Relationship between food insecurity, child weight status, and parent-reported child eating and snacking behaviors

Family-Based Motivational Interviewing and Resource Mobilization to Prevent Obesity: Living Well Together Trial

OBJECTIVE

Test an obesity intervention for families with low incomes.

METHODS

A total of 208 families were included (a parent with a body mass index [BMI] ≥ 30 and a child aged 6-12 years). A 12-month randomized controlled trial combining family health coaching (motivational interviewing) and connection to community resources. Comparison group: referrals for basic needs, written educational materials. Questionnaires, accelerometry, and anthropometrics. Intention-to-treat analysis of change in outcomes. Two-sided t test with multiple imputation.

RESULTS

Parents were 95% female, 31% Black, and 27% Hispanic. Children had a mean BMI-Z score of 1.15. Primary outcomes did not differ between groups at 12 months. Both groups significantly (P < 0.05) improved on the Family Nutrition and Physical Activity Scale for behaviors related to childhood obesity (mean ± SE: comparison, 2.8 ± 1.0; intervention, 2.2 ± 0.9), increased child sedentary activity (comparison, 32.5 ± 12.1; intervention, 39.9 ± 12.4 min/d), and decreased child moderate-vigorous physical activity (comparison, -9.6 ± 3.3; intervention -7.0 ± 3.0 min/d). Parents had no change in BMI.

CONCLUSIONS AND IMPLICATIONS

We successfully embedded screening and referral to address social needs within an obesity intervention. The coaching intervention did not provide additional benefits. Future research could explore ways to make these interventions more accessible, valuable, and effective for families.

Relationship between food insecurity and malnutrition in schoolchildren from low- and middle-income countries - A systematic review

Introduction

The objective of this review is to study the relationship between food insecurity (FI) and malnutrition in schoolchildren from low-and middle-income countries (LMIC). The review was conducted using the databases PubMed, MEDLINE, CENTRAL, LILACS and SCiELO during the months of March to April 2022 without language or publication date restrictions. The search strategy consisted of combinations of text words and controlled vocabulary (MeSH terms and DeCS) related to "schoolchildren", "low- and middle-income countries" and "food insecurity". Fifteen studies were included in this review. Studies assessing FI and undernutrition in LMIC schoolchildren have indicated that FI is associated with lower height-for-age and higher prevalence of undernutrition overall. Only two studies identified a positive risk association between FI and overweight and obesity, the remaining studies suggested that schoolchildren with FI have a lower risk of overweight and obesity than those without FI. The review suggests a link between FI and undernutrition in schoolchildren from LMIC, with controversial results on overweight and obesity. Comprehensive public health policies should consider contextual and population-specific factors in addressing FI's impact on nutritional status.

Association of household food insecurity with sociodemographic factors and obesity in US youth: findings from the National Health and Nutrition Examination Survey 2017-2018

Background

The objective is to determine the prevalence of household food insecurity (HFI) based on sociodemographic factors and their relationship to obesity in youth.

Methods

The study included a sample of 1,962 youth (aged 6-18) from the National Health and Nutrition Examination Survey (NHANES). The US Household Food Security Survey Module is used to measure food security over the past 12 months. Logistic regression models were used to estimate adjusted odds ratios (ORs) while controlling for covariates.

Results

In total, 27.4% of the individuals surveyed experienced HFI. Youth from food insecure households were more likely to be obese (adjusted odds ratio [aOR]: 1.59 [95% confidence interval: 1.19-2.13]) and also having abdominal obesity (aOR: 1.56 [95% CI: 1.19-2.03]). however, factors such as non-Hispanic ethnicity, having a Head of household with a college degree, and households with an income exceeding 350% of the poverty line were associated with a reduced risk of facing HFI.

Conclusion

Hispanic individuals, households with lower parental education levels, and lower family incomes, are disproportionately affected by food insecurity. Furthermore, HFI has been associated with an increased risk of overweight and abdominal obesity among youth. Addressing FI requires targeted policies and interventions that prioritize vulnerable groups.

Lifestyle Clusters of Diet Quality, Sleep, and Screen Time and Associations with Weight Status in Children from Madrid City: ENPIMAD Study

BACKGROUND

Childhood overweight and obesity is a global concern and has increased in Spain over the last decades. Combinations of lifestyle behaviors (i.e., diet, sleep, and sedentarism) are highly related to weight status. Therefore, this study aimed to identify lifestyle patterns among children from Madrid City, and analyze associations with the prevalence of overweight, obesity, and abdominal obesity, considering socio-economic factors.

METHODS

A cross-sectional analysis was conducted on 4545 children from the ENPIMAD study with data on diet, sleep, anthropometric, and socio-economic variables. K-means cluster analysis was used to identify lifestyle clusters, and logistic regressions were used to examine the associations between socio-economic indicators and cluster membership, and between clusters and weight status.

RESULTS

Findings show three lifestyle clusters (healthy, mixed, and unhealthy), with boys and older children more represented in the unhealthy cluster. Food insecurity and low socio-economic status were associated with unhealthier clusters in boys and girls. Children in unhealthier clusters were more likely to have obesity and abdominal obesity. However, these associations disappeared in girls after controlling for food insecurity.

CONCLUSION

These results provide insight into the combination of behaviors and socio-economic factors associated with childhood obesity that may aid in the design of future interventions.

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

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.

Eating behaviors as pathways from early childhood adversity to adolescent cardiometabolic risk

OBJECTIVE

To identify specific eating behavior pathways that mediate associations between financial difficulties, negative life events, and maternal depressive symptoms from 0 to 5 years and cardiometabolic risk in adolescence.

METHOD

Hypotheses were tested with data from birth to age 15 years using the Avon Longitudinal Study of Parents and Children, a birth cohort in the United Kingdom (n = 3,887 for current analyses). Mothers reported on financial difficulties, negative life events, and maternal depressive symptoms at multiple points from 0 to 5 years and reported on worry about child overeating at 8 years. Youth self-reported restrained, emotional, and external eating at age 14. Youth completed a cardiometabolic health assessment at age 15 where waist circumference, triglycerides, high-density lipoprotein, and insulin resistance were measured. Longitudinal structural equation modeling with bootstrapping was used to test mediation models.

RESULTS

Greater negative life events and maternal depressive symptoms predicted greater parental worry about child overeating at age 8, which directly predicted greater restrained and emotional eating at 14 and cardiometabolic risk at 15. Restrained and emotional eating at 14 directly predicted greater cardiometabolic risk at age 15.

CONCLUSIONS

Negative life events and maternal depressive symptoms in infancy/early childhood are associated with cardiometabolic risk in adolescence through pathways of parental worry about child overeating in middle childhood and youth-reported restrained and emotional eating in adolescence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Associations of social determinants of health and childhood obesity: a cross-sectional analysis of the 2021 National Survey of Children's Health

CONTEXT

Childhood obesity is a growing health problem in the United States, with those affected having an increased likelihood of developing chronic diseases at a younger age. Social determinants of health (SDOH) are known to influence overall health. Families who are of low socioeconomic status (SES) have also been shown to be more likely to experience food insecurity.

OBJECTIVES

Our primary objective was to utilize the National Survey of Children's Health (NSCH) 2021 data to determine the current associations between childhood obesity and SDOH. Secondarily, we estimated the prevalence of select SDOH among children with obesity.

METHODS

We conducted a cross-sectional analysis of 2021 NSCH to extract data related to the SDOH domains. We extracted sociodemographic variables to utilize as controls and constructed logistic regression models to determine associations, via odds ratios, between SDOH and childhood obesity.

