Relationship of child-feeding practices to overweight in low-income Mexican-American preschool-aged children

OBJECTIVE: The purpose of this research was to examine the relationship of child-feeding practices and other factors to overweight in low-income Mexican-American preschool-aged children. DESIGN: Cross-sectional survey with anthropometric measurements of mothers and target children. Trained bilingual staff interviewed the parents to collect data on child-feeding strategies, food patterns, child's health history, parental acculturation level, food insecurity, and other household characteristics.Subjects and setting Complete data were available from 204 low-income Mexican-American parents residing in California with at least one child aged 3 to 5 years.Outcomes measured Risk of overweight was defined as body mass index (BMI) (measured as weight [in kilograms]/height [in meters](2)) >/=85th percentile and overweight was defined as BMI >/=95th percentile. The Student t test, chi(2) test, and logistic regression were used. RESULTS: Three variables were positively related to risk of overweight: birth weight (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.11 to 4.82), mother's BMI >/=30 (OR, 2.05; 95% CI, 1.11 to 3.79), and juice intake (OR, 2.33; 95% CI, 1.09 to 4.98). Being enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children was negatively related to risk of overweight (OR, 0.40; 95% CI, 0.21 to 0.75). Additional variables related to overweight were monthly income >$1,500 (OR, 2.33; 95% CI, 1.00 to 5.42) and child takes food from the refrigerator between meals (OR, 0.32; 95% CI, 0.13 to 0.76). CONCLUSIONS: The results of this study suggest that biological and socioeconomic factors are more associated with overweight in Mexican-American preschool-aged children than most of the self-reported child-feeding strategies.     

Child-specific food insecurity and overweight are not associated in a sample of 10- to 15-year-old low-income youth

In the United States, 17% of children and adolescents are overweight and 20% live in a food insecure household. Previous studies examining the association between household food insecurity and overweight among children have been inconclusive but are limited insofar as they did not assess child-specific measures of food insecurity and overweight. In response, this study examined the association between food insecurity and child overweight status when these variables were measured for the same child using information on children (n = 1031) aged 10-15 y from the Three-City Study. Approximately 8% of the children were food insecure, whereas 50% were either at risk of overweight or overweight. Bivariate analyses indicated that there were no significant differences in the prevalence of at risk of overweight and overweight between food secure and food insecure children. Gender, race, and income showed similar patterns. Results from logistic regression analyses also indicated that the likelihood of being overweight or at risk of overweight was not significantly different for food secure and food insecure children. Although child-specific food insecurity was not associated with overweight in this sample of low-income children, food insecurity and overweight coexist among these low-income children, because approximately 25% of the food insecure children were overweight. Additional research is needed to explore the potential relationships between food insecurity and overweight and to better inform policy that attempts to address these issues among low-income households with children.     

Food insecurity and food supplies in Latino households with young children

OBJECTIVE: To examine the relationship between food insecurity and food supplies in Latino households. DESIGN: Cross-sectional survey, conducted February to May 2001. SETTING: Six California counties. PARTICIPANTS: Convenience sampling was used to recruit 274 low-income Latino families with preschool children from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), Head Start, and other community-based organizations. Complete data were available for 256 families. Variables Measured: Food security, household food scores. ANALYSIS: Pearson correlations, Kruskal-Wallis test, and logistics regression. Significance level at P <.05. RESULTS: Controlling for maternal education, food insecurity over the past 3 months was associated with lower household food supplies: dairy, r = -.18, P <.01; fruit, r = -.36, P <.001; grains, r = -.27, P <.0001; meats, r = -.22, P <.001; snack foods, r = -.23, P <.001; and vegetables, r = -.29, P <.001. CONCLUSIONS AND IMPLICATIONS: In Latino households, greater food insecurity is associated with a lower variety of most foods, particularly fruits and vegetables. Future research in Latino households should explore the effects of seasonal food insecurity and household food shortages on food intake of individual household members, especially young children.     

