Recent findings concerning childhood food insecurity

Food insecurity and associated health and social determinants among older adults in Ghana: Analysis of the WHO's study on global AGEing and adult health (SAGE), 2014-2015

This study was conducted to assess the prevalence and factors associated with Food Insecurity (FI) and further quantify its association with unmet need for health services and health-related outcomes among older adults aged 50 years and above in Ghana. The Ghana Study on Global AGEing and Adult Health was used. Body Mass Index (BMI), depressive episodes, functional difficulties (FD), low Quality of Life (QoL), memory decline, and Unmet Needs of Health Services (UNHS) are the the study outcomes. Ordinary Least Square, and Poisson regression analysis modified with Mahalanobis distance matching within propensity score caliper weights were employed. Stata 16.1 was used to perform analysis and a p-value < 0.05 was deemed significant. The prevalence of FI among older adults aged 50 years or older in Ghana was approximately 28 %(95 %CI = 24.5-31.7) and was strongly associated with lower educational attainment and social support. The prevalence ratio of depression, FD, low QoL and UNHS among older adults who experienced FI were; 3.43(95 %CI = 2.25-5.21), 1.18(95 %CI = 1.12-1.23), 2.01(95 %CI = 1.54-2.62), and 1.46(95 %CI = 1.01-2.11). Memory significantly decreased by 85 percentage points% among food insecure older adults [aβ(95 %CI) = -0.85(-1.62--0.07)]. Older adults with relatively higher educational attainment and social support are less likely to suffer FI and associated limited health and poor social well-being. In the national quest to achieve SDG 2, these health and social determinants of FI among older adults should be considered in the implementation of the national ageing policy to improve the health and well-being of older adults in Ghana.

Household Food Insecurity and Cognition in Youth and Young Adults with Youth-Onset Diabetes

Objective

We evaluated the association of household food insecurity (FI) with cognition in youth and young adults with type 1 diabetes (T1D) or type 2 diabetes (T2D).

Design

In this cross-sectional study, age-adjusted scores for composite Fluid Cognition, and sub-domain scores for Receptive Language and Inhibitory Control and Attention, were modeled stratified by diabetes-type using linear regression, with FI in the past year as the predictor, controlling for covariates. Tests for processing speed, inhibitory control/attention, working memory, episodic memory, and cognitive flexibility were administered to measure composite Fluid Cognition score. The NIHT-CB Picture Vocabulary Test was used to assess Crystallized Cognition score and rapid identification of congruent versus noncongruent items were used to assess Inhibitory Control and Attention score.

Setting

The SEARCH for Diabetes in Youth study, representative of 5 U.S. states.

Participants

Included 1574 youth and young adults with T1D or T2D, mean age of 21 years, mean diabetes duration of 11 years, 51% non-Hispanic white, and 47% had higher HbA1c levels (>9% HbA1c).

Results

Approximately 18% of the 1,240 participants with T1D and 31% of the 334 with T2D experienced FI. The food-insecure group with T1D had a lower composite Fluid Cognition score (β= -2.5, 95% confidence interval (CI)= -4.8, -0.1) and a lower Crystallized Cognition score (β= -3.4, CI= -5.6, -1.3) than food-secure peers. Findings were attenuated to non-significance after adjustment for demographics. Among T2D participants, no associations were observed. In participants with T1D effect modification by glycemic levels were found in the association between FI and composite Fluid Cognition score but adjustment for socioeconomic characteristics attenuated the interaction (p=0.0531).

Conclusions

Food-insecure youth and young adults with T1D or T2D did not have different cognition compared to those who were food-secure after adjustment for confounders. Longitudinal research is needed to further understand relations amongst these factors.

‘Mens sana in corpore Sano’: Home food consumption implications over child cognitive performance in vulnerable contexts

Diet directly affects children’s physical and mental development. Nonetheless, how food insecurity and household food consumption impact the cognitive performance of children at risk of social exclusion remains poorly understood. In this regard, children in Guatemala face various hazards, mainly related to the socioeconomic difficulties that thousands of families have in the country. The main objective of this study was to analyze the differences in cognitive performance considering food insecurity and household food consumption in a sample of rural and urban Guatemalan children and adolescents at risk of social exclusion. Child cognitive performance was assessed in 134 children and adolescents (age M = 11.37; SD = 3.54) from rural and urban settings. Language, attention, and executive functions were assessed using neuropsychological tasks. Differences in cognitive performance in each level of food insecurity and household diet consumption were compared using the Mann–Whitney U test. A stepwise multivariate regression analysis was conducted to determine which factors may influence cognitive scores. The results showed that rural and urban groups did not differ in terms of food insecurity. However, considering just rural areas, differences were found between groups with food security and insecurity in attention and executive function tasks. Moreover, differences were found in food consumption for certain groups of food (e.g., meat, U = 1,146, p < 0.001, g = 0.72). Regarding regressions, protein food consumption (e.g., meat and fish), which is related to having a more balanced diet, was a relevant factor in executive performance. Contrary to what we expected, performance in attentional tasks was not related to the consumption of any food group. These findings could help politicians and decision-makers to select actions focused on improving diet balance and food security in families at risk of social exclusion. It is necessary to carry out more specific studies on the factors related to diet that affect the cognitive development of minors at risk of social exclusion. In addition, it is necessary to study the implementation of alternative interventions that include low-cost nutrients, thus ensuring that minors have access to a more balanced diet.

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.

Qualitative program evaluation of social determinants of health screening and referral program

Although the integration of social determinants of health (SDH) screening and referral programs in clinical settings has rapidly grown, the voice and experience of participants within SDH programs has not been well understood in program evaluations. To qualitatively evaluate a comprehensive SDH screening and referral program based in an academic primary care setting, we conducted a qualitative analysis of a semi-structured, focus group interview of 7 caregivers. We performed inductive coding representing emerging ideas from each transcript using focus group transcripts from families who participated in the SDH screening and referral program. A thematic model was created describing caregivers’ experiences with respect to screening, intake, and referral phases of the program. Caregivers reported satisfaction with structural and process-related components of screening, intake, and referral. They expressed a preference for trained patient navigators over physicians for screening and intake for they were perceived to have time to prioritize caregivers’ social needs. Caregivers reported disappointment with legal services screening, intake, and referral, citing lack of timely contact from the legal resource team and prematurity of provided legal resources. Overall, caregivers recommend the program, citing that the program provided social support, an environment where expression is encouraged, motivation to address their own health needs, and a convenient location. Overall, caregivers would recommend the program because they feel socially supported. The use of trained patient navigators appears to be instrumental to the successful implementation of the program in clinics, for navigators can provide caregivers with the appropriate time and personal attention they need to complete the survey and discuss their needs. Streamlining the referral process for evaluation of health-harming needs by the medical legal partnership was highlighted as an area for improvement.

Associations between Subjective and Objective Measures of the Community Food Environment and Executive Function in Early Childhood

The present study utilized a cross-sectional design to assess whether two indicators of the community food environment, parent perceptions of the community food environment (i.e., as assessed by parent reports of access to, availability, and affordability of foods) and limited food access (via census data), were related to executive function in preschool children. Children were recruited during the 2014–2015 academic year from Head Start and community-based preschools (N = 102) and children’s executive function ability was tested using the Head–Toes–Knees–Shoulders task. Multiple linear regression analysis was used, as well as adjusted standard errors to account for clustering at the classroom level. Parent reports of their food environment were significantly related to children’s executive function, such that children living in higher quality community food environments had better executive function. In contrast, limited food access using census data was not significantly related to executive function. The results suggest that parent reports of the community food environment in early childhood may contribute to young children’s cognitive outcomes more so than being in a limited food access area, as these data may not represent individual behaviors or capture the variability of the accessibility and affordability of healthy foods. Policy makers should consider correlations between the food environment and early executive functioning when developing new community health/wellness legislation.

