1
|
Vijayakumar N, Husin HM, Dashti SG, Mundy L, Moreno-Betancur M, Viner RM, Goddings AL, Robson E, Sawyer SM, Patton GC. Characterization of Puberty in an Australian Population-Based Cohort Study. J Adolesc Health 2024; 74:665-673. [PMID: 37815771 DOI: 10.1016/j.jadohealth.2023.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Current knowledge of the characteristics of puberty beyond age at menarche and thelarche is limited, particularly within population-based cohorts. Secular trends and concerns of the health effects of early puberty reinforce the value of contemporary studies characterizing the timing, tempo, duration, and synchronicity of puberty. METHODS The Childhood to Adolescence Transition Study is a unique Australian cohort of individuals followed annually from late childhood to late adolescence, with up to eight assessments of pubertal stage from 9 to 19 years of age (N = 1,183; 636 females). At each assessment, females reported their Tanner Stage of breast and pubic hair development, while males reported on genital/pubic hair development. Nonlinear mixed-effects models characterized pubertal trajectories and were used to derive each individual's estimates of timing, tempo, and synchronicity. Parametric survival models were used to estimate the overall duration of puberty. RESULTS Timing of mid-puberty (Tanner Stage 3) ranged from 12.5 to 13.5 years, with females developing approximately 6 months before males. Pubertal tempo (at mid-puberty) was similar across sex (between half and one Tanner Stage per year), but the overall duration of puberty was slightly shorter in males. Most females exhibited asynchronous changes of breast and pubic hair development. DISCUSSION Estimates of pubertal timing and tempo are consistent with reports of cohorts from two or more decades ago, suggesting stabilization of certain pubertal characteristics in predominantly White populations. However, our understanding of the duration of puberty and individual differences in pubertal characteristics (e.g., synchronicity of physical changes) remains limited.
Collapse
Affiliation(s)
- Nandita Vijayakumar
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Parkville, Victoria, Australia; Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia.
| | - Hanafi Mohamad Husin
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Parkville, Victoria, Australia
| | - S Ghazaleh Dashti
- Clinical Epidemiology & Biostatistics, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Lisa Mundy
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Parkville, Victoria, Australia; Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Victoria, Australia
| | - Margarita Moreno-Betancur
- Clinical Epidemiology & Biostatistics, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Russell M Viner
- Population, Policy and Practice Research Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Anne-Lise Goddings
- Population, Policy and Practice Research Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ellie Robson
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Parkville, Victoria, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Parkville, Victoria, Australia
| | - George C Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute and Royal Children's Hospital, Parkville, Victoria, Australia
| |
Collapse
|
2
|
Ahmed MR. Climate shocks' impact on agricultural income and household food security in Bangladesh: An implication of the food insecurity experience scale. Heliyon 2024; 10:e25687. [PMID: 38379971 PMCID: PMC10877247 DOI: 10.1016/j.heliyon.2024.e25687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
Floods and extreme rainfall are common climatic phenomena in Bangladesh, and farm households are more susceptible to such shocks. This paper assesses the impact of climate shocks on agricultural income and food security of farm households in Bangladesh using an extensive nationally representative dataset from the Bangladesh Integrated Household Survey 2018-19, including 5604 sample rural households in 64 districts. However, this research considered 24 districts, representing 2131 sample farm households, by developing an exogenous climate shock indicator based on data from the Yearbook of Agricultural Statistics of Bangladesh 2018. Empirical findings on the grounds of simultaneous quantile regression reveal that climate shocks substantially lower agricultural income in the study regions. However, the presence of prime-age women (15-49) in the home, the male-headed family, farmland, and livestock ownership of the household are the decisive factors that safeguard agricultural income. Applying the Food Insecurity Experience Scale (FIES), descriptive statistics disclose that most farm households suffer at various food insecurity levels (considerably moderate, noticeably mild, and tiny severe), while the rest are at the food security level. The key finding regarding ordered probit regression uncovers that climate shocks significantly increase household food insecurity (at different levels of FIES). In other words, cropland damage due to floods and extreme rainfall reduces the food security of farm households in the study districts. On the other hand, increased farm size and educated households are profoundly protected against food insecurity. This study, therefore, recommends that raising livestock can complement agricultural income, and enhancing education would ensure households' food security in the climate-exposed areas of Bangladesh.