RESULTS

Within the binary regression models, children with obesity (≥95th percentile) were more likely than children without obesity to experience SDOH in all domains. After controlling for sociodemographic variables, children with obesity were significantly more likely to experience food insecurity when compared to children without obesity (adjusted odds ratio [AOR]=1.39; 95 % confidence interval [CI]: 1.13-1.17).

CONCLUSIONS

In line with the current American Academy of Pediatrics (AAP) Clinical Practice Guidelines (CPG), improving policies for nutrition programs and addressing the lack of access to nutritious foods may alleviate some food insecurity. Ensuring that children have access to sufficient nutritious foods is critical in addressing childhood obesity and thus decreasing risk of chronic disease.

Family meals and food insecurity in Spanish adolescents

The world is not on track to achieve the goal of food security for the global population by 2030. New approaches to understand individuals' food insecurity are needed, especially insecurity related to children and adolescents, since it is associated with health and psychosocial problems. The study aimed to characterise the family dinners among a representative cohort of schooled adolescents (n = 1017) and their parents (n = 261) in Terrassa (Catalonia, Spain) and how family dinners could be related to household food insecurity. The survey findings revealed that in 2022, 19.2% of the adolescents were experiencing household food insecurity. Adolescents with a lower socioeconomic status and of foreign origin showed the highest likelihood of experiencing household food insecurity. Household food security was also associated with some characteristics of family dinners, such as better quality and a higher frequency (seven or more dinners eaten together per week). Based on this finding, possible ways in which family dinners could offer a beneficial effect, alleviating the consequences of food insecurity in adolescents, are discussed. In line with the 2030 Agenda and the Sustainable Development Goal of guaranteeing food security, the promotion of family dinners and their quality, frequency, and duration to leverage the beneficial effect in states of household food insecurity in Spanish adolescents should be taken into account to design actions and public campaigns in Spain.

Living in food insecurity: A qualitative study exploring parents' food parenting practices and their perceptions of the impact of food insecurity on their children's eating

Food insecurity in rich countries is a growing problem with far reaching consequences but how it impacts parents, particularly their food parenting practices, is under researched. Food parenting practices play a critical role in the development of children's eating and may be a mechanism in the link between food insecurity and children's health outcomes; this study aims to illuminate their potential role. Twenty-one parents participated in a qualitative interview study. Their household food security was very low (18/21) or low (3/21). Reflexive Thematic Analysis generated three themes. Challenges of food insecurity: parents shielded children from hunger by eating less themselves, relying on free school meals and turning to family and food banks when in crisis. They perceived a conflict between giving children food of high nutritional quality and its cost. Practical impact of food insecurity: although motivated to provide children with healthy food, finances meant parents struggled to achieve this goal. Parents used a range of food parenting practices but their use of some that are known to be effective may have been compromised by their food insecurity. Emotional impact of food insecurity: parents described feelings of failure, despair, helplessness and shame. Food insecurity adversely effects both children and parents, and non-stigmatising services that mitigate its impact and facilitate children's exposure to food parenting practices known to be effective are needed.

Pediatric produce prescription initiatives in the U.S.: a scoping review

BACKGROUND

To describe pediatric Produce Prescription (PRx) interventions and their study designs, outcomes, and opportunities for future research.

METHODS

A scoping review framework was used to describe PRx interventions published between January 2000 and September 2023. Articles from online databases were uploaded into Covidence. Data on study characteristics, outcomes of interest (health, food insecurity (FI), nutritional and culinary efficacy, and fruit and vegetable (F/V) consumption), and feasibility were extracted. The Mixed Methods Appraisal Tool (MMAT) was used for quality assessment.

RESULTS

19 articles met inclusion criteria. Ten studies were quantitative, five were qualitative, and four used mixed-methods. Interventions included food vouchers (n = 14) or food box/pantries (n = 5). Four studies allowed food items in addition to F/Vs. Six studies measured changes in FI and five reported a statistically significant decrease. Seven studies measured changes in F/V consumption and five reported a statistically significant increase. One study reported a statistically significant reduction in child BMI z-score. Most studies reported high feasibility. Few studies used high-quality methods.

CONCLUSIONS

Pediatric PRx interventions show promising potential to reduce FI and improve diet quality and health-related outcomes. Future studies should utilize rigorous study designs and validated assessment tools to understand the impact of pediatric PRx on health.

IMPACT

This work offers a summary of programmatic outcomes including retention, redemption, incentives, nutrition education, study design and quality limitations to help inform future work. We found positive impacts of pediatric produce prescriptions (PRx) on FI, F/V consumption, and nutritional knowledge and culinary skills. More high-quality, rigorous studies are needed to understand the best delivery and design of PRx and their impact on child behavior and health outcomes. This work provides support for the need for rigorous studies and the potential for PRx to play a role in multi-pronged strategies that address pediatric FI and diet-related disease.

Black Parents' Perceptions and Barriers to Limiting Sugar-Sweetened Beverages Among Young Children: A Social Cognitive Theory Application

Introduction: Sugar-sweetened beverages (SSBs) are a major contributor to obesity among young children 0 to 5 years of age. In addition, parental beverage intake influences children's beverage intake. Objective: This study explores Black parents' perceptions about and barriers to limiting SSBs among young children. Methods: Twenty-seven Black parents participated in six focus groups conducted across the state of Georgia. Questions grounded in Social Cognitive Theory (SCT) assessed perceived health impacts of SSBs and water consumption, influences of beverage choices, barriers to limiting SSB intake, and resources needed to overcome barriers. Before the focus group sessions, participants completed a demographic survey. Quantitative data were analyzed using R statistical software. Focus group sessions were analyzed using NVivo. Results: Family and cultural norms, price, taste, flavor, water safety, tantrums, and product placement at grocery stores primarily influenced beverage choice and consumption. Restaurant refills, price, lack of confidence, advertisements, cravings, tantrums, and budget were perceived barriers to drinking more water and fewer SSBs daily. Resources Black parents noted would help in promoting and serving healthy beverages to their young children included education on beverage recommendations, training on how to read nutrition labels, healthy alternatives, and the presence of support systems. Conclusion: Findings from this study will inform interventions to reduce SSB intake among Black families with young children.

Experiencing food insecurity in childhood: influences on eating habits and body weight in young adulthood

OBJECTIVE

To examine how food insecurity in childhood up to adolescence relates to eating habits and weight status in young adulthood.

DESIGN

A longitudinal study design was used to derive trajectories of household food insecurity from age 4·5 to 13 years. Multivariable linear and logistical regression analyses were performed to model associations between being at high risk of food insecurity from age 4·5 to 13 years and both dietary and weight outcomes at age 22 years.

SETTING

A birth cohort study conducted in the Province of Quebec, Canada.

PARTICIPANTS

In total, 698 young adults participating in the Québec Longitudinal Study of Child Development.

RESULTS

After adjusting for sex, maternal education and immigrant status, household income and type of family, being at high risk (compared with low risk) of food insecurity in childhood up to adolescence was associated with consuming higher quantities of sugar-sweetened beverages (ßadj: 0·64; 95 % CI (0·27, 1·00)), non-whole-grain cereal products (ßadj: 0·32; 95 % CI (0·07, 0·56)) and processed meat (ßadj: 0·14; 95 % CI (0·02, 0·25)), with skipping breakfast (ORadj: 1·97; 95 % CI (1·08, 3·53)), with eating meals prepared out of home (ORadj: 3·38; 95 % CI (1·52, 9·02)), with experiencing food insecurity (ORadj: 3·03; 95 % CI (1·91, 4·76)) and with being obese (ORadj: 2·01; 95 % CI (1·12, 3·64)), once reaching young adulthood.

CONCLUSION

Growing up in families experiencing food insecurity may negatively influence eating habits and weight status later in life. Our findings reinforce the importance of public health policies and programmes tackling poverty and food insecurity, particularly for families with young children.

