Economic determinants and dietary consequences of food insecurity in the United States

Diet and nutrition in pediatric dentistry

Optimal growth and development are the primary objectives of pediatric nutrition. Dietary habits and food choices to support both oral health and systemic health are similar. Each emphasizes structured meal patterns and food choices. The oral health professional has a responsibility to screen for diet-related disorders and to treat or refer as appropriate.

Food insecurity is associated with increased risk of obesity in California women

Food insecurity, the limited or uncertain availability of nutritionally adequate and safe foods, may be associated with disordered eating and a poor diet, potentially increasing risk for obesity and health problems. Patterns of food insecurity in California women are described and relationships between food insecurity and obesity (body mass index > or = 30 kg/m(2)) are evaluated using data from the 1998 and 1999 California Women's Health Survey. A total of 8169 women aged > or = 18 y were randomly selected and interviewed by telephone. Food insecurity was evaluated by use of four questions adapted from the U.S. Household Food Security Module. Logistic regression was used to examine the relationship between food insecurity and obesity, controlling for income, race/ethnicity, education, country of birth, general health status and walking. Food insecurity without hunger affected 13.9% of the population and food insecurity with hunger, 4.3%. Almost one fifth (18.8%) of the population was obese. Obesity was more prevalent in food insecure (31.0%) than in food secure women (16.2%). Food insecurity without hunger was associated with increased risk of obesity in whites [odds ratio (OR) = 1.36] and others (OR = 1.47). Food insecurity with hunger was associated with increased risk of obesity for Asians, Blacks and Hispanics (OR = 2.81) but not for non-Hispanic Whites (OR = 0.82). Food insecurity is associated with increased likelihood of obesity and risk is greatest in nonwhites.

Fat and sugar: an economic analysis

As incomes rise, the share of income spent on food decreases. To Engel's law should be added the observation that the diet structure changes as well. Incomes and the macronutrient composition of the diet are linked at the aggregate and-most likely-the individual level. People in higher income nations consume more added sugars and fats than do people in lower income nations. Lower income consumers within rich nations consume lower-quality diets than do higher income consumers. The lowering of energy costs ($/MJ) through technological innovation has been most marked for foods containing added sugars and fat. Although wealthier persons in poor nations are more likely to be overweight, obesity in the United States is associated with lower incomes. Obesity in the United States and similar societies may be a socioeconomic, as opposed to a medical, problem and one that is related to diet structure and diet costs.

The Kids Café: a program to reduce child hunger

Hunger and food insecurity affect nearly 12 million children in the United States. Poverty is the foremost reason for hunger and food insecurity, but even the working poor sometimes have difficulty providing enough food for their household. Undernourished children may not present with severe clinical symptoms, but their ability to learn and psychosocial behavior can be affected. Feeding programs such as Kids Café can help decrease child hunger while improving learning and overall health. Kids Café's are operated by local food banks and sponsored by America's Second Harvest in partnership with ConAgra Foods, Inc. This article reviews the problem of child hunger and describes the Kids Café Program.

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

OBJECTIVE

To examine the occurrence and predictors of hunger and food insecurity over the past year and month among low-income mother-led households in Atlantic Canada.

METHOD

The Cornell-Radimer Questionnaire to Estimate the Prevalence of Hunger and Food Insecurity was administered weekly for a month, with modifications, to a community sample of 141 lone mothers who took part in a larger dietary intake study. Eligible women included those living alone with at least two children under the age of 14 years in the four Atlantic Provinces and having an annual income less than or equal to Statistics Canada's low-income cut-off.

RESULTS

Food insecurity over the past year occurred in 96.5% of households. Child hunger was similar to maternal hunger over the one-month study period (23%), however, it was lower than maternal hunger over the past year. On multiple logistic regression analysis, maternal hunger over the past year was predicted by maternal age over 35 years (p < 0.0005), and Nova Scotia residence (p = 0.03). Child hunger over the past year was also predicted by maternal age over 35 years (p = 0.009). Families from New Brunswick experienced less food insecurity over the past month at both the household (p = 0.01) and maternal levels (p < 0.0005).

DISCUSSION

Provincial policies that might contribute to the regular occurrence of food insecurity in these families should be investigated.

Food management practices used by people with limited resources to maintain food sufficiency as reported by nutrition educators

The food management practices used by people with limited resources to ensure food sufficiency have not been fully characterized. Semistructured interviews were conducted with 51 nutrition educators from the New Jersey Expanded Food and Nutrition Education Program and Food Stamp Nutrition Education Program, regarding the food management practices of program participants. Practices were grouped into two categories using the constant comparative method: manage food supply (n = 14) and regulate eating patterns (n = 15). Well-documented stratagems, such as overeating when food is available and cycling monthly eating patterns, were confirmed. Novel practices were identified. Practices causing food safety or nutritional risks included removing spoiled sections, slime, mold, and insects from food; eating other people's leftovers; and, eating meat found as road kill. A foundation was formed for a grounded theory concerning food management practices by people with limited resources. Verification of these results with audiences with limited resources and determination of prevalence and relative risk of these practices is necessary. This research is important for nutrition professionals who work with people with limited resources because it elucidated a spectrum of safe and risky food management practices, proposed methods to ameliorate monthly eating pattern cycles, and exposed the possibility of food insecurity in unsuspected cases.