Food Insecurity Is Associated with Overweight in Children Younger than 5 Years of Age

Both household food insecurity and childhood overweight are serious public health problems that appear to be paradoxically correlated. This study examines the relationship between overweight and household food insecurity with/without hunger in low-income children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children. Weight, height, and household food insecurity data were collected on 8,493 children ages 1 month to 5 years and analyzed by sex and age groups using logistic regression to model the odds of being overweight (weight for length or body mass index [calculated as kg/m²] for age ≥95th percentile) given household food insecurity status, controlling for race/ethnicity and maternal education. Analyses were stratified by age and sex because interaction terms with household food insecurity were significant (P<0.10). In this sample, prevalence of household food insecurity was 30.7% (8.3% with hunger) and 18.4% were overweight. Among girls younger than 2 years of age, household food insecurity was associated with reduced odds of overweight compared with food-secure households (odds ratio=0.65; 95% confidence interval: 0.47 to 0.88); hunger status did not alter this association. Among 2- to 5-year-old girls, there was no overall significant association between household food insecurity and overweight; however, household food insecurity with hunger was positively associated with overweight compared with those from food-secure households (odds ratio=1.49; 95% confidence interval: 1.06 to 2.10). No association between household food insecurity and overweight was found among boys. These findings suggest an association between household food insecurity and overweight prevalence in this low-income population. However, sex and age appear to modify both the magnitude and direction of the association.     

Acculturation of Mexican-American mothers influences child feeding strategies

OBJECTIVE: The purpose of this study was to examine the influence of maternal acculturation level on child feeding strategies and anthropometry in preschoolers from low-income Mexican-American families. DESIGN/SUBJECTS: Data are from a cross-sectional survey of 238 low-income Mexican-American families with preschool children living in California during 1998. Interviewers collected data from the mothers on child-feeding practices and weighed and measured the children in their homes. STATISTICAL ANALYSES: Spearman's correlation coefficients, analysis of variance, and chi 2 were used to examine the relationship pf maternal acculturation level with feeding strategies and anthropometric measurements. RESULTS: Compared with more acculturated mothers, less acculturated mothers tend to offer alternative foods more often when their children refuse to eat. More acculturated women are less likely to view bribes, threats, and punishments as effective strategies and are more likely to give vitamins than less acculturated mothers. Maternal acculturation is not associated with differences in weight-for-height z-scores, height-for-age, or body mass index of the children. Triceps skinfold thickness are larger in children of more acculturated mothers than in children of less acculturated women. APPLICATIONS/CONCLUSIONS: Dietitians should consider differences in child feeding practices due to acculturation among Mexican-Americans. Successful strategies to encourage consumption of nutritious traditional foods and to transition from child-led snacking to more structured meals should be part of nutrition education programs.     

Food insecurity is highly prevalent and predicts underweight but not overweight in adults and school children from Bogotá, Colombia

The aims of this study were to determine the sociodemographic and dietary correlates of household and child food insecurity in Bogotá, Colombia and to examine whether food insecurity is a risk factor for underweight or overweight in this population. We analyzed data from 2359 families with 2526 children 5-12 y of age who completed a cross-sectional survey conducted in 2006. The survey was representative of low- and middle-income families who had children enrolled in the public primary school system of Bogotá. We used a 16-item food insecurity scale, modified from the United States Household Food Security Survey Module, assessed children's dietary intake with a FFQ, and measured their height and weight. Mothers' anthropometry was obtained through self-report. We estimated adjusted prevalence ratios and 95% CI from binomial regression models. Household food insecurity with hunger and child food insecurity were each positively associated with maternal age, parity, and single parent status and inversely related to mean household income and number of home assets. Animal protein and snack food intake were inversely related to child food insecurity. In multivariate analyses, food-insecure children were 3 times more likely to be underweight than food-secure children (95% CI = 1.6, 5.4; P = 0.0007). Hunger in the household was significantly associated with maternal underweight. Food insecurity was not related to child stunting, child overweight, or maternal overweight. The prevalence of food insecurity in Bogotá is high and related to poverty. Food insecurity does not necessarily predict overweight in countries undergoing the nutrition transition.     

