Children's very low food security is associated with increased dietary intakes in energy, fat, and added sugar among Mexican-origin children (6-11 y) in Texas border Colonias

Self-Reported Food Security in Adolescents with Type 1 Diabetes: Association with Hemoglobin A1c and Mental Health Symptoms Independent of Household Food Security

BACKGROUND

Typically, child exposure to food insecurity is assessed by caregiver reports of household food security. Child report has the potential for greater accuracy because it pertains only to the child whose experiences may differ from caregiver reports.

OBJECTIVE

We assessed if adolescent-reported food insecurity was associated with levels of hemoglobin A1c (HbA1c), acute diabetes-related complications, depressive symptoms, and disordered eating behaviors in adolescents with type 1 diabetes, independently from household food security.

METHODS

In a cross-sectional analysis of the multicenter SEARCH for Diabetes in Youth Cohort Study (phase 4, 2016-2019) including 601 adolescents aged 10-17 y with type 1 diabetes and their caregivers, household food security, and adolescent-reported food security were assessed using the 18-item Household Food Security Survey Module and the 6-item Child Food Security Assessment questionnaire. Age-stratified (10-13 and 14-17) regression models were performed to estimate independent associations, adjusting for sociodemographics, clinical factors, and household food security.

RESULTS

Food insecurity was reported by 13.1% (n = 79) of adolescents and 15.6% (n = 94) of caregivers. Among adolescent-caregiver dyads, 82.5% (n = 496) of reports were concordant and 17.5% (n = 105) discordant, Cohen's κ= 0.3. Adolescent-reported food insecurity was not independently associated with HbA1c, diabetic ketoacidosis, and severe hypoglycemia, including in age-stratified analyses. Adolescent-reported food insecurity was independently associated with elevated odds of depressive symptoms [odds ratio (OR): 3.6; 95% confidence interval (CI): 1.3, 10.3] and disordered eating behaviors (OR: 2.5, 95% CI: 1.4, 4.6) compared with adolescents reporting food security; these associations remained in both age groups for disordered eating behaviors and in the older group for depressive symptoms.

CONCLUSIONS

Adolescents with type 1 diabetes may experience food insecurity differently than caregivers. Adolescent-reported food insecurity was independently associated with depressive symptoms and disordered eating behaviors and thus may be an important attribute to assess in addition to household food security in adolescents with type 1 diabetes.

Bridging Bone Health: Osteoporosis Disparities in the Rio Grande Valley

INTRODUCTION

Osteoporosis is characterized by decreased bone mass and decreased bone quality, leading to increased bone fragility and risk of fractures. The number of fractures due to osteoporosis is projected to increase to over three million by the year 2025 and cost $25.3 billion annually. It ranks highly among diseases that cause patients to become bedridden with serious complications and reduced quality of life. Additionally, osteoporosis disproportionately affects Hispanics, which comprise most of the Rio Grande Valley (RGV) population. Therefore, our primary objective was to determine the prevalence of osteoporosis within the RGV. Additionally, we had secondary objectives to determine the screening rates of osteoporosis in the RGV and identify other potential risk factors associated with osteoporosis. We hypothesize that individuals residing in the RGV have higher rates of osteoporosis and lower rates of osteoporosis screening than the national average.

METHODS

This retrospective observational cross-sectional study utilized Medicare beneficiary data via the "Mapping Medicare Disparities by Population" interactive tool. Osteoporosis data were compared within the RGV (comprising Starr, Hidalgo, Cameron, and Willacy counties) and compared with national averages between the years 2016 and 2021. Statistical analysis included prevalence ratios with 95% confidence intervals and chi-square values when applicable.

RESULTS

Among Medicare beneficiaries residing in the RGV, there are higher rates of osteoporosis compared to the national average (11.5% vs. 7.20%; p < .00001). Screening for osteoporosis within the RGV is above the national average (9.29% vs. 6.67%, p < .00001). Hispanics residing in the RGV have higher overall rates of osteoporosis than Caucasians residing in the RGV (12.3% vs. 8.60%, p < .00001). Females residing in the RGV have nearly twice the rate of osteoporosis compared to the national average (19.1% vs. 11.8%, p < .00001) and 6.58 times the rate of males residing in the RGV (19.1% vs. 2.9%, p < .00001).

