1
|
Bailey J, Baker E, Schechter MS, Robinson KJ, Powers KE, Dasenbrook E, Hossain M, Durham D, Brown G, Clemm C, Reno K, Oates GR. Food insecurity screening and local food access: Contributions to nutritional outcomes among children and adults with cystic fibrosis in the United States. J Cyst Fibros 2024; 23:524-531. [PMID: 37666711 PMCID: PMC10907545 DOI: 10.1016/j.jcf.2023.08.006] [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: 04/30/2023] [Revised: 07/18/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND As the nutritional status of people with CF (PwCF) is associated with their socioeconomic status, it is important to understand factors related to food security and food access that play a role in the nutritional outcomes of this population. We assessed the contributions of CF program-level food insecurity screening practices and area-level food access for nutritional outcomes among PwCF. METHODS We conducted a cross-sectional analysis of 2019 data from the U.S. CF Patient Registry (CFFPR), linked to survey data on CF program-level food insecurity screening and 2019 patient zip code-level food access. Pediatric and adult populations were analyzed separately. Nutritional outcomes were assessed with annualized BMI percentiles (CDC charts) for children and BMI (kg/m2) for adults, with underweight status defined as BMIp <10% for children and BMI <18.5 kg/m2 for adults, and overweight or obese status defined as BMIp >85% for children and BMI >25 kg/m2 for adults. Analyses were adjusted for patient sociodemographic and clinical characteristics. RESULTS The study population included 11,971 pediatric and 14,817 adult PwCF. A total of 137 CF programs responded to the survey, representing 71% of the pediatric sample and 45% of the CFFPR adult sample. The joint models of nutritional status as a function of both program-level food insecurity screening and area-level food access produced the following findings. Among children with CF, screening at every visit vs less frequently was associated with 39% lower odds of being underweight (OR 0.61, p = 0.019), and the effect remained the same and statistically significant after adjusting for all covariates (aOR 0.61, p = 0.047). Residence in a food desert was associated both with higher odds of being underweight (OR 1.66, p = 0.036; aOR 1.58, p = 0.008) and with lower BMIp (-4.81%, p = 0.004; adjusted -3.73%, p = 0.014). Among adults with CF, screening in writing vs verbally was associated with higher odds of being overweight (OR 1.22, p = 0.028; aOR 1.36, p = 0.002) and higher BMI (adjusted 0.43 kg/m2, p = 0.032). Residence in a food desert was associated with higher odds of being underweight (OR 1.48, p = 0.025). CONCLUSIONS Food insecurity screening and local food access are independent predictors of nutritional status among PwCF. More frequent screening is associated with less underweight among children with CF, whereas screening in writing (vs verbally) is associated with higher BMI among adults. Limited food access is associated with higher odds of being underweight in both children and adults with CF, and additionally with lower BMI among children with CF. Study results highlight the need for standardized, evidence-based food insecurity screening across CF care programs and for equitable food access to optimize the nutritional outcomes of PwCF.
Collapse
Affiliation(s)
- Julianna Bailey
- The University of Alabama at Birmingham, Lowder 620, 1600 7th Avenue South, Birmingham, AL 35233-1711, United States
| | - Elizabeth Baker
- The University of Alabama at Birmingham, Lowder 620, 1600 7th Avenue South, Birmingham, AL 35233-1711, United States
| | - Michael S Schechter
- Virginia Commonwealth University and Children's Hospital of Richmond at VCU, Richmond, VA, United States
| | - Keith J Robinson
- University of Vermont Children's Hospital, Burlington, VT, United States
| | | | - Elliot Dasenbrook
- Cleveland Clinic Respiratory Institute, Cleveland, OH, United States
| | - Monir Hossain
- The University of Alabama at Birmingham, Lowder 620, 1600 7th Avenue South, Birmingham, AL 35233-1711, United States
| | - Dixie Durham
- St. Luke's Cystic Fibrosis Center of Idaho, United States
| | - Georgia Brown
- Community Advisor to the Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Cristen Clemm
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Kim Reno
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Gabriela R Oates
- The University of Alabama at Birmingham, Lowder 620, 1600 7th Avenue South, Birmingham, AL 35233-1711, United States.