Acculturation and environmental change impacts dietary habits among adult Hmong

Focus groups (n=65) were conducted with Hmong adults in St. Paul/Minneapolis, MN to determine how environmental factors, acculturation, and food insecurity influence dietary behavior, body mass index (BMI), and health. Acculturation was assessed by examining linguistic, social, and eating behavior, length of time in the US, and BMI for B-TL(1) (born in Thailand/Laos and in US < or =5 years), B-TL(2) (in Thailand/Laos through adolescence, had food memories, and in US >5 years), and B-US (born in US or in Thailand/Laos less than 8 years and no food memories from there). Acculturation was associated with years lived in the US, household size and income, and food assistance usage. Years lived in the US was correlated with food assistance usage, education, household size and income, and perception of diet. B-TL(1) and B-TL(2) were on average overweight (BMI> or =25<30), US men were obese (mean BMI=32.4+/-7.4), and women were overweight (mean BMI=29.1+/-6.8). Themes identified were cultural values impact eating and lifestyle behaviors, food insecurity history influences post-migration behavior, acculturation impacts BMI through diet and exercise, and health status is influenced by changed environments. Environmental changes and increased acculturation have negatively impacted the weight and health of Hmong adults.     

Cigarette smoking and food insecurity among low-income families in the United States, 2001

PURPOSE: To quantify the association between food insecurity and smoking among low-income families. DESIGN AND SETTING: A retrospective study using data from the 2001 Panel Study of Income Dynamics (PSID), a longitudinal study of a representative sample of U.S. men, women, and children and the family units in which they reside. SUBJECTS: Low-income families. MEASURES: Family income was linked with U.S. poverty thresholds to identify 2099 families living near or below 200% of the federal poverty level. Food insecurity (i.e., having insufficient funds to purchase enough food to maintain an active and healthy lifestyle) was calculated from the 18-core-item food security module of the U.S. Department of Agriculture. Current smoking status was determined. RESULTS: Smoking prevalence was higher among low-income families who were food insecure compared with low-income families who were food secure (43.6% vs. 31.9%; p < .01). Multivariate analysis revealed that smoking was associated with an increase in food insecurity of approximately six percentage points (p < .01). CONCLUSIONS: Given our finding that families near the federal poverty level spend a large share of their income on cigarettes, perhaps it would be prudent for food-assistance and tobacco-control programs to work together to help low-income people quit smoking.     

Predictors of Obesity in Latino Children: Acculturation as a Moderator of the Relationship Between Food Insecurity and Body Mass Index Percentile

As Latino children acculturate to the United States, they are at risk for excess weight gain. Existing literature suggests that higher levels of food insecurity may predict obesity, but the role of acculturation is not well understood. Latino children ages 2–17 of both immigrant and non-immigrant parents (n = 63) were recruited from a primary care clinic serving low income families. Child anthropometric measures, and parent acculturation and food insecurity measures were collected via self-administered questionnaires. Over 63% of the patients were either overweight or obese according to criteria established by the Center for Disease Control and Prevention (CDC). Regression analysis revealed acculturation as a significant moderating variable between food insecurity and BMI percentile, F(5,12) = 4.836, P = .017, R ² = .707 in children of Latino immigrants. The identification of this relationship may serve to facilitate in the development of future weight-gain prevention interventions in primary care settings within Latino immigrant populations.     

