An adapted version of the U.S. Department of Agriculture Food Insecurity module is a valid tool for assessing household food insecurity in Campinas, Brazil

Associação entre insegurança alimentar e níveis de hemoglobina e retinol em crianças assistidas pelo Sistema Único de Saúde no Município do Rio de Janeiro, Brasil

Neste trabalho foi analisada a associação entre insegurança alimentar e níveis de hemoglobina e retinol em crianças de 6 a 59 meses de idade. Trata-se de um estudo seccional, realizado em 2014, com amostra representativa da população de crianças nessa faixa etária, atendidas em unidades básicas de saúde do Município do Rio de Janeiro, Brasil. Para a análise dos níveis de insegurança alimentar foi utilizada a Escala Brasileira de Insegurança Alimentar e, para a determinação de hemoglobina e de retinol sérico, foi realizada a punção venosa. A associação entre as variáveis foi avaliada por intermédio de modelos de regressão quantílica. Do total de crianças estudadas, 40,3% apresentavam insegurança alimentar e as prevalências de anemia e de deficiência de vitamina A foram 13,7% e 13%, respectivamente. Os resultados do estudo revelaram associação inversa, estatisticamente significativa, entre insegurança alimentar leve e níveis de retinol. Para os demais níveis de insegurança alimentar (moderada e grave), os resultados também sugerem a presença de associação inversa para hemoglobina e, quanto aos níveis de retinol, as estimativas pontuais parecem menores em crianças com insegurança alimentar grave, entretanto, estas estimativas não foram estatisticamente significativas. Esses resultados sugerem que a insegurança alimentar pode estar associada com carências de micronutrientes em crianças menores de 5 anos.

Relationship between social indicators and food insecurity: a systematic review

ABSTRACT: Introduction: The relationships between the social indicators (SIs) that determine food insecurity (FI) have not been described yet. This systematic review aims to identify which SIs are associated with FI in Brazilian households and how these relationships are explained. Methods: The research protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO - CRD42018106527). Three independent researchers performed the search in the Latin American and Caribbean Health Sciences Literature (LILACS) and National Library of Medicine (PubMed) databases (June/2018). The study included articles that used the Brazilian Household Food Insecurity Measurement Scale (Escala Brasileira de Insegurança Alimentar - EBIA) to assess FI and that evaluated the association between SIs and FI. Results: We included 18 articles in this review. The Kappa concordance index between the researchers was 0.72 (95%CI 0.42 - 1.00). Most articles were cross-sectional and used multivariate regression for the statistical analysis. At least one income-related SI had a significant association with FI, and, in most studies, they presented the highest values of association measures. We organized the authors’ explanation about the relationships between SIs and FI in a conceptual model. The study identified three possible justifications for the association between SIs and FI: direct relationship, relationship mediated by income, or relationship mediated by another SI and income. Conclusion: Income assumed a central role in the mediation between several SIs and FI. However, the analysis methods of the studies did not allow us to investigate this mediation. Therefore, improving data analysis to isolate and understand the effect of SIs on FI is still necessary.

Food insecurity and weight status of socially vulnerable child beneficiaries of a food assistance programme in Maceió, Northeast Brazil

OBJECTIVE

To evaluate the association between weight status and food insecurity of children living in social vulnerability who are beneficiaries of a food assistance programme (FAP).

DESIGN

Cross-sectional study.

SETTING

From all children benefiting from the FAP in the municipality, 30 % were mapped in forty-seven distribution points. Their weight status was evaluated using BMI-for-age and food insecurity was determined with the Brazilian Food Insecurity Scale. Socio-economic data of the participants were collected using regular questionnaires. The main outcome measure was obesity.

PARTICIPANTS

To be a beneficiary of the FAP, a family must have a child aged 24-96 months and receive less than half a minimum wage per capita. Participating families receive 1 litre of whole milk per day.

RESULTS

In all, 1487 children had BMI-for-age and food insecurity data. Of these children, 376 (25·3 %) had excess weight, of whom 164 (11·0 %) presented with obesity, and only twenty-seven (1·8 %) were underweight; 76 % of the families had some degree of food insecurity. Multivariable analysis revealed no overall association between household food insecurity and weight status. In the specific comparison, children living in severe food insecurity were less likely to present obesity than those children living in food security (prevalence ratio = 0·60; 95 % CI 0·38, 0·96; P = 0·03).

CONCLUSIONS

In a socially vulnerable population that participates in a FAP, there was no overall association between food insecurity and weight status in children, a result which is similar to what is observed in more developed contexts.

Performance of an adapted household food insecurity access scale in measuring seasonality in household food insecurity in rural Ethiopia: a cohort analysis

Background

Seasonality poses a considerable food security challenge in Ethiopia. Yet, measuring seasonal variations in food insecurity, particularly the dimension of food access, lacks an adequately validated tool. We therefore evaluated the performance of an adapted Household Food Insecurity Access Scale (HFIAS) to estimate seasonal variations in food insecurity (FI) among subsistence villagers in Ethiopia.

Methods

We employed a cohort study design using a panel of four repeated measurements taken in June, September, and December in the year 2017, and in March 2018. The study recruited 473 villagers from the drought-affected Wolaita area in southwest Ethiopia. The performance of the HFIAS was evaluated via internal consistency (Chronbach's alpha values) and criterion validation techniques. The set of criteria include: parallelism between affirmative responses to FI questions and wealth strata; dose-response relationship between FI and dietary intake; and also FI severity and household wealth status.

Results

This study revealed that the HFIAS had satisfactory performance in four repeated measurements. The likelihood of affirmative responses to questions about FI decreased with ascending wealth quintiles. We observed an inverse dose-response relationship between FI and wealth status, and between FI and household dietary diversity.

Conclusions

The HFIAS showed an acceptable potential for measuring seasonal variations in FI in the study area. Our findings complement efforts to evaluate the scale's applicability in various settings, in order to promote cross-culture monitoring and comparisons. However, it required a careful adaption for contextual and cultural sensitivities.

Effects of family income and conditional cash transfers on household food insecurity: evidence from a longitudinal study in Northeast Brazil

Objective:

Food insecurity (FI) is a challenge to policy makers worldwide, who need to understand which polices and programmes are effective at overcoming FI. The present study aimed to examine the impact of family income and conditional cash transfers on changes in household FI status in a highly vulnerable municipality in Northeast Brazil.

Design:

A population-based longitudinal cohort study among families in a municipality in the semi-arid area in Northeast Brazil (2011 and 2014). FI was estimated with the Brazilian Household Food Insecurity Measurement Scale (EBIA). The effects of family income and cash transfer on changes in FI were estimated using logistic regression models and the population-attributable risk fraction.

Setting:

Households in Cuité, Paraíba, Brazil.

Participants:

Household respondents interviewed in 2011 (n 358) and 2014 (n 326).

Results:

There was a reduction in FI prevalence of 17·5 % across time; 24·5 % of families who were food insecure in 2011 became food secure in 2014. After adjustment, families that did not experience an increase in their total household income or a reduction in the cash transfer amount were at increased risk of persistent FI across time. If the cash transfer programme had not been in place, about 10 % of the families that switched from food insecure to food secure across time would have remained in FI instead.

Conclusions:

The decrease of FI occurred in an area of extreme climatic and social vulnerability. These changes were more related to the cash transfer than the increase in family income over time.

Household food insecurity and its association with anaemia in Mexican children: National Health and Nutrition Survey 2012

OBJECTIVES

To assess the association between household food insecurity (FI) and the presence of anaemia among Mexican children who were between 12 and 59 months old, and to determine whether this association differs by geographical regions.