| |
Collapse
|
2
|
Blasingame M, Samuels LR, Heerman WJ. The Combined Effects of Social Determinants of Health on Childhood Overweight and Obesity. Child Obes 2024; 20:107-118. [PMID: 36989504 DOI: 10.1089/chi.2022.0222] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Background: To characterize the association between multiple social determinants of health (SDOH) and overweight and obesity among US children. Methods: We conducted a cross-sectional analysis using the 2016-2020 National Survey of Children's Health. SDOH domains consisted of Economic Stability, Social and Community Context, Neighborhood and Built Environment, and Health Care Access and Quality. We used ordinal logistic regression to model associations between SDOH and weight status and calculate predicted probabilities of having overweight or obesity for various SDOH profiles. Results: Data from 81,716 children represented a weighted sample of 29,415,016 children ages 10-17 years in the United States. Of these, 17% had overweight and 17% had obesity. Compared with children with the theoretically lowest-risk SDOH profile, children with the highest-risk SDOH profiles in all four domains had an odds ratio of having a higher BMI category of 4.38 (95% confidence interval 1.67-7.09). For the lowest risk profile, the predicted probability of obesity varied from 8% to 11%, depending on race. For the highest risk profile, the predicted probability of obesity varied from 26% to 34%, depending on race. Conclusions: While high-risk values in each SDOH domain were associated with higher predicted probability of overweight and obesity, it was the combination of highest risk values in all the SDOH domains that led to greatest increases. This suggests a complex and multilayered relationship between the SDOH and childhood obesity, necessitating a comprehensive approach to addressing health equity to reduce childhood obesity.
Collapse
Affiliation(s)
| | - Lauren R Samuels
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
3
|
Addressing Food Insecurity: Lessons Learned from Co-Locating a Food Pantry with a Federally Qualified Health Center. Int J Integr Care 2022; 22:24. [PMID: 36248069 PMCID: PMC9524299 DOI: 10.5334/ijic.6430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/12/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Social determinants of health, such as food insecurity, contribute to chronic health conditions, decreased quality of life, and health disparities. Increasingly, healthcare systems seek to address social determinants of health by integrating medical and social care. Description: Eskenazi Health Center Pecar is a Federally Qualified Health Center providing comprehensive primary care to vulnerable patients in Indianapolis, IN, USA. This health center, in coalition with community partners, established and continually developed an integrated food pantry model to address food insecurity, improve nutrition education, and support patient access to healthy food. Discussion: Food insecurity and poor nutrition are common in primary care and contribute to the incidence and outcomes of chronic conditions such as obesity, hypertension, and diabetes. Long-term management of food assistance and nutrition programs requires substantial resources, partnerships, and leadership. We describe lessons learned in food pantry partnership, funding, logistics, and sustainability in a collaborative food access model integrated into healthcare. These lessons learned can be utilized by other health systems to scale up and accelerate strategies to better address food security and nutrition education. This paper articulates best practices for integrating a food pantry model within primary care with the goal of long-term sustainability and direct impact on patient health outcomes.
Collapse
|
4
|
St Pierre C, Ver Ploeg M, Dietz WH, Pryor S, Jakazi CS, Layman E, Noymer D, Coughtrey-Davenport T, Sacheck JM. Food Insecurity and Childhood Obesity: A Systematic Review. Pediatrics 2022; 150:188267. [PMID: 35694873 DOI: 10.1542/peds.2021-055571] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Addressing food insecurity while promoting healthy body weights among children is a major public health challenge. Our objective is to examine longitudinal associations between food insecurity and obesity in US children aged 1 to 19 years. METHODS Sources for this research include PubMed, CINAHL, and Scopus databases (January 2000 to February 2022). We included English language studies that examined food insecurity as a predictor of obesity or increased weight gain. We excluded studies outside the United States and those that only considered the unadjusted relationship between food security and obesity. Characteristics extracted included study design, demographics, methods of food security assessment, and anthropometric outcomes. RESULTS Literature searches identified 2272 articles; 13 met our inclusion criteria. Five studies investigated the relationship between food insecurity and obesity directly, whereas 12 examined its relationship with body mass index or body mass index z-score. Three studies assessed multiple outcomes. Overall, evidence of associations between food insecurity and obesity was mixed. There is evidence for possible associations between food insecurity and obesity or greater weight gain in early childhood, for girls, and for children experiencing food insecurity at multiple time points. Heterogeneity in study methods limited comparison across studies. CONCLUSIONS Evidence is stronger for associations between food insecurity and obesity among specific subgroups than for children overall. Deeper understanding of the nuances of this relationship is critically needed to effectively intervene against childhood obesity.