CONCLUSION

Individuals residing in the RGV are disproportionately affected by osteoporosis. Despite increased screening rates seen among Medicare beneficiaries, we also suspect many individuals, uninsured or undocumented, have not received any appropriate osteoporosis screening. Risk factors in the RGV associated with higher rates of osteoporosis could include low education levels, socioeconomic status, physical activity, and mineral intake. These results demonstrate a need to address osteoporosis health literacy, promote earlier interventions to treat osteoporosis and increase healthcare accessibility in the RGV.

Nutrition Effects of a Family-Centered Health Promotion Program for Mexican-Heritage Children in the Lower Rio Grande Valley of Texas

Systemic and social factors, like poverty and food insecurity, negatively influence fruit and vegetable (FV) intake and body mass index (BMI) among Latino/a children. Behavioral programs are needed to support children’s nutrition. This study examined program effects on FV intake and BMI outcomes for Mexican-heritage children (9–11 years). The program used a modified stepped-wedge design in the Lower Rio Grande Valley of Texas (2019 and 2020). Promotoras led experiential nutrition education sessions and collected height, weight, and instant skin carotenoid scores (biomarker for FV intake) at pre-test (baseline), post-test (6 weeks), and maintenance (3–4 months after post-test). Mean changes and group differences in skin carotenoid scores, BMI z-scores and percentiles were obtained from analyses of variance. Linear mixed-effects models were used to determine overall program effects. Mexican-heritage children were enrolled (n = 57 and 52.6% female). An overall decrease in skin carotenoid scores was observed at post-test (−15.1; 95% CI: −24.95, −5.33). While scores varied widely (range: 17–498), an increase of 14.8 ± 23.8 points occurred in one intervention group. Compared to the control period, greater reductions in BMI outcomes occurred during the program. These findings provide evidence for the use of strengths-based approaches in behavioral nutrition programs.

Association between food insecurity and kidney stones in the United States: Analysis of the National Health and Nutrition Examination Survey 2007-2014

Purpose

Although food insecurity is a major public health concern associated with various diseases, the relationship between food insecurity and kidney stones remains unclear. We aimed to investigate the association between food insecurity and kidney stones in the US population.

Materials and methods

Four continuous cycles of data from the year 2007 to 2014 were obtained from National Health and Nutrition Examination Survey (NHANES) in the current study. We utilized the Household Food Security Module to assess the food security status of individuals. The primary outcome was whether participants ever had kidney stones, and the secondary outcome was a stone recurrence. A multivariate logistic regression model adjusting for potential confounders was constructed to evaluate the independent association between food insecurity and kidney stones.

Results

A total of 21,914 participants were included in our analysis, with 8.8% having a history of kidney stones and 33.2% of these reporting stones recurrence. Food insecurity was associated with increased risks of kidney stones (odds ratio: 1.21; 95% confidence interval: 1.05-1.39; P = 0.010) and kidney stones recurrence (odds ratio: 1.33; 95% confidence interval: 1.00-1.77; P = 0.052) after adjusting for all potential confounders. In addition, participants with very low food security had 38% and 47% higher risks of kidney stones (odds ratio: 1.38; 95% confidence interval: 1.13-1.69; P = 0.002; P for trend = 0.009) and kidney stones recurrence (odds ratio: 1.47; 95% confidence interval: 1.03-2.10; P = 0.032; P for trend = 0.029), respectively.

Conclusion

There exists a significant association between food insecurity and kidney stones, which reveals the significance of the improvement of food insecurity in the alleviation of kidney stone formation and recurrence.