Collapse
Affiliation(s)
- Md. Rashid Ahmed
- Department of Social Sciences, Wageningen University & Research, the Netherlands
- Department of Agricultural Finance and Banking, Sylhet Agricultural University, Sylhet, 3100, Bangladesh
| |
Collapse
|
3
|
Wang C, Wang J, Wan R, Yuan T, Yang L, Zhang D, Li X, Liu H, Zhang L. Separate and combined effects of famine exposure and menarche age on metabolic syndrome among the elderly: a cross-sectional study in China. BMC Womens Health 2023; 23:600. [PMID: 37964223 PMCID: PMC10648701 DOI: 10.1186/s12905-023-02737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Epidemiological studies have revealed multiple risk factors for metabolic syndrome. However, there are no consistent findings on the association between famine exposure, age at menarche, and the prevalence of metabolic syndrome. This cross-sectional study aimed to reveal the individual and combined effects of famine exposure and age at menarche on the prevalence of metabolic syndrome among elderly women. METHODS Four thousand seven hundred seventy participants between 60 and 93 years of age were selected from the China Health and Retirement Longitudinal Study. Statistical differences between the baseline characteristics of famine exposure, age at menarche, and metabolic syndrome were evaluated using the t-test, F-test, and Chi-square test. Three multivariable-adjusted logistic regression models were used to test the association between famine exposure, age of menarche, and the odds ratio of metabolic syndrome. RESULTS Two thousand one hundred ninety-eight (46.08%) participants had metabolic syndrome, while 2572 (53.92%) participants did not. Furthermore, 3068 (64.32%) women reported onset of menarche under 15 years of age, while 1702 (35.68%) women reported onset of menarche above 16 years of age. Regarding the separate association of famine exposure and age of menarche with metabolic syndrome, in model three, the adolescence/adulthood famine exposure group vs. no famine exposure group odds ratio was 2.45 (95% CI 2.02, 2.97), and the older than 16 years vs. younger than 15 years group odds ratio was 1.23 (95% CI 1.09, 1.39), which was the highest odds ratio among the three models. Regarding the combined association of famine exposure and age of menarche with metabolic syndrome, in model three, among the age of menarche ≤ 15 years group, the adolescence/adulthood famine exposure vs. no famine exposure group odds ratio was 2.45 (95% CI: 1.91, 3.14); among the menarche age ≥ 16 years group, the adolescence/adulthood famine exposure stages vs. exposed group odds ratio was 3.27 (95% CI: 2.44, 4.38), which was the highest odds ratio among the three models. CONCLUSION These findings suggested that famine exposure and age at menarche, either separately or in combination, were positively associated with the prevalence of metabolic syndrome among older women.
Collapse
Affiliation(s)
- Congzhi Wang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, An Hui Province, Wuhu City, 241000, P.R, China
| | - Jiazhi Wang
- Sports Institute, Chi Zhou College, Education Park, Chi Zhou City, An Hui Province, People's Republic of China
| | - Rui Wan
- Business School, Yunnan University of Finance and Economics, 237 Longquan Road, Kunming City, Yun Nan Province, People's Republic of China
| | - Ting Yuan
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Liu Yang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, An Hui Province, Wuhu City, 241000, P.R, China
| | - Dongmei Zhang
- Department of Pediatric Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Xiaoping Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Haiyang Liu
- Student Health Center, Wannan Medical College, 22 Wenchang West Road, Higher Education ParkAn Hui Province, Wuhu City, People's Republic of China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, An Hui Province, Wuhu City, 241000, P.R, China.