Position of the American Dietetic Association: domestic food and nutrition security

In 2000, over 10% of United States (US) households, including more than 33 million people, experienced food insecurity. Food insecurity negatively affects the dietary intake and nutritional status of adults leading to poor health and increased risk for the development of chronic diseases. Food insecurity also negatively affects children's health, psychological and cognitive functioning, and their academic achievement. It is the position of the American Dietetic Association that systematic and sustained action is needed to bring an end to domestic food insecurity and hunger and to achieve food and nutrition security for all in the US. Immediate and long-range interventions, including adequate funding for and increased utilization of food and nutrition assistance programs, the inclusion of food and nutrition education in all programs providing food and nutrition assistance, and innovative programs to promote and support the economic self-sufficiency of individuals and families, are key to ending domestic food insecurity. Dietetics professionals can play a key role in ending food insecurity not only through competent and collaborative practice, but also through advocacy efforts at the local, state, regional, and national levels.

Energy intake during economic crisis depends on initial wealth and access to rice fields: the case of pregnant Indonesian women

Starting in August 1997, Indonesia experienced a radical and rapid deterioration in its economy. Between 1996 and 1998, dietary intake during the second trimester was measured in 450 pregnant women in Purworejo, Central Java, Indonesia. Using six 24 h recalls we describe the consequences of the economic crisis on the energy intake of pregnant Indonesian women. Depending on the date of data collection, women were grouped into 'before crisis', 'transition' and 'during crisis'. Mean energy intake among groups was compared using ANOVA and Student's t-test. All groups of pregnant women already had a mean energy intake before the emerging crisis that was lower than the Indonesian recommended dietary allowances (RDA). Nevertheless, energy intake differed significantly among women with different education levels (P = 0.00) and from different socio-economic groups (P = 0.00). 'During transition', a significant decrease in energy intake was experienced by urban poor women (P = 0.01). Poor women with access to rice fields had a higher rice consumption than other groups throughout the period. Our results most likely reflect the effect of higher rice price on income and welfare. 'During crisis', energy intake improved among vulnerable groups, perhaps reflecting government intervention.

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.

An Overview of Food Security and Its Measurement

Food insecurity is still found in approximately 10% of US households. Food security status can be measured reliably using the Food Security Survey Module. Nutrition and dietetics professionals have the skills to assist in the efforts to reduce hunger, improve nutrition, and measure and strengthen food security in the United States.

Nutrition education for the healthy elderly population: isn't it time?

In the United States, people are living longer, healthier lives. A major goal of our public health system is to maintain health among successful agers and prevent or delay chronic disease morbidity. Major strides are being made in identifying the dietary needs of elderly people that are different from those of younger adults. However, nutrition education programs to promote those dietary needs have lagged behind. This report reviews dietary needs, demographic information, and recent nutrition policies for older adults as a basis for nutrition education programs. This report suggests that it is time to keep pace with recent findings and develop national and state-sponsored programs that will provide nutrition education and information transference to older people in the communities.

Statewide prevalences of concern about enough food, 1996-1999

OBJECTIVE

Food insecurity is defined as not having access at all times to enough food for an active and healthy life-style. A Healthy People 2010 objective is to increase food security and reduce the risk of hunger for all households. The objective of this study was to characterize the prevalence of concern about enough food and its association with other sociodemographic and health characteristics at the state level.

METHODS

Adult respondents participating in the Behavioral Risk Factor Surveillance System survey provided information on concern about enough food from nine states from 1996 through 1999.

RESULTS

Overall, the prevalence of concern about enough food ranged from 3.1% to 11.8% for individual states. Across states, low household income was the strongest predictor of concern about enough food. The odds of being concerned about enough food were generally higher among respondents who were female, younger, and without health care coverage. The odds were generally lower among those reporting excellent or very good general health and among non-Hispanic whites.

CONCLUSION

Food security scales could be used at the state level to track progress for the Healthy People 2010 objective of reducing food insecurity and hunger across American households.

Dietary intakes of selected elements from longitudinal 6-day duplicate diets for pregnant and nonpregnant subjects and elemental concentrations of breast milk and infant formula

