Food purchase patterns indicative of household food access insecurity, children's dietary diversity and intake, and nutritional status using a newly developed and validated tool in the Peruvian Amazon

Seasonality of associations between production of indigenous foods and food security status of mother-child dyads in Kisumu County, Kenya

BACKGROUND

Food insecurity is a major predicament for rural populations, especially mothers and children, whose livelihoods are often dependent on rain-fed agriculture. Indigenous foods have the potential of mitigating food insecurity as they can thrive in poor agro-ecological conditions. However, the associations between indigenous food production and food security status of mothers and children drawn from rural contexts has not been expansively assessed. Food insecurity evident by high food poverty rates remain high in Kisumu County due to over-reliance on food imports from other counties. The objective of the study was to assess seasonality in associations between production of selected indigenous foods (kidney beans, soya beans, millet, cassava, sweet potatoes, groundnuts, green grams, cow peas, amaranth leaves, spider plant leaves, black night shade leaves, mangoes, guavas, lime, and tamarind) and food security status of mothers and children during planting and harvesting seasons.

METHODS

We used a longitudinal study design adopting both quantitative and qualitative data collection methods. A structured questionnaire assessed production of selected indigenous foods in the sampled households, Household Food Insecurity Access Scale for mother's food security status and Prevalence of Underweight for children's food security status. Ordinal logistic regression was used to derive odds ratio (OR), which assessed strength of associations between dependent variables (mother's and children's food security status) and independent variables (production of selected indigenous foods). Significance was determined at α ≤ 0.05.

RESULTS

Results demonstrated that during planting season, production of kidney beans decreased the odds of mothers being severely food insecure by 53% (OR = 0.469, 95% CI = 0.228-0.964, p = 0.039). In the same season, sorghum production demonstrated 3.5 times increase in odds of children being severely food insecure (OR = 3.498, 95% CI = 1.454-8.418, p = 0.005). During harvesting season, production of kidney beans was associated with a 62% reduction in the odds of children being severely food insecure (OR = 0.379, 95% CI = 0.190-0.754, p = 0.006).

CONCLUSIONS

Production of some of the selected indigenous foods demonstrated significant odds of predicting mother's and children's food security status across both study seasons. An intervention-based study approach that would best establish causal associations of indigenous food production and food security status is recommended.

How do Latina/o Parents Interpret and Respond to the US Household Food Security Survey Module? A Qualitative Cognitive Interviewing Study

BACKGROUND

The US Latino/a population disproportionately lives in poverty and experiences household food insecurity, especially households with children. The Household Food Security Survey Module (FSSM) was originally developed among rural White women. Despite wide use in English and Spanish, how well the FSSM captures the food insecurity experiences of Latino/a households is not well known.

OBJECTIVE

This study explored how Latino/a caregivers understood, interpreted, and perceived FSSM items and responses, and how well quantitative FSSM responses captured their reported food insecurity experiences.

DESIGN

Trained researchers conducted in-depth cognitive interviews in a qualitative study.

PARTICIPANTS AND SETTING

Interviews were conducted between October 2021 and August 2022 with Latino/a adults (N = 62) experiencing food insecurity while caring for a child (aged 18 years or younger) in the same household, and living in California, New York, or Texas.

STATISTICAL ANALYSIS PERFORMED

Qualitative analysis using iterative summaries for data reduction focused on item interpretation, response patterns, and cross-cutting themes.

RESULTS

Participants generally understood FSSM items as intended. The most salient findings were themes that applied across multiple FSSM items rather than wording issues with specific items. Underreporting of food insecurity was linked to nonaffirmative ("never") responses to items referencing not having enough money for food while describing reliance on nonmonetary resources (eg, food assistance or food pantries); emotional sensitivity to discussing food insecurity, particularly as it related to children; stigma and emotions related to skipping meals; and limited response options that participants believed did not reflect their experiences. These issues influenced multiple items, impeding ease of responding and leading to inaccurate responses in English- and Spanish-language versions.

CONCLUSIONS

Assessing coping strategies and providing more acceptable response options could enhance FSSM validity. Considering emic perspectives of Latino/a caregivers and how food access experiences differ from quantitative survey measures of food security could strengthen policy and programs.