METHODS

We analysed 7468 children of ages between 12 and 59 months, based on data from the 2012 National Health and Nutrition Survey (ENSANUT 2012). Haemoglobin was measured in capillary blood. Household FI levels were defined according to the Latin American and Caribbean Food Security Scale. An ordinal logistic regression model was developed to assess the relationship between FI and anaemia. The interaction between geographical regions and FI was determined.

RESULTS

The highest proportion of anaemia occurred in children with severe household FI (24.3%), compared to those from households with food security (21.2%). Children from severe FI households have a higher adjusted prevalence of anaemia than those from households with food security. FI and anaemia were associated mainly among children residing in the southern region of Mexico.

CONCLUSIONS

Our findings can contribute to a better understanding of FI and anaemia in children and to strengthen interventions to address these problems.

Prevalence of Systemic Arterial Hypertension and Associated Factors Among Adults from the Semi-Arid Region of Pernambuco, Brazil

Background

Systemic arterial hypertension is a substantial public health problem responsible for millions of deaths per year worldwide. However, little is known about the epidemiology of this disease in areas distant from large urban centers in Brazil. Such information is necessary to plan health promotion strategies.

Objective

To estimate the prevalence of hypertension and determine its associated factors in adults residing in the semi-arid region of the state of Pernambuco, Northeastern Brazil.

Method

This is a cross-sectional study conducted with a random sample of male and female adults. Individuals with systolic blood pressure ≥ 140 mm/Hg and/or diastolic blood pressure ≥ 90 mm/Hg and those who reported being under treatment with antihypertensive drugs were considered hypertensive. We collected data on demographic, socioeconomic, behavioral, and anthropometric characteristics, as well as health and nutrition. The statistical analysis used Pearson’s chi-square test, the chi-square test for trend, and multivariate Poisson regression analysis. A p-value < 0.05 in the final model was considered indicative of statistical significance.

Results

The sample consisted of 416 individuals, and the prevalence of hypertension was 27.4% (95%CI 23.2 - 32.0). In the final model, the independent predictors of hypertension were age of 40 years or older (p = 0.000), low economic class (p = 0.007), smoking (p = 0.023), overweight determined by the body mass index (p = 0.003), and reduced glucose tolerance/diabetes mellitus (p = 0.012).

Conclusion

The prevalence of hypertension was high and related to important risk factors. Thus, prevention and control strategies are recommended.

Spatial correlation between excess weight, purchase of ultra-processed foods, and human development in Brazil

The aim of this study was to analyze the spatial distribution of excess weight in Brazil and its correlation with household food insecurity, purchase of foods by type of processing, and Human Development Index (HDI). An ecological study was undertaken using data from three surveys conducted by the Brazilian Institute of Geography and Statistics. Spatial analysis techniques were used to perform univariate and bivariate analysis. The prevalence of excess weight was 34.2% (CI 95% 33.8-34.6%). Excess weight showed a moderate and significant spatial autocorrelation (0.581; p = 0.01), with higher prevalence in states in the South, Southeast and Center-West regions. A positive moderate spatial correlation was shown between the prevalence of excess weight and HDI (0.605; p < 0.05) and purchase of ultra-processed foods (0.559; p < 0.05), while a negative moderate spatial correlation was observed between prevalence of excess weight and household food insecurity (-0.561; p < 0.05). It can be concluded that there is an unequal distribution of excess weight across Brazil. The highest prevalence rates were found in states in the Southeast, South, and Center-West regions, associated with higher HDI values and higher ultra-processed food purchases as a proportion of overall household food purchases.

Associação entre risco de transtornos mentais comuns e insegurança alimentar entre mães com filhos menores de um ano de idade

Resumo Insegurança alimentar e nutricional está relacionada a problemas nutricionais e de saúde, entretanto poucos estudos a relacionam com saúde mental. O objetivo deste artigo é Investigar associação da insegurança alimentar familiar e risco de transtornos mentais comuns (TMC) em mães com filhos de um ano de idade. Estudo de coorte prospectivo com 194 mães e seus filhos desde o nascimento. Insegurança alimentar foi medida aos quatro meses pós-parto, com a Escala Brasileira de Insegurança Alimentar e risco de diagnóstico positivo de TMC nas mães ao final do primeiro ano da criança, com o Self Response Questionnaire (SRQ-20). Medidas socioeconômicas e de saúde foram utilizadas como controle. Das famílias, 59,3% apresentavam insegurança alimentar, tendo razão de risco para diagnóstico de TMC de 1,59 (IC 95%: 1,10 – 2,31), comparado com famílias em segurança alimentar. Após ajuste, modelo logístico múltiplo estimou OR = 2,20 (IC 95%: 1,16 – 4,20) para esta relação. Observou-se associação da insegurança alimentar familiar aos quatro meses pós-parto e risco de diagnóstico de TMC entre mães ao final do primeiro ano dos filhos. O enfrentamento da insegurança alimentar deve fazer parte das estratégias promotoras da saúde materna e da qualidade de vida materno-infantil.

How much does household food insecurity explain income inequalities in untreated dental caries?

BACKGROUND

The pathway by which socioeconomic disadvantages are manifested in the occurrence of dental caries remains unclear.

AIM

To explore how much the association between untreated dental caries and income inequalities is related to household food insecurity (HFI).

DESIGN

A population-based study was conducted with a sample of 466 12-year-old students. Dental caries was evaluated by an examiner who had undergone calibration exercises. HFI was assessed using the Food Insecurity Scale validated for Brazilian Portuguese. Poisson regression models were created to determine associations between dental caries and both household income and HFI. The proportion of the income effect on dental caries explained by HFI was determined by the variation in percentages between the crude prevalence ratio (PR_c ) for dental caries and this measure adjusted by HFI (PR_a ).

RESULTS

The prevalence of dental caries was higher among children from families with a per capita household income lower than US$ 71 (PR: 1.69; 95%CI: 1.15-2.49) or from US$ 71 to US$ 142 (PR: 1.50; 95%CI: 1.04-2.17). Moreover, 14% of the association between a low income and dental caries was explained by HFI.

CONCLUSIONS

Differences in the prevalence of dental caries in schoolchildren related to socioeconomic inequalities could partially be attributed to HFI in low-income families.

Evidence of the validity of the Food and Nutritional Security Scale for adolescents (ESANa)

This study aimed to develop a valid and reliable scale for assessing food and nutritional insecurity, specifically in adolescents. The initial version of the scale consisted of two subscales: perception of food insecurity and perception of nutritional security. The items were submitted to content analysis (n = 4) by a group of food and nutrition security experts, and semantic analysis (n = 20) by a group of adolescents conveniently sampled from the target population. After adjustments, the final version of the scale was applied to adolescent students (n = 425) aged 12 to 18 years (m = 14.32±0.96; CV = 6.7%). A two-factor model was the most appropriate after performing exploratory factor analysis. The subscales showed modest values of the alpha coefficient (0.69 and 0.60, respectively). Daily consumption of fruits, vegetables and soft drinks was significantly associated with higher scores in the food and nutrition security perception scale. Therefore, it is recommended to combine food access-based items with other aspects related to attitudes and behaviors towards healthy eating in order to achieve a more accurate picture of adolescent's needs and better guide public policies.