As part of a longitudinal investigation into mobilization of lead from the maternal skeleton during pregnancy and lactation, we have determined the daily intake of selected elements (hereafter called micronutrients) for various subjects and compared these intakes with recommended and/or published intakes, especially those of the United States, through the U.S. National Health and Nutrition Examination Survey (NHANES). We also sought to ascertain whether there was any seasonal effect in the diets. Six-day duplicate diets were collected from 15 pregnant and 16 nonpregnant migrants to Australia, 6 pregnant Australian control subjects, and 8 children of nonpregnant migrants (6 to 11 years). Samples of breast milk and infant formula were also analyzed. Blended samples were analyzed by inductively coupled plasma mass spectrometry for the elements Ca, Cu, Fe, Mg, P, K, Na, Zn, Ba, Sr, and Pb. Daily intakes of micronutrients were only about half of the daily intake estimated for non-Hispanic white females and infants in the U.S. NHANES III. Estimates of daily intakes from breast milk were also considerably lower for the migrant and Australian infants compared with the values extracted from tables of food composition and dietary recall for non-Hispanic white infants in the U.S. NHANES III. For example, Ca was a factor of approximately 3 times lower, Fe approximately 50, and Zn approximately 4. We consider our estimates a reliable indication of the daily intakes for several reasons, including the collection of up to nine quarterly collections of 6-day duplicate diets and retention of subjects in a longitudinal prospective study. The low intakes of the essential elements such as Ca, Fe, and Zn in all these population groups are of potential concern from a public health viewpoint.

Food insecurity is associated with past and present economic disadvantage and body mass index

Fears and experiences of food restriction influence eating behavior but the association between past and present economic disadvantage, food insecurity and body size is poorly understood. Therefore, we examined these associations in a nationwide, representative sample of 25- to 64-y-old Finnish men and women (n = 6506). The respondents were classified by their body mass index (BMI) into four groups: thin, normal, overweight and obese. Economic disadvantage was assessed by three indicators including low household income, unemployment during past 5 y and long-term economic problems in childhood. Food insecurity was assessed by five separate items concerning economic fears and experiences related to sufficient supply of food during the past 12 mo, and a combined scale in which those with affirmative responses to four to five items were classified as hungry. Multivariable logistic regression analyses were conducted using both the BMI grouping and indicators of economic disadvantage as independent variables to predict food insecurity, controlling simultaneously for age, educational attainment and sex. The results showed that low household income, recent unemployment and economic problems in childhood were all predictors of food insecurity. Thin people were most likely to be hungry and showed most food insecurity in five separate items. In addition, obese people reported more buying cheaper food due to economic problems and fears or experiences of running out of money to buy food than did normal weight subjects. In conclusion, both past and present economic disadvantage is associated with various aspects of food insecurity. The association between food insecurity and BMI is curvilinear.

Food insufficiency and the physical and mental health of low-income women

Poor women with children are disproportionately represented among the food insufficient. Recent research has linked food insufficiency with dietary deficiencies, but further research linking this problem to health and mental health problems is needed to inform health and social policy. We analyzed the relationship between food insufficiency and physical and mental health in a random sample of 724 single women who were welfare recipients in February, 1997. Food insufficiency was significantly associated with poor or fair self-rated health and physical limitations, and with respondents' meeting DSM-III-R criteria for recent major depression. Although the cross-sectional design of this study precludes causal inference, these findings add to a growing body of evidence that food insufficiency is associated with serious adverse physical and mental health consequences.

A critical examination of community-based responses to household food insecurity in Canada

Over the past two decades, household food insecurity has emerged as a significant social problem and serious public health concern in the "First World." In Canada, communities initially responded by establishing ad hoc charitable food assistance programs, but the programs have become institutionalized. In the quest for more appropriate and effective responses, a variety of community development programs have recently been initiated. Some are designed to foster personal empowerment through self-help and mutual support; others promote community-level strategies to strengthen local control over food production. The capacity of current initiatives to improve household food security appears limited by their inability to overcome or alter the poverty that under-pins this problem. This may relate to the continued focus on food-based responses, the ad hoc and community-based nature of the initiatives, and their origins in publicly funded health and social service sectors.

Is food insufficiency associated with health status and health care utilization among adults with diabetes?

OBJECTIVES

Preliminary studies have shown that among adults with diabetes, food insufficiency has adverse health consequences, including hypoglycemic episodes and increased need for health care services. The purpose of this study was to determine the prevalence of food insufficiency and to describe the association of food insufficiency with health status and health care utilization in a national sample of adults with diabetes.

METHODS

We analyzed data from adults with diabetes ( n =1,503) interviewed in the Third National Health and Nutrition Examination Survey. Bivariate and multivariate analyses were used to examine the relationship of food insufficiency to self-reported health status and health care utilization.

RESULTS

Six percent of adults with diabetes reported food insufficiency, representing more than 568,600 persons nationally (95% confidence interval, 368,400 to 768,800). Food insufficiency was more common among those with incomes below the federal poverty level (17% vs 4%, P < or = .001). Adults with diabetes who were food insufficient were more likely to report fair or poor health status than those who were not (63% vs 43%; odds ratio, 2.2; P=.05). In a multivariate analysis, fair or poor health status was independently associated with poverty, nonwhite race, low educational achievement, and number of chronic diseases, but not with food insufficiency. Diabetic adults who were food insufficient reported more physician encounters, either in clinic or by phone, than those who were food secure (12 vs 7, P<.05). In a multivariate linear regression, food insufficiency remained independently associated with increased physician utilization among adults with diabetes. There was no association between food insufficiency and hospitalization in bivariate analysis.

CONCLUSIONS

Food insufficiency is relatively common among low-income adults with diabetes and was associated with higher physician utilization.