Nutrition security screening in clinical care: a feasibility and implementation evaluation in family medicine and subspecialty clinics
4 affiliations
- 1Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.
- 2Department of Anthropology, University of North Carolina Wilmington, Wilmington, NC, USA.
- 3Tufts Medicine, Boston MA.
- 4Lowell General Hospital, Lowell, MA
Abstract
BACKGROUND: Nutrition insecurity (NI), or limited access to nutritious foods that support health, is increasingly recognized as relevant to health and distinct from food insecurity (FI). However, its integration into clinical assessment remains largely untested. OBJECTIVES: Our objective was to evaluate the feasibility of implementing a 2-item Nutrition Security Screener (NSS) alongside the Hunger Vital Sign, an existing FI screener, within a large integrated health system. METHODS: The NSS and FI screener were embedded in both Epic (electronic health record) and MyChart (patient portal) in a family medicine clinic and heart failure clinic from November 2023 to October 2025. Eligible patients were prompted to complete screeners electronically before visits or during rooming. We analyzed 24 mo of screening data, including completion rates, screening modality, referral rates, FI/NI prevalence, associations with sociodemographic and clinical characteristics, and reported barriers to healthy eating. RESULTS: Among 8218 eligible patients, 98.5% answered ≥1 question and 7697 (93.6%) answered all questions; 71% completed screening via the patient portal. Overall, 11.3% screened positive for NI or FI (4.8% both; 3.6% NI only; 3.0% FI only). After adjusting for demographics and FI, NI independently associated with Medicaid [odds ratio (OR) = 1.74; 95% confidence interval (CI): 1.30, 2.32] and Medicare (OR = 1.76; 95% CI: 1.22, 2.54), compared with commercial insurance; and with obesity (OR = 1.48; 95% CI: 1.19, 1.84) and type 2 diabetes (OR = 1.45; 95% CI: 1.08, -1.93). Among patients with NI (n = 648), common barriers to healthy eating included cost, limited time to cook, and uncertainty about qualification for government assistance. Of eligible patients, 7.1% received a documented referral. CONCLUSIONS: Integrating NI screening into routine clinical care was feasible and acceptable, with strong uptake through the patient portal. Clinical correlates and reported barriers highlight the utility of NI assessment, complementary to FI screening, for informing tailored nutritional and social interventions.
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BibTeX
@article{ridberg2026nutrition,
title = {{Nutrition security screening in clinical care: a feasibility and implementation evaluation in family medicine and subspecialty clinics}},
author = {Ronit Ridberg and Caroline Owens and Milos Damjanovic and Matthew Lombardo and Sydney Yearley and Frank Osborn and Dariush Mozaffarian},
journal = {The American journal of clinical nutrition},
year = {2026},
month = sep,
doi = {10.1016/j.ajcnut.2026.101522},
url = {https://doi.org/10.1016/j.ajcnut.2026.101522},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Nutrition security screening in clinical care: a feasibility and implementation evaluation in family medicine and subspecialty clinics
AU - Ronit Ridberg
AU - Caroline Owens
AU - Milos Damjanovic
AU - Matthew Lombardo
AU - Sydney Yearley
AU - Frank Osborn
AU - Dariush Mozaffarian
PY - 2026
DA - 2026/09/15
JO - The American journal of clinical nutrition
DO - 10.1016/j.ajcnut.2026.101522
UR - https://doi.org/10.1016/j.ajcnut.2026.101522
AB - BACKGROUND: Nutrition insecurity (NI), or limited access to nutritious foods that support health, is increasingly recognized as relevant to health and distinct from food insecurity (FI). However, its integration into clinical assessment remains largely untested. OBJECTIVES: Our objective was to evaluate the feasibility of implementing a 2-item Nutrition Security Screener (NSS) alongside the Hunger Vital Sign, an existing FI screener, within a large integrated health system. METHODS: The NSS and FI screener were embedded in both Epic (electronic health record) and MyChart (patient portal) in a family medicine clinic and heart failure clinic from November 2023 to October 2025. Eligible patients were prompted to complete screeners electronically before visits or during rooming. We analyzed 24 mo of screening data, including completion rates, screening modality, referral rates, FI/NI prevalence, associations with sociodemographic and clinical characteristics, and reported barriers to healthy eating. RESULTS: Among 8218 eligible patients, 98.5% answered ≥1 question and 7697 (93.6%) answered all questions; 71% completed screening via the patient portal. Overall, 11.3% screened positive for NI or FI (4.8% both; 3.6% NI only; 3.0% FI only). After adjusting for demographics and FI, NI independently associated with Medicaid [odds ratio (OR) = 1.74; 95% confidence interval (CI): 1.30, 2.32] and Medicare (OR = 1.76; 95% CI: 1.22, 2.54), compared with commercial insurance; and with obesity (OR = 1.48; 95% CI: 1.19, 1.84) and type 2 diabetes (OR = 1.45; 95% CI: 1.08, -1.93). Among patients with NI (n = 648), common barriers to healthy eating included cost, limited time to cook, and uncertainty about qualification for government assistance. Of eligible patients, 7.1% received a documented referral. CONCLUSIONS: Integrating NI screening into routine clinical care was feasible and acceptable, with strong uptake through the patient portal. Clinical correlates and reported barriers highlight the utility of NI assessment, complementary to FI screening, for informing tailored nutritional and social interventions.
SN - 0002-9165
SN - 1938-3207
ER -