Cultural Connectedness as Obesity Prevention: Indigenous Youth Perspectives on Feast for the Future

OBJECTIVE

To describe a community-based obesity-prevention initiative that promoted cultural connectedness and traditional food revitalization and gained insight into youth participants' perspectives on the program through a photovoice methodology.

METHODS

Photovoice methods were used with fourth- and fifth-grade youths (aged 9-11 years) in the US Southwest who had participated in the Feast for the Future program. A total of 44 youths from 3 communities met for 8-9 sessions; they took photos of current food environments and traditional food systems, and discussed them as well as Feast for the Future and hopes for the future, and then prepared a final presentation. Photovoice sessions were recorded, transcribed verbatim, then open coded using Atlas.ti.

RESULTS

Five common themes emerged: traditional food is farmed or gardened, traditional foods are healthy, Feast for the Future supported positive connections to culture, hope for more farming or gardening for future generations, and store or less nutrient-dense food is unhealthy.

CONCLUSIONS AND IMPLICATIONS

Photovoice can be an effective way to engage Indigenous youths in conversations about their culture and food environments. The findings suggest that attention to revitalizing traditional food systems and supporting cultural connectedness may be an effective approach to obesity prevention in tribal communities, although future research would be needed to assess the impact of the intervention on obesity rates.

Food insecurity and psychological distress in Inuit adolescents of Nunavik

OBJECTIVE

The present study aims at measuring the association between household food insecurity and psychological distress in adolescents in Inuit communities, concurrently and overtime from childhood to adolescence.

DESIGN

The study used measures of internalising behaviours (anxiety, withdrawn attitude, somatic complaints and depression) as indicators of psychological distress during adolescence, a concurrent measure of household food insecurity in adolescence and an assessment of longitudinal patterns of household food insecurity from childhood to adolescence. We collected descriptive information at birth, childhood and adolescence on potential confounders.

SETTING

Inuit communities of Nunavik in northern Quebec, Canada.

PARTICIPANTS

The study consisted of 212 participants from the Nunavik Child Development Study, who have been assessed at birth, childhood (mean age = 11 years, range = 9-13 years) and adolescence (mean age = 18 years, range = 16-21 years).

RESULTS

Concurrent severe household food insecurity in adolescence was associated with higher measures of psychological distress: depression (βstd = 0·26, P < 0·01) and withdrawn attitude (βstd = 0·20, P = 0·04). Persistent household food insecurity (both at childhood and adolescence) was associated with higher levels of adolescent depression (βstd = 0·18, P = 0·02) and anxiety (βstd = 0·17, P = 0·03).

CONCLUSIONS

Adolescents from Nunavik living with higher food insecurity and those having experienced food insecurity in both childhood and adolescence were more likely to report symptoms of psychological distress. Considering the high level of distress experienced by young Inuit, existing initiatives to reduce food insecurity in Nunavik communities should be targeted to include children and adolescents.

Unreliable and Difficult-to-Access Food for Those in Need: A Qualitative and Quantitative Study of Urban Food Pantries

For individuals who are food insecure, food pantries can be a vital resource to improve access to adequate food. Access to adequate food may be conceptualized within five dimensions: availability (item variety), accessibility (e.g., hours of operation), accommodation (e.g., cultural sensitivity), affordability (costs, monetary or otherwise), and acceptability (e.g., as related to quality). This study examined the five dimensions of access in a convenience sample of 50 food pantries in the Bronx, NY. The design was cross-sectional. Qualitative data included researcher observations and field notes from unstructured interviews with pantry workers. Quantitative data included frequencies for aspects of food access, organized by the five access dimensions. Inductive analysis of quantitative and qualitative data revealed three main inter-related findings: (1) Pantries were not reliably open: only 50% of pantries were open during hours listed in an online directory (several had had prolonged or indefinite closures); (2) Even when pantries were open, all five access dimensions showed deficiencies (e.g., limited inventory, few hours, pre-selected handouts without consideration of preferences, opportunity costs, and inferior-quality items); (3) Open pantries frequently had insufficient food supply to meet client demand. To deal with mismatch between supply and demand, pantries developed rules for food provision. Rules could break down in cases of pantries receiving food deliveries, leading to workarounds, and in cases of compelling client need, leading to exceptions. Adherence to rules, versus implementation of workarounds and/or exceptions, was worker- and situation-dependent and, thus, unpredictable. Overall, pantry food provision was unreliable. Future research should explore clients' perception of pantry access considering multiple access dimensions. Future research should also investigate drivers of mismatched supply and demand to create more predictable, reliable, and adequate food provision.

A Qualitative Evaluation of a Community Based, Culturally Relevant Intervention to Promote Healthy Food Access in American Indian Communities

In response to a need for healthy, affordable food, Johns Hopkins Center for American Indian Health and three rural indigenous communities launched the "Feast for the Future," (FFF) to promote access to healthy foods and the transfer of traditional food-based knowledge from farmers/elders to youth. To assess program impact, 43 in-depth interviews were conducted with participating farmers, elders, and Community Advisory Board members. Interviews were recorded, transcribed, and analyzed in Atlas.ti. Common themes from qualitative analyses included: FFF programs support farming/gardening revitalization and cultural connectedness/identity; FFF has supported positive behavior change among interviewees and their families; There is a need to revitalize traditional food systems; Farming/gardening is central to cultural identity; and Responsibility for food choices. The interviews revealed that the community-based program is perceived by key stakeholders as reaffirming cultural identity and promoting healthy eating. As a CAB member shared.

Factors Associated with Food Insecurity Following Hurricane Harvey in Texas

Food insecurity prevalence among disaster-affected households has been found to be higher than state prevalence in non-disaster times. This study applies a socio-ecological model of post-disaster food insecurity to a nested quota sample (n = 1002) recruited for a web survey from 41 Texas counties affected by Hurricane Harvey 12-15 months post-event. This analysis identifies risk and protective factors for food insecurity. Chi-square analysis was used to examine independent associations between individual, household, and social factors with food insecurity. A multivariate logistic model was fitted and adjusted odds ratios are reported. Economic instability (adjusted odds ratio (OR) 2.43; 95% Confidence Interval (CI) 1.73, 3.41), relocation due to Hurricane Harvey (OR 1.89; CI 1.15, 3.09), major home damage (OR 2.11; CI 1.12, 3.98), non-white race - black (OR 1.79; CI 1.01, 3.18), Hispanic (OR 1.67; CI 1.09, 2.54), other race (OR 4.39; CI 1.96, 9.82) - and community-based organization assistance (1.99; 1.11, 3.58) were risk factors while older age (45-64 years: 0.49; 0.32, 0.73; 65+ years 0.40; 0.22, 0.75), better physical health (0.46; 0.29, 0.71), better mental health (0.46; 0.32, 0.67), and high social support (0.37; 0.25, 0.55) were protective against food insecurity. Disaster policies and programs should address the disproportionate burden on households that relocate or have health conditions. Fostering social support networks, especially among relocated populations, may improve disaster health outcomes.