The association of food insecurity on body mass index change in a pediatric weight management intervention

BACKGROUND

Childhood obesity is a critical public health concern. One potential determinant to obesity that is less understood is food insecurity.

OBJECTIVE

To examine the association of food security status on body mass index (BMI) change in a Pediatric Weight Management Intervention (PWMI) consistent with national treatment recommendations.

METHODS

This analysis included 201 participants from the Healthy Weight Clinic (HWC). Using linear mixed models, we compared BMI and %BMIp95 change per year between the food insecure group and food secure group, adjusting for baseline BMI, age and sex, and SNAP enrolment.

RESULTS

In fully adjusted models, children in households with food insecurity had a 0.50 (0.26-0.74) kg/m2 BMI increase per year and a 2.10 (1.02-3.19) %BMIp95 increase per year compared to households that were food secure.

CONCLUSIONS

When comparing the BMI effect of the HWC between the food insecure group and food secure group, those experiencing food insecurity in the HWC had an increase in BMI compared to those with food security. These findings suggest that food insecurity may reduce the effectiveness of PWMIs consistent with national recommendations; however, more studies should be conducted to better understand this relationship.

The interplay between food insecurity and family factors in relation to disordered eating in adolescence

This study examined the association between food insecurity and both binge eating and unhealthy weight-control behaviors (UWCBs) and assessed whether such associations differ by factors within the family environment. Data were collected from a diverse sample of adolescents (Mage = 14.5 years; 54.1% female) and their parents/guardians (N = 2137 dyads) participating in EAT 2010 (Eating and Activity over Time). Food-insecure adolescents were more likely to report binge eating (prevalence ratio [PR] = 1.94; 95% confidence interval [CI]: 1.41-2.69) and UWCBs (PR = 1.34; 95% CI: 1.21-1.49) than food-secure adolescents. Family meal importance (p = .03) and family communication (p < .001) significantly moderated the association between food insecurity and UWCBs, such that the association was weaker at lower levels of these factors. Significant interactions with parental weight talk/concern (p < .001) and weight teasing (p = .04) indicated a weaker association between food insecurity and UWCBs in the presence of these factors. Findings indicate that the association between food insecurity and UWCBs among youth is less salient in the absence of family protective factors and in the presence of family risk factors for UWCBs, indicating the importance of targeting food insecurity itself, regardless of the presence of family risk or protective factors for UWCBs.

Food insecurity and disordered eating behaviors in children and adolescents: A systematic review

This study is the first systematic review to investigate the relationship between food insecurity (FI) and disordered eating behaviors exclusively in children and adolescents. Database searches were conducted in PUBMED, Embase, PsycINFO, ProQuest, and Gale OneFile: Informe Académico using English and Spanish search terms. Studies were included if they were published before August 2022, included youth aged 18 years and below, included either parent- or child-report of food security status, included either parent- or child-report of child disordered eating behaviors, and examined the relationship between food security status and child disordered eating behaviors. Following independent title/abstract and full-text screening, 20 studies were included in the review. There were 13 cross-sectional studies, five longitudinal studies, and two qualitative studies, from the United States (19 studies), and Bangladesh (1 study). Sample sizes ranged from 33 to 6077. Findings generally indicated a relationship between FI and behaviors such as binge eating, loss-of-control eating, eating in the absence of hunger, unhealthy weight control behaviors, and picky eating in children and adolescents, though this association varied depending on the type of disordered eating behavior assessed and FI severity. Results highlight the importance of screening for disordered eating behaviors among youth with FI towards eating disorder prevention and intervention. However, given the limited number of primary research articles examining this relationship in youth, further hypothesis-driven research is needed. In addition, more global representation and additional longitudinal studies are needed to further examine the generalizability and temporality of FI and disordered eating in children and adolescents.

Child Weight Status: The Role of Feeding Styles and Highly Motivated Eating in Children

Although parental feeding plays an important role in child eating and weight status, high food motivation among children may also be a factor shaping how feeding impacts child weight. This study explored whether individual differences in preschool children’s food motivation interacted with mothers’ feeding styles in predicting subsequent child weight status. Participants included 129 Hispanic Head Start mother/child dyads. Data were collected at ages 4–5 years (Time 1) and 7–9 (Time 3). Staff measured heights/weights and observed children in an eating in the absence of hunger task. Mothers reported on feeding styles/practices and children’s eating behaviors. A principal components analysis derived a measure of highly motivated eating in children. Multiple regressions predicted Time 3 child BMI z-scores. Time 3 BMI z-scores were positively predicted by authoritative and indulgent feeding styles and negatively predicted by monitoring. Since feeding style interacted with highly motivated eating, separate regressions were run for high and low food motivation in children. Unexpectedly, results showed that authoritative feeding positively predicted Time 3 child BMI z-scores only for children showing low levels of food motivation. Characterizing differential parental feeding and child eating phenotypes may assist in tailoring childhood obesity prevention programs for the target populations.

Food Insecurity and Parent Feeding Practices in Urban and Rural Children Ages 7-12 years

Objective

To examine associations between food insecurity and parent feeding practices for children ages 7-12 years; to determine differences between cohorts in urban and rural communities.

Design

Secondary analysis using baseline data from 2 randomized controlled trials: HOME Plus (urban) and NU-HOME (rural).

Participants

Convenience sample of 264 parent-child dyads. Children were 51.5% female, 9.28 ± 1.45 years.

Variables Measured

Dependent variables included the Child Feeding Questionnaire (CFQ) restrictive feeding subscale, parent modeling of fruits and vegetables score, and family meal frequency (FMF) at breakfast and the evening meal. Food insecurity was the primary independent variable.

Analysis

Multivariable linear or Poisson regression for each outcome.

Results

Food insecurity was associated with a 26% lower weekly rate of FMF at breakfast (95% CI 6%-42%; p=0.02). In stratified analysis, this association was only in the rural NU-HOME study (44% lower weekly rate; 95% CI 19%-63%; p=0.003). Food insecurity was not associated with CFQ restrictive score, parent modeling score, or FMF at the evening meal.

Conclusions and Implications

Food insecurity was associated with less frequent family breakfast, but not with other parent feeding practices. Future studies could investigate supportive mechanisms for positive feeding practices in households experiencing food insecurity.

Factors Associated with Eating in the Absence of Hunger among Children and Adolescents: A Systematic Review

Eating in the absence of hunger (EAH) has been extensively studied over the past two decades and has been associated with excess body weight and the development of obesity. However, determinants of EAH remain uncertain. This systematic review aims to identify individual, familial, and environmental factors associated with EAH among children and adolescents. We included studies with a measure of EAH in participants aged 3-17 years old and including ≥1 factor associated with EAH. Our search identified 1494 articles. Of these, we included 81 studies: 53 cross-sectional, 19 longitudinal and nine intervention studies. In childhood (≤12 years old), EAH increases with age, it is greater in boys compared to girls, and it is positively associated with adiposity. Moreover, EAH development seems to be influenced by genetics. In adolescence, the number of studies is limited; yet, studies show that EAH slightly increases or remains stable with age, is not clearly different between sexes, and findings for overweight or obesity are less consistent across studies in adolescence. For familial factors, parental restrictive feeding practices are positively associated with EAH during childhood, mostly for girls. Studies assessing environmental factors are lacking and robust longitudinal studies spanning from early childhood to adolescence are needed.