Collapse
Affiliation(s)
| | | | - William H Dietz
- Milken Institute School of Public Health.,Sumner M. Redstone Center for Prevention and Wellness, The George Washington University, Washington, District of Columbia
| | | | | | | | | | | | | |
Collapse
|
5
|
Orr CJ, Ritter V, Coker TR, Perrin EM, Flower KB. Time-Varying Associations between Food Insecurity and Infant and Maternal Health Outcomes. J Nutr 2022; 152:1291-1297. [PMID: 35084466 PMCID: PMC9272420 DOI: 10.1093/jn/nxac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Food insecurity (FI) is dynamic for families and adversely affects infant and maternal health. However, few studies have examined the longitudinal impact of FI on infant and maternal health. OBJECTIVES We aimed to examine the relation between food insecurity in the first year of life and infant and maternal health outcomes. We hypothesized FI would be associated with poorer infant and maternal health outcomes. METHODS We conducted a retrospective cohort study of 364 infants 12-15 months and their caregivers receiving care at a single primary care clinic. The exposure of interest was food insecurity measured during well-child checks using a validated 2-item screening tool. The primary outcome was infant weight-for-length z score. Secondary outcomes included infant log-transformed ferritin, infant hemoglobin, infant lead concentrations, and maternal depression, assessed by the Edinburgh Postnatal Depression Scale. Unadjusted and adjusted effects were estimated using generalized mixed linear models, and the linear effect of visit time was tested using likelihood ratios. RESULTS In adjusted models, no overall association between FI and infant weight-for-length z score was observed; however, FI male infants had lower weight-for-length z scores than female infants (P = 0.05). FI infants had 14% lower log ferritin concentrations per month of exposure to FI. FI was positively associated with maternal depression (IRR 5.01 [95% CI 2.21-11.3]). CONCLUSIONS Food insecurity can have longitudinal and demographically-varied associations with infant and maternal outcomes that warrant further exploration.
Collapse
Affiliation(s)
| | - Victor Ritter
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, WA, USA
| | - Eliana M Perrin
- Department of Pediatrics, School of Medicine and School of Nursing, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Kori B Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
6
|
Zheng S, Ngo AL, Forman MR, Barcellos AL, Liao L, Ferrara A, Zhu Y. Associations of household food insufficiency with childhood depression and anxiety: a nationwide cross-sectional study in the USA. BMJ Open 2021; 11:e054263. [PMID: 34493526 PMCID: PMC8424875 DOI: 10.1136/bmjopen-2021-054263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Household food insufficiency (HFIS) is a major public health threat to children. Children may be particularly vulnerable to HFIS as a psychological stressor due to their rapid growth and accelerated behavioural and cognitive states, whereas data focusing on HFIS and childhood mental disorders are as-yet sparse. We aimed to examine the associations of HFIS with depression and anxiety in US children. DESIGN Cross-sectional study. SETTING The 2016-2018 National Survey of Children's Health, a nationally-representative study. PARTICIPANTS Primary caregivers of 102 341 children in the USA. PRIMARY AND SECONDARY OUTCOME MEASURES Physician diagnosed depression and anxiety were assessed by questionnaires administered to primary caregivers of 102 341 children. Multivariable logistic regression models estimated adjusted OR (aOR) for current depression or anxiety associated with HFIS measured through a validated single-item instrument. RESULTS Among children aged 3-17 years, 3.2% and 7.4% had parent-reported physician-diagnosed current depression and anxiety, respectively. Compared with children without HFIS, children with HFIS had approximately twofold higher weighted prevalence of anxiety or depression. After adjusting for covariates, children with versus without HFIS had a 1.53-fold (95% CI 1.15 to 2.03) and 1.48-fold (95% CI 1.20 to 1.82) increased odds of current depression and anxiety, respectively. Associations were slightly more pronounced among girls (aOR (95% CI): depression 1.69 (1.16 to 2.48); anxiety 1.78 (1.33 to 2.38)) than boys (1.42 (0.98 to 2.08); 1.32 (1.00 to 1.73); both P-for-interaction <0.01). The associations did not vary by children's age or race/ethnicity. CONCLUSIONS HFIS was independently associated with depression and anxiety among US children. Girls presented slightly greater vulnerability to HFIS in terms of impaired mental health. Children identified as food-insufficient may warrant mental health assessment and possible intervention. Assessment of HFIS among children with impaired mental health is also warranted. Our findings also highlight the importance of promptly addressing HFIS with referral to appropriate resources and inform its potential to alleviate childhood mental health issues.
