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Cho S. Child meal support program, food and nutrition insecurity, and health among Korean children. Nutr Health 2024:2601060241261437. [PMID: 38887061 DOI: 10.1177/02601060241261437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND Korea's child meal support program (CMSP) aims to reduce food and nutrition insecurity (FNI) and improve health among children from low-income households. AIM We examined the impact of different types of CMSP on children's FNI and health in Korea, analyzing meal frequency and healthful food consumption (FNI), and general health and depression (health) among child meal card (CMC) and facility meal service (FMS) participants compared with nonparticipants. METHODS The 2018 Comprehensive Survey on Korean Children data were analyzed. Precisely, 847 children from low-income households aged 9-17 were categorized into CMC (n = 331), FMS (n = 209), and income-eligible nonparticipants (n = 307). Propensity score-weighted generalized linear models assessed CMSP's impact on FNI and health. Stratified generalized linear models examined heterogeneity in FNI-health associations by CMSP status. RESULTS CMC participants reported more frequent breakfast consumption (odds ratio [OR] = 0.662, p < 0.05) but poorer self-rated general health (OR = 1.890, p < 0.05); FMS participants were less likely to have three meals (OR = 1.814, p < 0.05), fruits and vegetables (OR = 2.194, p < 0.001), and protein-rich foods daily (OR = 1.695, p < 0.05) than nonparticipants. Health risks associated with healthful food consumption and meal frequency were more pronounced among CMC and FMS/nonparticipants, respectively. CONCLUSION CMSP had a limited impact on reducing FNI and improving health among children from low-income households. CMC appeared more effective than FMS in alleviating FNI, notwithstanding potential health concerns. Food assistance programs should seek comprehensive enhancements in children's food and nutrition security and health.
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Affiliation(s)
- Seongha Cho
- Department of Social Welfare, Seoul National University, Seoul, Republic of Korea
- Institute of Social Welfare, Seoul National University, Seoul, Republic of Korea
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2
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Paik JM, Duong S, Zelber-Sagi S, Lazarus JV, Henry L, Younossi ZM. Food Insecurity, Low Household Income, and Low Education Level Increase the Risk of Having Metabolic Dysfunction-Associated Fatty Liver Disease Among Adolescents in the United States. Am J Gastroenterol 2024; 119:1089-1101. [PMID: 38477467 DOI: 10.14309/ajg.0000000000002749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION In the United States, 10.2% households (HH) report child food insecurity. We assessed associations between metabolic dysfunction-associated fatty liver disease (MASLD) and food insecurity among the adolescents in the United States. METHODS This cross-sectional study was performed using data from the National Health and Nutrition Examination Survey 2017-2018. Food insecurity was assessed by the US Department of Agriculture Child Food Security Survey Module. MASLD was defined by transient elastography. RESULTS Among 771 adolescents (aged 12-18 years) (mean age 14.7 years; 52.5% male; 50.9% White, 12.7% Black, 24.4% Hispanic, and 12.1% other), 9.8% reported food insecurity; MASLD prevalence of 10.12% (95% confidence interval [CI] 7.13%-13.20%) affecting 4.27 million adolescents; and nonalcoholic fatty liver disease prevalence of 10.77% (95% CI 7.76-13.78) affecting 4.52 million adolescents. There was near-perfect concordance between MASLD and nonalcoholic fatty liver disease (Cohen's κ coefficient of 0.971, 95% CI 0.946-0.996). The prevalence of MASLD was greater among food-insecure adolescents vs food-secure ones (17.4% vs 9.4%) and adolescents living with a low HH income vs those with a higher HH income (15.0% vs 7.2%) and living with a head of HH with a lower education level vs one with a higher education level (18.0% vs 8.2%) ( P < 0.05). The fully adjusted model showed that compared with adolescents living in a higher HH income, food-insecure adolescents living in low income HH had a 3-fold greater risk (odds ratio [OR] 3.25, 1.31-8.08) of having MASLD, while food-secure adolescents living in low-income HH had no increased risk (OR 1.58, 0.85-2.93, P = 0.139). The fully adjusted odds of having MASLD was elevated by +163% with the presence of HTN (OR 2.63, 1.02-6.78), +241% with being Hispanic (OR 3.41, 1.36-8.56), and +138% with being male (OR 2.38, 1.20-4.75). In addition, a 1-unit increase in BMI was associated with 25% increase in the odds of having MASLD (OR 1.25, 1.17-1.33) among US adolescents. DISCUSSION Food insecurity is associated with MASLD among US low-income adolescents especially Hispanic male individuals with obesity and hypertension. Policies addressing inequities are needed.
