Household food security and nutritional status of Hispanic children in the fifth grade

BACKGROUND: Food insecurity is a critical variable for understanding the nutritional status of low-income populations. However, limited research is available on the relation between household food insecurity and children's nutritional status. OBJECTIVE: Our objective was to examine the relations among household food insecurity, household food supplies, and school-age children's dietary intakes and body mass indexes (BMIs). DESIGN: A sample of 124 predominantly Hispanic, fifth-grade children and their mothers were surveyed as part of a school-based obesity-prevention program. Data on the children's weights and heights were collected and three 24-h dietary recalls were conducted. The mothers provided reports of household food insecurity and household food supplies. RESULTS: Food insecurity was negatively associated with the children's BMIs and household food supplies but not with the children's food intakes. However, a secondary analysis showed that as payday approached, children from the most food-insecure households had significant decreases in energy intakes and meat consumption. CONCLUSIONS: This is one of the first studies to report a significant association between food insecurity and children's nutritional status. The ages and sex-adjusted BMIs of the food-insecure children were lower than those of the food-secure children but were still within the normal range. The lower BMIs in the food-insecure children may have been due to short-term, yet periodic food restrictions that resulted as household food supplies diminished before payday. Future research is needed to assess the physiologic and psychological effects of periodic food restriction on children's health.     

Food insecurity and the relationship between household income and children's health and nutrition in Brazil

Empirical evidence indicates that children living in wealthier households have better health. Food insecurity could be related to lack of adequate nutrition experienced by poor children and may be pointed out as one of the possible explanations for this relationship. This paper investigates the association between food insecurity and children's health and nutrition and the role of the former in the child health income gradient. Using data from the 2006 Brazilian Demographic and Health Survey, the results show that children living in households with food insecurity have worse nutrition and health indicators. In addition, the relationship between household income and many children's health and nutrition measures weakens but remains significant when controlling for food insecurity.     

Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents

Household food insecurity constrains food selection, but whether the dietary compromises associated with this problem heighten the risk of nutrient inadequacies is unclear. The objectives of this study were to examine the relationship between household food security status and adults' and children's dietary intakes and to estimate the prevalence of nutrient inadequacies among adults and children, differentiating by household food security status. We analyzed 24-h recall and household food security data for persons aged 1-70 y from the 2004 Canadian Community Health Survey (cycle 2.2). The relationship between adults' and children's nutrient and food intakes and household food security status was assessed using regression analysis. Estimates of the prevalence of inadequate nutrient intakes by food security status and age/sex group were calculated using probability assessment methods. Poorer dietary intakes were observed among adolescents and adults in food-insecure households and many of the differences by food security status persisted after accounting for potential confounders in multivariate analyses. Higher estimated prevalences of nutrient inadequacy were apparent among adolescents and adults in food-insecure households, with the differences most marked for protein, vitamin A, thiamin, riboflavin, vitamin B-6, folate, vitamin B-12, magnesium, phosphorus, and zinc. Among children, few differences in dietary intakes by household food security status were apparent and there was little indication of nutrient inadequacy. This study indicates that for adults and, to some degree, adolescents, food insecurity is associated with inadequate nutrient intakes. These findings highlight the need for concerted public policy responses to ameliorate household food insecurity.     

Household food insecurity is associated with adult health status

The prevalence of household food security, which reflects adequacy and stability of the food supply, has been measured periodically in the United States and occasionally in high-risk groups or specific regions. Despite a plausible biological mechanism to suggest negative health outcomes of food insecurity, this relation has not been adequately evaluated. This study was conducted in the Lower Mississippi Delta region to examine the association between household food insecurity and self-reported health status in adults. A two-stage stratified cluster sample representative of the population in 36 counties in the Delta region of Arkansas, Louisiana, and Mississippi was selected using list-assisted random digit dialing telephone methodology. After households were selected and screened, a randomly selected adult was interviewed within each sampled household. Data were collected to measure food security status and self-reported mental, physical, and general health status, using the U.S. Food Security Survey Module and the Short Form 12-item Health Survey (SF-12). Data were reported on a sample of 1488 households. Adults in food-insecure households were significantly more likely to rate their health as poor/fair and scored significantly lower on the physical and mental health scales of the SF-12. In regression models controlling for income, gender, and ethnicity, the interaction between food insecurity status and race was a significant predictor of fair/poor health and lower scores on physical and mental health. Household food insecurity is associated with poorer self-reported health status of adults in this rural, high-risk sample in the Lower Mississippi Delta.     