Collapse
Affiliation(s)
- Siwen Zheng
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Amanda L Ngo
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Michele R Forman
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| | - Anna L Barcellos
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Lauren Liao
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
7
|
AbuKishk N, Gilbert H, Seita A, Mukherjee J, Rohloff PJ. Under-five malnutrition among Palestine refugee children living in camps in Jordan: a mixed-methods study. BMJ Glob Health 2021; 6:bmjgh-2021-005577. [PMID: 34348932 PMCID: PMC8340287 DOI: 10.1136/bmjgh-2021-005577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/23/2021] [Indexed: 01/07/2023] Open
Abstract
Background Jordan hosts the largest Palestine refugee population in the world. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) is the primary healthcare provider for Palestine refugees. To better inform UNRWA’s health programme, we conducted this study to assess the prevalence and determinants of malnutrition among Palestine refugee children in Jordan and to analyse caregiver perceptions of food insecurity and structural barriers to accessing food. Methods A cross-sectional study was conducted with a randomly selected sample of 405 households, for children under 5 years old in two refugee camps in Jordan, Jerash and Souf. Sociodemographic, food insecurity, diet quality and child anthropometric data were collected. Also, twenty in-depth interviews were conducted with children’s caregivers, along with two focus group discussions with UNRWA staff. Results Out of the 367 participants, the prevalence of stunting was 23.8% in Jerash and 20.4% in Souf (p=0.46), and overweight was 18.2% versus 7.1%, respectively (p=0.008). However, high food insecurity in Jerash was 45.7% and 26.5% in Souf (p=0.001), with no significant difference after multivariable adjustment. Qualitative perspectives saw food insecurity and low-quality children’s diets as largely mediated by job and income insecurity, especially marked in Jerash due to the lack of Jordanian citizenship. Conclusion We found a moderate-to-high prevalence of stunting and overweight levels among Palestine refugee children, which are three times higher than the 2012 Demographic and Health Survey data for Jordanian non-refugee children. High rates of household food insecurity were closely tied to households’ lack of essential civil and economic rights. We call for international collective efforts to expand economic livelihoods for Palestine refugees and to support UNRWA’s ongoing operations.
Collapse
Affiliation(s)
| | - Hannah Gilbert
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Joia Mukherjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter J Rohloff
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Center for Research in Indigenous Health, Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| |
Collapse
|
8
|
Biadgilign S, Gebremariam MK, Mgutshini T. The association of household and child food insecurity with overweight/obesity in children and adolescents in an urban setting of Ethiopia. BMC Public Health 2021; 21:1336. [PMID: 34229650 PMCID: PMC8261988 DOI: 10.1186/s12889-021-11392-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/25/2021] [Indexed: 01/22/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Sibhatu Biadgilign
- Department of Health Studies, College of Human Sciences, University of South Africa, Addis Ababa, Ethiopia.
| | - Mekdes K Gebremariam
- Department of Nutrition, Faculty of Medicine, University of Oslo, P.O. Box 1046 Blindern, 0316, Oslo, Norway
| | - Tennyson Mgutshini
- Department of Health Studies, College of Human Science, University of South Africa, PO Box 392, Preller Street, Pretoria, 0003, South Africa
| |
Collapse
|
9
|
Gamba RJ, Eskenazi B, Madsen K, Hubbard A, Harley K, Laraia BA. 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. Pediatr Obes 2021; 16:e12762. [PMID: 33394569 DOI: 10.1111/ijpo.12762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
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.