A mixed-method systematic review and meta-analysis of the influences of food environments and food insecurity on obesity in high-income countries

Obesity remains a serious public health concern in rich countries and the current obesogenic food environments and food insecurity are predictors of this disease. The impact of these variables on rising obesity trends is, however, mixed and inconsistent, due to measurement issues and cross-sectional study designs. To further the work in this area, this review aimed to summarize quantitative and qualitative data on the relationship between these variables, among adults and children across high-income countries. A mixed-method systematic review was conducted using 13 electronic databases, up to August 2021. Two authors independently extracted data and evaluated quality of publications. Random-effects meta-analysis was used to estimate the odds ratio (OR) for the association between food insecurity and obesity. Where statistical pooling for extracted statistics related to food environments was not possible due to heterogeneity, a narrative synthesis was performed. Meta-analysis of 36,113 adults and children showed statistically significant associations between food insecurity and obesity (OR: 1.503, 95% confidence interval: 1.432-1.577, p < .05). Narrative synthesis showed association between different types of food environments and obesity. Findings from qualitative studies regarding a reliance on energy-dense, nutrient-poor foods owing to their affordability and accessibility aligned with findings from quantitative studies. Results from both qualitative and quantitative studies regarding the potential links between increased body weight and participation in food assistance programs such as food banks were supportive of weight gain. To address obesity among individuals experiencing food insecurity, wide-reaching approaches are required, especially among those surrounded by unhealthy food environments which could potentially influence food choice.

Diet Quality and Contextual Factors Influencing Food Choice among Adolescents with Food Security and Food Insecurity in Baltimore City

This study evaluated differences in overall diet quality, diet quality components, and food-related contextual factors between adolescents with food security and those with food insecurity. Mixed methods analysis was conducted on data from three 24-h dietary recalls from 61 adolescents ages 14–19 years old living in Baltimore, Maryland, USA in 2020–2021. All adolescents were sampled from households eligible for the Supplemental Nutrition Assistance Program in 2020. There were no significant differences in overall diet quality or components between adolescents with food security and those with food insecurity in this sample, except for seafood and plant proteins, which was higher for adolescents with food insecurity. Qualitative analysis found that adolescents were largely influenced by their parents and the home food environment, and that workplace environments enabled adolescents to eat foods high in refined grains, sugar, and saturated fat. These findings provide insight about the experiences of low-income adolescents during times when they are home for prolonged periods (i.e., emergency school closures, summer, and winter breaks). Programs and policies that aim to improve healthy food access may positively impact adolescent food security and diet quality, and it is important to ensure that healthy foods are available and accessible to adolescents in the places where they spend the most time. Multilevel interventions in the home, school, and workplace may be most effective in encouraging healthy eating behaviors among adolescents.

Food Security of Temporary Foreign Farm Workers under the Seasonal Agricultural Worker Program in Canada and the United States: A Scoping Review

Temporary foreign farm workers (TFWs) are among the most vulnerable and exploitable groups. Recent research shows alarming rates of food insecurity among them. This review explores research focussing on food security of TFWs in Canada and the United States, summarizes findings, and identifies research gaps. Online databases, including MEDLINE, Web of Science, Scopus, Google Scholar, and government and nongovernment websites, and websites of migrant worker-supporting organizations were searched for peer-reviewed and non-peer-reviewed papers and reports published between 1966 and 2020 regarding food security of TFWs. Articles reviewed were analyzed to determine publication type, country, year, target population, and main findings. Content analysis was performed to identify major themes. Of 291 sources identified, 11 met the inclusion criteria. Most articles (n = 10) were based on studies conducted in the United States. The prevalence of food insecurity among TFWs ranged between 28% and 87%. From the content analysis, we formulated 9 themes, representing a diversity of perspectives, including access to resources, income, housing and related facilities, food access, dietary pattern and healthy food choices, and migrant's legal status. Instruments reported for the measurement of food security include USDA Household Food Security Survey Module (HFSSM; n = 8, 72.7%), the modified version of the USDA HFSSM (n = 1, 9%), hunger measure (n = 1, 9%), the modified CDC's NHANES (n = 1, 9%), and 24-h recall, diet history, and/or food-frequency questionnaire (n = 3, 27.3%). Factors impacting food security of TFWs working under the Seasonal Agricultural Worker Programs (SAWPs) in North America are understudied. There is a need to advance research looking particularly at policies and regulatory and administrative aspects of the SAWPs to improve the food security of this cohort. There is also a need for qualitative studies that explore lived experiences and perspectives of TFWs and key informants. Longitudinal studies may be useful to examine various factors, including policy-related, contributing to food insecurity of TFWs over time.

Relationship Between Food Security Status in a Caregiver's Family of Origin and Current Feeding Practices Among Low-Income, Single, Female Primary Caregivers

A child's familial environment is paramount to the formation and maintenance of their health behaviors. Factors that influence a child's health behaviors include parental modeling, types of available food, timing of food availability, and characteristics of the home environment. Previous research has demonstrated an association between a caregiver's current food security status and feeding practices, but no studies have explored the association between food security in the caregiver's childhood and their current feeding practices. This study investigates the relationship between parental food insecurity (both current and childhood) and child feeding practices. The US Household Food Security Survey and the Child Feeding Questionnaire were completed by 103 low-income, single, female primary caregivers. Results indicated that caregivers who reported current food insecurity expressed greater tendency to pressure their children to eat. Caregivers who reported food insecurity during their childhood also expressed greater tendency to pressure their children to eat and a greater concern about their child's weight. These findings can serve in both research and clinical efforts as an early screening tool to indicate families most in need of accessible resources. Findings also help to highlight the transgenerational nature of food insecurity, including its residual effects on health behaviors.

Chronic experience with unpredictable food availability promotes food reward, overeating, and weight gain in a novel animal model of food insecurity

Ubiquitous, easy access to food is thought to promote obesity in the modern environment. However, people coping with food insecurity have limited, unpredictable food access and are also prone to obesity. Causal factors linking food insecurity and obesity are not understood. In this study we describe an animal model to investigate biopsychological impacts of the chronic unpredictability inherent in food insecurity. Female rats were maintained on a 'secure' schedule of highly predictable 4x/day feedings of uniform size, or an 'insecure' schedule delivering the same total food over time but frequently unpredictable regarding how much, if any, food would arrive at each scheduled feeding. Subgroups of secure and insecure rats were fed ordinary chow or high-fat/high-sugar (HFHS) chow to identify separate and combined effects of insecurity and diet quality. Insecure chow-fed rats, relative to secure chow-fed rats, were hyperactive and consumed more when provided a palatable liquid diet. Insecure HFHS-fed rats additionally had higher progressive ratio breakpoints for sucrose, increased meal size, and subsequently gained more weight during 8 days of ad libitum HFHS access. Insecurity appeared to maintain a heightened attraction to palatable food that habituated in rats with secure HFHS access. In a second experiment, rats fed ordinary chow on the insecure schedule subsequently gained more weight when provided ad libitum chow, showing that prior insecurity per se promoted short-term weight gain in the absence of HFHS food. We propose this to be a potentially useful animal model for mechanistic research on biopsychological impacts of insecurity, demonstrating that chronic food uncertainty is a factor promoting obesity.

Nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity: An Obesity Medical Association (OMA) Clinical Practice Statement 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details nutritional and activity recommendations for the child with normal weight, overweight, and obesity (Appendix A) with consideration of food insecurity. This CPS is intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices in the normal range and body mass indices greater than or equal to the 85th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA.

Methods

The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors.

Results

This OMA Clinical Practice Statement details nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity. In addition, this CPS addresses nutritional recommendations for complications related to the disease of obesity as well as providing guidance on food insecurity as it impacts children with obesity and their families.

Conclusions

This OMA Clinical Practice Statement on nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity is an overview of current recommendations. These recommendations provide a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.

Food insecurity, housing instability, and dietary quality among children with sickle cell disease: Assessment from a single urban center

BACKGROUND

Food insecurity and housing instability, both social determinants of health (SDoH), disproportionately affect economically unstable, under-resourced US communities in which children with sickle cell disease (SCD) live. Association between these SDoH markers and dietary quality among children with SCD is unknown.