Household food insecurity but not dietary diversity is associated with children's mean micronutrient density adequacy in rural communities across Ghana

OBJECTIVE

The aim of this study was to examine predictors of household food insecurity, dietary diversity, and children's mean micronutrient density adequacy and the relationship among these dietary measures.

METHOD

Baseline analysis of a quasi-experimental 16-mo intervention study conducted in 12 rural communities in the three main agroecological zones in Ghana. The study included 608 caregivers with their 2- to 5-y-old children. Nutrient density adequacy was estimated for a subsample of 120 children.

RESULTS

Food insecurity was more severe among farming households than their non-farming counterparts (P = 0.032). Dietary diversity score was significantly higher among non-farming households than farming households (P < 0.001). Food insecurity was negatively correlated with both household dietary diversity (r = -0.385; P < 0.001) and child mean micronutrient adequacy (r = -0.305; P < 0.001). There was no significant correlation between dietary diversity and children's mean micronutrient density adequacy. Belonging to a household that is severely food insecure and household size were significant predictors of children's mean micronutrient density adequacy (ß = -0.124, P = 0.006; ß = 0.011, P = 0.006, respectively).

CONCLUSION

Household food insecurity continues to be a good indicator of lower nutrient intake in children.

Validation of a Scale to Assess Household Food Insecurity in One Rural and One Periurban Area of Ecuador, with a High Percentage of Migrants

Ecuador is the country that receives and integrates the largest amount of refugees and migrants of Latin America into its population and it has to have valid instruments for measuring and monitoring its food insecurity situation. A food security scale was applied to a sample of households in one rural area (n = 36), and another peri-urban one (n = 153). The validation was made following FAO recommendations. On applying the Raschse model it was observed that the theoretical severity of the questions was reflected similarly in the experiences of the households. The infit statistics for each item are placed in acceptable values (0.7-1.3). The results of the validated scale indicate that the study population finds itself in a serious food insecurity situation.

[Evolution of food insecurity in Mexican households: 2012-2016]

OBJECTIVE

To describe three relevant aspects of household food insecurity (FI) in Mexico: its magnitude, its distribution by social and nutritional vulnerability characteristics; its evolution between 2012 and 2016 and the effect of food assistance programs on FI in Mexican households.

MATERIALS AND METHODS

Data on 9 019 households were drawn from the 2016 National Health and Nutrition Survey (Ensanut 2016 for its Spanish initials) and were compared with data from the 2012 Ensanut. An analysis of differences in differences was made to measure the effect of food assis-tance programs on the evolution of FI.

RESULTS

As many as 69.5% of households were classified as FI. Families located in rural areas (78.0%) and residing in southern Mexico (76.3%). Households with support from a food assistance program experienced a decrease in moderate and severe FI between 2012 and 2016.

CONCLUSIONS

Findings can be used to design and target public policies seeking to improve food security governance in Mexico.

Suitability of the eight-item version of the Brazilian Household Food Insecurity Measurement Scale to identify risk groups: evidence from a nationwide representative sample

Objective

The Brazilian Household Food Insecurity Measurement Scale (EBIA) has eight general/adult items applied in all households and six additional items exclusively asked in households with children and/or adolescents (HHCA). Continuing an investigation programme on the adequacy of model-based cut-off points for EBIA, the present study aims to: (i) explore the capacity of properly stratifying HHCA according to food insecurity (FI) severity level by applying only the eight ‘generic’ items; and (ii) compare it against the fourteen-item scale.

Design

Latent class factor analysis (LCFA) models were applied to the answers to the eight general/adult items to identify latent groups corresponding to FI levels and optimal group-separating cut-off points. Analyses involved a thorough classification agreement evaluation and were performed at the national level and by macro-regions.

Setting

Data derived from the cross-sectional Brazilian National Household Sample Survey of 2013.

Participants

A nationally representative sample of 116 543 households.

Results

In all households and investigated domains, LCFA detected four distinct household food (in)security groups (food security and three levels of severity of FI) and the same set of cut-off points (1/2, 4/5 and 6/7). Misclassification in the aggregate data was 0·66 % in adult-only households and 1·06 % in HHCA. Comparison of the scale reduced to eight items with the ‘original’ fourteen-item scale demonstrated consistency in the classification. In HHCA, the agreement between both classifications was 96·2 %.

Conclusions

Results indicate the eight ‘generic’ items in HHCA can be reliably used when it is not possible to apply the fourteen-item scale.

Socioeconomic, demographic, and obstetric inequalities in food insecurity in pregnant women

Abstract Objectives: to estimate the prevalence of Food Insecurity (FI) in pregnant women and to identify its association with demographic, socioeconomic, obstetric, and anthropometric variables in female users of Family Health Units (FHUs) in the city of Colombo, state of Paraná, South Region of Brazil. Methods: a cross-sectional study of a representative sample of pregnant women from 17 FHUs in Colombo. We used the short version of the Brazilian Household Food Insecurity Measurement Scale (EBIA). In addition, we used Poisson Regression Models with robust, crude, and adjusted variance to investigate the association between FI and exposure variables. Results: 316 pregnant women participated in the study. The prevalence of FI was 45.1% (CI95% = 39.6-50.6). Adjusted analysis showed higher prevalence of FI in pregnant women with 30 years of age or older (PR = 1.66; IC95% = 1.02-2.69), with black skin or indigenous background (PR= 1.39; CI95%= 1.08-1.79), with 7 years of education or less (PR = 1.58; CI95% = 1.14-2.19), and with lower income (PR = 2.07; CI95% = 1.36-3.14). Conclusions: There was a high prevalence of FI among pregnant women, particularly among those of older age and with worse socioeconomic conditions, a group that should be considered a priority for actions aimed at promoting food security.

Food Insecurity in Older Adults: Results From the Epidemiology of Chronic Diseases Cohort Study 3

Introduction: The public health problem of food insecurity also affects the elderly population. This study aimed to estimate the prevalence of household food insecurity and its associations with chronic disease and health-related quality of life characteristics in individuals ≥65 years of age living in the community in Portugal. Methods: The data were collected from the Epidemiology of Chronic Diseases Cohort Study 3 (EpiDoC3)-Promoting Food Security Study (2015-2016), which was the third evaluation wave of the EpiDoC and represented the Portuguese adult population. Food insecurity was assessed using a psychometric scale adapted from the Brazilian Food Insecurity Scale. The data on sociodemographic variables, chronic disease, and management of chronic disease were self-reported. Health-related quality of life were assessed using the European Quality of Life Survey (version validated for the Portuguese population). Logistic regression models were used to determine crude and adjusted odds ratios (for age group, gender, region, and education). The dependent variable was the perceived level of food security. Results: Among older adults, 23% were living in a food-insecure household. The odds of living in a food-insecure household were higher for individuals in the 70-74 years age group (odds ratio (OR) = 1.405, 95% confidence interval (CI) 1.392-1.417), females (OR = 1.545, 95% CI 1.534-1.556), those with less education (OR = 3.355, 95% CI 3.306-3.404), low income (OR = 4,150, 95% CI 4.091-4.210), and those reporting it was very difficult to live with the current income (OR = 16.665, 95% CI 16.482-16.851). The odds of having a chronic disease were also greater among individuals living in food-insecure households: diabetes mellitus (OR = 1.832, 95% CI 1.818-1.846), pulmonary diseases (OR = 1.628, 95% CI 1.606-1.651), cardiac disease (OR = 1.329, 95% CI 1.319-1.340), obesity (OR = 1.493, 95% CI 1.477-1.508), those who reduced their frequency of medical visits (OR = 4.381, 95% CI 4.334-4.428), and who stopped taking medication due to economic difficulties (OR = 5.477, 95% CI 5.422-5.532). Older adults in food-insecure households had lower health-related quality of life (OR = 0.212, 95% CI 0.210-0.214). Conclusions: Our findings indicated that food insecurity was significantly associated with economic factors, higher values for prevalence of chronic diseases, poor management of chronic diseases, and decreased health-related quality of life in older adults living in the community.