Housing Circumstances are Associated with Household Food Access among Low-Income Urban Families

Household food insecurity is a pervasive problem in North America with serious health consequences. While affordable housing has been cited as a potential policy approach to improve food insecurity, the relationship between conventional notions of housing affordability and household food security is not well understood. Furthermore, the influence of housing subsidies, a key policy intervention aimed at improving housing affordability in Western countries, on food insecurity is unclear. We undertook a cross-sectional survey of 473 families in market rental (n = 222) and subsidized (n = 251) housing in high-poverty urban neighborhoods to examine the influence of housing circumstances on household food security. Food insecurity, evident among two thirds of families, was inversely associated with income and after-shelter income. Food insecurity prevalence did not differ between families in market and subsidized housing, but families in subsidized housing had lower odds of food insecurity than those on a waiting list for such housing. Market families with housing costs that consumed more than 30% of their income had increased odds of food insecurity. Rent arrears were also positively associated with food insecurity. Compromises in housing quality were evident, perhaps reflecting the impact of financial constraints on multiple basic needs as well as conscious efforts to contain housing costs to free up resources for food and other needs. Our findings raise questions about current housing affordability norms and highlight the need for a review of housing interventions to ensure that they enable families to maintain adequate housing and obtain their other basic needs.     

The modifying effects of Food Stamp Program participation on the relation between food insecurity and weight change in women

Food insecurity has been associated with overweight status in women. A number of hypotheses have been proposed to explain this association, some of which assume that household food insecurity is a cause of overweight. Similar to food insecurity, Food Stamp Program (FSP) participation has been associated with overweight status in women. One longitudinal study has also found a small effect of program participation on obesity status in women. Modeling FSP participation without accounting for the effect of need to participate in the program, as estimated by household food insecurity status, may lead to confounded findings. To estimate the direction and timing of the relation between food insecurity, this study reports on recently available longitudinal data from the Panel Study of Income Dynamics. The major finding of this paper is that persistent food insecurity was associated with a smaller weight change, controlling for other income and health-related risk factors for weight change. Among persistently food-insecure women, full participation in the FSP offset the weight change. There were no significant associations between change in food insecurity status and weight change in these data.     

Food Security Status,WIC Participation,and Early Childhood Caries in a Nationally Representative Sample of Children

BackgroundDespite the potential role of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in mitigating the adverse effects of food insecurity on oral health, to our knowledge, no study has examined whether WIC participation could modify the association between food insecurity with caries in young children.ObjectiveOur aim was to investigate the impact of WIC participation in modifying the association between food insecurity and early childhood caries.DesignThis was a cross-sectional study.Participants/settingUsing 2011-2018 National Health and Nutrition Examination Survey data, children aged 2 through 5 years; with household income ≤185% of the Federal Poverty Level; and with data on WIC participation, food security, and dental examinations were included (n = 1,921).Study exposuresFood-security status and WIC participation were the study exposures.Main outcome measuresTotal and untreated dental caries were the main outcome measures.Statistical analysesLogistic regression examined associations of food security (household-level and child-level) and WIC participation with odds of caries. Interactions between food security and WIC participation were examined using multiplicative interaction terms.ResultsMarginal child food security was significantly related to higher odds of total caries in income-eligible WIC nonparticipants (odds ratio 1.92; 95% CI 1.07 to 3.46); however, this relationship was not observed in WIC participants. Furthermore, food insecurity was significantly associated with greater odds of untreated caries only among income-eligible WIC nonparticipants (odds ratio 1.79; 95% CI 1.12 to 2.85).ConclusionsIn this sample of preschool-aged children, the relationship of food insecurity with caries differed by WIC participation status. Findings suggest that WIC participation could improve the oral health of income-eligible children with lower levels of food security.     

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.     