Collapse
Affiliation(s)
- Ryan J Gamba
- Department of Health Sciences, California State University East Bay, Hayward, California, USA
| | - Brenda Eskenazi
- Director, Center for Children's Environmental Health Research, University of California Berkeley, Berkeley, California, USA
| | - Kristine Madsen
- Division of Community Health Sciences, University of California Berkeley, Berkeley, California, USA
| | - Alan Hubbard
- Division of Biostatistics, University of California Berkeley, Berkeley, California, USA
| | - Kim Harley
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, California, USA
| | - Barbara A Laraia
- Division of Community Health Sciences, University of California Berkeley, Berkeley, California, USA
| |
Collapse
|
10
|
Te Vazquez J, Feng SN, Orr CJ, Berkowitz SA. Food Insecurity and Cardiometabolic Conditions: a Review of Recent Research. Curr Nutr Rep 2021; 10:243-254. [PMID: 34152581 PMCID: PMC8216092 DOI: 10.1007/s13668-021-00364-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/26/2022]
Abstract
Purpose of Review To understand recent literature that examines associations between food insecurity and cardiometabolic conditions and risk factors. We included original research, systematic reviews, and meta-analyses on the topic of food insecurity and cardiometabolic risk published from January 1, 2017, to December 31, 2020. Editorials, perspectives, and case reports were excluded. After the initial search, 3 reviewers selected studies for inclusion based on relevance and methods. Ultimately, fifty studies were included. Recent Findings We included 35 studies of adults (20 cross-sectional observational studies, 5 longitudinal observational studies, 5 interventional studies, and 5 meta-analyses/reviews). In adults, food insecurity is associated with greater prevalence of overweight/obesity (especially for women). It is also associated with hypertension, diabetes (including worse glycemic control and more diabetes complications), coronary heart disease, congestive heart failure, stroke, and chronic kidney disease. We included 15 studies of children (11 cross-sectional observational studies and 4 longitudinal observational studies). In children, findings were more nuanced, and in particular, many studies did not find an association between food insecurity and overweight/obesity. However, authors noted that these conditions may not have had time to develop. With notable exceptions, many studies were cross-sectional, and there were few interventions. Summary There is a robust association between food insecurity and cardiometabolic conditions and risk factors in adults, but the picture is less clear in children. Overt cardiometabolic clinical conditions develop more rarely in children, but childhood experiences may set a trajectory for worse health later in life. Detailed life course epidemiologic studies are needed to better understand this relationship. Future interventions should examine how to reduce the prevalence of food insecurity, and how best to improve health for those who experience food insecurity.
Collapse
Affiliation(s)
- Jennifer Te Vazquez
- College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shi Nan Feng
- College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Nutrition Science Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Colin J Orr
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Seth A Berkowitz
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 5034 Old Clinic Bldg, CB 7110, Chapel Hill, NC, 27599, USA.
| |
Collapse
|
11
|
McClain AC, Evans GW, Dickin KL. Maternal Stress Moderates the Relationship of Food Insufficiency with Body Mass Index Trajectories from Childhood to Early Adulthood among U.S. Rural Youth. Child Obes 2021; 17:263-271. [PMID: 33769835 PMCID: PMC8147486 DOI: 10.1089/chi.2020.0284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Findings on the relationships between household food insufficiency (HFI), maternal stress, and youth body mass index (BMI) are mixed, possibly due to cross-sectional study designs and measurement issues. Furthermore, little is known about how childhood exposure to HFI and maternal stress influences BMI into young adulthood among rural youth. We aimed to determine the independent and moderating relationships of HFI and maternal perceived stress on youth BMI trajectories from age 9 to 24 years. Methods: We used longitudinal data from rural New York youth (n = 341). At youth age 9 years, parents reported HFI using a reliable one-item measure, and mothers responded to the 10-item Perceived Stress Scale (PSS; range: 0-40). BMI was calculated (kg/m2) from objective measures of height and weight at 9, 13, 17, and 24 years. Multivariate random-intercept trajectory models estimated the relationships of HFI and PSS on BMI trajectories (p < 0.05 for main effects, p < 0.10 for interactions). Results: At age 9 years, 16.4% experienced HFI and mean (standard deviation) BMI and PSS were 18.4 (3.6) kg/m2 and 7.7 (2.9), respectively. HFI and PSS were not associated with BMI trajectories (p = 0.18, p = 0.64, respectively), but their interaction was significant (p < 0.01). Each one-unit increase in PSS was associated with 0.6 (0.2) kg/m2 higher mean change in BMI trajectories for youth in food-insufficient, compared with food-sufficient, households. Conclusions: Higher levels of maternal stress in food-insufficient households may lead to greater increases in BMI from childhood to young adulthood. Public health interventions should simultaneously address parental stress and quality food access among low-income rural households.