[Evolution of social food assistance programs in Mexico through Ensanut MC 2016 data]

OBJECTIVE

To describe the coverage and targeting of Social Food Assistance Programs (SFAP) in Mexico.

MATERIALS AND METHODS

Data were obtained from 9 137 households of the Halfway National Health and Nutrition Survey 2016 (Ensanut MC 2016) who receive SFAP. The distribution of the SFAP by place of residence, index of socioeconomic status and SFAP relevance were analyzed.

RESULTS

44% of households receive some SFAP, with a higher concentration in indigenous households (70%), a very low socioeconomic level (70%), and moderate and severe food insecurity. The SFAP with the greatest coverage were Prospera (21%), Liconsa (9%), School Breakfasts Program (17%) and the Support Program for Older Adults; of these the best-focused program was Prospera.

CONCLUSIONS

It is necessary to review the resources of the programs and direct them to the population with greater deficiencies and greater nutritional vulnerability.

[Trends and factors associated with food insecurity in Brazil: the National Household Sample Survey, 2004, 2009, and 2013]

The aim of this study was to analyze trends and factors associated with food insecurity in Brazil in 2004, 2009, and 2013, using microdata from the National Household Sample Survey (PNAD). Food insecurity was assessed using the Brazilian Food Insecurity Scale. Independent variables were selected from a conceptual model of determination of food insecurity, which was also used in the elaboration of multiple generalized linear models. The results show a downward trend in food insecurity prevalence from 2004 to 2013, especially for moderate and severe food insecurity, from 17% in 2004 (95%CI: 15.7-18.4) to 7.9% in 2013 (95%CI: 7.2-8.7). Despite important decreases in the prevalence of moderate and severe food insecurity, regardless of the level of determination, the population strata with the lowest prevalence in 2004 showed the largest relative reduction. As for factors associated with moderate and severe food insecurity, they remained the same in the ten years covered by the PNAD survey, namely: the North and Northeast regions, urban areas with inadequate sanitation, household density > 2 persons per bedroom, ≤ 4 household durable consumer goods, and households headed by females, individuals < 60 years, and non-whites, ≤ 4 years of schooling, and being unemployed. From 2004 to 2013, the prevalence of Brazilian households with moderate and severe food insecurity dropped by half, but from the perspective of equity the advances occurred unequally and were lower in strata with greater social, economic, and demographic vulnerability.

Association between food insecurity and food intake

BACKGROUND

We aim to identify the prevalence of food insecurity and to ascertain the association between food insecurity and food intake.

METHOD

A cross-sectional survey.

SETTING

The study included users of a primary healthcare service in Belo Horizonte, Brazil, from 2013 to 2014. Socioeconomic, health, and food intake data were gathered using a questionnaire and the Brazilian Food Insecurity Scale.

SUBJECTS

Individuals 20 years old or older (n = 2817).

RESULTS

The prevalence of food insecurity among families with individuals under 18 years was 41.0%, and 26.4% in other households. After adjusting for potential confounders, the households in food insecurity with members under 18 years old, the consumption of fruits and vegetables (RP = 0.70, 95%IC: 0.58-0.84), and fruits (RP = 0.74, 95%IC: 0.59-0.93) was lower; and consumption of beans was higher (RP = 1.49, 95%IC: 1.06-2.09) compared to those with food security. In households without members under 18 years old, the consumption of fruits and vegetables (RP = 0.68, 95%IC: 0.58-0.79), fruits (RP = 0.61, 95%IC: 0.50-0.74), and beans (RP = 0.78, 95%IC: 0.63-0.97) was lower; and the consumption of tubers (RP = 1.36, 95%IC: 1.03-1.79) was higher. However, the state of food insecurity did not affect the consumption of ultra-processed foods, independently of age, sex, marital status, educational level, and employed status.

CONCLUSION

Food insecurity negatively affected the fruit and vegetable consumption in both types of families tested. The consumption of beans was higher in households with children and adolescents, and the consumption of tubers was higher in households without children and adolescents. However, food insecurity did not change the intake of ultraprocessed foods.

The relation of cash transfer programs and food insecurity among families with preschool children living in semiarid climates in Brazil

Abstract Background Food insecurity has important effects on human health, particularly in children’s. It continues to increase, with an estimated prevalence of 14.9% in the USA and 35% in Brazil. There have been few studies on the effect of cash transfer programs (CTPs) on the prevalence of food security in Brazil. Objective Evaluate the association between cash transfer programs and reductions in inequity and food insecurity. Method Population-based cross-sectional study in the state of Ceará, Northeast Brazil, with a sample of 8.000 households. Ceará is one of the poorest states. The state population of 8.5 million inhabitants, social security benefits and government grants, “ Bolsa Família”, have become the most stable source of income. The main outcomes measures were food insecurity and CTP participation. Multivariate logistic models were constructed to assess the association between participation in CTPs and food security. Results Participation in CTPs was found to be independently related to the prevalence of food security (APR 2.29 95% CI 1.57-3.33), as are education level, residential setting, and children’s nutritional status. Conclusions CTPs and investment in education are initiatives that might be used to reduce food insecurity.

Escalas de percepção da insegurança alimentar validadas: a experiência dos países da América Latina e Caribe

Resumo Objetivou-se nesta revisão sistemática comparar as escalas de insegurança alimentar validadas e utilizadas nos países latino-americanos e caribenhos, e analisar os métodos empregados nos estudos de validação. Realizou-se busca nas bases eletrônicas Lilacs, SciELO e Medline. As publicações foram pré-selecionas pelos títulos e resumos, e posteriormente pela leitura integral. Dos 16.325 estudos revisados, selecionou-se 14. Foram identificadas 12 escalas validadas para os seguintes países: Venezuela, Brasil, Colômbia, Bolívia, Equador, Costa Rica, México, Haiti, República Dominicana, Argentina e Guatemala. Além dessas, tem-se a escala latino-americana e caribenha cuja abrangência é regional. As escalas variaram em relação ao padrão de referência utilizado, número de questões e diagnóstico da insegurança. Os métodos empregados pelos estudos para validação interna foi o cálculo do coeficiente alfa de Cronbach e o modelo Rasch; para validação externa os autores calcularam associação e/ou correlação com variáveis socioeconômicas e de consumo alimentar. A exitosa experiência da América Latina e Caribe no desenvolvimento de escalas nacionais e regionais pode ser exemplo para outros países que ainda não possuem esse importante indicador capaz de dimensionar o fenômeno da insegurança alimentar.