Household Food Insecurity Is Not Associated with Overall Diet Quality Among Pregnant Women in NHANES 1999–2008

Objective

Analyze the association between household food security status and diet quality during pregnancy.

Methods

Cross-sectional analysis of pregnant women from the National Health and Nutrition Examination Survey from 1999 to 2008. Of the 1158 pregnant women with complete household food security information, we analyzed 688 women who had complete dietary information and household incomes ≤300 % of the Federal Poverty Level (FPL). Diet quality was measured by the Alternate Healthy Eating Index modified for Pregnancy (AHEI-P) from 1 to 2 24 h dietary recalls. Multivariate linear and logistic regression models were implemented to assess the association between household food security status and AHEI-P, adjusting for age, nativity, marital status, race/ethnicity, education, and household income.

Results

Among women with household incomes ≤300 % of the FPL, 19 % were food insecure and 4 % were marginally food secure. The mean AHEI-P score was 41.9 (95 % CI 40.4, 43.3). Household food insecurity was not associated with overall diet quality. However, living in a food insecure household compared to a food secure household was associated with a 2.3 (1.3, 4.1) greater odds of having a calcium component score greater than the median intake of calcium scores among food secure women in the sample.

Conclusions for Practice

In a nationally representative sample of pregnant women, 80 % lived in a fully food secure household. Improving household food security during pregnancy is a public health opportunity to improve health outcomes; however household food security status may not be associated with overall diet quality.

     

Food Insecurity Among Latin American Recent Immigrants in Toronto

Food security is an important social determinant of health. The 2004 Canadian Community Health Survey, Cycle 2.2 reported high prevalence of food insecurity among low income households and those formed by recent immigrants. Exploration of the extent and correlates of food insecurity among recent Latin Americans (LA) immigrants is essential considering they encompasses an increasing number of young immigrants, many of whom, despite relatively high education, are unemployed or have low wage positions. This study examines the extent of food insecurity and its correlates among recent Latin American (LA) immigrants in Toronto. A cross-sectional study was conducted with a convenience sample of 70 adult LA recent immigrants. Participants were recruited from selected community health centres across Toronto using snow ball sampling. Data were collected using questionnaires in face-to-face interviews with primary household care givers. A considerably high rate of food insecurity (56%) was found among participants. Household food insecurity was highly related to: being on social assistance; limited proficiency in English; and the use of foodbanks. Our findings indicate that the primary correlate of a household’s food security status is income, which suggests the potential for strategies to improve the financial power of new immigrants to purchase sufficient, nutritious, and culturally acceptable food. Enhancing the employability of new immigrants, reforming the income structure for working adults beyond social assistance, and providing more subsidized English language and housing programs may be effective.     

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.     

Caregiver behaviors and resources influence child height-for-age in rural Chad

The purpose of this study was to identify caregiver characteristics that influence child nutritional status in rural Chad, when controlling for socioeconomic factors. Variables were classified according to the categories of a UNICEF model of care: caregiving behaviors, household food security, food and economic resources and resources for care and health resources. Sixty-four households with 98 children from ages 12 to 71 mo were part of this study. Caregivers were interviewed to collect information on number of pregnancies, child feeding and health practices, influence on decisions regarding child health and feeding, overall satisfaction with life, social support, workload, income, use of income, and household food expenditures and consumption. Household heads were questioned about household food production and other economic resources. Caregiver and household variables were classified as two sets of variables, and separate regression models were run for each of the two sets. Significant predictors of height-for-age were then combined in the same regression model. Caregiver influence on child-feeding decisions, level of satisfaction with life, willingness to seek advice during child illnesses, and the number of individuals available to assist with domestic tasks were the caregiver factors associated with children's height-for-age. Socioeconomic factors associated with children's height-for-age were the amount of harvested cereals, the sources of household income and the household being monogamous. When the caregiver and household socioeconomic factors were combined in the same model, they explained 54% of the variance in children's height-for-age, and their regression coefficients did not change or only slightly increased, except for caregiver's propensity to seek advice during child illnesses, which was no longer significant. These results indicate that caregiver characteristics influence children's nutritional status, even while controlling for the socioeconomic status of the household.     