| |
Collapse
|
4
|
Srikanth N, Xie L, Francis J, Messiah SE. Association of Social Determinants of Health, Race and Ethnicity, and Age of Menarche among US Women Over 2 Decades. J Pediatr Adolesc Gynecol 2023; 36:442-448. [PMID: 37196755 DOI: 10.1016/j.jpag.2023.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Age of menarche (AOM), or the first menstrual cycle, is one indicator of female puberty. The timing of AOM can be influenced by social determinants of health (SDOH). This study examined associations between SDOH and AOM over the past 2 decades in the United States. METHODS US National Health and Nutrition Examination Survey data (1999 to early 2020) were analyzed. Multinomial logistic regression analyses examined associations between AOM (early [11.99 years and younger], typical [12-13 years], and late [13.01 years and older]) and race/ethnicity, insurance coverage, education, family income-to-poverty ratio, money management, and home status. RESULTS AOM remained consistent over the past 2 decades (mean 12.50 years, SE 0.02) for the aggregate sample. Females identifying as Hispanic (excluding Mexican Americans) were 63% more likely (adjusted odds ratio [aOR] 1.63, 95% confidence interval [CI] 1.13-2.36) to report early menarche. Those identifying as other/multiracial were 46% more likely to report late menarche (aOR 1.46, 95% CI 1.13-1.89) vs non-Hispanic Whites. Financial and home status instability was associated with early menarche (aOR 1.46, 95% CI 1.17-1.83; aOR 1.25, 95% CI 1.05-1.48). Less than 9th-grade education was associated with late menarche (aOR 1.47, 95% CI 1.14-1.89). CONCLUSION Although the average AOM has remained stable in the United States over the past 20 years, identifying as Hispanic (excluding Mexican Americans) and financial/home instability are associated with early AOM, and lower education levels are associated with late AOM. Identifying programming and policy options targeting SDOH may help improve current and future reproductive health.
Collapse
Affiliation(s)
- Nimisha Srikanth
- University of Texas Health Science Center at Houston, School of Public Health, Dallas Campus, Dallas, Texas; Center for Pediatric Population Health, University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas; Texas A&M University, School of Public Health, College Station, Texas
| | - Luyu Xie
- University of Texas Health Science Center at Houston, School of Public Health, Dallas Campus, Dallas, Texas; Center for Pediatric Population Health, University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas
| | - Jenny Francis
- University of Texas Southwestern Medical Center, Department of Pediatrics, Dallas, Texas
| | - Sarah E Messiah
- University of Texas Health Science Center at Houston, School of Public Health, Dallas Campus, Dallas, Texas; Center for Pediatric Population Health, University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas; UTHealth McGovern Medical School, Department of Pediatrics, Houston, Texas.
| |
Collapse
|
5
|
Gibb JK, Spake L, McKinnon L, Shattuck EC, McKerracher L. Sexual minority status is associated with earlier recalled age of menarche: Evidence from the 2005-2016 National Health and Nutrition Examination Survey. Am J Hum Biol 2023; 35:e23825. [PMID: 36301198 DOI: 10.1002/ajhb.23825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 09/19/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Menarcheal timing is associated with growth, development, health, wellbeing, and reproduction across the lifespan. Although sexual orientation is a known correlate of health and developmental inequities, relatively little evolutionarily framed research has investigated sexual orientation-based variation in maturational timing. To improve our understanding of menarcheal timing among sexual minority (SM) people, we use a biocultural-evolutionary life history lens that takes into account the stresses of minoritization to examine the relationship between sexual orientation and self-reported age at menarche in a sample of American adults. METHODS Using the U.S. National Health and Nutrition Examination Survey (NHANES), a large, nationally representative dataset (n = 9757), we fit multiple logistic regression models and survival curves to evaluate associations between sexual orientation, indicators of somatic and material resources during adolescence (e.g., education, citizenship, upper arm length), and self-reported menarche. RESULTS SM respondents were more likely to report earlier (by 4-5 months) ages of menarche (p < .001). Post-hoc tests revealed that these differences were driven by bisexual (p < .001) and same-sex experienced (p < .001) relative to heterosexual and lesbian/gay respondents. Earlier menarcheal timing among SM respondents persisted after adjusting for socio-demographic factors and proxies of developmental conditions. DISCUSSION Our findings reveal that SM status is associated with earlier ages of menarche, an important social and reproductive milestone. We argue that uniting life history theory with the minority stress hypothesis better explains differences in menarcheal timing by sexual orientation than previous paradigms. Investigators should attend to sexual orientation-based variation in maturational timing using holistic, inclusive approaches.