Prevalence and Factors Associated with Food Insecurity in the Context of the Economic Crisis in Brazil

Background: The Brazilian economy has been officially in recession since 2014. Since then, there has been an increase in the unemployment rate, cost of food, and cuts in the budgets of social programs, among other situations that may interfere with the food security of the population. Objectives: The aims of this study were to identify the prevalence of and factors associated with food insecurity (FI) in Alagoas, one of the poorest states in Brazil, and to discuss the results in the context of the national economic crisis. Methods: This was a cross-sectional study in a probabilistic sample of 3366 families. FI was identified on the basis of the Brazilian Food Insecurity Measurement. The associations with independent variables that achieved P < 0.2 (by chi-square test) in the crude analysis were submitted to multivariable analysis. Results: The observed prevalence of FI was 58.3% (33.1%, 17.9%, and 7.3% for mild, moderate, and severe FI, respectively), which is considerably higher than the 34.6% found in 2013 by the Brazilian Institute of Geography and Statistics before the worsening of the economic crisis. The factors independently associated with FI in this study included the following: female head of household, head of the family having no income, female head of household being overweight, ≥4 family members, ≤4 rooms in the house, household income less than the minimum wage, family belonging to the lower economic classes (D or E), using the Bolsa Família program, residing in a nonmasonry house, or not residing in their own house. Conclusions: The prevalence of FI in Alagoas is very high, and considering previous studies, there was a marked increase in FI during the Brazilian economic crisis. All associated factors are related to the greater social vulnerability of the family. The present data point to the need to strengthen public policies for health promotion, education, employment, and income and to ensure the human right to adequate food, with the aim of reducing social vulnerability within the family in a sustainable way. In addition, this study contributes to the understanding of how national conditions can influence household-level FI.

Shame, Blame, and Status Incongruity: Health and Stigma in Rural Brazil and the Urban United Arab Emirates

Stigma is a powerful determinant of physical and mental health around the world, a perennial public health concern that is particularly resistant to change. This article builds from sociologist Erving Goffman's classic conception of stigma as a unitary social phenomenon to explore the stigma attached to two seemingly dissimilar conditions: food insecurity in rural Brazil, and obesity in the urban United Arab Emirates. Our analyses underscore that both conditions are stigmatized because they represent a departure from a deeply-held social norm, and in both cases, self-stigma plays an important role. Furthermore, in both cases, the stigma associated with food insecurity and obesity is likely at least as harmful to personal wellbeing as are the biological consequences of these conditions. Finally, evidence increasingly links obesity and food insecurity causally. Our analyses suggest that these forms of stigma transcend individuals and are largely structural in their origins, and therefore that they are most likely to be improved through structural change.

Food insecurity and maternal-child nutritional status in Mexico: cross-sectional analysis of the National Health and Nutrition Survey 2012

OBJECTIVE

To examine the association between household food insecurity (HFI) and risk of childhood stunting and to determine whether this association is modified by maternal-child overweight/obesity.

DESIGN

Observational cross-sectional study.

SETTING

Data come from the Mexican National Health and Nutrition Survey (ENSANUT 2012 by its initials in Spanish), representative of rural and urban areas.

PARTICIPANTS

Our study sample included 5087 mother-preschool child pairs and 7181 mother-schoolchild pairs.

MAIN OUTCOME MEASURES

Differences in the prevalence (95% CI) of each HFI category by socioeconomic characteristics and maternal-child nutritional status were estimated. A logistic regression model was conducted for stunting and overweight among preschool children and for stunting and overweight/obesity among schoolchildren, adjusting for pertinent covariates. HFI was measured according to the Latin American and Caribbean Food Security Scale (ELCSA by its initials in Spanish). Weight and recumbent lenght or height measures were obtained from children. Overweight and obesity in women were determined according to the WHO Growth Reference Charts. The following covariates were included: sex of the child. urbanicity (urban/rural), region of residence and maternal education. Benefiting from food assistance programmes and socioeconomic status index were also included. Results were expressed as adjusted ORs.

RESULTS

Stunting proved more prevalent in preschool children with moderate or severe HFI (16.2% and 16.8%, respectively) (p=0.036 and p=0.007, respectively) than in their counterparts with mild or no HFI (13.2% and 10.7%, respectively). Furthermore, the interaction between HFI and maternal obesity had a significant impact on stunting in preschool children (p<0.05). Severe HFI increased risk of stunting in children with non-obese mothers but not in those with obese mothers.

CONCLUSION

We have discovered a new relationship between HFI and maternal obesity on the one hand and risk of childhood stunting on the other hand. This may reflect a shared mechanism involving dual forms of malnutrition.

Household food insecurity is associated with a higher burden of obesity and risk of dietary inadequacies among mothers in Beirut, Lebanon

BACKGROUND

Mixed evidence exists with respect to the association between household food insecurity (HFIS) and obesity in low-to-middle income countries (LMICs), particularly among women. This study aimed to measure socioeconomic correlates of HFIS and explores its association with dietary intake and odds of obesity among mothers in Lebanon, a middle-income country undergoing nutrition transition.

METHODS

A cross-sectional study was conducted among a representative sample of households (n = 378) in Beirut, Lebanon. Surveys were completed with mothers of children <18 years. HFIS was measured using a locally-validated, Arabic-translated Household Food Insecurity Access Scale (HFIAS). Dietary intake was assessed using the multiple pass 24-h recall method. Associations between HFIS (food vs food insecure) and socio-demographic characteristics were reported using crude and adjusted odds ratios. The odds of consuming <2/3rd Dietary Reference Intakes (DRIs) for nutrients among mothers from food secure and food insecure households were explored. In addition, logistic regression analyses were conducted to explore the association of HFIS with obesity (BMI ≥ 30 kg/m2) and at-risk waist circumference (WC ≥ 80 cm) among mothers.

RESULTS

HFIS was found among 50% of study sample and was inversely associated with household income and mother's educational level, even after adjusting for other socioeconomic variables (p < 0.01). Mothers in food insecure households reported consuming significantly less dairy products, fruits, and nuts yet more breads and sweets; and they had higher odds of consuming <2/3rd the DRI's for key micronutrients (potassium, folate, and vitamin C) compared to secure ones. Adjusting for socioeconomic correlates, food insecure mothers had 1.73 odds of obesity (95% CI: 1.02-2.92) compared to food secure mothers.

CONCLUSIONS

High HFIS prevalence was reported among urban Lebanese households. Mothers from food insecure households had a high risk of dietary inadequacy and obesity. Adequate evidence-based public health strategies are needed to reduce the vulnerability of mothers to food insecurity in LMIC settings and alleviate their risk of a high burden of nutrient insecurity and obesity.

Food insecurity and nutritional status of individuals in a socially vulnerable situation in Brazil

Abstract The objective was to investigate the association between food insecurity (FI) and anthropometric indicators among beneficiaries of a Brazilian social program called Community Canteens (CCs). This was a cross-sectional study. The associations were analyzed by chi-square test and Poisson regression. The subjects were 1,232 patrons of Brazil’s CCs. Men with severe FI had a lower mean BMI (-1.53 kg/m2) and a lower body fat percentage (-3.83 percentage points). Men that had a fat percentage classified as “risk of diseases associated with malnutrition” had a 2.34 times greater chance of experiencing severe FI, as did those who had low weight (PR: 2.64). However, these results were no longer significant after Poisson regression. With respect to women, there were no significant associations between the variables studied and FI. The high prevalence of overweight and body fat in the population at all of the FI levels and for both sexes are an indication of the complexity of the Brazilian scenario regarding the aspect of nutrition and excess weight in poor communities.

