Food insecurity is associated with self-reported oral health in school-age Ecuadorian children and is mediated by dietary and non-dietary factors

A systematic review of the association between food insecurity and behaviours related to caries development in adults and children in high-income countries

OBJECTIVES

To synthesize and appraise the evidence regarding the relationship between food insecurity and behaviours associated with dental caries development in adults and children in high-income countries.

METHODS

A systematic review including observational studies assessing the association between food insecurity and selected dietary (free sugar consumption) and non-dietary factors (tooth brushing frequency; use of fluoridated toothpaste; dental visiting; oral hygiene aids; type of toothbrush used; interdental cleaning frequency and mouthwash use) related to dental caries development in adults and children in high-income countries. Studies specifically looking at food insecurity during the COVID-19 pandemic were excluded. Searches were performed in MEDLINE, Embase, Global Health and Scopus from inception to 25 May 2023. Two authors screened the search results, extracted data and appraised the studies independently and in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale (with modifications for cross-sectional studies). Vote counting and harvest plots provided the basis for evidence synthesis.

RESULTS

Searches identified 880 references, which led to the inclusion of 71 studies with a total of 526 860 participants. The majority were cross-sectional studies, conducted in the USA and reported free sugar consumption. Evidence for the association between food insecurity and free sugar intake from 4 cohort studies and 61 cross-sectional studies including 336 585 participants was equivocal, particularly in the sugar-sweetened beverage (SSB) consumption post-hoc subgroup, where 20 out of 46 studies reported higher SSB consumption in food insecure individuals. There was consistent, but limited, evidence for reduced dental visiting in adults experiencing food insecurity compared to food secure adults from 3 cross-sectional studies including 52 173 participants. The relationship between food insecurity and dental visiting in children was less clear (3 cross-sectional studies, 138 102 participants). A single cross-sectional study of 3275 children reported an association between food insecurity and reported failure to toothbrush the previous day.

CONCLUSIONS

This review did not identify clear associations between food insecurity and behaviours commonly implicated in the development of dental caries that would explain why individuals experiencing food insecurity are more likely to have dental caries than those who have food security. There was some evidence of decreased dental visiting in adults experiencing food insecurity. Common methodological weaknesses across the evidence base related to the selection of participants or control of potentially confounding variables. Consequently, the quality of evidence for all outcomes was downgraded to very low. More research is needed to explore access to oral hygiene products and household environments conducive to habitual oral self-care in food insecure populations.

Household food insecurity and physical activity behaviour in Ecuadorian children and adolescents: findings from the Ecuador 2018 National Health and Nutrition Survey (ENSANUT-2018)

OBJECTIVE

Ecuador has a high prevalence of household food insecurity (HFI) and is undergoing nutritional and epidemiologic transition. Evidence from high-income countries has reported negative or null associations between HFI and physical activity (PA) in children. It remains uncertain whether the same is true of those from low- and middle-income countries like Ecuador whose environmental and socio-demographic characteristics are distinct from those of high-income countries. We aimed to investigate the association of HFI with PA, sedentary behaviour (SB) and anthropometric indicators in children.

DESIGN

Cross-sectional analysis of data from the nationally representative 2018 Ecuadorian National Health and Nutrition Survey. Data were collected on HFI, PA, SB, socio-demographic characteristics and measured height and weight. Unadjusted and adjusted linear, log-binomial and multinomial logistic regression analyses assessed the relationship of HFI with PA, SB, stunting and BMI-for-age.

SETTING

Ecuador.

PARTICIPANTS

23 621 children aged 5-17 years.

RESULTS

Marginal and moderate-severe HFI was prevalent in 24 % and 20 % of the households, respectively. HFI was not associated with PA, SB, stunting nor underweight. Moderate-severe HFI was associated with a lower odds of overweight and obesity. However, adjustment for household assets attenuated this finding for overweight (adjusted OR:0·90, 95 % CI: 0·77, 1·05) and obesity (adjusted OR: 0·88, 95 % CI: 0·71, 1·08).

CONCLUSION

HFI is a burden in Ecuadorian households, but is not associated with PA, SB nor anthropometric indicators in children aged 5-17 years. However, a concerning prevalence of insufficient PA was reported, emphasising the critical need for evidence-based interventions aimed at promoting PA and reducing SB.

Factors increasing the risk for food addiction in Ecuadorian students

Background

Food addiction (FA) is a construct that has gained interest in recent years, but its relevance in the Ecuadorian population has not yet been explored. The aims of this study were to explore the differences in the psychological profile (including FA) between university students from Ecuador and to identify the underlying structure of the relationships of the FA severity level through a mediational model.

Methods

The sample consisted of 972 university students, women and men (mean age: 20.1 years old, SD = 2.6), recruited from four Ecuadorian regions. The assessment tools included a unidimensional scale of FA, eating-related measures, emotion regulation state, impulsivity, and psychopathology state. Path analysis modeled the direct and indirect effects explaining the FA severity level.

Results

The results indicated that higher psychopathological levels were associated with FA. Similarly, no differences in FA were observed between the Ecuadorian regions. The path analysis suggested that older age, female sex, and higher difficulties in emotional regulation, impulsivity, negative mood, and anxiety trigger disordered eating; subsequently, more impaired eating behavior impacted the FA level.

Conclusion

FA is a complex clinical entity that includes multiple components related to eating disorders (EDs) and other mental health problems. The results of this study provide empirical knowledge for designing evidence-based prevention and treatment strategies.