Maternal Depression: Relationship to Food Insecurity and Preschooler Fruit/Vegetable Consumption

Background: Maternal Depression (MD) has been implicated in the etiology of obesity. The present study investigated MD and both child fruit/vegetable consumption (FVC) and household food insecurity (FI) in an early childhood population. Methods: This cross-sectional study was conducted in Arkansas, United States, in 26 Head Start centers. Teachers obtained the Family Map (FM), an interview assessment tool used by Head Start staff to identify potential risk factors that affect child learning and development. The FM contains a two-item screener of parent depression-the Patient Health Questionaire-2, two questions about family FI, and two questions about FVC. The FM was completed in 693 households. Chi square analyses and logistic regressions utilizing adjusted and unadjusted odds ratios were utilized to compare differences in risk for children of mothers with no symptoms compared to mothers with low- or high-level depressive symptoms. Results: Children whose mothers had high MD were 2.90 (CI: 1.21-7.00) and 7.81 (CI: 3.71-16.45) times more likely to be at risk for low FVC and FI, respectively, compared to children of mothers with no MD. Similar findings but at lower magnitude were found for mothers with low symptoms of MD in comparison with mothers with no MD-both for Low FVC (1.57 times more likely; CI: 1.01-2.45) and FI (2.14 times more likely; CI: 1.28-3.58). The results presented are Odds Ratios from the multivariable adjusted models. Conclusions: Implications for the etiology of obesity, prevention/intervention efforts, and future research are offered, including recommended addition of maternal depression and household FI screening in early childhood programs.

Food Insecurity and Nutritional Risk among Canadian Newcomer Children in Saskatchewan

Food insecurity continues to persist among vulnerable groups in Canada, including newcomer families. This mixed-methods study uses an exploratory sequential design to characterize the food security status of newcomer families with children aged 3–13 years. Parents completed food security and 24-hour dietary recall questionnaires, and parents and service providers were interviewed to explore their food insecurity experiences. Fifty percent of participant households experienced food insecurity, while 41% of children were food insecure. More recent newcomer families, and families with parents that had completed high school or some years of postsecondary training, more commonly experienced household food insecurity, compared to families with parents without high school diplomas or those with university degrees. Food-insecure children aged 4–8 years were at higher risk of consuming a lower proportion of energy from protein, lower servings of milk products, and inadequate intakes of vitamin B₁₂ and calcium. Participants identified changes in food buying habits due to low income, using food budgets to purchase prescription drugs and to repay transportation loans, while the school food environment impacted children’s food security. Food security initiatives targeting newcomers may benefit from building on the strengths of newcomers, including traditional dietary practices and willingness to engage in capacity-building programming.

Varying Levels of Food Insecurity Associated with Clinically Relevant Depressive Symptoms in U.S. Adults Aged 60 Years and Over: Results from the 2005-2014 National Health and Nutrition Survey

Food insecurity refers to restricted or uncertain access to and ineffective utilization of nutritious and safe foods. Although food insecurity is linked to poorer physical health consequences among older adults, national estimates are not well known on food insecurity and depression. Using the 2005-2014 National Health and Nutrition Examination Survey, this study examines the associations between varying food insecurity levels and clinically relevant depressive symptoms (defined by PHQ-9 ≥ 10) among adults ≥60 years old (n = 7969). Rates of clinically relevant depressive symptoms in marginal, low, and very low food security were 12.3, 16.3, and 25.2%, respectively. Marginal, low, and very low food security were significantly associated with clinically relevant depressive symptoms: odds ratio (OR) = 1.12 (95% confidence intervals [CI] 1.07-1.18), OR = 1.07 (95% CI 1.03-1.12), and OR = 1.24 (95% CI 1.16-1.32), respectively. Given the intersection of food insecurity and depression, geriatric health professionals should work to improve health and nutrition programs for older adults at risk for or experiencing both public health concerns.

Early Exposure to Cumulative Social Risk and Trajectories of Body Mass Index in Childhood

BACKGROUND

Childhood social risk has been associated with increased risk of childhood obesity. However, little is known about early exposure of cumulative social risk on BMI percentile (BMIp) trajectories in early childhood.

METHODS

Public data from the Fragile Families and Child Wellbeing Study were analyzed (N = 3809). Maternal reports of experiences of multiple social risk factors were obtained at age 1 and 3 assessments of children. Two cumulative social risk scores were calculated by summing social factors assessed at age 1 and at age 3. Child BMIp was assessed at ages 3, 5, and 9. Linear mixed models were used to examine the effect of cumulative social risk on sex-specific BMIp trajectories.

RESULTS

Compared with girls experiencing low social risk at either age 1 or 3, girls experiencing high social risk (≥ 2 factors) at age 1 or 3 only had higher initial BMIp at age 3 [β₀ = 5.70 (95% confidence interval, CI: 0.15-1.26) and 1.37 (95% CI: -2.25 to 4.99), respectively] and had nonsignificantly greater BMIp growth rate [β₁ = 0.39 (95% CI: -0.86 to 1.63) and 0.32 (95% CI: -0.86 to 1.63)]. Girls experiencing high social risk at both ages had nonsignificantly but consistently lower BMIp [β₁ = -1.24 (95% CI: -2.93 to 0.46)]. In addition, girls experiencing a sum of ≥4 risk factors at both ages had lower BMIp growth rate [β₁ = -1.77 (95% CI: -3.39 to -0.15)] compared to girls experiencing no risk factor. No associations were observed among boys.

CONCLUSIONS

Early exposure to cumulative social risk may have long-term impact on BMIp trajectories among girls, depending on timing of exposure. Understanding the effect of cumulative social risk in different contexts, including sex, chronicity, and timing of exposure, may have practical implications for informing effective intervention to combat childhood obesity.

Application of a Theoretical Model Toward Understanding Continued Food Insecurity Post Hurricane Katrina

OBJECTIVE

Disaster recovery efforts focus on restoring basic needs to survivors, such as food, water, and shelter. However, long after the immediate recovery phase is over, some individuals will continue to experience unmet needs. Ongoing food insecurity has been identified as a post-disaster problem. There is a paucity of information regarding the factors that might place an individual at risk for continued food insecurity post disaster.

METHODS

Using data from a sample (n=737) of households severely impacted by Hurricane Katrina, we estimated the associations between food insecurity and structural, physical and mental health, and psychosocial factors 5 years after Hurricane Katrina. Logistic regression models were fit and odds ratios (OR) and 95% CI estimated.

RESULTS

Nearly one-quarter of respondents (23%) reported food insecurity 5 years post Katrina. Marital/partner status (OR: 0.7, CI: 0.42, 0.99), self-efficacy (OR: 0.56, CI: 0.37, 0.84), sense of community (OR: 0.7, CI: 0.44, 0.98), and social support (OR: 0.59, CI: 0.39, 0.89) lowered the odds of food insecurity and explained most of the effects of mental health distress on food insecurity. Social support, self-efficacy, and being partnered were protective against food insecurity.

CONCLUSIONS

Recovery efforts should focus on fostering social-support networks and increased self-efficacy to improve food insecurity post disaster. (Disaster Med Public Health Preparedness. 2018;12:47-56).

Food insecurity and food consumption by season in households with children in an Arctic city: a cross-sectional study

BACKGROUND

High rates of food insecurity are documented among Inuit households in Canada; however, data on food insecurity prevalence and seasonality for Inuit households with children are lacking, especially in city centres. This project: (1) compared food consumption patterns for households with and without children, (2) compared the prevalence of food insecurity for households with and without children, (3) compared food consumption patterns and food insecurity prevalence between seasons, and (4) identified factors associated with food insecurity in households with children in Iqaluit, Nunavut, Canada.

METHODS

Randomly selected households were surveyed in Iqaluit in September 2012 and May 2013. Household food security status was determined using an adapted United States Department of Agriculture Household Food Security Survey Module. Univariable logistic regressions were used to examine unconditional associations between food security status and demographics, socioeconomics, frequency of food consumption, and method of food preparation in households with children by season.