Exploring the associations between neighbourhood food environment, household food insecurity and child weight-related outcomes in socio-economically and racially/ethnically diverse families

OBJECTIVE

To examine associations among neighbourhood food environments (NFE), household food insecurity (HFI) and child's weight-related outcomes in a racially/ethnically diverse sample of US-born and immigrant/refugee families.

DESIGN

This cross-sectional, observational study involving individual and geographic-level data used multilevel models to estimate associations between neighbourhood food environment and child outcomes. Interactions between HFI and NFE were employed to determine whether HFI moderated the association between NFE and child outcomes and whether the associations differed for US-born v. immigrant/refugee groups.

SETTING

The sample resided in 367 census tracts in the Minneapolis/St. Paul, MN metropolitan area, and the data were collected in 2016-2019.

PARTICIPANTS

The sample was from the Family Matters study of families (n 1296) with children from six racial/ethnic and immigrant/refugee groups (African American, Latino, Hmong, Native American, Somali/Ethiopian and White).

RESULTS

Living in a neighbourhood with low perceived access to affordable fresh fruits and vegetables was found to be associated with lower food security (P < 0·01), poorer child diet quality (P < 0·01) and reduced availability of a variety of fruits (P < 0·01), vegetables (P < 0·05) and whole grains in the home (P < 0·01). Moreover, residing in a food desert was found to be associated with a higher child BMI percentile if the child's household was food insecure (P < 0·05). No differences in associations were found for immigrant/refugee groups.

CONCLUSIONS

Poor NFE were associated with worse weight-related outcomes for children; the association with weight was more pronounced among children with HFI. Interventions aiming to improve child weight-related outcomes should consider both NFE and HFI.

Promotoras de Salud in a Father-Focused Nutrition and Physical Activity Program for Border Communities: Approaches and Lessons Learned from Collaboration

Promotoras de salud (promotoras) have been a valuable part of community research for Latino families, such as in the recruitment or delivery of health promotion programs. However, there has been limited discussion of how to integrate a promotora model into a father-focused program to support nutrition and physical activity within Latino families. This manuscript's purpose is to describe how to engage and collaborate with promotoras in a father-focused, family-centered program for Latino families living in colonias near the U.S.-Mexico border. As part of a longstanding community-academic partnership, the authors outline approaches and lessons learned from collaboration with promotoras during the design (including formative work and training), implementation, and evaluation of a behavioral program-¡Haz Espacio para Papi! (HEPP, Make Room for Daddy!). Promotoras' contributions supported the entire program, from design through evaluation. The team of all-female promotoras created a balance between the needs and preferences of the community and the goals and requirements of the research. While there is considerable time and human capital required for collaboration, the mutual benefits can make this work meaningful to all involved.

Associations between children's reports of food insecurity and dietary patterns: findings from the Generation XXI birth cohort

Evidence on the association between children's food insecurity (FI) and dietary patterns (DPs) is scarce. This study assessed the association between children's FI and a priori and a posteriori-defined DPs in a Portuguese population-based sample of children. A cross-sectional study including 2800 children from the 10-year-old follow-up of the Generation XXI birth cohort was performed. Data on food security status, assessed by the Self-administered Food Security Survey Module for children (SAFSSMC), dietary intake and socio-demographics were collected. A previously developed Healthy Eating Index (HEI) was adapted for this study. Using the HEI score and its food groups, linear and logistic regression models were performed. Using latent class analysis, five a posteriori-defined DPs were identified. The DPs names considered an overall picture of the DP. Food security status as a categorical (food security/FI) and continuous variable (SAFSSMC raw score: higher scores representing higher FI) was used. Multinomial logistic regression models were used to assess the association between food security status and DPs. Children's FI (9·4 %) was inversely associated with the HEI score (β=-0·695;95%CI:-1·154,-0·235), representing worse diet quality. A higher SAFSSMC raw score was associated with low fruit and vegetables (OR=1·089;95%CI:1·023,1·159) and seafood and eggs consumption (OR=1·073;95%CI:1·009,1·142) and high consumption of meat and meat products (OR=1·091;95%CI:1·026,1·160), salty snacks (OR=1·067;95%CI:1·003,1·136) and soft drinks (OR=1·097;95%CI:1·031,1·168). The SAFSSMC raw score was positively associated with 'Low consumption' (OR=1·119;95%CI:1·016,1·232), 'Energy-dense foods' (OR=1·155;95%CI:1·028,1·298) and 'Snacking' (OR=1·119;95%CI:1·006,1·245) DPs. FI was associated with worse dietary choices. Intervention strategies targeting food insecure children should be developed to promote healthy dietary habits.