PROCEDURES

We assessed a cross-sectional sample of dyadic parent-child patients and young adult patients up to age 21 from one pediatric SCD center. Food insecurity, housing instability, and dietary quality were measured using validated US instruments and a food frequency questionnaire. Better dietary quality was defined using US dietary guidelines. Multivariate regression assessed for associations among dietary quality and food insecurity with or without (±) housing instability and housing instability alone.

RESULTS

Of 100 enrolled participants, 53% were Black and 43% Hispanic; mean age 10.6 ± 5.6 years. Overall, 70% reported less than or equal to one economic instability: 40% housing instability alone and 30% both food insecurity and housing instability. Eighty percent received more than or equal to one federal food assistance benefit. Compared to no economic instability, food insecurity ± housing instability was significantly associated with higher intake of higher dairy and pizza, while housing instability alone was significantly associated with higher dairy intake. Food insecurity ± housing instability was significantly associated with lower intake of whole grains compared to housing instability alone.

CONCLUSIONS

Our sample reported high frequencies of both food insecurity and housing instability; having more than or equal to one SDoH was associated with elements of poorer diet quality. Screening families of children with SCD for food insecurity and housing instability may identify those with potential nutrition-related social needs.

Validation of a Classroom Version of the Eating in the Absence of Hunger Paradigm in Preschoolers

Eating in the absence of hunger (EAH), a measure of children's propensity to eat beyond satiety in the presence of highly palatable food, has been associated with childhood obesity and later binge eating behavior. The EAH task is typically conducted in a research laboratory setting, which is resource intensive and lacks ecological validity. Assessing EAH in a group classroom setting is feasible and may be a more efficient alternative, but the validity of the classroom assessment against the traditional individually-administered paradigm has not been tested. The objective of this study was to compare EAH measured in a classroom setting to the one-on-one version of the paradigm in a sample of Head Start preschoolers. Children (n = 35) from three classrooms completed both classroom and individual EAH tasks in a random, counterbalanced order. In the group condition, children sat with peers at their classroom lunch tables; in the individual condition, children met individually with a researcher in a separate area near their classroom. In both conditions, following a meal, children were provided free access to generous portions of six snack foods (~750 kcal) and a selection of toys for 7 min. Snacks were pre- and post-weighed to calculate intake. Parents completed a survey of their child's eating behaviors, and child height and weight were measured. Paired t-tests and intraclass correlation coefficients were used to compare energy intake between conditions, and correlations between EAH intake and child BMI, eating behaviors, and parent feeding practices were examined to evaluate concurrent validity. Average intake was 63.0 ± 50.4 kcal in the classroom setting and 53.7 ± 44.6 in the individual setting, with no significant difference between settings. The intraclass correlation coefficient was 0.57, indicating moderate agreement between conditions. Overall, the EAH protocol appears to perform similarly in classroom and individual settings, suggesting the classroom protocol is a valid alternative. Future studies should further examine the role of age, sex, and weight status on eating behavior measurement paradigms.

Food insecurity is associated with higher food responsiveness in low-income children: The moderating role of parent stress and family functioning

BACKGROUND

Food insecurity (FI) may increase the odds for childhood obesity, yet little is known about the mechanism explaining this relationship. Parents experience greater psychosocial stress in the context of FI. In these environments, children from FI households may exhibit different appetitive behaviours.

OBJECTIVES

To examine associations between FI and appetitive behaviours in children (3-5 years) and to explore whether social, emotional and structural properties of the home environment moderate this relationship.

METHODS

In a low-income sample of 504 parent-child dyads, parents completed the household food security module and the Children's Eating Behavior Questionnaire. A subsample (n = 361) self-reported perceived stress, depressive symptoms, household chaos and family functioning. Children were categorized as food secure, household FI and child FI.

RESULTS

Food responsiveness (LSmeans ± SE; child FI: 2.56 ± 0.13; food secure: 2.31 ± 0.10, p < 0.05) and emotional overeating (LSmeans ± SE; child FI: 1.69 ± 0.10; food secure: 1.48 ± 0.08, p < 0.05) were higher among children in the child FI group compared to the food secure group. Child FI was only associated with higher food responsiveness among children of parents reporting high levels of perceived stress (p = 0.04) and low levels of family functioning (p = 0.01). There were no differences in food responsiveness by food security status at mean or low levels of perceived stress or at mean or high levels of family functioning (p > 0.05).

CONCLUSIONS

Child FI may contribute to obesity risk through differences in appetitive behaviours. For low-income families, stress management and improving family dynamics may be important factors for interventions designed to improve children's appetitive behaviours.

Household Food Security and Associated Factors among Portuguese Children

This study investigated the household food insecurity (HFI) among Portuguese children following the last world financial crisis. A cross-sectional study was conducted on 4737 Portuguese children (3-11 yrs). Socio-demographics, food insecurity, and household geographic location were assessed via questionnaire. Nutritional status was measured. Following the economic crisis, 14.2% of school children and 12.0% of preschool children experienced HFI. Preschool children having parents with low and medium parental education (paternal: OR = 4.4; 95% CI 2.7-7.1 and OR = 2.4; 95% CI 1.5-3.6; maternal: OR = 2.2; 95% CI 1.4-3.5 and OR = 1.6; 95% CI 1.1-2.3), living in the south (OR = 1.4; 95% CI 1.0-2.0) and being overweight/obese (OR = 1.1; 95% CI 0.7-1.3) were more likely to experience HFI than food secure household peers. Higher OR of belonging to a food insecure household were observed in school-aged children with low and medium parental education (paternal: OR = 2.9; 95% CI 1.9-4.6 and OR = 1.7; 95% CI 1.1-2.5; maternal: OR = 2.5; 95% CI 1.6-3.9 and OR = 2.3; 95% CI 1.6-3.3), living in Coimbra (OR = 1.7; 95% CI 1.1-2.6) and being overweight/obese (OR = 1.3; 95% CI 0.8-1.5) compared to food secure household peers. Data are instructive and support the need to increase awareness of HFI, reduce its incidence in overweight/obese children from low socio-economic status families and specific geographic areas, and increase food availability based on local ecology.

Pre-pandemic to early-pandemic changes in risk of household food insecurity among Maryland families with children

OBJECTIVE

The objective was to examine risk and protective factors associated with pre- to early-pandemic changes in risk of household food insecurity (FI).

DESIGN

We re-enrolled families from two statewide studies (2017-2020) in an observational cohort (May-August 2020). Caregivers reported on risk of household FI, demographics, pandemic-related hardships, and participation in safety net programs (e.g. CARES stimulus payment, school meals).

SETTING

Maryland, United States.

PARTICIPANTS

Economically, geographically, and racially/ethnically diverse families with preschool to adolescent-age children. Eligibility included reported receipt or expected receipt of the CARES stimulus payment or a pandemic-related economic hardship (n=496).

RESULTS

Prevalence of risk of FI was unchanged (pre-pandemic: 22%, early-pandemic: 25%, p=0.27). Risk of early-pandemic FI was elevated for non-Hispanic Black (aRR=2.1 [95% CI 1.1, 4.0]) and Other families (aRR=2.6 [1.3, 5.4]) and families earning ≤300% federal poverty level. Among pre-pandemic food secure families, decreased income, job loss, and reduced hours were associated with increased early-pandemic FI risk (aRR=2.1 [1.2, 3.6] to 2.5 [1.5, 4.1]); CARES stimulus payment (aRR=0.5 [0.3, 0.9]) and continued school meal participation (aRR=0.2 [0.1, 0.9]) were associated with decreased risk. Among families at risk of FI pre-pandemic, safety net program participation was not associated with early-pandemic FI risk.