RESULTS

Households with children (n = 431) and without children (n = 468) participated in the survey. Food insecurity was identified in 32.9% (95% CI: 28.5-37.4%) of households with children; this was significantly higher than in households without children (23.2%, 95% CI: 19.4-27.1%). The prevalence of household food insecurity did not significantly differ by season. Demographic and socioeconomic characteristics of the person responsible for food preparation, including low formal education attainment (ORSept = 4.3, 95% CI: 2.3-8.0; ORMay = 3.2, 95% CI: 1.8-5.8), unemployment (ORSept = 1.1, 95% CI: 1.1-1.3; ORMay = 1.3, 95% CI: 1.1-1.5), and Inuit identity (ORSept = 8.9, 95% CI: 3.4-23.5; ORMay = 21.8, 95% CI: 6.6-72.4), were associated with increased odds of food insecurity in households with children. Fruit and vegetable consumption (ORSept = 0.4, 95% CI: 0.2-0.8; ORMay = 0.5, 95% CI: 0.2-0.9), as well as eating cooked (ORSept = 0.5, 95% CI: 0.3-1.0; ORMay = 0.5, 95% CI: 0.3-0.9) and raw (ORSept = 1.7, 95% CI: 0.9-3.0; ORMay = 1.8, 95% CI: 1.0-3.1) fish were associated with decreased odds of food insecurity among households with children, while eating frozen meat and/or fish (ORSept = 2.6, 95% CI: 1.4-5.0; ORMay = 2.0, 95% CI: 1.1-3.7) was associated with increased odds of food insecurity.

CONCLUSIONS

Food insecurity is high among households with children in Iqaluit. Despite the partial subsistence livelihoods of many Inuit in the city, we found no seasonal differences in food security and food consumption for households with children. Interventions aiming to decrease food insecurity in these households should consider food consumption habits, and the reported demographic and socioeconomic determinants of food insecurity.

Food insecurity and cardiovascular health: Findings from a statewide population health survey in Wisconsin

BACKGROUND

The social and economic environment has become a major area of interest regarding the determinants of cardiovascular health. Among markers of economic distress, food insecurity has been found associated with metabolic disorders, dyslipidemia, and obesity, but no previous studies have examined its association with overall cardiovascular health.

METHODS AND RESULTS

We conducted a cross-sectional analysis among 2935 participants in the Survey of the Health of Wisconsin (SHOW), a statewide population-based representative sample. The presence of food insecurity was determined by an affirmative answer to the question "In the last 12months, have you been concerned about having enough food for you or your family?" Cardiovascular health (CVH) was defined based on the American Heart Association Life's Simple 7 criteria and classified as "poor," "intermediate," or "ideal" using previously published criteria. "Good" CVH was defined as having no poor in any of the seven criteria (any amount of intermediate or ideal). Crude and adjusted odds ratios (OR) of good CVH according to presence of food insecurity were calculated using logistic regression models. Overall, food insecurity was associated with a decreased likelihood of good CVH (OR 0.53; 95% Confidence Interval 0.31 to 0.92; p=0.02). This association persisted in models controlling for age, gender, race, and urbanization.

CONCLUSIONS

Participants who were food insecure were significantly less likely to have good CVH compared to participants who were food secure. Even though this study cannot confirm causality, these results suggest that food insecurity might be one of several socio-economic barriers contributing to poor CVH.

Food insecurity and migraine in Canada

Aim

The aim of this study was to examine the prevalence of household food insecurity in individuals reporting migraine within a large population-based sample of Canadians.

Methods

The Canadian Community Health Survey (CCHS) uses a stratified cluster sample design to obtain information on Canadians ≥12 years of age. Data on household food insecurity were assessed for individuals who reported having migraine or not, providing a current point prevalence. This was assessed for stability in two CCHS datasets from four and eight years earlier. Factors associated with food insecurity among those reporting migraine were examined and a logistic regression model of food insecurity was developed. We also examined whether food insecurity was associated with other reported chronic health conditions.

Results

Of 48,645 eligible survey respondents, 4614 reported having migraine (weighted point prevalence 10.2%). Food insecurity was reported by 14.8% who reported migraine compared with 6.8% of those not reporting migraine, giving an odds ratio of 2.4 (95% confidence interval 2.0–2.8%). This risk estimate was stable over the previous eight years. The higher risk for food insecurity was not unique to migraine and was seen with some, but not all, chronic health conditions reported in the CCHS.

Conclusions

Food insecurity is more frequent among individuals reporting migraine in Canada.

Association between food and nutrition insecurity with cardiometabolic risk factors in childhood and adolescence: a systematic review

Objective:

To address the association between food and nutrition insecurity and cardiometabolic risk factors in childhood and adolescence.

Data source:

Articles were selected from the Medline, Lilacs and SciELO databases with no publication date limit, involving children and adolescents, using the descriptors: food and nutrition security, diabetes mellitus, hypertension, metabolic syndrome, stress and dyslipidemia. The terms were used in Portuguese, English and Spanish. The search was carried out systematically and independently by two reviewers.

Data synthesis:

Exposure to food insecurity during childhood and adolescence ranged from 3.3% to 82% in the selected publications. Exposure to food insecurity was associated with stress, anxiety, greater chance of hospitalization, nutritional deficiencies, excess weight and inadequate diets with reduced intake of fruits and vegetables and increased consumption of refined carbohydrates and fats.

Conclusions:

Food and nutrition insecurity was associated with the presence of cardiometabolic risk factors in the assessed publications. Childhood and adolescence constitute a period of life that is vulnerable to food insecurity consequences, making it extremely important to ensure the regular and permanent access to food. Because this is a complex association, some difficulties are found, such as the synergy between risk factors, the assessment of heterogeneous groups and extrapolation of data to other populations, in addition to the influence of environmental factors.

Household food insecurity and child health

Food insecurity, the lack of consistent access to sufficient quality and quantity of food, affects an estimated 800 million people around the world. Although household food insecurity is generally associated with poor child nutrition and health in the USA, we know less about household food insecurity and child health in developing countries. Particularly lacking is research assessing how associations between household food insecurity and children's health outcomes may differ by child age and among children beyond age 5 years in low-income settings. We use data from a population-based sample of households with children ages 3-11 years (N = 431) in León, Nicaragua to consider how household food insecurity is associated with three measures of child health: illness, anaemia and low height-for-age. Our results provide new evidence that even mild household food insecurity is detrimental to children's health; and that child age conditions the associations between household food insecurity and child health. We find that food insecurity is especially harmful to health during early childhood, but continues to have significant associations with health into middle childhood (up to ages 7-8 years). We discuss the potential implications of these results for future child health research and policies in low-income countries. © 2016 John Wiley & Sons Ltd.

Association between untreated dental caries and household food insecurity in schoolchildren

Abstract The aim of the present study was to assess the association between untreated dental caries (UDC) and household food insecurity (HFI) among schoolchildren in different income strata. A population-based study was carried out with a sample of 584 12-y-old schoolchildren. Oral examinations were performed and HFI was determined using a validated scale. Other independent variables were analyzed for being of interest to the stratification of the results (per capita household income) or for acting as potential confounding variables. The prevalence of UDC and HFI was 45% and 39%, respectively. The multivariate models demonstrated that the UDC was significantly more prevalent among children in food-insecure households with per capita income of up to US$ 70.71 than among those in the same income stratum that were free of HFI [PR = 1.52 (95%CI = 1.01-2.29)]. HFI was associated with a greater frequency of UDC among low-income schoolchildren, but had no significant impact on this variable among children from other income strata. Thus, ensuring access to quality food may be a good strategy for minimizing inequities in oral health and reducing dental caries experience among schoolchildren from low-income families.