Infancy Dietary Patterns, Development, and Health: An Extensive Narrative Review

Correct dietary patterns are important for a child’s health from birth to adulthood. Understanding a child’s health as a state of entire physical, mental, and social well-being is essential. However, reaching adulthood in a complete health proper state is determined by feeding and dietary habits during preconception, pregnancy, or children infancy. Different factors, such as the mother’s lifestyle, culture, or socioeconomic status, are crucial during all these phases. In this review, we aimed to assess the long-term associations between infancy dietary patterns and health and their influence on development and growth. To reach this objective, a consensus critical review was carried out using primary sources such as scientific articles, and secondary bibliographic indexes, databases, and web pages. PubMed, SciELO, and Google Scholar were the tools used to complete this research. We found that high-income countries promote high-calorie foods and, consequently, obesity problems among children are rising. However, undernutrition is a global health issue concerning children in low- and middle-income countries; thus, parental socioeconomic status in early life is essential to children’s health and development, showing that biological, social, and environmental influences are increased risk factors for chronic diseases. This narrative review is aimed to collect evidence for early nutritional intervention and future disease prevention.

Household food insecurity and obesity risk in preschool-aged children: A three-year prospective study

BACKGROUND

Household food insecurity (FI) is a pressing social, economic and public health issue. However, little is known regarding the effect of FI exposure during the first few years of life, the most active postnatal time for neurobiological and physiological development, on patterns of weight gain during early childhood. It is also unknown whether dietary quality would serve as a pathway through which FI affects children's weight development.

METHOD

This was a secondary data analysis from a three-year randomized clinical trial with five hundred and thirty-four parent/child dyads. Household FI in the past year was reported by parents at baseline when children were 2-4 years of age using the USDA Household Food Security Survey Module-Six Item Short Form. Children's dietary quality at baseline was measured by the US Department of Agriculture Healthy Eating Index (HEI). Child body mass index (BMI) was measured following standardized protocols at baseline and 12-, 24-, and 36-month follow-up. A latent growth curve model was used to examine 1) the association between baseline FI and sex-and-age-adjusted BMI z-scores in children and 2) the HEI pathway between the FI- BMI association.

RESULTS

FI early in life was associated with higher baseline BMI z-scores. Children who had higher BMI at baseline maintained their higher BMI status over the next three years. Children's dietary intake quality did not explain the association between baseline FI and BMI z-scores.

CONCLUSION

Early exposure to FI was associated with higher BMI in children as early as two years of age, setting them up for an increased likelihood of persistently high BMI-for-age in later childhood. These data suggest that the first few years may be a critical time for developing obesity risk, calling for policy and practices designed for early intervention of food insecurity.

Development, Validity, and Cross-Context Equivalence of the Child Food Insecurity Experiences Scale for Assessing Food Insecurity of School-Age Children and Adolescents

BACKGROUND

Children ages 6 to 17 years can accurately assess their own food insecurity, whereas parents are inaccurate reporters of their children's experiences of food insecurity. No globally applicable scale to assess the food insecurity of children has been developed and validated.

OBJECTIVES

We aimed to develop a globally applicable, experience-based measure of child and adolescent food insecurity and establish the validity and cross-contextual equivalence of the measure.