Insegurança alimentar em gestantes da rede pública de saúde de uma capital do nordeste brasileiro

Resumo O objetivo deste artigo é avaliar a insegurança alimentar e os seus fatores associados em gestantes atendidas pela rede pública de saúde de uma capital do nordeste brasileiro. Estudo transversal, realizado com gestantes que residiam em Maceió, e que eram atendidas pela rede pública de saúde municipal, das quais foram coletados dados socioeconômicos, antropométricos e realizadas medidas de hemoglobina e glicemia capilar e aferição da pressão arterial. A insegurança alimentar foi avaliada através da Escala Brasileira de Insegurança Alimentar e sua associação com os fatores de risco foi testada por meio de análise de regressão de Poisson, com os resultados expressos pela Razão de Prevalência e Intervalo de Confiança de 95%. Foram analisadas 363 gestantes, com prevalência de insegurança alimentar de 42,7%, sendo 8,0% delas em insegurança grave. Houve associação da insegurança alimentar com: hiperglicemia materna e níveis pressóricos maternos elevados. Foi elevada a prevalência de insegurança alimentar em gestantes atendidas pela rede pública de saúde de uma capital do nordeste brasileiro, estando associada à hiperglicemia materna e a níveis pressóricos elevados. Os resultados precisam ser vistos para que sejam realizadas mais ações que garantam o direito à alimentação adequada a essa população.

Influence of sociodemographic characteristics on different dimensions of household food insecurity in Montevideo, Uruguay

Objective

To determine the factor structure of the Latin American & Caribbean Household Food Security Scale (ELCSA) and to study the influence of sociodemographic characteristics on each of the identified dimensions in Montevideo, Uruguay.

Design

Cross-sectional survey with a representative sample of urban households. Household food insecurity was measured using the ELCSA. The percentage of respondents who gave affirmative responses for each of the items of the ELCSA was determined. Exploratory factor analysis was carried out to determine the ELCSA’s factor structure. A probit model was used to determine the impact of some individual and household sociodemographic characteristics on the identified dimensions of food insecurity.

Setting

Metropolitan area centred on Montevideo, the capital city of Uruguay, April–September 2014.

Subjects

Adults aged between 18 and 93 years (n 742).

Results

The percentage of affirmative responses to the items of the ELCSA ranged from 4·4 to 31·7 %. Two factors were identified in the exploratory factor analysis performed on data from households without children under 18 years old, whereas three factors were identified for households with children. The identified factors were associated with different severity levels of food insecurity. Likelihood of experiencing different levels of food insecurity was affected by individual characteristics of the respondent as well as characteristics of the household.

Conclusions

The influence of sociodemographic variables varied among the ELCSA dimensions. Household income had the largest influence on all dimensions, which indicates a strong relationship between income and food insecurity.

Food Insecurity and the Negative Impact on Brazilian Children’s Health—Why Does Food Security Matter for Our Future Prosperity? Brazilian National Survey (PNDS 2006/07)

Background:

Food insecurity (FI) refers to limited or uncertain access to food resulting from financial constraints. Numerous studies have shown association between FI and adverse health outcomes among adults and children around the world, but in Brazil, such information is scarce, especially if referring to nationally representative information.

Objective:

To test for an independent association between FI and health outcomes.

Methods:

Most recent Brazilian Demographic and Health Survey using nationally representative complex probability sampling. Participants were 3923 children <5 years of age, each representing a household. Data from the validated Brazilian Food Insecurity Scale were dichotomized as food secure (food security/mild FI) or food insecure (moderate FI/severe FI). Poisson regression was used to test for associations between FI and various health indicators.

Results:

Models adjusted for socioeconomic and demographic variables showed that children hospitalized for pneumonia or diarrhea were 30% more prevalent in FI households (adjusted prevalence ratio [aPR]: 1.3; 1.1-1.6). Underweight children were 40% more prevalent in FI households (aPR: 1.4; 1.1-1.7). Children who didn’t eat meat and fruits and vegetables every day were 20% and 70% more prevalent in FI households (aPR: 1.2; 1.1-1.4 and aPR: 1.7; 1.3-2.3), respectively.

Conclusion:

Children who grow up in food-insecure households have been shown to have worse health conditions than those in food-secure households. Consequently, their human capital accumulation and work–life productivity are likely to be reduced in the future, leading them into adulthood less capable of generating sufficient income, resulting in a cycle of intergenerational poverty and FI.

[Social inequalities influence the quality and diversity of diet in Brazilian children 6 to 36 months of age]

The objective of this study was to assess dietary patterns in Brazilian children and factors associated with better diet. The authors used data for 2,477 children 6 to 36 months of age from the Brazilian National Survey of Demographic and Health in 2006-2007. Diet was assessed and classified using a composite index. The results showed that 28.2% of the children received a high-quality diet and 20% had a diversified diet. Children from socioeconomically underprivileged families or with serious food insecurity were approximately 40% less likely to have high-quality diets. Children living in homes with food insecurity were 71% less likely to have diversified diets, and those whose mothers had limited education were 43% less likely. Children residing in the North of Brazil were less likely to have diversified and high-quality diets. The dietary quality of Brazilian children is inadequate, and social vulnerability is closely associated with this adverse dietary situation.

Household food security and breast-feeding duration among Canadian Inuit

Objective

There have been few studies investigating the association between food security and breast-feeding duration and none have been conducted among Canadian Inuit, a population disproportionately burdened with food insecurity. We evaluated the association between household food security and breast-feeding duration in Canadian Inuit children.

Design

Data were obtained from the Nunavut Inuit Child Health Survey, a population-based cross-sectional survey.

Setting

The Canadian Territory of Nunavut in 2007 and 2008.

Subjects

Caregivers of Inuit children aged 3–5 years. Participating children were randomly sampled from community medical centre lists.

Results

Out of 215 children, 147 lived in food-insecure households (68·4 %). Using restricted mean survival time models, we estimated that children in food-secure households were breast-fed for 16·8 (95 % CI 12·5, 21·2) months and children in food-insecure households were breast-fed for 21·4 (95 % CI 17·9, 24·8) months. In models adjusting for social class, traditional knowledge and child health, household food security was not associated with breast-feeding duration (hazard ratio=0·82, 95 % CI 0·58, 1·14).

Conclusions

Our research does not support the hypothesis that children living in food-insecure households were breast-fed for a longer duration than children living in food-secure households. However, we found that more than 50 % of mothers in food-insecure households continued breast-feeding well beyond 1 year. Many mothers in food-secure households also continued to breast-feed beyond 1 year. Given the high prevalence of food insecurity in Inuit communities, we need to ensure infants and their caregivers are being adequately nourished to support growth and breast-feeding, respectively.

The impact of nutritional status and nutrition supplementation on outcomes along the HIV treatment cascade in the resource-limited setting

PURPOSE OF REVIEW

This review proposes to examine the role of nutrition (defined at body mass index, food security or nutrition interventions) in each of the steps of the treatment cascade for HIV.

RECENT FINDINGS

Food insecurity was found to be associated with increase in risk behaviors, with decreased retention in care and with lower adherence to antiretroviral therapy; fewer studies looked at the role of baseline body weight on outcomes such as mortality. Studies of nutrition interventions had more complex outcomes but improvement in nutritional status was the outcome that was most commonly identified.

SUMMARY

Nutrition has an important role to play in the current care of HIV-infected individuals and can have an impact on the treatment cascade. Food in security, which may be reversed by the provision of food, is of particular interest as studies suggest associations with multiple outcomes.

Inverse association between social support and household food insecurity in a metropolitan area of Rio de Janeiro, Brazil

OBJECTIVE

To verify the association between perceived social support and household food insecurity (HFI).

DESIGN

A cross-sectional survey.

