The Association between Food Insecurity and Obesity in Children-The National Health and Nutrition Examination Survey

Balancing nutrition and budgets: Socio-ecological impacts on nutritional environments of families with low incomes

BACKGROUND

Research on childhood nutritional environments, which are predictive of a variety of child and family health and wellbeing outcomes, has primarily focused on parenting behaviors and the home food environment. However, broader social and community factors play an important role in shaping nutritional environments during early childhood. Food security is a key example that is closely linked to nutrition-related health disparities, which can arise from constrained financial resources and material deprivations. Understanding parent and caregiver lived experiences related to social and community components of family nutritional environments in the context of economic constraints could help to support multi-level nutritional practices that are optimal for healthy child development.

METHOD

Semi-structured in-depth interviews were conducted using a narrative approach with parents (n = 21) of pre-school aged children living near or below the poverty line. Participants were recruited from social and community service sites pertinent to maternal and child health in Philadelphia where health disparities are highly concentrated. Analysis was conducted using MAX QDA analytic software following a systematic approach for thematic analysis in narrative research.

RESULTS

Three themes describe the feeding and eating environments in the home and community context: 1) Food Procurement and Meal Planning; 2) Family Togetherness; 3) Creativity, Variety, and Flexibility. Creative decision making and food procurement strategies responsive to child preferences were balanced by shopping to save and visiting multiple stores for the best foods and savings. Logistical (e.g., transportation, childcare) and emotional supports facilitated food shopping habits and routines, while lack of trusted childcare, reliable transportation, and social support barriers challenged feeding and eating decisions.

CONCLUSION

Strategies for improving cost and time-efficiencies could help support health-promoting nutritional environments of families with food insecurity. Building social and community capacity and facilitating connections to practical supports that include trustworthy childcare and peer support may be particularly important for this population.

Mapping computational cognitive profiles of aging to dissociable brain and sociodemographic factors

Aging is associated with declines in cognition and brain structural integrity. However, there is equivocality over (1) the specificity of affected domains in different people, (2) the location of associated patterns of brain structural deterioration, and (3) the sociodemographic factors contributing to 'unhealthy' cognition. We aimed to identify cognitive profiles displayed by older adults and determine brain and sociodemographic features potentially shaping these profiles. A sample of Southeast-Asian older adults (N = 386) participated in a multi-session study comprising cognitive testing, neuroimaging, and a structured interview. We used computational models to extract latent mechanisms underlying cognitive flexibility and response inhibition. Data-driven methods were used to construct cognitive profiles based on standard performance measures and model parameters. We also investigated grey matter volume and machine-learning derived 'brain-ages'. A profile associated with poor set-shifting and rigid focusing was associated with widespread grey matter reduction in cognitive control regions. A slow responding profile was associated with advanced brain-age. Both profiles were correlated with poor socioeconomic standing and cognitive reserve. We found that the impact of sociodemographic factors on cognitive profiles was partially mediated by total grey and white matter, and dorsolateral prefrontal and cerebellar volumes. This study furthers understanding of how distinct aging profiles of cognitive impairment uniquely correspond to specific vs. global brain deterioration and the significance of socioeconomic factors in informing cognitive performance in older age.

Applying an Equity Lens to Pediatric Obesity: Clinical, Environmental, and Policy Considerations for Clinicians

The etiology of pediatric obesity is complex and multifactorial. This article encourages pediatric clinicians to consider patient's socioenvironmental context and structural discrimination as drivers of pediatric obesity. Viewing pediatric obesity through an equity lens can inform clinical practice, advocacy, and policy to promote equity.

Food Insecurity Screening and Referral Practices of Pediatric Clinicians in Metropolitan Washington, DC

BACKGROUND/OBJECTIVES

In 2022, 17.3% of US households with children experienced food insecurity (FI). The objective of this study was to examine pediatric clinicians' FI screening and management immediately following the release of the American Academy of Pediatrics (AAP) 2015 FI Policy Statement.

METHODS

Data were collected in 2016 from 85 primary care pediatric clinicians via an online survey of clinicians in the Washington, DC metropolitan area. Descriptive statistics were calculated using univariate/bivariate analyses. Fisher's exact test and Chi-square tests were used to explore the association between FI screening, health insurance, and clinician demographics.

RESULTS

Sixty-six percent of clinicians indicated that they infrequently screened for FI. Only 13% of clinicians used a standardized FI screening tool. Forty-five percent of clinicians screened for FI only when they perceived an acute concern. About 70% of them screened for FI when a patient presented with poor weight gain or was underweight.

CONCLUSIONS

Immediately after the release of the AAP Policy Statement, it was found that few pediatric clinicians appropriately and frequently screened for FI in our regional sample. Our data emphasize the common misconceptions held by clinicians around FI and the necessity to incorporate training that underscores the invisibility of FI along with effective techniques to screen and intervene.

Translational science approaches for food insecurity research

Food insecurity is a pervasive problem that impacts health and well-being across the lifespan. The human research linking food insecurity to poor metabolic and behavioral health outcomes is inherently correlational and suffers from a high degree of variability both between households and even within the same household over time. Further, food insecurity is impacted by societal and political factors that are largely out of the control of individuals, which narrows the range of intervention strategies. Animal models of food insecurity are being developed to address some of the barriers to mechanistic research. However, animal models are limited in their ability to consider some of the more complex societal elements of the human condition. We believe that understanding the role that food insecurity plays in ingestive behavior and chronic disease requires a truly translational approach, and that understanding the health impacts of this complex social phenomenon requires understanding both its psychological and physiological dimensions. This brief review will outline some key features of food insecurity, highlighting those that are amenable to investigation with controlled animal models and identifying areas where integrating animal and human studies can improve our understanding of the psychological burden and health impacts of food insecurity. In the interest of brevity, this review will largely focus on food insecurity in the United States, as the factors that contribute to food insecurity vary considerably across the globe.

Relationship between food insecurity and malnutrition in schoolchildren from low- and middle-income countries - A systematic review

Introduction

The objective of this review is to study the relationship between food insecurity (FI) and malnutrition in schoolchildren from low-and middle-income countries (LMIC). The review was conducted using the databases PubMed, MEDLINE, CENTRAL, LILACS and SCiELO during the months of March to April 2022 without language or publication date restrictions. The search strategy consisted of combinations of text words and controlled vocabulary (MeSH terms and DeCS) related to "schoolchildren", "low- and middle-income countries" and "food insecurity". Fifteen studies were included in this review. Studies assessing FI and undernutrition in LMIC schoolchildren have indicated that FI is associated with lower height-for-age and higher prevalence of undernutrition overall. Only two studies identified a positive risk association between FI and overweight and obesity, the remaining studies suggested that schoolchildren with FI have a lower risk of overweight and obesity than those without FI. The review suggests a link between FI and undernutrition in schoolchildren from LMIC, with controversial results on overweight and obesity. Comprehensive public health policies should consider contextual and population-specific factors in addressing FI's impact on nutritional status.

Fathers Nutrition Knowledge and Child Feeding Practices Associated with Childhood Overweight and Obesity: A Scoping Review of Literature From 2000 to 2023

Objective. Childhood overweight/obesity is a serious global public health issue, demanding parental involvement to reverse trends. Despite fathers' crucial parenting roles, research on fathers and childhood overweight/obesity is limited. This scoping review examines the literature on fathers' nutrition knowledge and feeding practices with childhood overweight/obesity. Methods. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and Arksey and O'Malley (2005) framework, multiple databases were searched. Eligible father-child related studies focused on fathers' nutrition knowledge, feeding practices, and childhood overweight/obesity. Results. Of 26 eligible articles, 52% originated from the United States, and 44% focused on father-child dyads. Most studies were cross-sectional (64%) and survey-based (68%). Further, 11.5% assessed fathers' nutrition knowledge, and child feeding practices (53.4%). Conclusion. Literature on fathers' nutrition knowledge and feeding practices concerning childhood overweight/obesity is limited. Scaling-up fathers' inclusion in childhood nutrition research is encouraged for the design of holistic interventions.