Nutrient intakes from complementary foods are associated with cardiometabolic biomarkers among undernourished Peruvian children

Relatively little is known about how the diet of chronically undernourished children may impact cardiometabolic biomarkers. The objective of this exploratory study was to characterise relationships between dietary patterns and the cardiometabolic profile of 153 3-5-year-old Peruvian children with a high prevalence of chronic undernutrition. We collected monthly dietary recalls from children when they were 9-24 months old. At 3-5 years, additional dietary recalls were collected, and blood pressure, height, weight, subscapular skinfolds and fasting plasma glucose, insulin and lipid profiles were assessed. Nutrient intakes were expressed as average density per 100 kcals (i) from 9 to 24 months and (ii) at follow-up. The treelet transform and sparse reduced rank regress'ion (RRR) were used to summarize nutrient intake data. Linear regression models were then used to compare these factors to cardiometabolic outcomes and anthropometry. Linear regression models adjusting for subscapular skinfold-for-age Z-scores (SSFZ) were then used to test whether observed relationships were mediated by body composition. 26 % of children were stunted at 3-5 years old. Both treelet transform and sparse RRR-derived child dietary factors are related to protein intake and associated with total cholesterol and SSFZ. Associations between dietary factors and insulin were attenuated after adjusting for SSFZ, suggesting that body composition mediated these relationships. Dietary factors in early childhood, influenced by protein intake, are associated with cholesterol profiles, fasting glucose and body fat in a chronically undernourished population.

A systematic literature review of indicators measuring food security

Measurement is critical for assessing and monitoring food security. Yet, it is difficult to comprehend which food security dimensions, components, and levels the numerous available indicators reflect. We thus conducted a systematic literature review to analyse the scientific evidence on these indicators to comprehend the food security dimensions and components covered, intended purpose, level of analysis, data requirements, and recent developments and concepts applied in food security measurement. Data analysis of 78 articles shows that the household-level calorie adequacy indicator is the most frequently used (22%) as a sole measure of food security. The dietary diversity-based (44%) and experience-based (40%) indicators also find frequent use. The food utilisation (13%) and stability (18%) dimensions were seldom captured when measuring food security, and only three of the retrieved publications measured food security by considering all the four food security dimensions. The majority of the studies that applied calorie adequacy and dietary diversity-based indicators employed secondary data whereas most of the studies that applied experience-based indicators employed primary data, suggesting the convenience of collecting data for experience-based indicators than dietary-based indicators. We confirm that the estimation of complementary food security indicators consistently over time can help capture the different food security dimensions and components, and experience-based indicators are more suitable for rapid food security assessments. We suggest practitioners to integrate food consumption and anthropometry data in regular household living standard surveys for more comprehensive food security analysis. The results of this study can be used by food security stakeholders such as governments, practitioners and academics for briefs, teaching, as well as policy-related interventions and evaluations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40066-023-00415-7.

Water-Energy-Food Accessibility and Tracking Progress towards Achieving Sustainable Development Goals in the Savannah Region of Katsina State, Nigeria

Although remarkable progress has been achieved in reducing hunger and poverty and improving people’s health in the past couple of decades, humanity still faces considerable socio-economic and sustainability challenges. Ensuring sustainable access to safe and sufficient water, improved sanitation facilities, clean energy sources and healthy food is a necessary requirement for ending hunger and poverty, advancing health and achieving all the goals of the sustainable development agenda. Socio-economic variables are determinant factors of water, energy and food accessibility. Ecological region, income and education are measures used in this study, which aims to examine a pairwise comparison of water and energy sources, sanitation facilities and food accessibilities in six sampling communities and tracking progress towards achieving the sustainable development goals (SDG) at a local scale using nine specific SDG indicators. A study involving questionnaire administration covering 1785 households across the three ecological regions of Katsina state was performed. Two communities representing urban and rural households from each of the ecological regions were selected. An analysis of variance was used to test the equality of resource accessibility across the investigated communities followed up by a post hoc analysis to identify significant mean groups. The results showed that the overall access level to safely manage water and sanitation facilities were 16.5% and 28.1%, respectively. Access indices of 1.83 and 1.24 for electricity and cooking fuel, respectively, were calculated in the study area. The study revealed that location, education and income are the key drivers of water, energy and food access and choice.