Family food insufficiency is related to overweight among preschoolers

This paper studies the relationship between family food insufficiency and being overweight in a population-based cohort of preschool children (n=2103) using data from the Longitudinal Study of Child Development in Québec (1998-2002) (LSCDQ). Family food insufficiency status was derived when children were 1.5 years of age (from birth to 1.5 years) and at 4.5 years of age (from 3.5 to 4.5 years). Children's height and weight were measured at home at 4.5 years. Overweight was defined according to the US CDC sex- and age-specific growth charts and Cole's criteria. Statistical analyses were done with SAS (version 8.2). In multivariate analyses, mean body mass index (BMI) was higher for children from food insufficient families compared to children from food sufficient families, even when important factors associated with BMI, such as child's birth weight, parental BMI, maternal education, and family income sufficiency were considered. We did not report any gender effects in the multivariate analyses. The presence of family food insufficiency at some point during preschool years more than tripled (OR 3.4, 95% CI 1.5-7.6) the odds for obesity using the Cole criteria, and doubled (OR 2.0, 95% CI 1.1-3.6) the odds for overweight at 4.5 years using the CDC growth curves indicator. We observed an interaction between birth weight and family food insufficiency in relation to being overweight at 4.5 years. Low-birth-weight children living in a household that experienced food insufficiency during preschool years are at higher risk of overweight at 4.5 years. Given this important finding, supportive interventions targeting low-income and food insufficient families, including pregnant women, are recommended for preventing overweight and obesity among their children.     

Predictors and outcomes of household food insecurity among inner city families with preschool children in Vancouver

OBJECTIVES: The purposes of this study were to measure household food security and to determine its association with potential predictor variables related to household and community environments, as well as the relationship between household food insecurity and preschool children's nutritional status. METHODS: In this cross-sectional study, household food security was measured in a convenience sample of households (n=142) with children aged 2-5 years in Vancouver in March 2004. We assessed the association between environmental predictors and household food security status, adjusted for household income. Indicators of children's nutrition were compared between categories of household food security. RESULTS: Household food insecurity was associated with indicators of suboptimal health status in preschoolers. After controlling for household income, parents with less access to food of reasonable quality, fewer kitchen appliances and a lower rating of their cooking skills had greater odds of experiencing household food insecurity. IMPLICATIONS: Our study results support the need to test interventions involving collaborative efforts among government, social planners and public health practitioners to remove barriers to food security for families. Multiple measures, including opportunities to gain practical food skills and household resources that enable convenient preparation of nutrient-dense foods, could be examined. Our findings suggest the need for improved selection and quality at existing small stores and an increase in the number of food outlets in low-income neighbourhoods.     

Family characteristics have limited ability to predict weight status of young children

The ability of (a) family characteristics (marital status, income, race, and education), (b) parental control over child's food intake, and (c) parental belief in causes of overweight to predict weight status of children was assessed. Parents/caretakers of elementary school-aged children were surveyed to determine attitudes related to childhood nutrition and overweight. Anthropometric measurements were obtained from children to determine weight status (n=169 matched surveys and measurements). chi(2) tests and nested logistic regression models were used to determine relationships between children's weight status and family characteristics, parental control, and parental belief in the primary cause of overweight. Low household income was an important predictor of overweight; marital status and race added no further explanatory power to the model. Parental control was not a significant predictor of overweight. Parental belief in the primary cause of overweight in children (diet vs physical activity) was significantly related to children's weight; however, it was not significant after controlling for income. Low household income relates strongly to increased childhood weight status; therefore, school and government policies should promote an environment that supports affordable, safe, and feasible opportunities for healthful nutrition and physical activity, particularly for low-income audiences.     

Head Start teachers' perceptions of children's eating behavior and weight status in the context of food scarcity

ObjectiveTo describe Head Start teachers' perceptions of mealtime, feeding, and overweight risk in Head Start students.DesignQualitative focus group study.SettingFive Head Starts in a greater metropolitan area in the Northeast.ParticipantsThirty-five teachers in 5 focus groups.InterventionTwo experienced focus group facilitators elicited comments from each group.Main Outcome MeasureIdentification of themes for future nutrition education programming.AnalysisParticipant comments were transcribed and common themes identified by 7 readers.ResultsTeachers felt (1) empowered to shape the content of children's diets; (2) that meals served at Head Start were chaotic; (3) uncertain how to address children's voracious appetites, since children often were from homes with limited food resources; (4) skeptical about the definition of overweight; (5) that children's eating behaviors and their weight status were not connected; and (6) uncomfortable addressing overweight with students' families.Conclusions and ImplicationsTeachers' skepticism about overweight, uncertainty around managing the seemingly voracious eating behavior of children perceived as hungry as a result of inadequate food at home, and discomfort in addressing overweight with families may all represent nutrition education opportunities. Tailoring prevention programs such that they evoke support and agreement from these teachers as well as harnessing strengths, such as teachers' confidence in shaping children's eating behaviors, will be important.     