Disparities in Cardiovascular Disease-Related Outcomes Among Cancer Survivors in the United States: A Systematic Review of the Literature

BACKGROUND

Cancer and cardiovascular disease (CVD) are major causes of morbidity and mortality in the United States (US). Cancer survivors have increased risks for CVD and CVD-related mortality due to multiple factors including cancer treatment-related cardiotoxicity. Disparities are rooted in differential exposure to risk factors and social determinants of health (SDOH), including systemic racism. This review aimed to assess SDOH's role in disparities, document CVD-related disparities among US cancer survivors, and identify literature gaps for future research.

METHODS

Following the Peer Review of Electronic Search Strategies (PRESS) guidelines, MEDLINE, PsycINFO, and Scopus were searched on March 15, 2021, with an update conducted on September 26, 2023. Articles screening was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, a pre-defined Population, Exposure, Comparison, Outcomes, and Settings (PECOS) framework, and the Rayyan platform. A modified version of the Newcastle-Ottawa Scale was used to assess the risk of bias, and RAW Graphs for alluvial charts. This review is registered with PROSPERO under ID #CRD42021236460.

RESULTS

Out of 7,719 retrieved articles, 24 were included, and discussed diverse SDOH that contribute to CVD-related disparities among cancer survivors. The 24 included studies had a large combined total sample size (n=7,704,645; median=19,707). While various disparities have been investigated, including rural-urban, sex, socioeconomic status, and age, a notable observation is that non-Hispanic Black cancer survivors experience disproportionately adverse CVD outcomes when compared to non-Hispanic White survivors. This underscores historical racism and discrimination against non-Hispanic Black individuals as fundamental drivers of CVD-related disparities.

CONCLUSIONS

Stakeholders should work to eliminate the root causes of disparities. Clinicians should increase screening for risk factors that exacerbate CVD-related disparities among cancer survivors. Researchers should prioritise the investigation of systemic factors driving disparities in cancer and CVD and develop innovative interventions to mitigate risk in cancer survivors.

"You just have to spread it thin": Perceptions and feeding experiences of Australian fathers of young children living with disadvantage

The role of fathers in feeding is an emerging field within child feeding literature. Fathers have unique contributions to make to family mealtimes and child eating behaviours. However, qualitative research on fathers' experiences is limited, especially in the context of disadvantage. This study explored fathers' perceptions of their roles and feeding practices and their lived experience of disadvantage through a symbolic interactionism lens. Twenty-five Australian fathers of children aged six months to five years who experienced socioeconomic disadvantage participated in semi-structured interviews. Five themes were constructed from reflexive thematic analysis: (i) responsibilities for foodwork are based on strengths, opportunities, and values, (ii) negotiating fatherhood identity from a place of tension to acceptance, (iii) struggling with financial and mental strain, and food insecurity, (iv) managing adversity whist prioritising feeding children, and (v) paternal feeding practices are driven by values, adversity, and emotions. The division of foodwork was contingent on family capability and employment, maternal gatekeeping, paternal attitudes and values, and intergenerational, cultural and gender norms around earning and childrearing. Economic, environmental, and emotional stressors triggered changes to fathers' feeding practices, often contradicting their ideals (e.g., providing alternative meals, using rewards and electronic devices, unstructured settings). Fathers described income and food-based strategies to protect children's food intake, which may involve caregivers forgoing meals. These findings provide insight into fathers' feeding experiences through recognising personal, interpersonal, and systemic enablers and barriers. Promoting optimal feeding practices should include targeted feeding support and broader structural interventions to address inequality. Fathers' experiences as they navigate child mealtime interactions within a context of adversity can be used to inform child feeding interventions to improve child health and development.

The association between household food insecurity and healthcare costs among Canadian children

OBJECTIVE

To examine the relationship between household food insecurity and healthcare costs in children living in Ontario, Canada.

METHODS

We conducted a cross-sectional, population-based study using four cycles of the Canadian Community Health Survey (2007-2008, 2009-2010, 2011-2012, 2013-2014) linked with administrative health databases (ICES). We included Ontario children aged 1-17 years with a measure of household food insecurity (Household Food Security Survey Module) over the previous 12 months. Our primary outcome was the direct public-payer healthcare costs per child over the same time period (in Canadian dollars, standardized to year 2020). We used gamma-log-transformed generalized estimating equations accounting for the clustering of children to examine this relationship, and adjusted models for important sociodemographic covariates. As a secondary outcome, we examined healthcare usage of specific services and associated costs (e.g. visits to hospitals, surgeries).

RESULTS

We found that adjusted healthcare costs were higher in children from food-insecure than from food-secure households ($676.79 [95% CI: $535.26, $855.74] vs. $563.98 [$457.00, $695.99], p = 0.047). Compared with children living in food-secure households, those in insecure households more often accessed hospitals, emergency departments, day surgeries, and home care, and used prescription medications. Children from food-secure households had higher usage of non-physician healthcare (e.g. optometry) and family physician rostering services.

CONCLUSION

Even after adjusting for measurable social determinants of health, household food insecurity was associated with higher public-payer health services costs and utilization among children and youth. Efforts to mitigate food insecurity could lessen child healthcare needs, as well as associated costs to our healthcare systems.

Food Insecurity and Pediatric Nonalcoholic Fatty Liver Disease Severity

OBJECTIVE

To determine the association between food insecurity and pediatric nonalcoholic fatty liver disease (NAFLD).

METHODS

Cross-sectional study of patients < 21 years of age with histologically confirmed NAFLD. The Household Food Security Survey Module was administered to determine food insecurity status. Skin lipidomics were performed to explore pathophysiologic mechanisms.

RESULTS

Seventy-three patients with histologically confirmed NAFLD completed the Household Food Security Survey Module. Of these, the majority were male (81%) and non-Hispanic (53%), with a mean age at biopsy of 13 ± 3 years. Food insecurity was seen in 42% (n = 31). Comparison of features between food insecure and food secure subgroups revealed no differences in sex, ethnicity, BMI z-score, aminotransferases, or histologic severity. However, children experiencing food insecurity presented on average 2 years before their food secure counterparts (12.3 ± 3.0 vs 14.4 ± 3.6 years, P = .015). A subset of 31 patients provided skin samples. Skin lipidomics revealed that food insecurity was associated with down-regulated features from the lipoamino acid class of lipids, previously linked to inflammation and adipocyte differentiation.

CONCLUSIONS

Food insecurity is highly prevalent in children with NAFLD and is associated with earlier presentation. Lipidomic analyses suggest a possible pathophysiologic link that warrants further exploration.

The association of food insecurity on body mass index change in a pediatric weight management intervention

BACKGROUND

Childhood obesity is a critical public health concern. One potential determinant to obesity that is less understood is food insecurity.

OBJECTIVE

To examine the association of food security status on body mass index (BMI) change in a Pediatric Weight Management Intervention (PWMI) consistent with national treatment recommendations.

METHODS

This analysis included 201 participants from the Healthy Weight Clinic (HWC). Using linear mixed models, we compared BMI and %BMIp95 change per year between the food insecure group and food secure group, adjusting for baseline BMI, age and sex, and SNAP enrolment.

RESULTS

In fully adjusted models, children in households with food insecurity had a 0.50 (0.26-0.74) kg/m2 BMI increase per year and a 2.10 (1.02-3.19) %BMIp95 increase per year compared to households that were food secure.

CONCLUSIONS

When comparing the BMI effect of the HWC between the food insecure group and food secure group, those experiencing food insecurity in the HWC had an increase in BMI compared to those with food security. These findings suggest that food insecurity may reduce the effectiveness of PWMIs consistent with national recommendations; however, more studies should be conducted to better understand this relationship.

Developing New Scales of Personal Food Security

BACKGROUND

Food insecurity is standardly measured at the household level or for groups of household members. However, food hardships may differ for individuals within households. Summary measures of people's individual experiences of food insecurity are needed.

OBJECTIVE

This study aims to develop and analyze psychometrically sound multi-item scales of people's individual experiences of food insecurity. It further aims to examine whether and how the distributions of personal food insecurity differ across age groups, from household food insecurity, and with people's observed characteristics.

DESIGN

The study analyzes questionnaire data on personal food security outcomes, household food security outcomes, and other characteristics.