CONCLUSIONS

The CARES stimulus payment and continued school meal participation protected pre-pandemic food secure families from early-pandemic FI risk but did not protect families who were at risk of FI pre-pandemic. Mitigating pre-pandemic FI risk and providing stimulus payments and school meals may support children's health and reduce disparities in response to pandemics.

Maternal perceptions and concerns about children's weight status and diet quality: a study among Black immigrant families

OBJECTIVE

To identify factors influencing Black immigrant mothers' perceptions and concerns about child weight and to compare children's diet quality according to these perceptions and concerns.

DESIGN

Mothers' perceptions and concerns about child weight were assessed with sex-specific figure rating scales and the Child Feeding Questionnaire, respectively. Participants' weights and heights were measured and characterised using WHO references. Children's dietary intakes were estimated using a 24-h dietary recall. Children's diet quality was evaluated using the relative proportion of their energy intake provided by ultra-processed products, which were identified with the NOVA classification. χ2 tests, multivariate logistic regressions and t tests were performed.

SETTING

Ottawa, Ontario, Canada.

PARTICIPANTS

Black immigrant mothers of Sub-Saharan African and Caribbean origin (n 186) and their 6-12-year-old children.

RESULTS

Among mothers, 32·4 % perceived their child as having overweight while 48·4 % expressed concerns about child weight. Girls and children with overweight or obesity were significantly more likely to be perceived as having overweight by their mothers than boys and normal-weight children, respectively. Mothers of children living with obesity, but not overweight, were significantly more likely to be concerned about their child's weight than mothers of normal-weight children. Children's diet quality did not differ according to mothers' perceptions and concerns.

CONCLUSIONS

Children's gender and weight status were major determinants of perceptions and concerns about child weight among Black immigrant mothers. Including knowledge about mothers' perceptions and concerns about child weight will help nutrition professionals develop interventions tailored to specific family needs within the context of their cultural backgrounds.

Hungry is not safe: A mixed methods study to explore food insecurity in early care and education

The early care and education (ECE) environment has the potential to affect both children and their families. Food insecurity in ECE and its management may be an important influence. Objectives of this mixed methods study were to (1) elicit prominent themes relating to teacher experiences with food insecurity (in the classroom) through qualitative interviews; (2) translate interview themes into survey items and analyze survey data to explore generalizability of the qualitative findings; and (3) provide preliminary data on properties of a new tool to study the influence of food insecurity in the ECE setting. An exploratory sequential mixed methods design (QUAL → quant) was used. Twenty-eight interviews about teacher experiences with food insecurity were followed by 781 surveys to assess generalizability of interview findings. Qualitative themes highlighted that ECE teachers are concerned about children's food insecurity in their classroom; ECE teachers have developed their own set of strategies to manage their concern; and teachers often struggle with what to do. Quantitative results demonstrated many teachers had the same concerns and used the strategies described in the interviews. Further, in exploratory analyses, ECE teachers with Food Insecurity scored significantly higher on all scales (e.g., Food Insecurity Concerns, Struggle with Addressing Food Security) in both adjusted and unadjusted analyses. ECE teachers with Food Acquisition Stress had higher scores on Strategies to Address Food Insecurity with Families in adjusted analyses.

Associations between food provision and feeding practices in socially disadvantaged childcare centres

Preschool children consume a large proportion of their daily food intake in their childcare settings. These settings, therefore, provide important opportunities for children to experience food socialisation, and related positive nutrition. Yet, the extent to which these opportunities are taken, particularly in socioeconomically disadvantaged areas where risk of poor nutrition is high, is not well documented. This study focused on 10 childcare centres in socially disadvantaged locations and examined daily feeding practices via direct in-situ observation (n = 189 children observed). Centres were randomly selected based on type of food provision: centre-provided (n = 5 centres) or family-provided (n = 5 centres). Analyses showed that where food was family-provided, educators were significantly more likely to use controlling feeding practices, including pressuring children to eat, restricting food choices and rushing children into finishing meals. These practices were particularly evident during mid-morning meals, where pressuring children to eat healthy foods first, was more often observed. Further research and interventions that target feeding practices in childcare are indicated and should consider how source of food provision impacts upon these practices.

Self-regulatory processes in early childhood as predictors of Hispanic children's BMI z-scores during the elementary school years: Differences by acculturation and gender

Over the last decade, longitudinal research has shown that children's general, top-down self-regulation during early childhood is negatively associated with children's weight status in elementary school. The samples in these previous studies have been primarily White, and no study to date has examined this issue in a sample of Hispanic children from low-income families-a population at high risk for childhood obesity. The present study followed 130 Hispanic children over a time period of three to just under five years, examining the degree to which multiple measures of general, top-down self-regulation, along with a measure of appetite regulation (eating in the absence of hunger), predicted children's BMI z-scores in the early elementary school years. Results showed that children's ability to delay gratification in the preschool years was negatively associated with later BMI z-scores and that children's eating in the absence of hunger was positively associated. In separate models by gender, these relationships were significant only for girls. Moreover, analyses run separately for children of mothers low or high on acculturation showed that the relationship between delay of gratification and later BMI z-scores was significant only for children whose mothers were low on acculturation. Possible socialization and environmental factors contributing to these findings are considered.

A lifespan perspective of structural and perceived social relationships, food insecurity, and dietary behaviors during the COVID-19 pandemic

Physical distancing and economic impacts of the COVID-19 pandemic may influence dietary behaviors. Using a parallel mixed method design, we examined the relationships between structural and perceived social relationships on dietary behaviors across the adult lifespan and by food security status. A representative sample of 360 adults (18-78 years old) living in the United States were recruited through Prolific Academic to complete an online cross-sectional survey. Participants provided data about demographics, food insecurity, structural and perceived social relationships, diet quality, and unhealthy snacking at the onset of the pandemic. Participants responded to open-ended questions about perceived changes in social connections and dietary behavior since COVID-19. Quantitative findings indicated food insecure emerging and older adults were at highest risk for low diet quality and frequent unhealthy snacking. Friend support was associated with higher diet quality. Qualitative findings suggested overall decreases in social connection and changes in dietary behavior, with food insecure adults describing decreases in diet quality. Participants who reported increases in emotional eating also reported decreases in social connection. Findings suggest the pandemic may exacerbate inequalities, particularly among food insecure emerging and older adults. Scaling up preventive interventions to increase social connection and reduce food insecurity during unprecedented challenges may promote healthier dietary behaviors now and in the long-term.

Factors associated with feeding practices of black immigrant mothers of African and Caribbean origin living in Ottawa, Canada

In Canada, Black immigrant women and their children are at higher risk of developing obesity. Factors that could influence children's weight status include parental feeding practices. Feeding practices such as monitoring, restriction and pressure to eat, are well studied among non-Hispanic White and Latinos groups, however, little is known about the feeding practices of Black immigrant parents of African and Caribbean origin. The aim of this study was to identify factors associated with feeding practices of Black immigrant mothers in Ottawa, Canada. The sample includes 188 Black mothers of African and Caribbean origin and their 6-12-year-old children. The Child Feeding Questionnaire was used to assess mothers' feeding practices. Demographic and socioeconomic data were collected using questionnaires. All participants' weight status was determined from measured weight and height. Pearson Chi-square tests and multivariate logistic regressions were performed. Results showed that mothers who felt responsible for feeding their children were more likely to monitor their children's food intake (p < 0.05). While mothers of children with underweight or normal weight were more like to use pressure to eat (p < 0.01), mothers of children with overweight or obesity were more like to use restriction (P < 0.05). Recent immigrant mothers were also more likely to use pressure to eat (P < 0.05). This study also provides evidence for associations between maternal feeding practices and mothers' weight status, household income and food security status. Findings build on previous research suggesting that parental feeding practices vary based on parents' and children's characteristics. Longitudinal studies are needed to assess the directionality of the association between mothers' feeding practices, and children's weight, diet quality and health in this population.