Household Food Insecurity and Mental Health Problems Among Adolescents: What Do Parents Report?

OBJECTIVE

To investigate whether adolescents living in households with food insecurity have poorer parent-reported mental health (MH) than peers.

METHODS

We analyzed cross-sectional data from ∼8600 adolescents who participated in the 2007 (8th grade) wave of the Early Childhood Longitudinal Study-Kindergarten. Household food insecurity (HFI) was assessed by parental report on the 18-item US Household Food Security Scale. Total Difficulties score >13 on the parent-reported Strengths and Difficulties Questionnaire (SDQ) indicated problems with adolescent MH. SDQ subscale scores (Emotional, Conduct, Hyperactivity, Peer Problems) were also calculated. Associations between HFI and MH were explored in bivariate and multivariable analyses. Interactions of HFI and gender and HFI and receipt of free/reduced-price school lunch were analyzed with regard to problems with MH.

RESULTS

A total of 10.2% of adolescents lived with HFI; 11.2% had SDQ >13. Adolescents with HFI had higher rates of overall MH problems (28.7% vs 9.2%), emotional problems (21.6% vs 6.6%), conduct problems (26.5% vs 11.6%), hyperactivity (22.4% vs 11.3%), and peer problems (19.8% vs 8.6%) (all P < .01). After adjustment for confounders, the association between HFI and overall MH problems (odds ratio 2.3; 95% confidence interval 1.6-3.3) remained. Interactions of HFI and gender and HFI and free/reduced-price school lunch were not significant.

CONCLUSIONS

HFI was associated with increased risk of parent-reported MH problems among both male and female adolescents. Free/reduced-price school lunch did not significantly alter this relationship. Effective interventions to promote MH and reduce HFI among adolescents are necessary.

Physical and mental health outcomes associated with prior food insecurity among young adults

Following a biopsychosocial model of food insecurity, this study examined differences in physical health and mental health outcomes among young adults ( N = 98) with and without a history of food insecurity. Young adults with a history of food insecurity had higher average levels of body mass index, waist-to-height ratio, depressive symptoms, stress, and disordered eating scores than individuals with no history of food insecurity. No differences were found with symptoms of anxiety. Future research should examine interventions targeted at decreasing negative mental health outcomes and risk for overweight among young adults who have experienced food insecurity.

Food insecurity and malnutrition in Chinese elementary school students

It has been shown that food insecurity is associated with poor diet quality and unfavourable health outcomes. However, little is known about the potential effects of food insecurity on the overall malnutrition status among children. In this study, we investigated the prevalence of food insecurity among 1583 elementary school students, aged 6-14 years, living in Chinese rural areas and examined its association with four malnutrition signs, including rickets sequelae, anaemia, stunting and wasting. Information on food security was collected via questionnaires. Rickets sequelae were assessed by an experienced paediatrician during the interview. Anaemia was determined by the WHO Hb thresholds adjusted by the local altitude. Weight and height were measured during the interview. Stunting and wasting were then evaluated according to WHO child growth standards (2007). We examined the association between food insecurity and the number of malnutrition signs (total number = 4), and the likelihood of having severe malnutrition (presence of 3+ signs), after adjusting for potential confounders, such as age, social-economic status and dietary intakes. During the previous 12 months, the overall prevalence of food insecurity was 6.1% in the entire studied population and 16.3% in participants with severe malnutrition. Participants with food insecurity had a slightly higher number of malnutrition signs (1.14 v. 0.96; P=0.043) relative to those who were food secure, after adjusting for potential confounders. Food insecurity was also associated with increased likelihood of having severe malnutrition (adjusted OR 3.08; 95% CI 1.47, 6.46; P=0.003). In conclusion, food insecurity is significantly associated with malnutrition among Chinese children in this community.

Food insecurity and epilepsy in a nationally representative sample

BACKGROUND

Food insecurity amongst patients with epilepsy has not been previously studied. The aim of this study was to compare the presence of food insecurity within a nationally representative sample of individuals reporting epilepsy with that within the general population.

METHODS

The Canadian Community Health Survey, Cycle 3.1, is a cross-sectional survey that uses a stratified cluster sample design to obtain information on Canadians 12years of age or older. Data on food insecurity were compared for those who reported having epilepsy and the remainder of the population.

RESULTS

Of the 102,927 eligible survey respondents, 654 reported having epilepsy. Food insecurity was considerably more likely to be reported amongst those also reporting epilepsy with a rate of 10.8% compared with those not reporting epilepsy with a rate of 5.2% (odds ratio=2.2, (95% CI=1.6, 3.0)). Binary bivariate prediction of food insecurity within the population of respondents reporting epilepsy included the following: education, income, family size, and home ownership.

CONCLUSIONS

The experience of food insecurity appears to be more frequent amongst persons living with epilepsy. Whether this is related directly to epilepsy or factors within the epilepsy experience is unclear.

Food insecurity and CD4% Among HIV+ children in Gaborone, Botswana

We investigated the association between household food insecurity (HFI) and CD4% among 2-6-year old HIV+ outpatients (n = 78) at the Botswana-Baylor Children's Clinical Center of Excellence in Gaborone, Botswana. HFI was assessed by a validated survey. CD4% data were abstracted from the medical record. We used multiple linear regression with CD4% (dependent variable), HFI (independent variable), and controlled for sociodemographic and clinical covariates. Multiple linear regression showed a significant main effect for HFI [beta = -0.6, 95% confidence interval (CI): -1.0 to -0.1] and child gender (beta = 5.6, 95% CI: 1.3 to 9.8). Alleviating food insecurity may improve pediatric HIV outcomes in Botswana and similar Sub-Saharan settings.

Food insecurity, food assistance and weight status in US youth: new evidence from NHANES 2007-08

OBJECTIVE

To investigate food assistance participation as a risk factor for overweight and obesity in youth, and food insecurity as an effect modifier.

METHODS

The sample included youth ages 4-17, in families ≤200% of the federal poverty line in the 2007-2008 National Health and Nutrition Examination Survey (n = 1321). Food insecurity was measured with the US Department of Agriculture survey module. Food assistance participation was assessed for Supplemental Nutrition Assistance Program, Special Supplemental Nutrition Program for Women, Infants and Children and school meals. Body size was classified by age- and sex-specific body mass index (BMI) percentile, BMI z-score and waist circumference percentile. Regression models with direct covariate adjustment and programme-specific propensity scores, stratified by food insecurity, estimated associations between food assistance participation and body size.

RESULTS

Food assistance participation was not associated with increased body size among food-insecure youth in models with direct covariate adjustment or propensity scores. Compared with low-income, food-secure youth not participating in food assistance, BMI z-scores were higher among participants in models with direct covariate adjustment (0.27-0.38 SD and 0.41-0.47 SD, for boys and girls, respectively). Using propensity scores, results were similar for boys, but less so for girls.

CONCLUSIONS

Food assistance programme participation is associated with increased body size in food-secure youth, but not food-insecure youth. Using both direct covariate adjustment and a propensity score approach, self-selection bias may explain some, but not all, of the associations. Providing healthy food assistance that improves diet quality without contributing to excessive intake remains an important public health goal.