PARTICIPANTS AND SETTING

The 29,040 participants in the study responded to the 2005-2006 through 2009-2010 cycles of the National Health and Nutrition Examination Survey in the United States.

MAIN OUTCOMES

The main outcomes are five-item scales of personal food insecurity for children younger than age 12 years, young adolescents aged 12 to 15 years, and people aged 16 years and older.

STATISTICAL ANALYSIS PERFORMED

The study develops the personal food insecurity scales through factor analyses and polytomous Item Response Theory models and analyzes characteristics that are related to the scale outcomes through multivariate regressions.

RESULTS

The article develops personal food insecurity scales that are related to but distinct from the standard household scales, with different scales being needed to capture the experiences of its three age groups. Children younger than age 12 years have much lower risks of personal food insecurity than other age groups, whereas young adolescents have higher risks than other groups. Three percent of children had an indication of personal food insecurity, whereas 10% of adolescents and 7% of adults had indications. Among adults, women and people between ages 31 and 65 years have higher risks of personal food insecurity than men and people of other ages, but they have similar risks for household food insecurity.

CONCLUSIONS

Personal food insecurity is a distinct component of well-being that can be summarized through scale measures. Evidence that characteristics, such as sex and age, are related to personal food insecurity but not household food insecurity indicates that food experiences can differ within households and that some people may be systematically disadvantaged.

The Role of Agricultural Systems in Teaching Kitchens: An Integrative Review and Thoughts for the Future

Diet-related chronic disease is a public health epidemic in the United States. Concurrently, conventional agricultural and food production methods deplete the nutritional content of many foods, sever connections between people and the origin of their food, and play a significant role in climate change. Paradoxically, despite an abundance of available food in the US, many households are unable to afford or attain a healthful diet. The linkages between agriculture, health, and nutrition are undeniable, yet conventional agriculture and healthcare systems tend to operate in silos, compounding these pressing challenges. Operating teaching kitchens in collaboration with local agriculture, including farms, community gardens, vertical farms, and urban agriculture, has the potential to catalyze a movement that emphasizes the role of the food system in promoting human and planetary health, building resilient communities, and encouraging cross-disciplinary collaboration. This paper reviews the current state of agricultural systems, food is medicine, consumer behavior, and the roles within these sectors. This is followed by a series of case studies that fill the gaps between TKs and agriculture. The authors summarize opportunities to combine the knowledge and resources of teaching kitchens and agriculture programs, as well as challenges that may arise along the way.

Body mass index and abdominal waist values are related to increased cardiometabolic risk in schoolchildren aged five to ten years

OBJECTIVE

To evaluate the frequency of obesity and cardiometabolic risk in schoolchildren under ten years old.

METHODS

This is a cross-sectional study with schoolchildren (n=639) aged five to ten years in a municipally of southern of Brazil. The cardiometabolic risk was calculated from values of body mass index (BMI), waist circumference (WC), diastolic (DBP) and systolic blood pressure (SBP), blood glucose levels, triglycerides and total cholesterol (TC). Odds ratio (OR), Spearman correlation and principal component analysis (PCA) were analyzed.

RESULTS

Independent of sex, elevated WC and BMI were related to higher values of SBP, DBP, and TC in schoolchildren. The frequency of cardiometabolic risk was 6.0% in girls and 9.9% in boys. Schoolchildren with elevated values of SBP, triglycerides and TC presented high OR for cardiometabolic risk. PCA indicated that schoolchildren with high WC (p>80) presented more frequently altered glucose levels, triglycerides, and TC.

CONCLUSIONS

Obesity, especially when associated with elevated WC, is related to metabolic dysfunctions and cardiometabolic risk in schoolchildren under ten years of age. These findings indicate the urgency of stablishing metabolic risk for this age group, enabling early diagnosis and adequate treatment, to prevent the development of diabetes and cardiovascular dysfunction throughout life.

TAX4U Pilot Trial: Addressing Material Needs in the Pediatric Hospital Setting

OBJECTIVE

Interventions to address poverty and food insecurity in pediatric hospital care have been scarce. Access to government support is based on the completion of taxes. Medical-financial partnerships are defined as novel cross-sector collaborations in which health care systems and financial service organizations work collaboratively to improve health by reducing financial stress. The objective of our pilot study was to assess the feasibility of implementing a "free tax service" within a pediatric academic hospital setting.

METHODS

A pilot randomized controlled trial "TAX4U" was conducted from November 2020 until April 2021 in the general inpatient setting of an academic pediatric hospital. Eligible families were randomly assigned to receive either "free tax services" according to the Canada Revenue Agency-funded Community Volunteer Income Tax Program (CVITP) or "care as usual."

RESULTS

A total of 140 caregivers filled in the 8-question recruitment survey. We found that 101 (72%) families were not eligible to participate in the study. Reasons for ineligibility were not meeting CVITP criteria (n = 59, 58%), already filed tax (n = 25, 25%), and families did not sign the consent form (n = 17, 17%). Thirty-nine families were randomly assigned, with 20 (51.3%) families assigned to the intervention and 19 (48.7%) families receiving care as usual. Ultimately, 7 (35%) families received the tax intervention.

CONCLUSIONS

Offering free tax services may be feasible and reached vulnerable families in a pediatric hospital setting; however, the inclusion criteria of the CVITP program did not meet the needs of caregivers. Further research should explore offering a full-scope medical-financial partnership that meets the needs of low-income families in a hospital setting.

An Ethical Analysis of Obesity as a Contraindication to Pediatric Liver Transplant Candidacy

Childhood obesity is becoming more prevalent in the United States (U.S.) and worldwide, including among children in need of liver transplant. Unlike with heart and kidney failure, end stage liver disease (ESLD) is unique in that no widely available medical technology can re-create the life-sustaining function a failing liver. Therefore, delaying life-saving liver transplant for weight loss, for example, is much harder, if not impossible for many pediatric patients, especially those with acute liver failure. For adults in the U.S., guidelines consider obesity a contraindication to liver transplant. While formal guidelines are lacking in children, many pediatric transplant centers also consider obesity a contraindication to pediatric liver transplant. Variations in practice among pediatric institutions may result in biased and ad hoc decisions that worsen health care inequities. In this paper we define and report the prevalence of childhood obesity among children with ESLD, 2) review existing guidelines for liver transplant in adults with obesity, 3) examine pediatric liver transplant outcomes and 4) discuss the ethical considerations of utilizing obesity as a contraindication to pediatric liver transplant informed by the principles of utility, justice and respect for persons.

Environmental justice and allergic disease: A Work Group Report of the AAAAI Environmental Exposure and Respiratory Health Committee and the Diversity, Equity and Inclusion Committee

Environmental justice is the concept that all people have the right to live in a healthy environment, to be protected against environmental hazards, and to participate in decisions affecting their communities. Communities of color and low-income populations live, work, and play in environments with disproportionate exposure to hazards associated with allergic disease. This unequal distribution of hazards has contributed to health disparities and is largely the result of systemic racism that promotes segregation of neighborhoods, disinvestment in predominantly racial/ethnic minority neighborhoods, and discriminatory housing, employment, and lending practices. The AAAAI Environmental Exposure and Respiratory Health Committee and Diversity, Equity and Inclusion Committee jointly developed this report to improve allergy/immunology specialists' awareness of environmental injustice, its roots in systemic racism, and its impact on health disparities in allergic disease. We present evidence supporting the relationship between exposure to environmental hazards, particularly at the neighborhood level, and the disproportionately high incidence and poor outcomes from allergic diseases in marginalized populations. Achieving environmental justice requires investment in at-risk communities to increase access to safe housing, clean air and water, employment opportunities, education, nutrition, and health care. Through policies that promote environmental justice, we can achieve greater health equity in allergic disease.