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Affiliation(s)
- James M Paik
- The Global NASH Council, Washington, District of Columbia, USA
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
| | - Sandy Duong
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
| | - Shira Zelber-Sagi
- The Global NASH Council, Washington, District of Columbia, USA
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Jeffrey V Lazarus
- The Global NASH Council, Washington, District of Columbia, USA
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USA
| | - Linda Henry
- The Global NASH Council, Washington, District of Columbia, USA
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia, USA
| | - Zobair M Younossi
- The Global NASH Council, Washington, District of Columbia, USA
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, Virginia, USA
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia, USA
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Acciai F, Uehara S, Ojinnaka C, Yedidia MJ, Ohri-Vachaspati P. The association between unhealthy dietary behaviors and participation in the Supplemental Nutrition Assistance Program (SNAP): No evidence in support of the self-selection hypothesis. Appetite 2024; 197:107302. [PMID: 38462052 PMCID: PMC11045168 DOI: 10.1016/j.appet.2024.107302] [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: 08/15/2023] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024]
Abstract
Supplemental Nutrition Assistance Program (SNAP) participants tend to have unhealthier dietary consumption compared to eligible non-participants. It has been suggested, though never empirically tested, that individuals who enroll in SNAP may have unhealthy diets prior to program participation. Using a longitudinal cohort study design, we examined the association between low-income adults' SNAP participation status and prior dietary behaviors to test the argument that individuals with unhealthier dietary consumption self-select into SNAP. A sample of households from predominantly lower-income cities were surveyed at baseline (T1) and 2-4 years later (T2). The main analyses were restricted to adults who did not participate in SNAP at T1 and with household income <200% of the federal poverty line (n = 170) at both T1 and T2. Participants were grouped into two categories, based on their SNAP participation at T2; (a) Non-participants (n = 132): no SNAP participation at T1 or T2, and (b) T2 SNAP participants (n = 38): SNAP participation at T2 but not T1. Daily consumption frequency of whole fruits, fruit juice, vegetables, sugar-sweetened beverages (SSBs), and energy dense snacks were measured through self-reports. To observe dietary differences between the two groups prior to SNAP participation, T1 behaviors were compared. There were no significant differences in dietary behaviors at T1 (prior to SNAP participation) between non-participants and T2 participants, providing no evidence of self-selection of individuals with unhealthier dietary consumption into SNAP among our study sample. Improvements in SNAP participants' diets may benefit from focusing on policy changes that encourage healthy dietary habits during participation in the program.
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Affiliation(s)
- Francesco Acciai
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
| | - Sarah Uehara
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Chinedum Ojinnaka
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Michael J Yedidia
- Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
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Heerman WJ, Kenney E, Block JP, Fiechtner L, McMahon E, Kruse L, Sharifi M, Edmondson EK, Virudachalam S. A Narrative Review of Public Health Interventions for Childhood Obesity. Curr Obes Rep 2024; 13:87-97. [PMID: 38172483 DOI: 10.1007/s13679-023-00550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Public health interventions that intervene on macrolevel systems hold the promise of reducing childhood obesity at the population level through prevention. The purpose of this review is to highlight some of the recent and best scientific evidence related to public health interventions for the prevention of childhood obesity. We provide a narrative review of scientific evidence for six categories of public health interventions and their impact on childhood obesity: federal nutrition assistance programs, programs implemented in early care and education centers, interventions to support healthy nutrition and physical activity in schools, community-based programs and policies, labeling policies and marketing to children, and taxes on sugar sweetened beverages (SSB). RECENT FINDINGS Federal nutrition assistance programs have the strongest evidence to support reduction in childhood obesity and serve populations with the highest prevalence of childhood obesity. Other interventions including SSB taxes, community-wide interventions, and interventions at schools and early care and education centers also show significant improvements in child weight status. Overall public health interventions have strong evidence to support widespread implementation in service of reducing childhood obesity rates at the population level. To effectively address the recalcitrant childhood obesity epidemic, multi-pronged solutions are needed. The current evidence for public health obesity interventions is consistent with the paradigm that recognizes the importance of macrolevel systems influences on childhood obesity: interventions that are most effective intervene at macrolevels.