Household food insecurity and excess weight/obesity among Brazilian women and children: a life-course approach

Household food insecurity (HFI) may increase obesity risk, but results are not consistent across the life course or between developed/underdeveloped settings. The objective of this paper is to review findings from previous analyses in Brazil among adult women, female adolescents, and children up to five. Data were derived from the 2006 Brazilian Demographic and Health Survey. Associations between HFI (measured with the Brazilian Food Insecurity Scale) and excess weight/obesity were investigated through Poisson regression models. While severe HFI was associated with obesity risk among adult women (PR: 1.49; 95%CI: 1.17-1.90), moderate HFI was associated with excess weight among female adolescents (PR: 1.96; 95%CI: 1.18-3.27). There was no association between HFI and obesity among children (either boys or girls). The nutrition transition in Brazil may be shaping the differential deleterious effect of HFI on body fat accumulation across the life course; the association is already evident among female adolescents and adult women but still not among children.

Child hunger and the protective effects of Supplemental Nutrition Assistance Program (SNAP) and alternative food sources among Mexican-origin families in Texas border colonias

BACKGROUND

Nutritional health is essential for children's growth and development. Many Mexican-origin children who reside in limited-resource colonias along the Texas-Mexico border are at increased risk for poor nutrition as a result of household food insecurity. However, little is known about the prevalence of child hunger or its associated factors among children of Mexican immigrants. This study determines the prevalence of child hunger and identifies protective and risk factors associated with it in two Texas border areas.

METHODS

This study uses 2009 Colonia Household and Community Food Resource Assessment (C-HCFRA) data from 470 mothers who were randomly recruited by promotora-researchers. Participants from colonias near two small towns in two South Texas counties participated in an in-home community and household assessment. Interviewer-administered surveys collected data in Spanish on sociodemographics, federal food assistance program participation, and food security status. Frequencies and bivariate correlations were examined while a random-effects logistic regression model with backward elimination was used to determine correlates of childhood hunger.

RESULTS

Hunger among children was reported in 51% (n = 239) of households in this C-HCFRA sample. Bivariate analyses revealed that hunger status was associated with select maternal characteristics, such as lower educational attainment and Mexican nativity, and household characteristics, including household composition, reliance on friend or neighbor for transportation, food purchase at dollar stores and from neighbors, and participation in school-based nutrition programs. A smaller percentage of households with child hunger participated in school-based nutrition programs (51%) or used alternative food sources, while 131 households were unable to give their child or children a balanced meal during the school year and 145 households during summer months. In the random effects model (RE = small town), increased household composition, full-time unemployment, and participation in the National School Lunch Program were significantly associated with increased odds for child hunger, while participation in Supplemental Nutrition Assistance Program (SNAP) and purchasing food from a neighbor were significantly associated with decreased odds for child hunger.

CONCLUSIONS

This study not only emphasizes the alarming rates of child hunger among this sample of Mexican-origin families, but also identifies economic and family factors that increased the odds for child hunger as well as community strategies that reduced the odds. It is unsettling that so many children did not participate in school-based nutrition programs, and that many who participated in federal nutrition assistance programs remained hungry. This study underscores the importance of identifying the presence of child hunger among low-income Mexican-origin children in Texas border colonias and increasing access to nutrition-related resources. Hunger-associated health inequities at younger ages among colonia residents are likely to persist across the life span and into old age.

Adverse health effects of experiencing food insecurity among Greenlandic school children

BACKGROUND

In vulnerable populations, food security in children has been found to be associated with negative health effects. Still, little is known about whether the negative health effects can be retrieved in children at the population level.

OBJECTIVE

To examine food insecurity reported by Greenlandic school children as a predictor for perceived health, physical symptoms and medicine use.

DESIGN

The study is based on the Greenlandic part of the Health Behavior in School-aged Children survey. The 2010 survey included 2,254 students corresponding to 40% of all Greenlandic school children in Grade 5 through 10. The participation rate in the participating schools was 65%. Food insecurity was measured as going to bed or to school hungry because there was no food at home.

RESULTS

Boys, the youngest children (11-12 year-olds), and children from low affluence homes were at increased risk for food insecurity. Poor or fair self-rated health, medicine use last month and physical symptoms during the last 6 months were all more frequent in children reporting food insecurity. Controlling for age, gender and family affluence odds ratio (OR) for self-rated health was 1.60 (95% confidence interval (CI 1.23-2.06) (p < 0.001), for reporting physical symptoms 1.34 (95% CI 1.06-1.68) (p = 0.01) and for medicine use 1.79 (95% CI 1.42-2.26) (p < 0.001). Stratification on age groups suggested that children in different age groups experience different health consequences of food insecurity. The oldest children reported food insecurity less often and experienced less negative health effects compared to the younger children.

CONCLUSIONS

All 3 measures of health were negatively associated to the occurrence of food insecurity in Greenlandic school children aged 11-17. Food security must be seen as a public health issue of concern, and policies should be enforced to prevent food poverty particularly among boys, younger school children and children from low affluence homes.

Food insecurity, CD4 counts, and incomplete viral suppression among HIV+ patients from Texas Children's Hospital: a pilot study

Determine the relationship between food insecurity and CD4 counts and viral suppression among pediatric HIV-positive patients. Food insecurity was assessed by validated survey. CD4 counts and viral load were abstracted from patients' charts. We used linear regression for the dependent variable of the natural log of CD4 counts and logistic regression for viral suppression, with backward deletion of covariates with p > 0.1. Food insecurity (β = -0.23, 95 % CI [-0.40, -0.01]) was associated with lower CD4 counts and higher odds of incomplete viral suppression (OR = 4.07, 95 % CI [1.02, 13.92]). Food insecurity may adversely impact pediatric HIV outcomes.

Prevalence and socioeconomic and geographical inequalities of household food insecurity in the Paris region, France, 2010

Background

Food insecurity (FI) is the situation where people do not have, at all times, access to sufficient, safe and nutritious food that meets their dietary needs for an active and healthy life. The objectives of this study were to estimate the prevalence of FI in the Paris area by using, for the first time in France, a specific FI questionnaire and to identify the characteristics of food-insecure households, taking into account a potential neighbourhood effect.

Methods

This study is based on data from the third wave of the SIRS cohort study (a representative, population-based socioepidemiological study) that were analysed using a cross-sectional design. In 2010, 3000 individuals in the Paris metropolitan area (PMA) were interviewed. FI was investigated by means of the USDA’s HFSSM. We used stratified multilevel models across three household income categories to identify populations at risk for FI.

Results

In 2010, 6.30% (95% CI = [4.99-7.97]) of the households in the PMA experienced FI (up to 13.59% in the most underprivileged neighbourhoods). About 2.50% of the households experienced severe FI and 2.85% of household living with an income above 1666 € experienced food insecurity, whereas the percentage raises to 23.38% among those living below the poverty threshold (<791 €). Depending on the income level, different household characteristics emerged as being associated with FI. In the poorest households, the presence of a child under 3 years of age was associated with an increased risk of FI (OR = 2.11; p = 0.03). Among higher-income households, the household composition appeared to be strongly associated with FI.

Conclusion

FI exists in several social groups in France. Its prevalence in the most underprivileged households should be considered an indicator of vulnerability, which could permit targeted social assistance policies.

Conceptualizing and contextualizing food insecurity among Greenlandic children

Objective

To review the context of food insecurity in Greenlandic children, to review and compare the outcomes related to food insecurity in Greenlandic children, in other Arctic child populations and in other western societies, and to explore the measure used by the Health Behaviour in School-aged Children (HBSC) study.

Design

The study includes literature reviews, focus group interviews with children and analyses of data from the HBSC study. HBSC is an international cross-national school-based survey on child and adolescent health and health behaviour in the age groups 11, 13 and 15 years and performed in more than 40 countries. The item on food insecurity is “Some young people go to school or to bed hungry because there is not enough food in the home. How often does this happen to you?” (with the response options: “Always”, “Often”, “Sometimes”, or “Never”).