An ethical analysis of obesity as a contraindication of pediatric kidney transplant candidacy

The inclusion of body mass index (BMI) as a criterion for determining kidney transplant candidacy in children raises clinical and ethical challenges. Childhood obesity is on the rise and common among children with kidney failure. In addition, obesity is reported as an independent risk factor for the development of CKD and kidney failure. Resultantly, more children with obesity are anticipated to need kidney transplants. Most transplant centers around the world use high BMI as a relative or absolute contraindication for kidney transplant. However, use of obesity as a relative or absolute contraindication for pediatric kidney transplant is controversial. Empirical data demonstrating poorer outcomes following kidney transplant in obese pediatric patients are limited. In addition, pediatric obesity is distributed inequitably among groups. Unlike adults, most children lack independent agency to choose their food sources and exercise opportunities; they are dependent on their families for these choices. In this paper, we define childhood obesity and review (1) the association and impact of obesity on kidney disease and kidney transplant, (2) existing adult guidelines and rationale for using high BMI as a criterion for kidney transplant, (3) the prevalence of childhood obesity among children with kidney failure, and (4) the existing literature on obesity and pediatric kidney transplant outcomes. We then discuss ethical considerations related to the use of obesity as a criterion for kidney transplant.

Association between socioeconomic status and arteriosclerotic cardiovascular disease risk and cause-specific and all-cause mortality: Data from the 2005-2018 National Health and Nutrition Examination Survey

Background

Morbidity and mortality of arteriosclerotic cardiovascular disease (ASCVD) varied according to socioeconomic status (SES), and evidence on the association between SES and ASCVD risk, and cause-specific and all-cause mortality was nevertheless lacking in large-scale or population-based studies.

Methods

A multicycle cross-sectional design and mortality linkage study was conducted using data from Continuous National Health and Nutrition Examination Survey (NHANES) in the United States, including public use linked mortality follow-up files through December 31, 2019. Poverty income ratio (PIR) served as a SES index. A series of weighted Logistic regressions and Cox proportional hazards regressions were used to investigate the association between the SES and the risk of ASCVD and mortality, respectively.

Results

The study sample was comprised of 30,040 participants aged 20-85 years old during the 2005-2018 period. Weighted Logistic regression models consistently indicated significant relationship between people experiencing poverty and increased risk of ASCVD, and linear trend tests were all statistically significant (all P for trend < 0.001). Additionally, weighted Cox regression analysis consistently demonstrated that the hazards of cause-specific and all-cause mortality increased, with the decrease of each additional income level, and trend analyses indicated similar results (all P for trend < 0.001).

Conclusions

Our study confirmed that the SES was strongly linked to living with ASCVD, and cause-specific and all-cause mortality, even after adjusting for other factors that could impact risk, such as the American Heart Association (AHA)'s Life's Simple 7 cardiovascular health score and variables of age, sex, marital status, education, and depression severity.

Household food insecurity and its association with overweight and obesity in children aged 2 to 14 years

BACKGROUND

The objective was to estimate the prevalence of household food insecurity (HFI) depending on sociodemographic factors and its association with lifestyle habits and childhood overweight and obesity.

METHODS

Data was collected from 1,938 children aged 2 to 14 years who participated in the "Study about Malnutrition" of the Community of Madrid. Weight and height were obtained through physical examination. Body mass index was calculated as weight/height² (kg/m²) and the criteria of the WHO were used for determining conditions of overweight and obesity. The participants' parents answered a structured questionnaire about their diet, lifestyle (physical activity and screen time), and food insecurity. The diet quality was assessed with the Healthy Eating Index in Spain and food insecurity, defined as the lack of consistent access to sufficient food for a healthy life, was measured via three screening questions and the Household Food Insecurity Access Scale (HFIAS). Odds Ratios (ORs) and Relative Risk Ratios (RRRs) were estimated using logistic regression models and adjusted for confounding variables.

RESULTS

The overall prevalence of HFI was 7.7% (95% CI: 6.6‒9.0), with lower values in children 2 to 4 years old (5.7%, 95% CI: 4.0‒8.1) and significantly higher values in households with low family purchasing power [37.3%; OR: 8.99 (95% CI: 5.5‒14.6)]. A higher prevalence of overweight (33.1%) and obesity (28.4%) was observed in children from families with HFI, who presented a lower quality diet and longer screen time compared to those from food-secure households (21.0% and 11.5%, respectively). The RRR of children in families with HFI relative to those from food-secure households was 2.41 (95% CI: 1.5‒4.0) for overweight and 1.99 (95% CI: 1.2‒3.4) for obesity.

CONCLUSION

The prevalence of HFI was high in the paediatric population, especially in households with low family purchasing power. HFI was associated with lower diet quality and higher prevalence of childhood overweight and obesity. Our results suggest the need for paediatric services to detect at-risk households at an early stage to avoid this dual burden of child malnutrition.

Food Insecurity in the Households of Polish Elderly: Diversity in the Perception of Its Causes by Demographic and Socioeconomic Characteristics

The aging of societies and the quality of life of the elderly may be accompanied by food insecurity. The aim of the study was to find the relationships between the perceptions of various causes of food insecurity, i.e., financial, social, health, and spatial, and then between those and the selected sociodemographic characteristics. The survey was conducted in late 2018 and early 2019 among 760 people aged 65 and older in two regions of Poland. Factor analysis with the use of principal component analysis (PCA) was used to identify the main causes of the prevalence of food insecurity. Cluster analysis using Ward’s hierarchical classification and logistic regression analysis were used to assess the relationship between the identified reasons for food insecurity, demographic characteristics, and socioeconomic status (SES). Two groups of causes that favor the experience of food insecurity among the elderly were identified, i.e., economic–social reasons and spatial–health reasons. They relate to such situations of food insecurity as concerns about food shortages, lack of staple foods, limited size or frequency of meals, and skipping meals. The high importance of economic–social (HE-S) reasons was associated with the low importance of spatial–health (LS-H) reasons, and conversely, the high importance of spatial–health (HS-H) causes was associated with the low importance of economic–social (LE-S) causes. HE-S and LS-H reasons were combined with low SES and residence in a city of more than 100,000 inhabitants. HS-H causes, on the other hand, were associated with LE-S causes and living in rural areas or towns of fewer than 100,000 inhabitants, as well as high SES. This specificity should be considered in the development of strategies and interventions aimed at reducing the phenomenon of experiencing food insecurity in the elderly population.

Reprint of: Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States

It is the position of the Academy of Nutrition and Dietetics that systematic and sustained action is needed to achieve food and nutrition security in the United States. To achieve food security, effective interventions are needed, along with adequate funding for, and increased utilization of, food and nutrition assistance programs; inclusion of nutrition education in such programs; strategies to support individual and household economic stability; and research to measure impact on food insecurity- and health-related outcomes. Millions of individuals living in the United States experience food insecurity. Negative nutritional and non-nutritional outcomes are associated with food insecurity across the lifespan, including substandard academic achievement, inadequate intake of key nutrients, increased risk for chronic disease, and poor psychological and cognitive functioning. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, play key roles in addressing food insecurity and are uniquely positioned to make valuable contributions through competent and collaborative practice, provision of comprehensive food and nutrition education and training, innovative research related to all aspects of food insecurity, and advocacy efforts at the local, state, regional, and national levels.

Obesity in Adolescents: Understanding the Combined Role of Food Security and Emotional and Behavioral Disorders

PURPOSE

To examine the associations and interactions between levels of food security and emotional and behavioral disorders with obesity in adolescents.

METHODS

Multiple logistic regression modeling was used to analyze the association of adolescent obesity with levels of food security and emotional and behavior disorders in children aged 12-17 years using data from National Health Interview Survey 2016-2018 combined years. Presence of emotional and behavioral disorders within food security categories was added to logistic regression modeling to examine interactions.

RESULTS

When added individually to multiple logistic regression models, marginal and low food security, Attention Deficit Hyperactivity Disorder (ADHD) and anxiety were associated with increased odds of obesity, but very low food security and depression were not. Within the group of adolescents with very low food security, those with anxiety, depression, or ADHD had a nearly two to three-fold increase in odds of obesity compared to adolescents with very low food security and no emotional and behavioral disorders. A similar increase in the odds of obesity with the presence of anxiety, depression, or ADHD was not seen in the adolescents with high food security.

DISCUSSION

This study finds a significant interaction between food security level and emotional and behavioral disorders. The distinction that very low food security in adolescents is only associated with obesity when either anxiety, depression or ADHD are present, but not independently, is an important contribution to understanding complex interactions contributing to obesity.