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Affiliation(s)
- William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA.
| | - Erica Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, USA
| | - Lauren Fiechtner
- Division of Pediatric Gastroenterology and Nutrition, Mass General for Children, The Greater Boston Food Bank, Boston, USA
| | - Ellen McMahon
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Lauren Kruse
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine, New Haven, USA
| | - Emma K Edmondson
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
| | - Senbagam Virudachalam
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
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5
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Leung CW, Insolera NE, Wolfson JA. Trends in Recurring and Chronic Food Insecurity Among US Families With Older Adults. JAMA HEALTH FORUM 2024; 5:e235463. [PMID: 38427343 PMCID: PMC10907918 DOI: 10.1001/jamahealthforum.2023.5463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/22/2023] [Indexed: 03/02/2024] Open
Abstract
Importance Food insecurity is a critical social determinant of health for older adults. Understanding national food insecurity trends among families with older adults has important policy implications. Objective To compare food insecurity trends among US families with an older adult from 1999 to 2003 and 2015 to 2019 and further stratify the analysis by race and ethnicity, socioeconomic status markers, and enrollment in the federal Supplemental Nutrition Assistance Program (SNAP). Design, Setting, and Participants In this cohort study using biennial data from the nationally representative Panel Study of Income Dynamics, balanced panels of families with at least 1 older adult (≥60 years) who participated from 1999 to 2003 (n = 1311) and 2015 to 2019 (n = 2268) were created. Analysis was completed in 2023. Main outcome Food insecurity was assessed using the US Household Food Security Survey Module. Within each 5-year period, we defined recurring food insecurity as 2 or more episodes of food insecurity and chronic food insecurity as 3 episodes of food insecurity. Results Overall, food insecurity among US families with older adults increased from 12.5% in 1999 to 2003 to 23.1% in 2015 to 2019. Rates of recurring food insecurity more than doubled (5.6% to 12.6%), whereas rates of chronic food insecurity more than tripled (2.0% to 6.3%). Across both time periods, higher rates of food insecurity persisted among Black and Hispanic families, with lower socioeconomic status, and participating in SNAP. Conclusions and Relevance These results highlight how rates of recurring and chronic food insecurity among families with older adults rose substantially over the past 20 years. Monitoring national trends in food insecurity among older adults has direct programmatic and policy implications.