Use of Formal and Informal Food Resources by Food Insecure Families in Lima, Peru: A Mixed-Methods Analysis

The goal of this study was to measure food insecurity among families with children in a low-income district of Lima, Peru and to identify the formal and informal food resources available to them that may affect their food security status. In June-July 2019, we collected data from 329 randomly selected households in Villa El Salvador (Lima, Peru). Following a mixed methods approach, we found that the percentage of households using food assistance programs (FAPs) increased with increasing levels of food insecurity, but two FAPs were heavily used by households regardless of food (in)security. The main reasons for using FAPs included financial need, already being signed up in the program, and believing that the food was of nutritional value; the main reasons for non-use were finding the program unnecessary, dislike or poor perceived quality of the food, and not being able to sign up for the program. Similarly, informal food resources, such as buying food on credit or receiving food from someone outside the household, were incrementally used with increased levels of food insecurity. Our study clarifies the relationship between level of household food insecurity and FAP use - FAPs more commonly used by food insecure households were used because of financial need, whereas the FAPs most commonly used by food secure households were those with automatic enrollment. At a programmatic level, our research highlights the need for making nutritious and preferred foods available in FAPs and standardizing the application of enrollment criteria.

Declining diversity of wild-caught species puts dietary nutrient supplies at risk

Although biodiversity loss adversely influences a variety of ecosystem functions, how declining wild food diversity affects nutrient supplies for people is poorly understood. Here, we analyze the impact of declining biodiversity on nutrients supplied by fish using detailed information from the Peruvian Amazon, where inland fisheries provide a critical source of nutrition for many of the region's 800,000 people. We found that the impacts of biodiversity loss on nutrient supplies depended on compensation, trophic dynamics, and functional diversity. When small sedentary species compensated for declines in large migratory species, fatty acid supplies increased, while zinc and iron supplies decreased. In contrast, the probability of failing to maintain supplies or nutrient supply risk increased when species were nutritionally unique. Our results show that trait-based regulations and public health polices need to consider biodiversity's vital role in sustaining nutritional benefits for over 2 billion people dependent on wild foods across the globe.

Quantification of Food Losses and Waste in Peru: A Mass Flow Analysis along the Food Supply Chain

The quantification of food losses and waste (FLW) has become a research hotspot in the last decade, but little work has been done to have food waste data in Latin American countries. This paper contributes to addressing this knowledge gap by examining the magnitude of FLW along the whole food supply chain (FSC) in Peru. The methodological approach was based on the top-down mass flow analysis at all steps of the FSC for the 2007–2017 period (most recently available data), including different food commodity groups (CGs), such as cereals, roots and tubers, oil seeds and pulses, fruits, vegetables, meat, fish and seafood, and milk. Results show an annual average of FLW of 12.8 million tonnes, which represents 47.76% of the national food supply. Regarding per capita quantities, the average amount of FLW was 426.56 kg per year when considering the entire FSC, and 67.34 kg per year when considering only the consumption step. This study suggests which steps of the FSC and CGs are the most promising targets for FLW reduction strategies in Peru.

Informal food environment is associated with household vegetable purchase patterns and dietary intake in the DECIDE study: Empirical evidence from food vendor mapping in peri-urban Dar es Salaam, Tanzania

We study the relationship between the food environment (FE) and the food purchase patterns, dietary intakes, and nutritional status of individuals in peri-urban Tanzania. In Africa, the prevailing high density of informal vendors creates challenges to characterizing the FE. We present a protocol and tool developed as part of the Diet, Environment, and Choices of positive living (DECIDE) study to measure characteristics of the FE. We mapped 6627 food vendors in a peri-urban settlement of Dar es Salaam, of which over 60% were semi-formal and informal (mobile) vendors. We compute and compare four FE metrics inspired by landscape ecology—density, dispersion, diversity, and dominance—to better understand how the informal food environment relates to food purchase patterns, diets, and nutritional status among households with persons living with human immunodeficiency virus (PLHIV).

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In Tanzania, a high density of informal vendors within this transitioning food system creates challenges to characterizing the food environment.

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We develop four metrics inspired by landscape ecology to characterize formal, semi-formal, and informal food environments.

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We use these metrics to evaluate associations to household food purchase patterns, energy intake, and nutritional status.

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Vegetables, especially green leafy vegetables, were primarily sold by informal mobile food vendors, most of whom were women.

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A greater density of vegetable vendors or informal vendors within 500 meters of a household is associated with a higher likelihood of vegetable purchases and lower energy intake.

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The role of informal and semi-formal food vendors in supporting consumption of nutritious diets should not be discounted, and gender sensitive actions to promote their livelihoods is needed.

La Niña weather impacts dietary patterns and dietary diversity among children in the Peruvian Amazon

Objective:

In 2011–2012, severe El Niño Southern Oscillation (ENSO) conditions (La Niña) led to massive flooding and temporarily displacement in the Peruvian Amazon. Our aims were to examine the impact of this ENSO exposure on child diets, in particular: (1) frequency of food consumption patterns, (2) the amount of food consumed (g/d), (3) dietary diversity (DD), (4) consumption of donated foods, among children aged 9–36 months living in the outskirts of City of Iquitos in the Amazonian Peru.