Food insecurity among Australian children: potential determinants, health and developmental consequences

Children in food-insecure households may be at risk of poor health, developmental or behavioural problems. This study investigated the associations between food insecurity, potential determinants and health and developmental outcomes among children. Data on household food security, socio-demographic characteristics and children's weight, health and behaviour were collected from households with children aged 3-17 years in socioeconomically disadvantaged suburbs by mail survey using proxy-parental reports (185 households). Data were analysed using logistic regression. Approximately one-in-three households (34%) were food insecure. Low household income was associated with an increased risk of food insecurity [odds ratio (OR), 16.20; 95% confidence interval (CI), 3.52-74.47]. Children with a parent born outside of Australia were less likely to experience food insecurity (OR, 0.42; 95% CI, 0.19-0.93). Children in food-insecure households were more likely to miss days from school or activities (OR, 3.52; 95% CI, 1.46-8.54) and were more likely to have borderline or atypical emotional symptoms (OR, 2.44; 95% CI, 1.11-5.38) or behavioural difficulties (OR, 2.35; 95% CI, 1.04-5.33). Food insecurity may be prevalent among socioeconomically disadvantaged households with children. The potential developmental consequences of food insecurity during childhood may result in serious adverse health and social implications.     

A Longitudinal Study of Food Insecurity on Obesity in Preschool Children

BackgroundObesity and its co-occurrence with household food insecurity among low-income families is a public health concern, particularly because both are associated with later adverse health consequences.ObjectiveOur aim was to examine the relationship between household food insecurity with and without hunger in infancy and later childhood with weight status at 2 to 5 years.DesignThis longitudinal study uses household food-security status, weight, and height data collected at the first infancy and last child (2 to 5 years) Special Supplemental Nutrition Program for Women, Infants, and Children visits. Household food security was based on parent/caretaker responses to a four-question subscale of the 18-item Core Food Security Module. Obesity was defined as sex-specific body mass index for age ≥95th percentile.Participants/settingA diverse (58.6% non-white) low-income sample of 28,353 children participating in the Massachusetts Special Supplemental Nutrition Program for Women, Infants, and Children (2001-2006); 24.9% of infants and 23.1% of children lived in food-insecure households and 17.1% were obese at their last child visit.Statistical analysisMultivariate logistic regression analyses assessed the association between household food-security status during the infant and child visits, and risk of preschool obesity, while controlling for child race/Hispanic ethnicity, sex, child and household size, maternal age, education, and prepregnancy weight. Interactions between these covariates and household food-security status were also examined. In cases of multiple comparisons, a Bonferroni correction was applied.ResultsPersistent household food insecurity without hunger was associated with 22% greater odds of child obesity (odds ratio=1.22; 95% CI 1.06 to 1.41) compared with those persistently food secure (P<0.05). Maternal prepregnancy weight status modified this association with children of underweight (adjusted odds ratio=3.22; 95% CI 1.70 to 6.11; P=0.003) or overweight/obese (adjusted odds ratio=1.34; 95% CI 1.11 to 1.62; P=0.03) mothers experiencing greater odds of child obesity with persistent household food insecurity without hunger compared with those with persistent household food security.ConclusionsThese results suggest that persistent household food insecurity without hunger is prospectively related to child obesity, but that these associations depend on maternal weight status. Vulnerable groups should be targeted for early interventions to prevent overweight and obesity later in life.     

Food Security and Perceptions of Health Status: A Preliminary Study in Rural Appalachia

Food insecurity is estimated to affect about 10% of the United States population. Rural areas experience even higher rates and intensity of food security problems related to poverty, food access, and higher food costs. Reports of the relationship between household food security and health status, however, are limited. This report examines the relationship between household food security and measures of functional health status in a rural Appalachian sample. A comprehensive health status survey was completed by 1,006 individuals seen either in a clinical (n = 605) or nonclinical (n = 401) community setting. The survey included the USDA Food Security Core Module, the SF-36, and demographic and health care access questions. Household food insecurity was reported by 23% of respondents. Food insecure respondents reported significantly poorerfunctional status on all SF-36 scales compared tofood secure respondents (all p < 0.05). After adjusting for demographic and access variables in a multiple regression analysis, food insecurity remained a significant independent predictor of responses for each SF-36 scale. Generalizability of results are limited by the convenience sampling methods and geographic region in which the study was conducted. In this preliminary study, even minimal levels of food insecurity are related to self-reported levels of health status as measured by the SF-36 spectrum. Health professionals must be able to identify individuals at risk for food insufficiency; policy makers must develop more effective programs for alleviating the basic causes of food insecurity.     