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Affiliation(s)
- Cindy W. Leung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Julia A. Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Evans RW, Maguet ZP, Stratford GM, Biggs AM, Goates MC, Novilla MLB, Frost ME, Barnes MD. Investigating the Poverty-Reducing Effects of SNAP on Non-nutritional Family Outcomes: A Scoping Review. Matern Child Health J 2024; 28:438-469. [PMID: 38372834 PMCID: PMC10914930 DOI: 10.1007/s10995-024-03898-3] [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] [Accepted: 12/20/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION/PURPOSE Poverty-reduction efforts that seek to support households with children and enable healthy family functioning are vital to produce positive economic, health, developmental, and upward mobility outcomes. The Supplemental Nutrition Assistance Program (SNAP) is an effective poverty-reduction policy for individuals and families. This study investigated the non-nutritional effects that families experience when receiving SNAP benefits. METHODS We conducted a scoping review using the PRISMA Guidelines and strategic search terms across seven databases from 01 January 2008 to 01 February 2023 (n=2456). Data extraction involved two researchers performing title-abstract reviews. Full-text articles were assessed for eligibility (n=103). Forty articles were included for data retrieval. RESULTS SNAP positively impacts family health across the five categories of the Family Stress Model (Healthcare utilization for children and parents, Familial allocation of resources, Impact on child development and behavior, Mental health, and Abuse or neglect). DISCUSSION/CONCLUSION SNAP is a highly effective program with growing evidence that it positively impacts family health and alleviates poverty. Four priority policy actions are discussed to overcome the unintentional barriers for SNAP: distributing benefits more than once a month; increasing SNAP benefits for recipients; softening the abrupt end of benefits when wages increase; and coordinating SNAP eligibility and enrollment with other programs.
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Affiliation(s)
- R William Evans
- Department of Public Health, Brigham Young University, Provo, USA.
| | - Zane P Maguet
- Department of Public Health, Brigham Young University, Provo, USA
| | - Gray M Stratford
- Department of Public Health, Brigham Young University, Provo, USA
| | - Allison M Biggs
- Department of Public Health, Brigham Young University, Provo, USA
| | | | | | - Megan E Frost
- Science Librarians, Harold B. Lee Library, Provo, USA
| | - Michael D Barnes
- Department of Public Health, Brigham Young University, Provo, USA
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Konuthula D, Tan MM, Burnet DL. Challenges and Opportunities in Diagnosis and Management of Cardiometabolic Risk in Adolescents. Curr Diab Rep 2023; 23:185-193. [PMID: 37273161 PMCID: PMC10240116 DOI: 10.1007/s11892-023-01513-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE OF REVIEW This review aims to elucidate the limitations of diagnosing metabolic syndrome in adolescents as well as challenges and opportunities in the identification and reduction of cardiometabolic risk in this population. RECENT FINDINGS There are multiple criticisms of how we define and approach obesity in clinical practice and scientific research, and weight stigma further complicates the process of making and communicating weight-related diagnoses. While the goal of diagnosing and managing metabolic syndrome in adolescents would be to identify individuals at elevated future cardiometabolic risk and intervene to reduce the modifiable component of this risk, there is evidence that identifying cardiometabolic risk factor clustering may be more useful in adolescents than establishing a cutoff-based diagnosis of metabolic syndrome. It has also become clear that many heritable factors and social and structural determinants of health contribute more to weight and body mass index than do individual behavioral choices about nutrition and physical activity. Promoting cardiometabolic health equity requires that we intervene on the obesogenic environment and mitigate the compounding effects of weight stigma and systemic racism. The existing options to diagnose and manage future cardiometabolic risk in children and adolescents are flawed and limited. While striving to improve population health through policy and societal interventions, there are opportunities to intervene at all levels of the socioecological model in order to decrease future morbidity and mortality from the chronic cardiometabolic diseases associated with central adiposity in both children and adults. More research is needed to identify the most effective interventions.
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Affiliation(s)
| | - Marcia M Tan
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Deborah L Burnet
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Pediatrics, University of Chicago, Chicago, IL, USA
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Leung CW, Wolfson JA, Brandt EJ, Rimm EB. Disparities in Cardiovascular Health by Food Security Status and Supplemental Nutrition Assistance Program Participation Using Life's Essential 8 Metrics. JAMA Netw Open 2023; 6:e2321375. [PMID: 37389879 PMCID: PMC10314299 DOI: 10.1001/jamanetworkopen.2023.21375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/17/2023] [Indexed: 07/01/2023] Open
Abstract
This cross-sectional study examines the associations among household food security, Supplemental Nutrition Assistance Program participation, and cardiovascular health among 2013-2018 National Health and Nutrition Examination Survey participants.
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Affiliation(s)
- Cindy W. Leung
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Julia A. Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric J. Brandt
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor
| | - Eric B. Rimm
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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