and tobacco exposure—showed no statistically significant differences.

The interaction between food insecurity and SNAP participation was significant, indicating that SNAP altered the strength and direction of the association. Among children whose households did not participate in SNAP, food insecurity predicted a 4.9-point lower overall LE8 score (95% CI, −7.6 to −2.3). By contrast, among those whose households did participate in SNAP, the association was attenuated and statistically insignificant (+1.0, 95% CI, −1.6 to +3.7).

In stratified analyses, food insecurity among non-SNAP households was associated with markedly worse BMI (−7.7 points; 95% CI, −14.4 to −1.1) and lower physical activity (−11.5 points; 95% CI, −20.9 to −2.1). In SNAP households, however, food insecurity was paradoxically linked to a modestly better diet score (+5.9 points; 95% CI, 0.0004 to 11.9), suggesting that participation may promote more stable access to nutritious food despite persistent hardship.

Secondary analyses showed that food insecurity increased the likelihood of falling into the “moderate” rather than “high” cardiovascular health category (adjusted odds ratio [AOR], 1.46; 95% CI, 1.04–2.06). It also raised the odds of being in cardiovascular-kidney-metabolic (CKM) stage 1 (AOR, 1.44; 95% CI, 1.04–1.98) or stage 3/4 (AOR, 1.63; 95% CI, 1.06–2.52), both reflecting excess adiposity and early subclinical disease.

Sex-specific analyses revealed that the negative association between food insecurity and LE8 score was significant among females (−2.4 points; 95% CI, −4.8 to −0.03) but not among males. This suggests possible sex-linked differences in vulnerability to early-life nutritional and psychosocial stressors.

Collectively, these findings demonstrate that early food insecurity is linked to measurable decrements in cardiovascular health by early adulthood, primarily through elevated BMI and reduced physical activity. Importantly, SNAP participation in childhood appears to buffer these effects, indicating that social policy interventions targeting food insecurity may yield lasting health benefits.

Conclusion

This study provides robust longitudinal evidence that food insecurity in early childhood predicts poorer cardiovascular health in young adulthood, largely mediated by elevated BMI. The estimated 2.2-point reduction in overall LE8 score—though modest in absolute terms—is meaningful when interpreted within population-level gradients of cardiovascular risk. The mitigating role of SNAP participation suggests that early policy interventions can alter long-term health trajectories, reinforcing the notion that social welfare programs function as upstream health determinants.

The study’s strengths include its longitudinal design spanning two decades, rigorous measurement of both early exposure and later health outcomes, and the use of a validated, comprehensive cardiovascular index (LE8). The authors appropriately control for major confounders and apply standard statistical methods suitable for observational data. However, the analysis relies on multivariate regression rather than causal inference methods such as instrumental variables, difference-in-differences, or natural experiments. Thus, causal claims remain tentative. The self-reported nature of food insecurity and SNAP participation introduces potential reporting bias, and results may generalize primarily to urban U.S. populations of lower socioeconomic status.

Despite these limitations, the study contributes significantly to understanding the intergenerational effects of economic hardship and the protective capacity of federal nutrition programs. By linking childhood socioeconomic environments to measurable adult health outcomes, it strengthens the empirical foundation for policies that address food insecurity as a public health intervention. The findings are timely given ongoing debates about SNAP eligibility and benefit levels, as well as rising child poverty following the expiration of pandemic-related supports. In sum, while not a randomized or causal study, this article stands out for its longitudinal scope, methodological rigor, and policy relevance—offering persuasive evidence that investments in early food security can yield tangible health dividends decades later.