Collapse
Affiliation(s)
- James K Gibb
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA.,Department of Health & Society, University of Toronto, Scarborough, Canada
| | - Laure Spake
- Religion Programme, and Centre for Research on Evolution, Belief, and Behaviour, University of Otago, Dunedin, Otago, New Zealand.,Department of Anthropology, Binghamton University, Binghamton, USA
| | - Leela McKinnon
- Department of Anthropology, University of Toronto, Toronto, Canada
| | - Eric C Shattuck
- Department of Public Health, University of Texas at San Antonio, San Antonio, USA.,Institute for Health Disparities Research, University of Texas at San Antonio, San Antonio, USA
| | | |
Collapse
|
6
|
Diet and Nutrients Intakes during Infancy and Childhood in Relation to Early Puberty: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14235004. [PMID: 36501034 PMCID: PMC9739867 DOI: 10.3390/nu14235004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/17/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022] Open
Abstract
The onset of puberty has become earlier over the decades, and nutrients and diet are related to the timing of puberty onset. Hence, we aimed to investigate the association between diet or nutrients in infancy, childhood and early puberty. PubMed, Embase, and Cochrane library were searched systematically up to 15 April 2022. The pooled relative risks (RRs) or regression coefficients (beta) were estimated using the random-effect model or fixed-effect model according to the heterogeneity between studies. Twenty-two articles on diet or nutrients in childhood and six about breastfeeding in infancy were included. The prolonged breastfeeding duration in infancy could reduce the risk of early menarche (beta 0.31, 95% CI: 0.01, 0.60, p = 0.045). The high intake of yogurt was associated with a 35% reduction in the risk of earlier menarche (RR 0.65, 95% CI: 0.47, 0.89, p = 0.008). Girls with severe food insecurity experienced later menarche (RR 0.81, 95% CI: 0.67, 0.98, p = 0.027). Conversely, due to the high intake of protein, the risk of early menarche increased by 8% (RR 1.08, 95% CI: 1.01, 1.16, p = 0.016). High intake of yogurt, longer duration of breastfeeding, and food insecurity decreased the possibility of earlier menarche, while high intake of protein increased that risk. As a modifiable factor, diet and nutrients in infancy and childhood provide new insights into the future prevention of early puberty.
Collapse
|
7
|
DeCaro JA, Helfrecht C. Applying minimally invasive biomarkers of chronic stress across complex ecological contexts. Am J Hum Biol 2022; 34:e23814. [PMID: 36201446 PMCID: PMC9788276 DOI: 10.1002/ajhb.23814] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 01/25/2023] Open
Abstract
Chronic stress is both theoretically and methodologically challenging to operationalize through biomarkers. Yet minimally invasive, field-friendly biomarkers of chronic stress are valuable in research linking biology and culture, seeking to understand differential patterns of human development across ecological contexts, and exploring the evolution of human sociality. For human biologists, a central question in measurement and interpretation of biomarkers is how stress-responsive physiological systems are regulated across diverse human ecologies. This article aims to describe a conditional toolkit for human biologists interested in the study of chronic stress, highlighting a mix of longstanding and novel biomarkers, with special focus on hair/fingernail cortisol, latent herpesvirus antibodies, allostatic load indices, and serial/ambulatory data collection approaches. Future trends in chronic stress biomarker research, including epigenetic approaches, are briefly considered. This overview considers: (1) challenges in separating a distinctly psychosocial dimension of chronic stress from adversity more broadly; (2) essential characteristics of human ecology that shape interpretation; (3) retrospective vs. longitudinal sampling; (4) the role of age, developmental effects, and local biologies; (5) different timescales of chronicity; and (6) the role of culture.