Design:

This was a longitudinal study that used quantitative 24-h recall dietary data collection from children aged 9–36 months from 2010 to 2014 as part of the MAL-ED birth cohort study.

Setting:

Iquitos, Loreto, Peru.

Participants:

Two hundred and fifty-two mother–child dyads.

Results:

The frequency of grains, rice, dairy and sugar in meals reduced by 5–7 %, while the frequency of plantain in meals increased by 24 % after adjusting for covariates. ENSO exposure reduced girl’s intake of plantains and sugar. Despite seasonal fluctuations in the availability of fruits, vegetables and fish, DD remained constant across seasons and as children aged. However, DD was significantly reduced under moderate La Niña conditions by 0·32 (P < 0·05) food groups. Adaptive social strategies such as consumption of donated foods were significantly higher among households with girls.

Conclusions:

This is the first empirical study to show differential effect of the ENSO on the dietary patterns of children, highlighting differences by gender. Public health nutrition programmes should be climate- and gender-sensitive in their efforts to safeguard the diets of vulnerable populations.

Longitudinal association between food frequency and changes in body mass index: a prospective cohort study

OBJECTIVES

Analysing data of the Young Lives Study in Peru, we aimed at assessing the association between daily food frequency and body mass index (BMI) changes between 2006 and 2016.

DESIGN

Secondary analysis of a prospective ongoing cohort study.

SETTING

20 sentinel sites in Peru.

PARTICIPANTS

Children enrolled in the younger cohort of the Young Lives Study. We used information from the second (2006-2007), third (2009-2010), fourth (2013-2014) and fifth (2016-2017) rounds of the younger cohort in Peru.

PRIMARY AND SECONDARY OUTCOMES

BMI as well as BMI-for-age z-score, both as numerical variables.

RESULTS

Data from 1948 children, mean age 4.3 (SD: 0.3) years and 966 (49.6%) women were included at baseline. In multivariable model, lower food consumption frequency was associated with increased BMI and BMI-for-age z-scores: children reporting <4 times of food consumption per day had a greater increase in BMI (β=0.39; 95% CI 0.17 to 0.62) and BMI-for-age z-score (β=0.07; 95% CI 0.01 to 0.13) compared with those reporting 5 per day. Results were consistent for those reporting exactly eating 4 times per day (β for BMI=0.16; 95% CI 0.02 to 0.30 and β for BMI-for-age z-score=0.05; 95% CI 0.01 to 0.09).

CONCLUSIONS

Children who eat <5 times per day, gain more BMI compared with those who eat ≥5 times. Parents should receive information to secure adequate nutrition for their children, both in terms of quality and quantity.

Food Access and Nutritional Status of Rural Adolescents in India: Pune Maternal Nutrition Study

INTRODUCTION

The relationships among food access, foods consumed, and nutritional status and health in developing countries are not well understood. Between 2013 and 2018, differences in the rural food environment and access to food, nutritional status, and body size in the rural villages where the Pune Maternal Nutrition birth cohort was recruited were measured and analyzed.

METHODS

Food access measures included the number of shops per 1,000 population, water availability, and distance from the highway. A total of 418 adolescents (223 boys, 195 girls) aged 18 years had diet assessed by a quantitative food frequency questionnaire; height, weight, and waist measured; body fat percentage determined by dual x-ray absorptiometry; and blood biomarkers (vitamin B12 and hemoglobin) assayed.

RESULTS

By village, the number of shops per 1,000 population ranged from 3.85 to 23.29. Boys and girls from the 2 villages with the highest food access, year-round water availability, and closest to the highway were heavier and had higher BMI, waist circumference, and body fat percentage compared with those from the lowest tertile of food access (p<0.05 for all, adjusted for SES). Across all villages, dietary diversity was poor and B12 insufficiency and anemia were prevalent. With easier access to food, consumption of staple foods decreased and outside food increased. On multivariate regression analysis, higher BMI of the adolescents was significantly associated with higher food access, along with higher weight at birth, socioeconomic scores, and daily energy consumption.

CONCLUSIONS

Results demonstrate a strong link between rural food access, foods consumed, and measures of nutritional status in an undernourished, mostly vegetarian, rural population.