中国3～5岁儿童肥胖与铁营养状况研究

目的了解我国3—5岁儿童肥胖与铁营养状况及其相关关系。方法以参加2002年中国居民营养与健康状况调查的8960名3～5岁儿童为研究对象,排除没有血清铁蛋白检测数据者。以2006年世界卫生组织提出的儿童生长标准为参照,计算身高体重Z评分（WHZ）,WFIZ≤-2判定为消瘦,2〈WHZ≤3判定为超重,WHZ〉3判定为肥胖。以血清铁蛋白作为铁营养状况指标。结果3～5岁儿童的资料,超重率和肥胖率分别为2．0％和2．1％。消瘦、体重正常、超重和肥胖儿童的血清铁蛋白〈12μg／L的患病率分别为2．4％、4．0％、4．4％和5．4％。将身高、体重、身高体重Z评分（WHZ）与血清铁蛋白浓度进行相关性分析,发现仅女孩的身高与血清铁蛋白未见显著性关联（P〉0．05）,血清铁蛋白与身高、体重、WHZ均呈显著负相关（P〈0．05）。结论3～5岁儿童肥胖状况与血清铁蛋白水平有一定关联,提示肥胖儿童更易出现血清铁蛋白低于正常水平（〈12μg／L）。     

Grandmothers, Fathers, and Depressive Symptoms Are Associated with Food Insecurity among Low-Income First-Time African-American Mothers in North Carolina

African Americans experience household food insecurity, ie, the limited availability of nutritionally adequate and safe food, or ability to acquire acceptable foods in socially acceptable ways, at three times the rate of non-Hispanic whites. Thirty percent of all African-American children live in food-insecure households. The purpose of this study was to identify characteristics associated with household food insecurity among a high-risk postpartum population. Two-hundred six low-income, African-American mother−infant dyads were recruited through the Special Supplemental Nutrition Program for Women, Infants, and Children clinics. The six-item US Department of Agriculture food security scale was used to classify households as food secure, marginally food secure, or food insecure. Multinomial logistic regression was used to estimate the association between selected maternal/household characteristics and household food-security status. Fifty-three percent of households were food secure, 34% were marginally food secure, and 13% were food insecure. Maternal education less than college (relative risk ratio [RRR]=0.46; 95% confidence interval [CI]: 0.22 to 0.98) was inversely associated with marginal food security. Depressive symptoms (RRR=1.09; 95% CI: 1.02 to 1.16) and having the baby's father in the household (RRR=3.46; 95% CI: 1.22 to 9.82) were associated with household food insecurity, while having a grandmother in the household (RRR=0.15; 95% CI: 0.03 to 0.80) was inversely associated with experiencing household food insecurity. Findings from this study suggest that young, low-income, African-American families with only one child are particularly susceptible to experiencing household food insecurity. Intergenerational support and transfer of knowledge can be a key protective attribute among low-income African-American households.     

Urban Youth Perspectives on Food Insecurity during the COVID-19 Pandemic: Evidence from the COACHES Study

School disruptions during the COVID-19 pandemic were a likely threat to food security and exacerbated risk factors associated with poor nutrition and health outcomes among low-income youth. As part of an ongoing school-based study aimed at improving physical activity and dietary behaviors (the COACHES study), associations between youth-reported food insecurity and dietary intake across the pandemic-affected academic year of 2020–2021 were examined. Middle school students (6th and 7th grade, 94% Black/African-American, 92% free-/reduced-price lunch eligible) answered validated surveys on food insecurity and diet and were measured for height and weight for calculation of weight status during Fall 2020 (n = 88) and Spring 2021 (n = 56). During this time, schools underwent a combination of in-person, hybrid, and remote learning. Nearly half of participants were overweight or obese (47%), and self-reported food insecurity was near 30% at both time points. Less than one-third of youth met fruit and vegetable intake guidelines, and more than half drank two or more sugar-sweetened beverages daily. While controlling for sex, maternal education, and weight status, food insecurity was not significantly associated with fruit and vegetable or sugar-sweetened beverage intake. Independent of weight status, youth were aware of being food insecure, yet it did not have an apparent impact on these food groups of concern. These findings highlight the need for greater understanding of youth perceptions of food insecurity in order to adequately address dietary quality and quantity concerns among children.     