Results

The context to food security among Inuit in Arctic regions was found to be very similar and connected to a westernization of the diet and contamination of the traditional diet. The major challenges are contamination, economic access to healthy food and socio-demographic differences in having a healthy diet. The literature on outcomes related to food insecurity in children in Western societies was reviewed and grouped based on 8 domains. Using data from the Greenlandic HBSC data from 2010, the item on food security showed negative associations on central items in all these domains. Focus group interviews with children revealed face and content validity of the HBSC item.

Conclusion

Triangulation of the above-mentioned findings indicates that the HBSC measure of food shortage is a reliable indicator of food insecurity in Greenlandic schoolchildren. However, more research is needed, especially on explanatory and mediating factors.

Exploring the paradox: double burden of malnutrition in rural South Africa

BACKGROUND

This article is a review of the PhD thesis by Elizabeth Kimani-Murage that explores the double burden of malnutrition in rural South Africa. This is in the context of a worryingly rapid increase in obesity and obesity-related diseases in low- and middle-income countries (LMICs) including South Africa, and in the wake of on-going nutrition transition and lifestyle changes in these countries.

OBJECTIVE

To understand the profiles of malnutrition among children and adolescents in a poor, high HIV prevalent, transitional society in a middle-income country.

METHODS

A cross-sectional growth survey was conducted in 2007 targeting 4,000 children and adolescents aged 1-20 years. In addition, HIV testing was carried out on children aged 1-5 years and Tanner pubertal assessment among adolescents aged 9-20 years.

RESULTS

The study shows stunting at an early age and adolescent obesity, particularly among girls, that co-exists in the same socio-geographic population. The study also shows that HIV is an independent modifiable risk factor for poor nutritional outcomes in children and makes a significant contribution to nutritional outcomes at the individual level. Significant predictors of undernutrition at an early age, documented at individual, household, and community levels, include child's HIV status, age and birth weight, maternal age, age of household head, and area of residence. Significant predictors of overweight/obesity and risk for metabolic disease during adolescence, documented at individual and household levels include child's age, sex, and pubertal development, household-level food security, socio-economic status, and household head's highest education level.

CONCLUSIONS

The combination of early stunting and adolescent obesity raises critical concerns in the wake of the rising public health importance of metabolic diseases in LMICs. This is because, both paediatric obesity and adult short stature are risk factors for metabolic syndrome and metabolic diseases in adulthood. Clearly, policies and interventions to address malnutrition in this and other transitional societies need to be double-pronged and gender-sensitive.

Obesity Prevention and National Food Security: A Food Systems Approach

Interventions that cultivate sustainable food systems to promote health, prevent obesity, and improve food security have the potential for many large-scale and long-lasting benefits including improvements in social, environmental, health, and economic outcomes. We briefly summarize findings from previous research examining associations between obesity and food insecurity and discuss the need for greater synergy between food insecurity initiatives and national obesity prevention public health goals in the United States. The common ground between these two nutrition-related public health issues is explored, and the transformation needed in research and advocacy communities around the shared goal of improving population health through individual, environmental, and policy level changes to promote healthy sustainable food systems is discussed. We propose an ecological framework to simultaneously consider food insecurity and obesity that identifies levers for change to promote sustainable food systems to improve food security and prevent obesity.

Child feeding practices and household food insecurity among low-income mothers in Buenos Aires, Argentina

This qualitative study of low-income mothers in Buenos Aires, Argentina, examines the influence of socio-economic conditions, organizational structures, family relationships, and food insecurity on child feeding practices and weight status. Thirty-eight mothers of preschool children living in urban Buenos Aires participated in four focus group discussions. The results indicated that many mothers were aware that obesity may be detrimental to the child's health, but most of them are unclear about the specific consequences. Maternal employment, family pressures, food insecurity and financial worries seem to influence child feeding practices. These findings have important implications for developing strategies for nutritional assistance that could benefit the health of children and provide opportunities for educational programs that are directed to nutritional awareness in Buenos Aires, Argentina. The right to eat regularly and properly is an obligation of the State and must be implemented taking into account the notion of food sovereignty and respecting the importance of preserving the culture and eating habits of a country and its diverse population groups.

Food insecurity and obesogenic maternal infant feeding styles and practices in low-income families

OBJECTIVES

We explored the relationship between household food insecurity and maternal feeding styles, infant feeding practices, and perceptions and attitudes about infant weight in low-income mothers.

METHODS

Mothers participating in the Special Supplemental Food Program for Women, Infants, and Children with infants aged between 2 weeks and 6 months were interviewed. By using regression analyses, the following relationships were examined between food insecurity and: (1) controlling feeding styles (restrictive and pressuring); (2) infant feeding practices, including breastfeeding, juice consumption, and adding cereal to the bottle; and (3) perceptions and attitudes about infant weight. Path analysis was used to determine if perceptions and attitudes about infant weight mediated the relationships between food insecurity and controlling feeding styles.

RESULTS

The sample included 201 mother-infant pairs, with 35% reporting household food insecurity. Food-insecure mothers were more likely to exhibit restrictive (B [SE]: 0.18 [0.08]; 95% confidence interval [CI]: 0.02-0.34) and pressuring (B [SE]: 0.11 [0.06]; 95% CI: 0.001-0.22) feeding styles compared with food-secure mothers. No associations were found with feeding practices. Concern for their infant becoming overweight in the future was associated with food insecurity (adjusted odds ratio: 2.11 [95% CI: 1.02-4.38]). This concern mediated the relationship between food insecurity and both restrictive (P = .009) and pressuring (P = .01) feeding styles.

CONCLUSIONS

Increased concern about future overweight and controlling feeding styles represent potential mechanisms by which food insecurity could be related to obesity. Obesity prevention should aim to decrease food insecurity and to reduce controlling feeding styles in families who remain food insecure.

Inconsistent Access to Food and Cardiometabolic Disease: The Effect of Food Insecurity

Food insecurity is defined as limited or uncertain ability to acquire nutritionally adequate and safe foods in socially acceptable ways. The United States Department of Agriculture (USDA) has divided food insecurity into two categories: low food security and very low food security. Low food security is characterized by irregular access to food, binge eating when food is available, overconsumption of energy-dense foods, obesity, and even type 2 diabetes. This type of food insecurity occurs in impoverished urban areas of high-income countries such as the United States. In contrast, very low food security is distinctly different from low food security and can lead to undernutrition and frank starvation. Very low food security is found in developing countries in both rural areas and urban slums. In these countries, food insecurity is often exacerbated by natural disasters and climate changes that compromise food availability. With a focus on the social, economic, and behavioral factors that promote obesity and cardiometabolic disease in food insecure households in the United States, this review will first define the key terms and concepts associated with food insecurity. Then, the characteristics of food insecure households and the relationship to cardiometabolic disease will be discussed. Finally, the cardiac consequences of food insecurity in developing countries will be briefly described.

Childhood socioeconomic factors and perinatal characteristics influence development of rheumatoid arthritis in adulthood

BACKGROUND

Rheumatoid arthritis (RA) has been associated with lower socioeconomic status (SES), but the reasons for this are not known.

OBJECTIVE

To examine childhood SES measures, SES trajectory and other perinatal factors in relation to RA.

METHODS

The sample included 50 884 women, aged 35-74 (84% non-Hispanic white) enrolled 2004-9 in a US national cohort study. In baseline questionnaires, cases (N=424, 0.8%) reported RA diagnosis after age 16, ever use of disease-modifying antirheumatic drugs or steroids for RA and ≥6 weeks bilateral joint swelling. Childhood SES measures are presented as OR and 95% CI adjusted for age and race/ethnicity. Analyses of perinatal factors also adjusted for childhood SES, and joint effects of childhood and adult SES and smoking exposures were evaluated.