SETTING

A population-based study with a representative sample of households from a metropolitan area of Rio de Janeiro, Brazil, conducted in 2010. HFI was estimated with the Brazilian Food Insecurity Scale (EBIA). Social support was assessed using the adapted and validated Brazilian version of the Medical Outcomes Study Social Support Survey. Multinomial logistic regression was used to evaluate the association between social support and HFI, adjusting for potential confounders.

SUBJECTS

Adults (n 1022) aged 19-60 years old (27% men, 73% women) who were responsible for feeding the household.

RESULTS

Individuals with high scores of social support were less likely to experience moderate HFI (OR=0·96; 95% CI 0·94, 0·99) and severe HFI (OR=0·96; 95% CI 0·94, 0·98).

CONCLUSIONS

These findings indicate that social support may contribute to reducing HFI in populations vulnerable to poverty. Strategies to increase social relationships should be encouraged in this group to enhance their perceived social support.

A Model-Based Approach to Identify Classes and Respective Cutoffs of the Brazilian Household Food Insecurity Measurement Scale

BACKGROUND

The Brazilian Household Food Insecurity Measurement Scale (EBIA) is the main tool for assessing household food insecurity (FI) in Brazil, assisting in monitoring and improving national public policies to promote food security. Based on the sum of item scores, households have been classified into 4 levels of FI, with the use of cutoffs arising from expert discussions informed by psychometric analyses and policy considerations.

OBJECTIVES

This study aimed to identify homogeneous latent groups corresponding to levels of FI, examine whether such subgroups could be defined from discriminant cutoffs applied to the overall EBIA raw score, and compare these cutoffs against those currently used.

METHODS

A cross-sectional population-based study with a representative sample of 1105 households from a low-income metropolitan area of Rio de Janeiro was conducted. Latent class factor analysis (LCFA) models were applied to the answers to EBIA's items to identify homogeneous groups, obtaining the number of latent classes for FI measured by the scale. Based on this and a thorough classification agreement evaluation, optimal cutoffs for discriminating between different severity levels of FI were ascertained. Model-based grouping and the official EBIA classification cutoffs were also contrasted.

RESULTS

LCFA identified 4 homogeneous groups with a very high degree of class separation (entropy = 0.906), endorsing the classification of EBIA as a 4-level measure of FI. Two sets of cutoffs were identified to separate such groups according to household type: 1/2, 5/6, and 10/11 in households with children and adolescents (score range: 0-14); and 1/2, 3/4, and 5/6 in adult-only households (score range: 0-7).

CONCLUSION

Although roughly classifying EBIA as in previous studies, the current approach suggests that, in terms of raw score, households endorsing only one item of the scale would be better classified by being placed in the same stratum as those remaining negative on all items.

Insegurança alimentar e consumo alimentar inadequado em escolares da rede municipal de São Leopoldo, RS, Brasil

Resumo Estudo transversal, de base escolar, que avaliou insegurança alimentar (IA) e associação com consumo alimentar inadequado (CAI) em 782 escolares (6,9 ± 0,5 anos) do 1º ano do ensino fundamental das escolas municipais de São Leopoldo, RS. Os dados foram obtidos das mães/responsáveis. Mediu-se IA com a Escala Brasileira de Insegurança Alimentar, e ingestão com questionário de frequência alimentar. Os alimentos foram classificados em marcadores de alimentação saudável (MAS) e não saudável (MANS) e receberam pontuação segundo a frequência de ingestão. MAS: 0 - 1 dia – zero; 2 a 3 dias – 0,25; 4 a 5 dias – 0,75; 6 a 7 dias – 1, sendo o inverso para os MANS. Os escores podiam variar de 0 a 25 (EMAS) e de 0 a 19 (EMANS). Um escore total (ET) padronizado foi obtido [EMAS*(19/44) + EMANS*(25/44)] e a pontuação podia variar de 0 a 22. Os escores foram categorizados em terços e o 1º considerado CAI. A IA foi de 45,1% e as pontuações médias foram 5,9 (EMAS), 15,9 (EMANS) e 11,6 (ET). Não se identificou associação entre IA e CAI. IA elevada e baixos escores alimentares exigem ações intersetoriais para garantir acesso à alimentação em quantidade e qualidade adequadas nesta população.

Factors associated with nutritional outcomes in the mother–child dyad: a population-based cross-sectional study

Objective

To estimate factors associated with double burden of nutritional outcomes in the mother–child dyad at the household level (child stunting and/or maternal overweight).

Design

Cross-sectional study using the Brazilian Demographic and Health Survey. Nutritional outcomes were: mother with normal weight and child with normal height; overweight mother and child with normal height; mother with normal weight and short-stature child; and overweight mother and child with short stature (double burden). The child was classified as short when height-for-ageZ-score was <−2 and the mother as overweight when BMI was ≥25·00 kg/m2. Socio-economic status, environment, social vulnerability, maternal characteristics and the child’s food intake were the exposure factors. The hierarchical approach for multinomial logistic regression modelling was used to assess the associations.

Setting

National Demographic and Health Survey of Children and Women conducted in Brazil, 2006–2007.

Subjects

Mother–child dyads (n3676).

Results

After adjustments, lower maternal educational level (OR=3·53; 95 % CI 1·33, 9·33) and inadequate household (non-masonry house; OR=2·54; 95 % CI 1·39, 4·66) were associated with the double burden of malnutrition. Mother’s short stature (OR=3·41; 95 % CI 1·76, 6·61), child’s vegetable intake on less than or equal to 4 d/week (OR=2·21; 95 % CI 1·03, 4·75) and inadequate household (non-masonry house; OR=2·29; 95 % CI 1·36, 3·87) were associated with child’s short stature. The lack of breast-feeding (OR=2·00; 95 % CI 1·07, 3·72) was associated with maternal overweight.

Conclusions

The present findings contribute to establishing strategies promoting health and healthy diets, by considering the growth deficit and overweight/obesity concomitantly.

Household food insecurity, nutritional status and morbidity in Brazilian children

OBJECTIVE

To identify the association of household food insecurity (HFI) with anthropometric status, the risk of vitamin A deficiency and anaemia, morbidities such as cough and fever, and hospitalizations for diarrhoea and pneumonia in children under 5 years old.

DESIGN

Cross-sectional study using data from the 2006 Brazilian Demographic and Health Survey. HFI was measured with the Brazilian Food Insecurity Measurement Scale (EBIA). Vitamin A deficiency and anaemia were assessed in blood samples. Child morbidities were reported by the child's mother and included cough, fever, and hospitalizations for diarrhoea and pneumonia. Regression results were expressed as unadjusted and adjusted OR and corresponding 95 % CI for severe food insecurity, with statistical significance set at P<0·05.

SETTING

Nationally representative survey.

SUBJECTS

Children (n 4064) under 5 years old.

RESULTS

There was no association between HFI and vitamin A deficiency, pneumonia, wasting or overweight. The prevalence of cough, fever, hospitalization for diarrhoea and stunting were associated with degree of HFI severity. There was a significant association of morbidities and stunting with severe food insecurity (v. food secure). After controlling for confounders, the association between severe food insecurity (v. food secure/rest of food insecurity categories) and the prevalence of common morbidities remained strong, showing that severely food-insecure children had a greater likelihood of experiencing cough (adjusted OR=1·79) and of being hospitalized for diarrhoea (adjusted OR=2·55).

CONCLUSIONS

Severe HFI was associated with cough and severe diarrhoea among Brazilian children.