Increasing Access to Healthy Foods through Improving Food Environment: A Review of Mixed Methods Intervention Studies with Residents of Low-Income Communities

Food insecurity is a broad and serious public health issue in the United States, where many people are reporting lack of access to healthy foods. The reduced availability of healthy, affordable foods has led to increased consumption of energy-dense and nutrient-poor foods, resulting in increasing the risk for many chronic diseases such as obesity, cardiovascular diseases, and type 2 diabetes mellitus. Thus, identifying promising approaches to increase access to healthy foods through improving the food environment is of importance. The purpose of this review article is to highlight how the food environment affects directly a person’s food choices, and how to increase access to healthy foods through improving environmental approaches. The literature search was focused on finding different approaches to improve food security, primarily those with an impact on food environment. Overall, potential solutions were gathered through multilevel environmental approaches, including nutrition education and peer education, community-based participatory research, and policy changes in supplemental nutrition programs. A recommendation to reduce food insecurity is learning to create meals with a variety of seasonal fruits and vegetables purchased from affordable farmers’ markets.

Too Many Treats or Not Enough to Eat? The Impact of Caregiving Grandparents on Child Food Security and Nutrition

With the number of grandparent-headed households on the rise, the influence of grandparents needs to be considered in the fight to reduce child obesity. The current study investigated the influence of caregiver type (i.e., grandparents only, parents only, or multi-generational households) on children’s nutrition, food security, and BMI. This was a cross-sectional, secondary analysis based on the 2009–2010 wave of the Health Behavior in School-Aged Children (HBSC) survey in collaboration with the World Health Organization. This sample included 12,181 students from 10,837 families with only parents present in the household, 238 with only grandparents present, and 1106 multi-generational families. One-way analyses of covariance (ANCOVAs) were conducted using caregiver type as the independent variable, controlling for SES, on items assessing frequency of breakfast consumption, nutrition intake, hunger, snacking frequency and location, and BMI. Children reported more unhealthy snacking in households with only grandparents. Hunger was reported more often in multi-generational households. These results support that caregiver type, especially caregiving grandparents, is a significant predictor of children’s BMI, nutrition, and food security. Tailoring nutrition education to the needs of grandparents could help both the health of grandparents and the reduction of child obesity.

Examining Associations Between Food Insecurity, Inhibitory Control, and Body Mass Index in Preschoolers

OBJECTIVE

This study examines relations between food insecurity, inhibitory control, and body mass index (BMI) in early childhood.

METHOD

The sample comes from an evaluation of a state-funded prekindergarten program and includes 126 children (mean age = 4.73 yrs, female = 42%) from families with low incomes. Parents reported on their child's food insecurity. Child inhibitory control was assessed using a performance-based task, and children's height and weight were objectively collected at the same time as the inhibitory control assessment. A regression model was used to test whether inhibitory control moderated the association between food insecurity and BMI. The model included a large battery of covariates and adjusted for clustering at the classroom level. Ad hoc analyses were conducted to examine the robustness of findings to different conceptualizations of food insecurity based on the US Department of Agriculture's categories for severity.

RESULTS

A significant interaction revealed that inhibitory control moderated the association between food insecurity and children's BMI percentile. Investigation of the simple slopes suggested that greater food insecurity was related to a higher BMI percentile among children who demonstrated stronger inhibitory control. In addition, results from ad hoc analyses examining categories of food insecurity indicated that experiencing very low food security was also related to a higher BMI among children with average and strong inhibitory control.

CONCLUSION

This study makes a unique contribution to the existing literature by examining relations among food insecurity, inhibitory control, and BMI during a critical period in children's physical and brain development. Findings have implications for public health efforts to address childhood obesity among populations with low incomes.

Food Insecurity and Cardiometabolic Markers: Results From the Study of Latino Youth

OBJECTIVES

Hispanic/Latino youth bear a disproportionate burden of food insecurity and poor metabolic outcomes, but research linking the two in this diverse population is lacking. We evaluated whether lower household and child food security (FS) were adversely associated with a metabolic syndrome (MetS) composite variable and clinically measured cardiometabolic markers: waist circumference, fasting plasma glucose, triglycerides, high-density lipoprotein cholesterol, and systolic and diastolic blood pressure.

METHODS

This cross-sectional study included 1325 Hispanic/Latino youth aged 8 to 16 years from the Hispanic Community Children's Health Study/Study of Latino Youth, a study of offspring of adults enrolled in the Hispanic Community Health Survey/Study of Latinos. Multivariable regression analyses were used to assess relationships between household FS (high, marginal, low, very low) and child FS (high, marginal, low/very low) status, separately, and our dependent variables, adjusting for participant age, sex, site, parental education, and poverty-income ratio.

RESULTS

For both FS measures, youth in the lowest FS category had significantly lower high-density lipoprotein cholesterol than those with high FS (household FS: -3.17, 95% confidence interval [CI]: -5.65 to -0.70, child FS: -1.81, 95% CI: -3.54 to -0.09). Low/very low versus high child FS was associated with greater fasting plasma glucose (β = 1.37, 95% CI: 0.08 to 2.65), triglycerides (β = 8.68, 95% CI: 1.75 to 15.61), and MetS expected log counts (β = 2.12, 95% CI: 0.02 to 0.45).

CONCLUSIONS

Lower FS is associated with unfavorable MetS-relevant cardiometabolic markers in Hispanic/Latino youth. These findings also support the use of a child-level versus a household-level measure to capture the health implications of food insecurity in this population.

Socioeconomic risks of food insecurity during the Covid-19 pandemic in the UK: findings from the Understanding Society Covid Survey

BACKGROUND

We estimated socioeconomic factors associated with food insecurity during the first year of the Covid pandemic in the UK and explored potential mechanisms explaining these associations.

METHODS

Data were from the April, July, and September 2020 waves of the UK Understanding Society Covid Survey. Food insecurity was measured as 'not having access to healthy and nutritious food' and 'reporting being hungry but not eating'. Logistic regression estimated the relationship between socioeconomic factors and food insecurity. A decomposition approach explored if financial vulnerability and having Covid-19 explained associations between socioeconomics factors and food insecurity.

RESULTS

Single parents and young people aged 16-30 years had a higher odds of reporting both measures of food insecurity. Financial insecurity explained 5% to 25% of the likelihood of reporting being food insecure for young people and single parents depending on the food insecurity measure used. Experiencing Covid-19 symptoms explained less than 5% of the likelihood of being food insecure for single parents but approximately 30% of not having access to healthy and nutritious food for young people.

CONCLUSION

Policies providing additional financial support may help to reduce the impact of Covid-19 on food insecurity in the UK.

Food insecurity, home ownership and income-related equity in dental care use and access: the case of Canada

Background

It has been documented that income is a strong determinant of dental care use in Canada, mostly due to the lack of public coverage for dental care. We assess the contributions of food insecurity and home ownership to income-related equity in dental care use and access. We add to the literature by adding these two variables among other socio-economic determinants of equity in dental care use and access to dental care. Evidence on equity in access to and use of dental care in Canada can inform policymaking.

Methods

We estimate income-related horizontal inequity indexes for the probability of 1) receiving at least one dental visit in the last 12 months; and 2) lack of dental visits during the 3 years before the interview. We conduct the analyses using data from the 2013–2014 Canadian Community Health Survey (CCHS) at the national and regional level.

Results

There is pro-rich inequity in the probability of visiting a dentist or an orthodontist and in access to dental care in Ontario. Inequities vary across jurisdictions. Housing tenure and food insecurity contribute importantly to both use of and access to dental care, adding information not captured by standard socio-economic determinants.

Conclusions

Redistributing income may not be enough to reduce inequities. Careful monitoring of equity in dental care is needed together with interventions targeting fragile groups not only in terms of income but also in improving house and food security.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12760-6.