Changes in food access by mestizo communities associated with deforestation and agrobiodiversity loss in Ucayali, Peruvian Amazon

Few longitudinal studies link agricultural biodiversity, land use and food access in rural landscapes. In this paper, we test the hypothesis that, in a context of economic change, cash crop expansion is associated with deforestation, reduced agrobiodiversity and changes in food access. For this purpose, we analysed data collected from the same 53 upland and floodplain mestizo households in Ucayali, Peru, in 2000 and 2015. We found an emerging transition towards less diversified food access coupled with loss of forest cover and reduced agricultural biodiversity. In 2015, diets appeared to rely on fewer food groups, fewer food items, and on products increasingly purchased in the market compared to 2000. Wild fruits and plants were mentioned, but rarely consumed. Agricultural production systems became more specialised with a shift towards commercial crops. Peak deforestation years in the 15-year period appeared linked with incentives for agricultural expansion. Our results suggest an overall trend from diversified productive and “extractive” systems and more diverse food access, towards specialized productive systems, with less diverse food access and stronger market orientation (both in production and consumption). The assumption in the food and agricultural sciences that increased income and market-orientation is linked to improved food security, is challenged by our integrated analyses of food access, agrobiodiversity, land use and forest cover. Our results highlight the importance of longitudinal, multidimensional, systemic analyses, with major implications for land use, food and health policies. The potential risks of parallel homogenisation of diets and agricultural production systems require interdisciplinary research and policies that promote integrated landscape approaches for sustainable and inclusive food systems.

Osteoporosis Knowledge and Health Beliefs Among Female Community Leaders in Peru

Background: Osteoporosis presents an increasing problem globally, primarily affecting older adults and postmenopausal women. Among important modifiable risk factors for osteoporosis, physical activity and calcium intake help reduce bone mineral loss and decrease the prevalence of osteoporosis. Although osteoporosis knowledge and health beliefs are associated with adopting preventive behavior and screening rates, few studies have evaluated them in Latin American populations. Materials and Methods: We conducted a cross-sectional study among female community leaders in a Peruvian periurban setting. A total of 60 women participated in the study, with a mean age of 43.7 ± 8.3 years, mean body mass index of 30.4 ± 5.3 kg/m², 88% being overweight or obese, and 58.3% having completed high school education or beyond. Participants completed translated and culturally adapted Osteoporosis Knowledge Test and Osteoporosis Health Belief Scale via semistructured interviews. Results: Most participants reported high knowledge regarding osteoporosis, perceived benefits to exercise and calcium intake, and health motivation. The level of osteoporosis knowledge was highly associated with the level of education, and we found a trend for the association between level of knowledge and perceived benefits of exercise and barriers to calcium intake among participants. Conclusions: Female community leaders with high health motivation and community engagement can contribute enormously to osteoporosis prevention programs in local communities in the future.

Social connectedness is associated with food security among peri-urban Peruvian Amazonian communities

BACKGROUND

Food insecurity is a major global public health issue. Social capital has been identified as central to maintaining food security across a wide range of low- and middle-income country contexts, but few studies have examined this relationship through sociocentric network analysis.

OBJECTIVE

We investigated relationships between household- and community-level social connectedness, household food security, and household income; and tested the hypothesis that social connectedness modified the relationship between income and food security.

METHODS

A cross-sectional census with an embedded questionnaire to capture social relationships was conducted among eleven peri-urban communities. Community connectedness was related to study outcomes of food security and per-capita income through regression models.

RESULTS

Of 1520 households identified, 1383 were interviewed (91.0%) and 1272 (83.9%) provided complete data. Households in the youngest communities had the most total contacts, and the highest proportion of contacts outside of the community. Household income was also associated with more outside-community contacts (0.05 more contacts per standard deviation increase in income, p<0.001).Less food secure households reported more contacts nearby (0.24 increase in household food insecurity access scale (HFIAS) for each additional contact, p<0.001). After adjusting for household-level socioeconomic status, membership in an older, larger, and better-connected community, with a greater proportion of residents engaged in rural livelihood strategies, was associated with greater food security (-0.92 decrease in HFIAS for each one-unit increase in community mean degree, p=0.008). There was no evidence that social connectedness modified the relationship between income and food security such that lower-income households benefited more from community membership than higher-income households.

CONCLUSIONS

Although households reported networks that spanned rural villages and urban centers, contacts within the community, with whom food was regularly shared, were most important to maintaining food security. Interventions that build within-community connectedness in peri-urban settings may increase food security.