The association of household and child food insecurity with overweight/obesity in children and adolescents in an urban setting of Ethiopia

BACKGROUND

Existing evidence on the association between food insecurity and childhood obesity is mixed. In addition, literature from developing countries in general and Ethiopia in particular on the nexus and impact of household and child food insecurity on childhood obesity in the context of urbanization remains limited. The objective of this study was to explore the association between household and child food insecurity and childhood obesity in an urban setting of Ethiopia.

METHODS

An observational population based cross-sectional study was conducted in five sub-cities of Addis Ababa. Multi-stage sampling techniques were employed to identify the study unit from the selected sub-cities. Multivariable logistic regression models with robust estimation of standard errors were utilized to determine the associations. Interactions by age and sex in the associations explored were tested.

RESULTS

A total of 632 children and adolescents-parent dyads were included in the study. About 29.4% of those in food secure households and 25% of those in food insecure households were overweight/obese. Similarly, 29.8% of food secure children and 22% of food insecure children were overweight/obese. Household and child food insecurity status were not significantly associated with child and adolescent overweight or obesity in the final adjusted models.

CONCLUSIONS

Household and childhood food insecurity status were not associated with child and adolescent overweight/obesity in the study setting. Interventions aimed at combating overweight and obesity in the study setting should target children and adolescents irrespective of their food security status.

Household food insecurity and children's physical activity and sedentary behaviour in the United States: the Healthy Communities Study

Objective:

To examine associations between household food insecurity and children’s physical activity and sedentary behaviours.

Design:

Secondary analysis was conducted on the Healthy Communities Study, an observational study from 2013 to 2015. Household food insecurity was assessed by two items from the US Department of Agriculture’s 18-item US Household Food Security Survey Module. Physical activity was measured using the 7-d Physical Activity Behaviour Recall instrument. Data were analysed using multilevel statistical modelling.

Setting:

A total of 130 communities in the USA.

Participants:

In sum, 5138 US children aged 4–15 years.

Results:

No associations were found for the relationship between household food insecurity and child physical activity. A significant interaction between household food insecurity and child sex for sedentary behaviours was observed (P = 0·03).

Conclusions:

Additional research capturing a more detailed assessment of children’s experiences of food insecurity in relation to physical activity is warranted. Future studies may consider adopting qualitative study designs or utilising food insecurity measures that specifically target child-level food insecurity. Subsequent research may also seek to further explore sub-group analyses by sex.

Effects of Parenting and Perceived Stress on BMI in African American Adolescents

OBJECTIVE

This study set out to examine the role of parenting practices in protecting or exacerbating the negative effects of parent and adolescent stress on adolescent body mass index (BMI) over time. Separate longitudinal models were conducted to evaluate how parenting practices interacted with parental perceived stress and adolescent perceived stress in predicting adolescent BMI.

METHODS

Baseline data were collected from 148 African American adolescents (Mage = 12.93, SD = 1.75; Mz-BMI = 0.78, SD = 0.50; MBMI%-ile = 96.7, SD = 3.90) and their caregivers (Mage = 44.45, SD = 8.65; MBMI = 37.63, SD = 8.21) enrolled in the Families Improving Together for Weight Loss trial. Adolescents self-reported their perceptions of caregiver parenting style and feeding practices. Both caregivers and adolescents self-reported their perceptions of chronic stress. BMI for parents and adolescents was assessed objectively at baseline and 16 weeks post-intervention.

RESULTS

Hierarchical regression models predicting adolescent BMI z-score (z-BMI) indicated a significant interaction between parental perceived stress and parental pressure to eat. Simple slopes analyses demonstrated that for those parents that exhibit higher pressure to eat, parent stress was positively associated with adolescent z-BMI.

CONCLUSIONS

These findings provide preliminary support suggesting that certain parenting practices interact with chronic stress on adolescent weight-related outcomes and that future interventions may consider integrating these factors.

Children's eating behaviour traits and dental caries

OBJECTIVES

This cross-sectional study aimed to assess eating behavior traits in children with or without dental caries.

METHODS

A sample of 580 children aged 8 years enrolled in 20 public schools in the city of Pelotas, Brazil were included. Parents/caregivers provided sociodemographic information and answered the Children's Eating Behavior Questionnaire (CEBQ) to assess eating behavior traits. This instrument possesses the subscales: food responsiveness, enjoyment of food, satiety responsiveness, slowness in eating, food fussiness, emotional overeating, emotional undereating, and desire to drink. To assess the presence of decayed, missing or filled teeth (DMFT/dmft), the World Health Organization (WHO) criteria were adopted. WHO criteria were used to evaluate presence of overweight and obesity. Analysis of variance (ANOVA) was used to compare the mean score in each CEBQ subscale according to the different exposure variables. Linear regression was used to assess the association between dental caries and CEBQ subscales means.

RESULTS

Approximately half of the children were male (51.03 percent) and 66.73 percent had low/middle socioeconomic status. The mean DMFT/dmft was 2.41, ranging from 0 to 13, and 63 percent of the children showed DMFT/dmft > 0. After adjustments for potential confounders, children with dental caries showed higher scores on the subscales desire to drink (P = 0.03), and satiety responsiveness (P = 0.04).

CONCLUSION

The present study showed that some aspects of eating behaviors differ in children with or without caries. Such knowledge adds to the understanding of the multifactorial etiology of caries and may help in the development of nutritional interventions to promote healthy eating behaviors, with benefits for oral health.

Pediatric Adapted Liking Survey (PALS) with Tailored Nutrition Education Messages: Application to a Middle School Setting

We tested the feasibility of a school-based, liking-based behavioral screener (Pediatric Adapted Liking Survey (PALS)) and message program to motivate healthy diet and activity behaviors. Students, recruited from middle- (n = 195) or low-income (n = 310) schools, online-reported: likes/dislikes of foods/beverages and physical/sedentary activities, scored into healthy behavior indexes (HBI); perceived food insecurity; and sleep indicators. Students received tailored motivating or reinforcing messages (aligned with behavior change theories) and indicated their willingness to improve target behaviors as well as program feasibility (acceptability; usefulness). Although HBIs averaged lower in the lower versus middle-income school, frequencies of food insecurity were similar (39-44% of students). Students in both schools reported sleep concerns (middle-income school-43% reported insufficient hours of sleep/night; low-income school-55% reported excessive daytime sleepiness). Students across both schools confirmed the PALS acceptability (>85% agreement to answering questions quickly and completion without help) and usefulness (≥73% agreed PALS got them thinking about their behaviors) as well as the tailored message acceptability (≥73% reported the messages as helpful; learning new information; wanting to receive more messages) and usefulness (73% reported "liking" to try one behavioral improvement). Neither message type nor response varied significantly by food insecurity or sleep measures. Thus, this program feasibly delivered students acceptable and useful messages to motivate healthier behaviors and identified areas for school-wide health promotion.