Household Food Security Is Inversely Associated with Undernutrition among Adolescents from Kilosa, Tanzania

Household food insecurity contributes to poor nutritional health, with negative consequences on growth and development during childhood. Although early childhood nutrition needs have received much attention, another important nutritional phase is adolescence. In a sample of 670 adolescents from Kilosa District, Tanzania, this study used 3 approaches to better understand the relationship between food insecurity and undernutrition. First, this study examined the associations between 3 commonly used measures of household food security and undernutrition among 670 adolescents from Kilosa District, Tanzania. The measures of household food security, energy adequacy per adult equivalent, dietary diversity score, and coping strategies index, were strongly correlated with each other and household assets (P < 0.05). Second, this study measured the nutritional status of adolescents in this district, finding a high prevalence of undernutrition (21% with BMI-for-age <5th percentile of the National Center for Health Statistics/WHO reference). Third, this study measured the association between the log odds of undernutrition (as the dependent variable) and each of the 3 measures of household food security. In separate models, household energy adequacy per adult equivalent and household dietary diversity score were inversely associated with undernutrition after adjusting for gender, age, puberty, and the interaction between age and puberty. By contrast, a greater use of coping strategies was not associated with undernutrition. Strategies focused on increasing household energy intake and improving dietary diversity among the most vulnerable households could improve the nutritional health of adolescents.     

Food insecurity: a nutritional outcome or a predictor variable?

The phenomenon loosely labeled hunger in the 1980s is now being discussed as food security or insecurity. Food security is defined as access by all people at all times to enough food for an active, healthy life, and at a minimum includes the following: 1) the ready availability of nutritionally adequate and safe foods and 2) the assured ability to acquire personally acceptable foods in a socially acceptable way. Food insecurity exists whenever food security is limited or uncertain. The measurement of food insecurity at the household or individual level involves the measurement of those quantitative, qualitative, psychological and social or normative constructs that are central to the experience of food insecurity, qualified by their involuntariness and periodicity. Risk factors for food insecurity include any factors that affect household resources and the proportion of those resources available for food acquisition. Potential consequences of food insecurity include hunger, malnutrition and (either directly or indirectly) negative effects on health and quality of life. The precise relationships between food insecurity and its risk factors and potential consequences need much more research now that there is an emerging consensus on the definition and measurement of food insecurity. Indicators of food security or insecurity are proposed as a necessary component of the core measures of the nutritional state of individuals, communities or nations.     

Individual weight change is associated with household food security status

This study examined the relation between household food security status and current measured weight and change in self-reported weight over 12 mo using data from the 1999-2000 and 2001-2002 National Health and Nutrition Examination Surveys. Current measured BMI categories were as follows: underweight (<18.5 kg/m(2)), overweight (> or =25 kg/m(2)), and obese (> or =30 kg/m(2)). Change in self-reported weight used 2 cut-off points, i.e., a gain/loss of at least 2.27 kg (5 lb) and at least 4.54 kg (10 lb). Household food security categories were as follows: fully secure, marginally secure, insecure without hunger, and insecure with hunger. Multivariate analyses were adjusted for race/ethnicity, household income, education level, and current health status. Compared with women in households that were fully food secure, women in households that were marginally food secure [odds ratio (OR) 1.58] and food insecure without hunger (OR 1.76) were significantly more likely to be obese. Compared with women in households that were fully food secure, those in households that were marginally food secure were significantly more likely to gain at least 4.54 kg (OR 1.68). Compared with men in households that were fully food secure, men in households that were marginally food secure were more likely to be obese and to gain at least 4.54 kg, but these effects were smaller in magnitude than those for women and insignificant in some specifications. This study corroborates previous cross-sectional associations between intermediate levels of food insecurity and obesity for women, and it finds an association between intermediate levels of food insecurity and 12-mo weight gain for women.