Has Food Security and Nutritional Status Improved in Children 1-<10 Years in Two Provinces of South Africa between 1999 (National Food Consumption Survey) and 2018 (Provincial Dietary Intake Study (PDIS))

The 1999 National Food Consumption Survey in South Africa showed that food insecurity (hunger) was prevalent in households with children aged one to <10 years. A repeat of the survey in two provinces: Gauteng (GTG) and the Western Cape (WC) was undertaken in 2018. Results showed that in all domains (living areas) in GTG, food shortage prevalence decreased between 1999 and 2018, from 55.0% to 29.6% in urban informal areas, from 34.1% to 19.4% in urban formal areas and from 42.1% to 15.6% in rural areas. While the prevalence of food shortage in urban formal areas in the WC remained similar in 2018, prevalence decreased from 81.8% to 35.7% in urban informal areas and from 38.3% to 20.6% in rural areas. Energy and macronutrient intakes improved significantly in GTG between 1999 and 2018 but not in the WC; intakes were significantly higher in the WC at both time points. The only significant change in stunting, wasting, overweight and obesity prevalence was that 7-<10-year-olds in GTG were significantly more likely to be wasted (BAZ < 2SD) in 2018 than in 1999 (20.2% versus 6.9% respectively). In the WC, 1-3-year-olds were significantly more likely to be obese in 2018 than in 1999 (8.1% versus 1.7% respectively) and 7-<10-year-olds were less likely to be stunted (14.5% versus 4.9% respectively). There were significant negative correlations between the hunger score and dietary variables in both provinces in 1999. In GTG in 2018, only the correlation with fat intake remained while there were still several significant correlations in WC in 2018. Changes in top 12 energy contributors reflect a shift to high or moderate energy foods low in nutrients from 1999 to 2018. Nutrient dense (high micronutrients, low energy/g) foods (e.g., fruit) fell off the list in 2018. Logistic regression analyses reflect the importance for food security of having a parent as head of the household and/or caregiver, and parents having grade 12 or higher education and being employed. We conclude that food security nutritional status indicators improved amongst 1-<10-year-old children especially in GTG between 1999 and 2018. However, the shift to poorer food choices and increase in wasting in older children and overweight in younger children are of concern.

The Importance of Biobehavioral Research to Examine the Physiological Effects of Racial and Ethnic Discrimination in the Latinx Population

A growing body of research is documenting how racial and ethnic populations embody social inequalities throughout the life course. Some scholars recommend the integration of biospecimens representing the hypothalamic-pituitary-adrenal axis, neurological and endocrinological processes, and inflammation to capture the embodiment of inequality. However, in comparison to other racial and ethnic groups, there has been little research examining how Hispanic/Latinx persons embody racial and ethnic discrimination, much less resulting from institutional and structural racism. We provide a rationale for expanding biobehavioral research examining the physiological consequences of racism among Latinx persons. We identify gaps and make recommendations for a future research agenda in which biobehavioral research can expand knowledge about chronic disease inequities among Latinx populations and inform behavioral and institutional interventions. We end by cautioning readers to approach the recommendations in this article as a call to expand the embodiment of racism research to include the diverse Latinx population as the United States addresses racial inequity.

Food insecurity during COVID-19 in a Canadian academic pediatric hospital: a cross-sectional survey

BACKGROUND

Hospital-based food insecurity is defined as the inability of caregivers to obtain adequate food during their child's hospital admission. We aimed to measure the prevalence of household and hospital-based food insecurity, and to explore the associations with caregiver distress in an academic pediatric hospital setting.

METHODS

We conducted a cross-sectional survey of caregivers of children admitted to the general pediatric ward of an academic pediatric hospital in Toronto, Ontario, from April to October 2020. We measured household food insecurity using the 18-item Household Food Security Survey Module, and included 3 adapted questions about hospital-based food insecurity. We measured caregiver distress with the Distress Thermometer for Parents. We used descriptive statistics to assess the proportion of respondents with food insecurity, and linear regression models to explore the relation of household (adult and child) and hospital-based food insecurity with caregiver distress. We used thematic analysis to explore caregivers' feedback.

RESULTS

We contacted 851 caregivers, and 775 (91.1%) provided consent to participate. Overall, 430 (50.5%) caregivers completed at least part of the survey. Caregivers described a high prevalence of household (34.2%) and hospital-based (38.1%) food insecurity. Adult (β = 0.21, 95% confidence interval [CI] 0.07-0.36), child (β = 0.38, 95% CI 0.10-0.66) and hospital-based (β = 0.56, 95% CI 0.30-0.83) food insecurity were significantly associated with caregiver distress, independent of covariates. We identified financial burden, emotional and practical barriers, stress obtaining food and advocacy for food as important themes in caregiver feedback.

INTERPRETATION

Both household and hospital-based food insecurity were highly prevalent among caregivers. To reduce caregiver distress, hospitals need to consider reducing barriers for caregivers in obtaining food for themselves during their child's admission.

The Influence of the COVID-19 Pandemic on the Food Supply in the Emergency Food System: A Case Study at 2 Food Pantries

BACKGROUND

The onset of the coronavirus disease 2019 (COVID-19) pandemic increased demand for emergency food assistance and has caused operational shifts in the emergency food system.

OBJECTIVE

This research explored how the initial phase of the COVID-19 pandemic influenced the food supply of 2 food pantries.

METHODS

A case study approach was applied to collect data during the initial phase of the COVID-19 pandemic. Food supply data were collected weekly at 2 food pantries in southwest Montana for 17 wk in 2020. Surveys and interviews were conducted with food pantry clients and staff, respectively. Descriptive statistics and inferential statistics were applied to analyze quantitative data. Food supply data were analyzed using the Healthy Eating Index (HEI)-2015, NOVA system, and Unprocessed Pantry Project (UP3) Framework. Thematic analysis was applied to qualitative data.

RESULTS

The food boxes collected between the 2 food pantries (n = 43) had a mean (± SD) total HEI-2015 score of 76.41 ± 7.37 out of a possible score of 100. According to both the NOVA and the UP3 Framework, 23.4% of the total food distributed was ultra-processed food. Of the food distributed, 50.0% and 48.3% was fresh, unprocessed food according to NOVA and UP3 Frameworks, respectively. From staff interviews, 3 themes arose that describe the food pantry operations that experienced change during the COVID-19 pandemic, including food procurement, distribution preparation, and food distribution. Nine supporting subthemes describing the causes and consequences of the operational themes were identified. Staff perceived that the nutrient quality of the food boxes increased from food distributed previously to the COVID-19 pandemic, whereas over one-third (39.4%) of food pantry clients who responded to surveys preferred the food box model.

CONCLUSIONS

The COVID-19 pandemic has caused enormous operational challenges within food pantries. Food pantries overcame these challenges by swiftly and effectively altering operations so as to continue to distribute nutritious food boxes to pantry clients.

Food insecurity and obesity among US young adults: the moderating role of biological sex and the mediating role of diet healthfulness

OBJECTIVE

To examine the association between food insecurity (FI) and obesity, measured by BMI and waist circumference (WC), among young adults and test the moderating role of biological sex and the mediating role of diet healthfulness (DH).

DESIGN

Cross-sectional.

SETTING

National Health and Nutrition Examination Survey 2011-2016.

PARTICIPANTS

The sample included 4667 young adults aged 18-35 years.

RESULTS

Given the interaction terms between sex and FI, biological sex was a moderator between both FI and WC (P = 0·031) and FI and BMI (P = 0·007) among young adults. FI was associated with a 1·16 kg/m2 higher BMI (95 % CI 0·27, 2·05) and a 2·09 cm larger WC (95 % CI 0·05, 4·14) among young female adults, while FI was associated with a 0·26 kg/m2 higher BMI (95 % CI -0·65, 1·16) and a 0·78 cm larger WC (95 % CI -1·13, 2·89) among young male adults. DH mediated the relationships between both FI and BMI (indirect effect β = 0·14; 95 % CI 0·05, 0·23) and FI and WC (indirect effect β = 0·31; 95 % CI 0·10, 0·51) among females. Females with FI had poorer DH and thus had higher BMI and larger WC.

CONCLUSIONS

Young female adults with FI were more likely to experience overall and abdominal obesity compared with their male counterparts. Results also suggest that females with FI had poorer DH and thus had increased risk of both abdominal and overall obesity.