Association between untreated dental caries and household food insecurity in schoolchildren

Abstract The aim of the present study was to assess the association between untreated dental caries (UDC) and household food insecurity (HFI) among schoolchildren in different income strata. A population-based study was carried out with a sample of 584 12-y-old schoolchildren. Oral examinations were performed and HFI was determined using a validated scale. Other independent variables were analyzed for being of interest to the stratification of the results (per capita household income) or for acting as potential confounding variables. The prevalence of UDC and HFI was 45% and 39%, respectively. The multivariate models demonstrated that the UDC was significantly more prevalent among children in food-insecure households with per capita income of up to US$ 70.71 than among those in the same income stratum that were free of HFI [PR = 1.52 (95%CI = 1.01-2.29)]. HFI was associated with a greater frequency of UDC among low-income schoolchildren, but had no significant impact on this variable among children from other income strata. Thus, ensuring access to quality food may be a good strategy for minimizing inequities in oral health and reducing dental caries experience among schoolchildren from low-income families.

Reliability and validity of an individually focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status

OBJECTIVE

To determine the reliability, validity and correlates of measures of food insecurity (FI) obtained using an individually focused food insecurity access scale (IFIAS) among pregnant women of mixed HIV status in northern Uganda.

DESIGN

A mixed-methods study involving cognitive interviews nested within a cross-sectional survey.

SETTING

The antenatal care clinic of Gulu Regional Referral Hospital.

SUBJECTS

Survey respondents included 403 pregnant women, recruited in a ratio of one HIV-infected to two HIV-uninfected respondents, twenty-six (nine of them HIV-infected) of whom were asked to participate in the cognitive interviews.

RESULTS

Over 80% of cognitive interview participants reported understanding the respective meanings of six of the nine items (i.e. items 4 to 9) on the IFIAS. Two main factors emerged from rotated exploratory factor analysis of the IFIAS: mild to moderate FI (IFIAS items 1-6) and severe FI (items 7-9). Together, they explained 90·4% of the FI measure's variance. The full IFIAS and the two subscales had moderate to high internal consistency (Cronbach's α ranged from 0.75 to 0.87). Dose-response associations between IFIAS scores, and measures of socio-economic status and women's diet quality, were observed. Multivariate linear regression revealed significant positive associations between IFIAS scores and HIV infection, maternal age, number of children and a history of internal displacement. IFIAS scores were negatively associated with women's diet diversity score, asset index and being employed.

CONCLUSIONS

The IFIAS showed strong reliability, validity and contextual relevance among women attending antenatal care in northern Uganda.

The association between intimate partner domestic violence and the food security status of poor families in Brazil

Objective

To assess the association between physical intimate partner violence and household food security within households with schoolchildren.

Design

Cross-sectional study.

Setting

Salvador, Bahia, north-eastern Brazil.

Subjects

The study was conducted in 1019 households with students. Violence between couples was evaluated using the Portuguese version of the revised Conflict Tactics Scales (CTS2), previously adapted and validated for use in Brazil. The Brazilian Food Insecurity Scale (BFIS) was used to identify food insecurity. We also obtained socio-economic information for each participant. We used multivariate Poisson regression to assess the associations of interest.

Results

According to the results of the BFIS, 62·5 % of the households were found to experience food insecurity, including 19·5 % moderate food insecurity and 6·5 % severe food insecurity. The prevalence of minor physical violence was 9·6 % (95 % CI 7·8, 11·4 %) and of severe physical violence was 4·7 % (95 % CI 3·4, 6·0 %) among the couples. In the final multivariate model, it was found that couples reporting minor (prevalence ratio=1·23; 95 % CI 1·12, 1·35) and severe (prevalence ratio=1·16; 95 % CI 1·00, 1·34) physical violence were more likely to be experiencing household food insecurity, compared with those not reporting physical violence.

Conclusions

Physical intimate partner violence was associated with food insecurity of households. The present study brings new data to the subject of the role of violence in the context of food insecurity.

Relationship between food insecurity and nutritional status of Brazilian children under the age of five

OBJECTIVE

The aim of this study was to investigate the relationship between food insecurity and nutritional status of Brazilian children.

METHODS

The National Demographic and Health Survey 2006 database is available on the worldwide web. Thus, the analyzed variables were obtained in this study, including nutritional indices, food insecurity and other socioeconomic and demographic variables. The height-for-age, weight-for-age and weight-for-height indices were evaluated as the Z-score of the World Health Organization reference curves. Food insecurity was defined by using the Brazilian Food Insecurity Scale. Averages of three indices according to the presence of food insecurity were analyzed, including other variables. Linear regression evaluated the effect of food insecurity on the Z-score of the three nutritional indices.

RESULTS

The sample included 4,817 children, out of whom 7% had deficit in height, 7% were overweight and 47% had food insecurity. It was found that the average of height-for-age, weight-for-age and weight-for-height were -0.31, 0.12 and 0.40, respectively, being lower among children with food insecurity.

CONCLUSION

The regression analysis showed that children living with some level of food insecurity have worse rates of height-for-age, even controlling for demographic and socioeconomic factors.

Insegurança alimentar entre adolescentes brasileiros: um estudo de validação da Escala Curta de Insegurança Alimentar

Objetivo Os objetivos do trabalho foram avaliar a validade interna e a capacidade preditiva da escala de segurança alimentar de seis itens aplicada a adolescentes. Métodos Foi um estudo transversal com amostra representativa de adolescentes brasileiros (N=14.690), realizado em escolas públicas e privadas nas 26 capitais de estados brasileiros e no Distrito Federal por meio de questionário online. Resultados A maior parte dos respondentes era do sexo feminino (53,2%), com idade média de 14,4 anos, sendo 72,7% de escolas públicas. O comportamento da escala, observado pelo modelo de Rasch, foi melhor sem o item cinco, apresentando valores ótimos de Infit e nível de severidade crescente entre os itens. O alfa de Cronbach foi 0,77, e as análises do funcionamento diferencial dos itens mostraram comportamento dos itens semelhante entre os subgrupos avaliados. A análise fatorial mostrou a unidimensionalidade do instrumento. Conclusão Foi proposta a retirada do item cinco e novos pontos de corte para a escala curta de segurança alimentar. A escala curta de segurança alimentar é válida e confiável para mensurar insegurança alimentar domiciliar entre adolescentes brasileiros.

Household Food Insecurity is Associated with Respiratory Infections Among 6-11-Month Old Infants in Rural Ghana

BACKGROUND

To determine the relationship between household food insecurity (HHFI) and symptoms of respiratory infections among infants in rural Ghana.

METHODS

The study was cross-sectional. The outcome variables were symptoms of respiratory infections (cough and nasal discharge) in infants. HHFI was measured using a 15-item modified U.S. Department of Agriculture (USDA) household food security module. Households were classified as food insecure if they had an affirmative answer for at least 1 item. Associations were examined using multiple logistic regression analysis. Data were collected in 32 communities located in 3 rural subdistricts in the Upper Manya Krobo district of the Eastern region of Ghana. The sample included 367 infants aged 6-11 months who attended a community-based growth monitoring session.

RESULTS

Overall, 20.5% of households reported experiencing food insecurity in the last month. Compared with infants in food secure households, infants living in food insecure households were about twice as likely to experience cough (adjusted odds ratio: 2.25, 95% confidence intervals: 1.25, 4.04) and nasal discharge (adjusted odds ratio: 1.87, 95% confidence intervals: 1.05, 3.36).

CONCLUSION

Infants living in food insecure households are at an increased risk of respiratory tract morbidity. Interventions that address HHFI might be important to improve infant health in rural Ghana.