Collapse
Affiliation(s)
- Amanda C. McClain
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
- Address correspondence to: Amanda C. McClain, PhD, MS, School of Exercise and Nutritional Sciences, San Diego State University, ENS 313, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Gary W. Evans
- Department of Design + Environmental Analysis, Department of Human Development, Cornell University, Ithaca, NY, USA
| | | |
Collapse
|
12
|
Bae JH, Choi JH. Gender disparities in childhood obesity and household food insecurity. Nutrition 2021; 87-88:111190. [PMID: 33773405 DOI: 10.1016/j.nut.2021.111190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Childhood obesity is a critical health issue. The etiology of childhood obesity is multifactorial, with age, gender, race/ethnicity, and socioeconomic status interacting to affect risk. Food insecurity is known to be associated with risk of childhood obesity, but the body of evidence regarding Koreans is lacking. This study investigated the association between childhood obesity and household food insecurity in Koreans. Other lifestyle and nutritional factors associated with obesity were also examined. METHODS Using data from the Korean National Health and Nutrition Examination Survey, a cross-sectional study was conducted with 1527 boys and 1366 girls. A comparison of general characteristics and nutritional intake between the groups was made using Student's t tests, χ2 tests, and general linear models. The association between childhood obesity and food insecurity was estimated with logistic regression models, and presented with odds ratios and 95% confidence intervals either with or without covariates. RESULTS Boys who were obese dined out less frequently and engaged less in regular exercise, but no differences in nutrition intake were observed between children who were and were not obese. Girls who were obese were less likely to have a caregiver and consumed a higher percentage of energy from protein. Boys experiencing household food insecurity were less likely to be obese (adjusted odds ratio, 0.25; 95% confidence interval, 0.06-0.99), but girls with food insecurity were at three times higher risk of obesity (adjusted odds ratio, 3.00; 95% confidence interval, 1.23-7.31). CONCLUSIONS Differential lifestyle factors are associated with obesity phenotypes in boys and girls. Food insecurity also showed a contrasting association with obesity risk by gender in young Koreans.
Collapse
Affiliation(s)
- Ji-Hyun Bae
- Department of Food Science and Nutrition, Keimyung University, Daegu, Korea
| | - Jeong-Hwa Choi
- Department of Food Science and Nutrition, Keimyung University, Daegu, Korea.
| |
Collapse
|
13
|
Spoede E, Corkins MR, Spear BA, Becker PJ, Gunnell Bellini S, Hoy MK, Piemonte TA, Rozga M. Food Insecurity and Pediatric Malnutrition Related to Under- and Overweight in the United States: An Evidence Analysis Center Systematic Review. J Acad Nutr Diet 2020; 121:952-978.e4. [PMID: 32402759 DOI: 10.1016/j.jand.2020.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Indexed: 01/19/2023]
Abstract
Both food insecurity and malnutrition are associated with adverse health outcomes in the pediatric population. However, the research on the relationship between these factors has been inconsistent, leading to uncertainty regarding whether or how evaluation of food insecurity should be incorporated into nutrition screening or the nutrition care process. The objective of this systematic review was to determine the association between food insecurity and malnutrition related to undernutrition or overnutrition (defined by anthropometrics) in the pediatric population in the United States. A literature search was conducted using Medline, Embase, and CINAHL databases for studies published from January 2002 through November 2017. A total of 23 studies (19 cross-sectional and 4 prospective cohort studies) met inclusion criteria and were included in qualitative analysis. In 6 studies, there was no overall relationship between food insecurity and underweight. All included studies examined the relationship between food insecurity status and overweight/obesity and results were mixed, with large cross-sectional studies demonstrating a positive relationship between food insecurity and overweight/obesity. There were no clear patterns according to subpopulation. Evidence quality was graded as fair due to heterogeneity in how food insecurity was measured and populations included as well as inconsistency in results. Use of a 2-item food insecurity screening tool may allow for efficient, effective screening of food insecurity in order to identify potential contributors overweight and obesity.
Collapse
|