Timing of Supplemental Nutrition Assistance Program Benefits and Families' Home Food Environments

BACKGROUND AND OBJECTIVES

Supplemental Nutrition Assistance Program (SNAP) benefits are designed to buffer families from food insecurity, but studies suggest that most benefits are used by midmonth. In this study, we examined whether the home food environment varies across the SNAP benefits cycle among participating families .

METHODS

Participants in this mixed-methods study were 30 SNAP participants who were primary caregivers of a child ages 4-10 years. The home food environment was measured 1 week before SNAP benefit replenishment and again within 1 week after replenishment by using the Home Food Inventory. Household food insecurity was assessed by using the US Department of Agriculture Household Food Security Survey. Wilcoxon rank tests were used to evaluate changes in median Home Food Inventory subscales and food insecurity pre- to post-replenishment. Qualitative interviews with participating caregivers were conducted to explore contextual factors influencing the home food environment across the benefits cycle.

RESULTS

Participants had significantly fewer types of vegetables (median: 7.0 vs 8.5, median difference 1.73, 95% confidence interval: 0.5-2.5, P = .03) and higher food insecurity pre- versus post-replenishment (median: 4.0 vs 2.0, median difference 1, 95% confidence interval: 0.1-1.5, P = .03). Caregivers described employing a variety of intentional strategies to reduce cyclic variation in food availability.

CONCLUSIONS

Findings suggest that there is relatively limited cyclic variation in the home food environment among families participating in SNAP. This may be explained by a number of assistance programs and behavioral strategies caregivers used to make food last and buffer against scarcity. Future research should evaluate the relationship between the degree of home food environment changes and child health outcomes.

The association of household and child food insecurity with overweight/obesity in children and adolescents in an urban setting of Ethiopia

BACKGROUND

Existing evidence on the association between food insecurity and childhood obesity is mixed. In addition, literature from developing countries in general and Ethiopia in particular on the nexus and impact of household and child food insecurity on childhood obesity in the context of urbanization remains limited. The objective of this study was to explore the association between household and child food insecurity and childhood obesity in an urban setting of Ethiopia.

METHODS

An observational population based cross-sectional study was conducted in five sub-cities of Addis Ababa. Multi-stage sampling techniques were employed to identify the study unit from the selected sub-cities. Multivariable logistic regression models with robust estimation of standard errors were utilized to determine the associations. Interactions by age and sex in the associations explored were tested.

RESULTS

A total of 632 children and adolescents-parent dyads were included in the study. About 29.4% of those in food secure households and 25% of those in food insecure households were overweight/obese. Similarly, 29.8% of food secure children and 22% of food insecure children were overweight/obese. Household and child food insecurity status were not significantly associated with child and adolescent overweight or obesity in the final adjusted models.

CONCLUSIONS

Household and childhood food insecurity status were not associated with child and adolescent overweight/obesity in the study setting. Interventions aimed at combating overweight and obesity in the study setting should target children and adolescents irrespective of their food security status.

Changing from a highly food secure household to a marginal or food insecure household is associated with decreased weight and body mass index z-scores among Latino children from CHAMACOS

BACKGROUND

Persistent household food insecurity may have a greater adverse effect on children's health outcomes than experiencing household food insecurity for a shorter duration.

OBJECTIVES

Examine how changing household food security status and prolonged exposure to household marginal food security or food insecurity are associated with changes in children's growth from age 5 to 12.

METHODS

We analyzed 204 mother-child dyads from the Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS), a longitudinal birth cohort study of Latino households. Generalized estimating equations assessed how changing household food security status and persistent exposure to marginal food security or food insecurity were associated with growth throughout childhood.

RESULTS

Living in a marginally food secure of food insecure household compared to highly food secure household was associated with a decrease in BMI z-score of 0.18 (0.09, 0.26) between age 9 and 10.5. Changing from a highly food secure household to a marginally food secure or food insecure household was associated with a 0.10 (0.01, 0.20) decrease in body mass index z-score compared to those who persistently lived in highly food secure households.

CONCLUSIONS

Changes in food security status and duration of food insecurity were associated with changes in children's growth.

Childhood food insecurity and incident asthma: A population-based cohort study of children in Ontario, Canada

BACKGROUND

Childhood food insecurity has been associated with prevalent asthma in cross-sectional studies. Little is known about the relationship between food insecurity and incident asthma.

METHODS

We used administrative databases linked with the Canadian Community Health Survey, to conduct a retrospective cohort study of children <18 years in Ontario, Canada. Children without a previous diagnosis of asthma who had a household response to the Household Food Security Survey Module (HFSSM) were followed until March 31, 2018 for new asthma diagnoses using a validated administrative coding algorithm. We used multivariable Cox proportional hazard models to examine the association between food insecurity and incident asthma, and adjusted models sequentially for clinical and clinical/socioeconomic risk factors. As additional analyses, we examined associations by HFSSM respondent type, severity of food insecurity, and age of asthma diagnosis. Moreover, we assessed for interaction between food security and child's sex, household smoking status, and maternal asthma on the risk of incident asthma.

RESULTS

Among the 27,746 included children, 5.1% lived in food insecure households. Over a median of 8.34 years, the incidence of asthma was 7.33/1000 person-years (PY) among food insecure children and 5.91/1000 PY among food secure children (unadjusted hazard ratio [HR] 1.24, 95% CI 1.00 to 1.54, p = 0.051). In adjusted analyses associations were similar (HR 1.16, 95% CI 0.91 to 1.47, p = 0.24 adjusted for clinical risk factors, HR 1.24, 95% CI 0.97 to 1.60, p = 0.09 adjusted for clinical/socioeconomic factors). Associations did not qualitatively change by HFSSM respondent type, severity of food insecurity, and age of asthma diagnosis. There was no evidence of interaction in our models.

CONCLUSIONS

Food insecure children have numerous medical and social challenges. However, in this large population-based study, we did not observe that childhood food insecurity was associated with an increased risk of incident asthma when adjusted for important clinical and socioeconomic confounders.

Annual incidence and prevalence of obesity in childhood and young adulthood based on a 30-year longitudinal population-based cohort study in Korea: the Kangwha study

PURPOSE

Childhood obesity is a major global issue that causes a variety of health problems and high social costs. Many previous studies have investigated childhood obesity using cross-sectional data, but few longitudinal cohort studies have been performed, especially in the Korean population.

METHODS

We analyzed the incidence and prevalence of obesity and overweight in a Korean prospective cohort study of children that were followed-up from age 7 to age 36. The study eventually recruited a total of 1216 participants, with 16 follow-up surveys over 30 years (1986-2017).

RESULTS

The annual incidence of obesity showed a small peak (2.1%) at age 13 when the cohort entered middle school, but a rapid increase (6.4%) when participants reached the age of 20. The prevalence of obesity and overweight at age 8 was 0.8% and 0.9%, respectively, and increased rapidly from age 12 (obesity 2.2%, overweight 4.6%), reaching 9.5% and 15.9%, respectively, at age 20. The prevalence of obesity and overweight was consistently higher in girls than in boys during the childhood period, but this trend reversed in adulthood.

CONCLUSIONS

Incidence and prevalence of obesity and overweight increased markedly after the final grades of elementary school in females, but after adolescence in males.

An ethical analysis of obesity as a determinant of pediatric heart transplant candidacy

BACKGROUND

Inclusion of BMI as criterion in the determination of heart transplant candidacy in children is a clinical and ethical challenge. Childhood obesity is increasing and children with heart disease are not spared. Currently, many adult heart transplant centers consider class II obesity and higher (BMI > 35 kg/m² ) to be a relative contraindication for transplantation due to risk of poor outcome after transplant. No national guidelines exist regarding consideration of BMI in pediatric heart transplant and outcomes data are limited. This leaves decisions about transplant candidacy in obese pediatric patients to individual institutions or on a case-by-case basis, allowing for bias and inequity.

METHODS

We review (a) the prevalence of childhood obesity, including among heart transplant candidates, (b) the lack of existing BMI guidelines, and (c) relevant literature on BMI and pediatric heart transplant outcomes. We discuss the ethical considerations of using obesity as a criterion using the principles of utility, justice, and respect for persons.