RESULTS

Patients with RA reported lower childhood household education (<12 years vs college degree; OR=1.7; 95% CI 1.1 to 2.5), food insecurity (OR=1.5, 95% CI 1.1 to 2.0) and young maternal age (<20 vs 20-34 years; OR=1.7, 95% CI 1.2 to 2.5), with a trend (p<0.0001) for increasing number of adverse factors (OR=3.0; 95% CI 1.3 to 7.0; 4 vs 0 factors) compared with non-cases. Low birth weight (<2500 g) [corrected] and preconception paternal smoking were independently associated with RA. Together, lower childhood SES and adult education (<college degree) were associated with RA (interaction p=0.03), with a joint effect magnitude similar to a history of paternal and adult smoking.

CONCLUSIONS

RA was associated with low childhood SES sustained into adulthood, with cumulative effects across multiple measures, suggesting the importance of other unmeasured factors linking SES and RA.

Use of concept mapping to explore the influence of food security on food buying practices

Paradoxically, individuals with food insecurity have been observed to have higher rates of obesity compared with their counterparts with food security. The factors influencing food purchasing behaviors in households with food security vs food insecurity are poorly understood. Using the mixed methods approach of concept mapping, we examined the perceptions and preferences driving the food purchasing behaviors of households with food security vs food insecurity. Twenty-six men and women with food security and 41 men and women with food insecurity from four neighborhoods in Boston, MA, completed the concept mapping process during 2010. Prevalence of overweight and obesity was greater among participants with food insecurity (80.5%) compared with those with food security (61.5%). Participants identified 163 unique factors that influenced their food purchasing behavior. Using multivariate analyses, these factors were grouped into eight unique concepts or clusters that reflected their perceptions of factors hindering healthy eating. Average cluster ratings were similar between participants with food security and food insecurity, suggesting that similar food purchasing behaviors are employed and are perceived similarly in how they hinder or promote healthy eating. The use of emergency food assistance programs may play a role in minimizing the burden of food insecurity while providing access to foods with varying degrees of nutritional quality that may be associated with increased risk of overweight and obesity observed in individuals and households with food insecurity.

Sex-dependent cognitive performance in baboon offspring following maternal caloric restriction in pregnancy and lactation

In humans a suboptimal diet during development has negative outcomes in offspring. We investigated the behavioral outcomes in baboons born to mothers undergoing moderate maternal nutrient restriction (MNR). Maternal nutrient restriction mothers (n = 7) were fed 70% of food eaten by controls (CTR, n = 12) fed ad libitum throughout gestation and lactation. At 3.3 ± 0.2 (mean ± standard error of the mean [SEM]) years of age offspring (controls: female [FC, n = 8], male [MC, n = 4]; nutrient restricted: female [FR, n = 3] and male [MR, n = 4]) were administered progressive ratio, simple discrimination, intra-/extra-dimension set shift and delayed matching to sample tasks to assess motivation, learning, attention, and working memory, respectively. A treatment effect was observed in MNR offspring who demonstrated less motivation and impaired working memory. Nutrient-restricted female offspring showed improved learning, while MR offspring showed impaired learning and attentional set shifting and increased impulsivity. In summary, 30% restriction in maternal caloric intake has long lasting neurobehavioral outcomes in adolescent male baboon offspring.

Does living in a food insecure household impact on the diets and body composition of young children? Findings from the Southampton Women's Survey

BACKGROUND

Little is known about food insecurity in the UK. The aims of this study were to assess the prevalence and factors associated with food insecurity in a UK cohort and to examine whether the diets, reported health and anthropometry of young food insecure children differed from those of other children.

METHODS

The Southampton Women's Survey is a prospective cohort study in which detailed information about the diets, lifestyle and body composition of 3000 women was collected before and during pregnancy. Between 2002 and 2006, 1618 families were followed up when the child was 3 years old. Food insecurity was determined using the Household Food Security Scale. The child's height and weight were measured; diet was assessed by food frequency questionnaire.

RESULTS

4.6% of the households were food insecure. Food insecurity was more common in families where the mothers were younger, smokers, of lower social class, in receipt of financial benefits and who had a higher deprivation score (all p<0.05). In comparison with other 3-year-old children, those living in food insecure households were likely to have worse parent-reported health and to have a diet of poorer quality, characterised by greater consumption of white bread, processed meat and chips, and by a lower consumption of vegetables (all p<0.05). They did not differ in height or body mass index.

CONCLUSIONS

Our data suggest that there are significant numbers of food insecure families in the UK. The poorer reported health and diets of young food insecure children have important implications for their development and lifelong health.

Predictors of adolescent weight status and central obesity in rural South Africa

OBJECTIVE

To investigate predictors of adolescent obesity in rural South Africa.

DESIGN

Cross-sectional study. Height, weight and waist circumference were measured using standard procedures. Overweight and obesity in adolescents aged 10-17 years were assessed using the International Obesity Taskforce cut-offs, while the WHO adult cut-offs were used for participants aged 18-20 years. Waist-to-height ratio of >0.5 defined central obesity in those at Tanner stages 3-5. Linear and logistic regression analysis was used to evaluate risk factors.

SETTING

Agincourt sub-district, rural South Africa.

SUBJECTS

Participants (n 1848) were aged 10-20 years.

RESULTS

Combined overweight and obesity was higher in girls (15 %) than boys (4 %), as was central obesity (15 % and 2 %, respectively). With regard to overweight/obesity, fourfold higher odds were observed for girls and twofold higher odds were observed for participants from households with the highest socio-economic status (SES). The odds for overweight/obesity were 40 % lower if the household head had not completed secondary level education. For central obesity, the odds increased 10 % for each unit increase in age; girls had sevenfold higher odds v. boys; post-pubertal participants had threefold higher odds v. pubertal participants; those with older mothers aged 50+ years had twofold higher odds v. those whose mothers were aged 35-49 years; those in highest SES households had twofold higher odds v. those in lowest SES households.

CONCLUSIONS

In rural South Africa, adolescent females are most at risk of obesity which increases with age and appears to be associated with higher SES. To intervene effectively, it is essential to understand how household factors influence food choice, diet and exercise.

Food insecurity and weight status among U.S. children and families: a review of the literature

CONTEXT

Food insecurity disproportionately affects U.S. demographic groups of children and adult family members at the highest risk for obesity and may lead to weight gain through various pathways. This article reviews research regarding the relationship between food insecurity and weight status, and the potential role of federal food and nutrition assistance programs.

EVIDENCE ACQUISITION

A search for relevant peer-reviewed research studies among U.S. children and nonelderly adults, published between 2000 and March 2010, identified 42 studies regarding the relationship between food insecurity and weight status. There were 22 studies regarding the potential role of food and nutrition assistance programs.

EVIDENCE SYNTHESIS

Among children and men, support for an association between food insecurity and weight status has been mixed. Women who experience food insecurity are more likely to be overweight or obese compared to women with adequate household resources for food; however, there is little evidence that food insecurity promotes increased weight gain over time. Long-term participation in the Supplemental Nutrition Assistance Program may increase risk for excess weight gain.

CONCLUSIONS

Additional research addressing the limitations of current studies is needed to fully understand the observed linkages between food insecurity and risk for obesity. Nevertheless, there is substantial evidence these nutritional problems coexist, and it is critical that future efforts to eliminate hunger consider opportunities to promote healthy food choices and physical activity. Evaluations of policy changes and other intervention strategies are needed to determine the potential for food and nutrition assistance programs to more effectively reduce obesity among participants.