Collapse
Affiliation(s)
- Jason A. DeCaro
- Department of AnthropologyThe University of AlabamaTuscaloosaAlabamaUSA
| | | |
Collapse
|
8
|
Glass DJ, Geerkens JT, Martin MA. Psychosocial and energetic factors on human female pubertal timing: a systematized review. EVOLUTIONARY HUMAN SCIENCES 2022; 4:e28. [PMID: 37588922 PMCID: PMC10426011 DOI: 10.1017/ehs.2022.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Childhood psychosocial stressors have been proposed to favour fast life history strategies promoting earlier puberty in females. However, studies demonstrating this association often do not elucidate causal mechanisms, nor account for greater childhood energetic availability - also known to promote rapid growth and earlier puberty. To assess the extent to which such confounding has been considered, we conducted a systematized review to identify studies examining measures of both prepubertal growth (e.g. weight, height) and psychosocial stressors (e.g. adversity, father absence) in relation to female pubertal timing. A total of 1069 non-duplicated studies were identified across five databases. Twenty studies met selection criteria for critical review following independent screening of titles, abstracts and manuscripts. Within these studies, measures indicative of rapid childhood growth were more consistently associated with earlier pubertal timing than were measures of psychosocial stress. We discuss future research directions to investigate the impact of psychosocial stress on pubertal timing more robustly, including methodological and mechanistic considerations, and contextualization of findings by socioecological environments.
Collapse
Affiliation(s)
- Delaney J. Glass
- University of Washington, Department of Anthropology, Seattle, Washington, USA
| | | | - Melanie A. Martin
- University of Washington, Department of Anthropology, Seattle, Washington, USA
| |
Collapse
|
9
|
Household marginal food security is associated with poorer self-rated health in Korean adults. Nutr Res 2022; 100:33-41. [DOI: 10.1016/j.nutres.2022.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/13/2021] [Accepted: 01/02/2022] [Indexed: 11/22/2022]
|
10
|
Men F, Tarasuk V. Classification Differences in Food Insecurity Measures between the United States and Canada: Practical Implications for Trend Monitoring and Health Research. J Nutr 2021; 152:1082-1090. [PMID: 34967852 PMCID: PMC8970993 DOI: 10.1093/jn/nxab447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/16/2021] [Accepted: 12/24/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Food insecurity, inadequate access to food due to financial constraints, is a major public health issue in the United States and Canada, where the same 18-item questionnaire is used to monitor food insecurity. Researchers often assume that findings on food insecurity from the 2 countries are comparable with each other, but there are between-country differences in how food insecurity status is determined. OBJECTIVES We aimed to compare the distribution of household food insecurity in the Canadian population applying the US and Canadian classification schemes. We also examined the extent to which associations between food insecurity and adults' health differ under the 2 schemes. METHODS We used the population-representative Canadian Community Health Survey 2005-2017 linked to administrative health records. Food insecurity was measured by the Household Food Security Survey Module. Adults 18 y and older with valid food insecurity status were included from all jurisdictions except Quebec (n = 403,200). We cross-tabulated food insecurity status classified by the US and Canadian schemes. We also fitted logistic regressions on self-reported and objective health measures adjusting for confounders. RESULTS Applying the Canadian classification scheme, 7.7% of households were food insecure; the number fell to 6.0% with the US scheme. Associations between food insecurity status and health measures were mostly similar across classification schemes, although the associations between food insecurity and self-reported health were slightly larger if the US scheme was applied. Marginal food security/insecurity was associated with worse health measures irrespective of the classification scheme. United States-Canada discordance in classification of marginal food security/insecurity had a limited effect on health prediction. CONCLUSIONS United States-Canada differences in classification affected the apparent distribution of household food insecurity but not the associations between food insecurity and measures of adult health. Marginal food security/insecurity should be set apart from the food-secure group for trend monitoring and health research.
Collapse
Affiliation(s)
- Fei Men
- Address correspondence to FM (E-mail: )
| | - Valerie Tarasuk
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|