RESULTS

Existing transplant outcomes data do not show that obese children have different or poor enough outcomes compared to non-obese children to warrant exclusion. Moreover, obesity in the United States is unequally distributed by race and socioeconomic status. Children already suffering from health disparities are therefore doubly penalized if obesity denies them access to life-saving transplant.

CONCLUSION

Insufficient data exist to support using any BMI cutoff as an absolute contraindication for heart transplant in children. Attention should be paid to health equity issues when considering excluding a patient for transplant based on obesity.

How Do Disadvantaged Children Perceive, Understand and Experience Household Food Insecurity?

Food insecurity is associated with reduced physical, social, and psychological functioning in children. There has been sparse research into child food insecurity that incorporates children's own perspectives, as adults are often interviewed as child proxies. While a nuanced, child-centred understanding of food insecurity is needed to inform effective policy and program responses, little is known about Australian children's firsthand understanding or experience of household food insecurity. This study aimed to fill this gap by inviting preadolescent children's perspectives. Eleven participants aged 10-13 years (seven girls and four boys) took part in the study and were recruited from an Australian charity school holiday camp that targets severely disadvantaged youth. Children took part in individual semi-structured interviews that incorporated drawings and emoji scales. Qualitative interviews were audio recorded, transcribed, and analysed using thematic techniques. Four themes emerged from the data analysis, children had: (i) financial understanding; (ii) awareness of food insecurity and coping mechanisms; (iii) sharing, empathy, and compassion for food insecure families; and (iv) described the nature of 'food' preparation. This study provides a child-centric analysis, demonstrating how children's agency is enacted and constrained in food insecure contexts. This child-derived understanding of food insecurity provides a critical basis from which to build effective approaches to assess and respond to this significant social issue.

Food insecurity, dietary acid load, dietary energy density and anthropometric indices among Iranian children

OBJECTIVES

Food insecurity significantly influences diet quality which in turn has an impact on individual health. This study aimed to determine the association of food insecurity, dietary energy density (DED), dietary acid load (DAL), and the anthropometric status of children.

STUDY DESIGN

A cross-sectional study.

METHODS

This study was conducted in 788 6-year-old girls who were referred to health care centers affiliated with Tehran University of Medical Sciences in the south of Tehran from October 2017 to March 2018. Food frequency questionnaires (168 food items) were assessed to calculate DAL and DED. Food insecurity was assessed using the 18-item United States Department of Agriculture questionnaire. Weight and height of children were measured as anthropometric indices.

RESULTS

Protein and energy intake were higher in participants with a higher DAL and DED, respectively. Energy, fat, carbohydrate, fiber, potassium, phosphorus, calcium, iron, folate, vitamin B12, mono- and poly-unsaturated fatty acid intake was inversely related to DAL. Children characterized as food insecure were more likely to be defined as thin (OR 5.36; 95% CI 3.41-8.40) than overweight (OR 0.18; 95% CI 0.12-027) and obese (OR 0.28; 95% CI 0.08-0.98, respectively). There was no significant association between DED, potential renal acid load (PRAL), and food security status. Moreover, there was no significant association between anthropometric measure and PRAL.

CONCLUSION

Findings from our study revealed that there was no association between DAL and food insecurity. However, food insecure children were more likely to be characterized as thin than children categorized as food secure. More studies need to be performed in both genders to confirm our findings.

LEVEL OF EVIDENCE

Level V cross-sectional descriptive study.

Food insecurity and the extremes of childhood weight: defining windows of vulnerability

BACKGROUND

Weight extremes and food insecurity (FIS) represent public-health challenges, yet their associations in childhood remain unclear. We aimed to investigate the longitudinal time-specific relationship between FIS and risk of overweight/obesity and underweight in kindergarten through 8th grade.

METHODS

In the prospective Early Childhood Longitudinal Study-Kindergarten Cohort (1998-2007) of 6368 children, household FIS was assessed by the validated US Household Food Security Survey Module in kindergarten, 3rd, 5th and 8th grades. Multivariable linear-regression and Poisson-regression models were computed.

RESULTS

Compared with children experiencing food security (FS), children exposed to FIS in 5th grade had 0.19 [95% confidence interval (CI): 0.07-0.30] and 0.17 (0.06-0.27) higher body mass index z-score (BMIZ) in the 5th and 8th grades, respectively, whereas FIS in the 8th grade was associated with a 0.29 (0.19-0.40) higher BMIZ at the same wave, after adjusting for covariates and FIS at earlier waves. Children with FIS vs FS had 27% (relative risk: 1.27, 95% CI: 1.07-1.51), 21% (1.21, 1.08-1.35) and 28% (1.28, 1.07-1.53) higher risk of overweight/obesity in the 3rd, 5th and 8th grades, respectively, adjusting for covariates and FIS at prior wave(s). Children with FIS vs FS in kindergarten had a 2.76-fold (1.22-6.25) higher risk of underweight in the 8th grade.

CONCLUSIONS

Proximal exposure to household FIS was associated with a higher risk of overweight/obesity in the 3rd, 5th and 8th grades. FIS in kindergarten was associated with a risk of underweight in the 8th grade. Thus, FIS coexists in weight extremes during vulnerable early-life windows in the USA, similarly to the global burden of FIS.

Food Insecurity and Obesity in US Adolescents: A Population-Based Analysis

Background: Food insecurity and obesity are significant problems affecting adolescents. There is a paucity of recent data examining this relationship. This study utilizes a recent nationally representative sample of US adolescents to examine the relationship between obesity and food security status, as well as other risk factors. Methods: A cross-sectional analysis of 4777 US adolescents (13-18 years old) was performed using data from the National Health and Nutrition Examination Surveys 2007-2016. Prevalence of obesity based on food security status was calculated. Multivariable logistic regression was performed to examine characteristics of adolescents in relationship to obesity. Results: The prevalence of obesity among adolescents from food insecure households was significantly higher compared to those who were not, with a prevalence ratio of 1.3 (95% CI: 1.2-1.5, p < 0.0001). Food insecurity was associated with a higher unadjusted rate of obesity, with an odds ratio of 1.4 (95% CI: 1.2-1.7, p = 0.0002). After adjustment for potential confounding factors, food insecurity was no longer significantly associated with obesity (OR 1.19, 95% CI: 1.0-1.4, p = 0.08). However, other factors such as black race, Hispanic ethnicity, male sex, and households with a monthly income ≤185% of the poverty line were associated with increased odds of obesity. Conclusions: While the prevalence of obesity in adolescents from food insecure households was higher compared to those who were not, no association between the two was found when accounting for other risk factors. Data on independent food-seeking behaviors of adolescents may help clarify this complex relationship in future work.

The translational implications of applying multiple measures to evaluate the nutrient quality of the food supply: a case study of two food pantries in Montana

Lower-income populations experience food insecurity, are less likely to meet dietary recommendations, and develop noncommunicable diseases at higher rates than the general U.S. population. Food pantries, which provide food to individuals in need, present an opportunity to decrease these disparities. The purpose of this study was to assess the nutrient quality of the food supply using multiple measures in two food pantry food environments and examine the methodological impactions for translation from research to practice. Nutrient quality of the food supply at two food pantries located in southwest Montana was evaluated using the Healthy Eating Index (HEI) 2015, NOVA classification system, and UnProcessed Pantry Project (UP3) framework every other month during 2018 and 2019. From a total of 63,429 pounds, 291,070 servings, and 32,818 calories of food, processed and ultraprocessed food (UPF) accounted for 57% of servings, 59% of pounds, and 67% of calories. UPF accounts for the highest proportion of food calories compared to its weight. Simutaneously, the food pantries' food supply had total HEI scores of 77.55 and 79.45 out of a total possible score of 100. NOVA, UP3, and HEI measured multiple aspects that increased the understanding of the nutrient quality of the food supply in two food pantries. A multifaceted approach should be applied, or an all-inclusive tool should be developed, to speed the translation of evidence to practice when assessing and promoting a food supply that limits UPF, increasing the availability of nutritious food and decreasing health disparities for low-income populations.