Folate and Cobalamin Serum Levels in Healthy Children and Adolescents and Their Association with Age, Sex, BMI and Socioeconomic Status

This study proposes age- and sex-specific percentiles for serum cobalamin and folate, and analyzes the effects of sex, age, body mass index (BMI), and socioeconomic status (SES) on cobalamin and folate concentrations in healthy children and adolescents. In total, 4478 serum samples provided by healthy participants (2 months-18.0 years) in the LIFE (Leipzig Research Centre for Civilization Diseases) Child population-based cohort study between 2011 and 2015 were analyzed by electrochemiluminescence immunoassay (ECLIA). Continuous age-and sex-related percentiles (2.5th, 10th, 50th, 90th, 97.5th) were estimated, applying Cole's LMS method. In both sexes, folate concentrations decreased continuously with age, whereas cobalamin concentration peaked between three and seven years of age and declined thereafter. Female sex was associated with higher concentrations of both vitamins in 13- to 18-year-olds and with higher folate levels in one- to five-year-olds. BMI was inversely correlated with concentrations of both vitamins, whilst SES positively affected folate but not cobalamin concentrations. To conclude, in the assessment of cobalamin and folate status, the age- and sex-dependent dynamic of the respective serum concentrations must be considered. While BMI is a determinant of both vitamin concentrations, SES is only associated with folate concentrations.

Parent Feeding Practices in the Context of Food Insecurity

The process of feeding is complex and highly dependent on parent, child, social, and environmental factors. Given the rising rates of food insecurity and concomitant poor nutrition and health, the purpose of this article was to outline the important and complex ways in which the context of food insecurity can impact parent feeding practices. Key factors discussed here include the impact of food insecurity on: expectations for motherhood, structural constraints, stress and depression, parents’ perceptions of health and child weight, and intergenerational transmission of parent feeding practices. Future research needs are also identified and discussed.

Food insecurity is associated with increased weight loss attempts in children and adolescents

Household food insecurity (HFI) has been associated with adverse childhood outcomes and shares many common risk factors with obesity. Half of adolescents with overweight or obesity are actively attempting to lose weight. We aim to evaluate whether HFI is associated with weight loss attempts and unhealthy weight loss control practices in children. We examined cross-sectional data of children ages 8 to 15 years old from the National Health and Nutrition Examination Survey. Attempted weight loss was more common among children with very low food security (OR 1.50, 95% CI 1.09, 2.07). Children with a healthy weight with very low food security had increased odds of attempting weight loss (OR 1.51, 95% CI 1.00, 2.26) but there was no association in children with overweight or obesity. Very low food security was also associated with unhealthy weight control practices (OR: 1.42, 95% CI: 1.04, 1.93). Physicians should counsel all children and adolescents on healthy and unhealthy weight loss behaviours, regardless of weight or food security status.

Food Insecurity, the Home Food Environment, and Parent Feeding Practices in the Era of COVID-19

OBJECTIVE

This study aimed to describe changes in families' home food environment and parent feeding practices, from before to during the coronavirus disease 2019 (COVID-19) pandemic, and examine whether changes differed by food security status.

METHODS

Parents (N = 584) in the US completed a single online survey, reporting on food security, home food availability, and feeding practices both retrospectively (considering before COVID-19) and currently (during COVID-19). χ² and univariate regressions examined associations by food security status.

RESULTS

The percent of families reporting very low food security increased by 20% from before to during COVID-19 (P < 0.01). About one-third of families increased the amount of high-calorie snack foods, desserts/sweets, and fresh foods in their home; 47% increased nonperishable processed foods. Concern about child overweight increased during COVID-19, with a greater increase for food-insecure versus food-secure parents (P < 0.01). Use of restriction, pressure to eat, and monitoring increased, with a greater increase in pressure to eat for parents with food insecurity compared with food-secure parents (P < 0.05).

CONCLUSIONS

During COVID-19, increases in very low food security and changes in the home food environment and parent feeding practices were observed. Results highlight the need to address negative impacts of COVID-19 on children's obesity risk, particularly among those facing health disparities.

Prevalence, socio-economic predictors and health correlates of food insecurity among Italian children- findings from a cross-sectional study

Considering food insecurity is a problem, even in developed countries, and the evidence gap regarding this issue in Italy, we aimed to assess the prevalence of food insecurity in a sample of Italian children and examine socio-economic and health correlates. This cross-sectional study was conducted in paediatric practices. Parents answered to the 18-items of the Household Food Security Module, 8 of which concern children. Paediatricians answered a questionnaire on children’s health. Socio-economic and health correlates of food insecurity in children were assessed using univariable and multivariable logistic regression. Among 573 households with children, 15·4% were food insecure, while 9·1% of children were food insecure. Socio-economic factors associated to food insecurity were living in south Italy, households with three or more children, lower household yearly income, worse economic situation description and younger parents. Food insecure children were less likely to have a normal relational [ aOR 0.31 (CI 0.11-0.85)] and physical development [aOR 0.32(CI 0.15-0.65) and had more school difficulties [aOR 3.1(CI 1.33-7.24)] compared to their food secure peers. Food insecure children had higher odds of a deterioration in their health since birth and of a worse perceived health status, as reported by their parents. Considering the results in this sample and the lack of research regarding this issues in Italy and Europe more broadly, we call for consistent, national monitoring to determine the magnitude of the problem of food insecurity in households with children in Italy and to examine the socio-economic variables and health implications in different contexts.

Parenting and social-ecological correlates with children's health behaviours: A latent profile analysis

BACKGROUND

Paediatric obesity poses dangers to children's short and long-term health. Multi-level ecological models posit how children's health behaviours are influenced by interpersonal relationships.

OBJECTIVES

To identify profiles of individual and interpersonal health behaviours and parenting skills among caregivers and their children with elevated BMI.

METHODS

Participants were 240 children (63.7% Latino) ages 5 to 12 years with body mass index ≥85th percentile and their caregivers in a paediatric weight management intervention trial. A latent profile analysis was used to identify profiles among caregiver report of parenting skills; child physical activity, eating behaviours, and food and beverage choices; family mealtime, media and sleep routines; and parent health behaviours, and associations with food and housing insecurity.

RESULTS

A three-class model was chosen based on conceptual interpretation and model fit. Profiles were differentiated by parenting skills, child food choices, child physical activity habits, family mealtime, media, and sleep routines, and parent health behaviours. Food and housing insecurity were associated with class membership while child and caregiver anthropometrics were not.

CONCLUSIONS

Distinct profiles existed among this low-income, racially/ethnically diverse sample of children with elevated BMI. Such findings emphasize the importance of assessing individual and interpersonal influences and contextual factors on childhood obesity.

Relationship Between Household Food Insecurity and Growth Disorders in Children Aged 3 to 6 in Qazvin City, Iran

PURPOSE

Food insecurity, which is the inability to obtain food or inadequate food consumption in terms of quality and quantity, has physical and psychological consequences on children's health. This study aimed to investigate the relationship between children's growth disorders and food insecurity in Qazvin city, Iran.

METHODS

A case-control study was conducted on 177 cases and 355 controls of children aged 3 to 6 years, who were referred to health centers in Qazvin city. The case group consisted of children with growth disorders. Data were obtained with the 18-item US Department of Agriculture questionnaire, a household socioeconomic questionnaire, a and growth monitoring card. The data were analyzed with using IBM SPSS Version 22.0, by independent sample t-test, chi-square test, and logistic regression.

RESULTS

A significant relationship was found between children's growth disorders and household food insecurity with (p<0.05, odds ratio [OR]=17.0, confidence interval [CI]=5.9, 48.8) and without hunger (p<0.05, OR=2.69, CI=1.4, 4.9). There were also significant relationships between children's growth disorders and socioeconomic status (p<0.05, OR=3.4, CI=1.4, 8.5), the duration of breastfeeding (p<0.05, OR=0.94, CI=0.9, 0.98), and children's ages (p<0.05, OR=0.94, CI=0.92, 0.96). Sex and birth order, and the age of the parents was not found to be significantly related with growth disorders.

CONCLUSION

Lower socioeconomic status and household food insecurity were the important predictors of children's growth disorders. Policymakers should focus more on promoting steady employment and income among family members. Nutritional education for mothers is also recommended, in order to better meet the nutritional needs of the children.