Food insecurity is associated with dietary intake and body size of Korean children from low-income families in urban areas

OBJECTIVE: This study examined household food insecurity of urban low-income families in Korea and the associations of the food insecurity with children's dietary intake and body size. DESIGN: Cross-sectional study. SETTING: Low-income neighborhoods in large cities. SUBJECTS: Included 370 children aged 4-12 y, who had all records on dietary intake and anthropometry as well as household food insecurity measures. RESULTS: Using the 10-item Radimer/Cornell Scale, 62.7% of the households showed some degree of food insecurity (8.6% for food insecure for family, 28.4% for food insecure for adults and 25.7% for child hunger households). Food insecurity was linearly and negatively associated with household economic conditions as well as the caretaker's use of nutrition knowledge. There were also significant associations of food insecurity with the children's dietary intakes, indicating the largest amount of nutrients for the children from the household food insecure, followed by those from the food secure, adult food insecure and child hunger groups. The household food insecure children were fatter than the food secure children. The fatter condition of the former children appeared to be related to more frequent intakes of low-quality foods. CONCLUSION: This study reports curvilinear associations between the status of household food insecurity and children's food intakes and fatness. SPONSORSHIP: This work was funded by a grant of the 2001 Korea Health Promotion Research Program, the Ministry of Health & Welfare, Republic of Korea.     

Food Security and Child Hunger among Recently Resettled Liberian Refugees and Asylum Seekers: A Pilot Study

Little is known about the food insecurity situation among families resettled into the United States as part of the refugee resettlement program. This paper reports on a pilot study examining food insecurity among recently arrived refugee families (n=33). Objectives were to evaluate the usefulness and feasibility of methods to assess the prevalence of food insecurity and child hunger, and to examine associations between child hunger and measures of socio-economic status and measures of acculturation. Results indicated that 85% of households were food insecure, and 42% experienced child hunger. Hunger was more likely to be indicated in households using foods stamps, with lower income, and lower education. Hunger was also more likely to be indicated in households where the primary shopper experienced difficulty shopping and with language. Results are in broad agreement with those reported in other studies and highlight economic and information barriers to achieving food security. These data suggest that further study of food insecurity is warranted among recently resettled refugee communities resettled in the United States.     

Food insecurity of low-income lone mothers and their children in Atlantic Canada

OBJECTIVE: To examine the occurrence and predictors of hunger and food insecurity over the past year and month among low-income mother-led households in Atlantic Canada. METHOD: The Cornell-Radimer Questionnaire to Estimate the Prevalence of Hunger and Food Insecurity was administered weekly for a month, with modifications, to a community sample of 141 lone mothers who took part in a larger dietary intake study. Eligible women included those living alone with at least two children under the age of 14 years in the four Atlantic Provinces and having an annual income less than or equal to Statistics Canada's low-income cut-off. RESULTS: Food insecurity over the past year occurred in 96.5% of households. Child hunger was similar to maternal hunger over the one-month study period (23%), however, it was lower than maternal hunger over the past year. On multiple logistic regression analysis, maternal hunger over the past year was predicted by maternal age over 35 years (p < 0.0005), and Nova Scotia residence (p = 0.03). Child hunger over the past year was also predicted by maternal age over 35 years (p = 0.009). Families from New Brunswick experienced less food insecurity over the past month at both the household (p = 0.01) and maternal levels (p < 0.0005). DISCUSSION: Provincial policies that might contribute to the regular occurrence of food insecurity in these families should be investigated.