METHODS

The 10-item Child Food Insecurity Experiences Scale (CFIES) was based on items previously validated from questionnaires from the United States, Venezuela, and Lebanon. Cognitive interviews were conducted to check understanding of the items. The questionnaire then was administered in 15 surveys in 13 countries. Other items in each survey that assessed the household socioeconomic status, household food security, or child psychological functioning were selected as criterion variables to compare to the scores from the CFIES. To investigate accuracy (i.e., criterion validity), linear regression estimated the associations of the CFIES scores with the criterion variables. To investigate the cross-contextual equivalence (i.e., measurement invariance), the alignment method was used based on classical measurement theory.

RESULTS

Across the 15 surveys, the mean scale scores for the CFIES ranged from 1.65 to 5.86 (possible range of 0 to 20) and the Cronbach alpha ranged from 0.88 to 0.94. The variance explained by a 1-factor model ranged from 0.92 to 0.99. Accuracy was demonstrated by expected associations with criterion variables. The percentages of equivalent thresholds and loadings across the 15 surveys were 28.0 and 5.33, respectively, for a total percentage of nonequivalent thresholds and loadings of 16.7, well below the guideline of <25%. That is, 83.3% of thresholds and loadings were equivalent across these surveys.

CONCLUSIONS

The CFIES provides a globally applicable, valid, and cross-contextually equivalent measure of the experiences of food insecurity of school-aged children and adolescents, as reported by them.

Food insecurity, food parenting practices, and child eating behaviors among low-income Hispanic families of young children

Food insecurity is associated with negative food parenting practices that may promote child obesity, including pressure to eat and food restriction. Less is known about the relationship between food insecurity and positive food parenting practices, including exposing the child to new foods and involving the child in food preparation. Further, few studies have investigated the associations between food insecurity and child eating behaviors that have been linked to poor dietary outcomes. Using baseline data collected as part of a larger pilot intervention, we examined the relationships between food security status, food parenting practices, and child eating behaviors in a predominately Hispanic, low-income sample of parents and their preschool aged children (n = 66). Between July of 2019 and 2020, caregivers recruited from 4 urban communities in Rhode Island completed assessments of household food security, food parenting practices, and four child eating behaviors: food responsiveness, emotional overeating, enjoyment of food, and satiety responsiveness. Although 46% of caregivers reported food insecurity, food insecurity was not directly associated with any food parenting practice. Children in food insecure households were rated as higher in levels of food responsiveness and enjoyment of food as compared to children in food secure households. Children in food insecure households were rated as lower in satiety responsiveness as compared to children in food secure households. Child emotional overeating did not vary by food security status. Future interventions to reduce child obesity among low-income Hispanic families should assess food security status and consider any level of food insecurity as a potential signal of unhealthy child eating behaviors.

Pedi-R-MAPP: The development of a nutritional awareness tool for use in remote paediatric consultations using a modified Delphi consensus

BACKGROUND & AIMS

The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments, and provide practical guidance for nutritional care. The aim of this study was to modify the R-MAPP into a version suitable for children, Pediatric Remote Malnutrition Application (Pedi-R-MAPP), and provide a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation.

METHODS

A ten-step process was completed: 1) permission to modify adult R-MAPP, 2) literature search to inform the Pedi-R-MAPP content, 3) Pedi-R-MAPP draft, 4) international survey of HCP practice using TECS, 5) nutrition experts invited to participate in a modified Delphi process, 6) first stakeholder meeting to agree purpose/draft of the tool, 7) round-one online survey, 8) statements with consensus removed from survey, 9) round-two online survey for statements with no consensus and 10) second stakeholder meeting with finalisation of the Pedi-R-MAPP nutrition awareness tool.

RESULTS

The international survey completed by 463 HCPs, 55% paediatricians, 38% dietitians, 7% nurses/others. When HCPs were asked to look back over the last 12 months, dietitians (n = 110) reported that 5.7 ± 10.6 out of every 10 appointments were completed in person; compared to paediatricians (n = 182) who reported 7.5 ± 7.0 out of every 10 appointments to be in person (p < 0.0001), with the remainder completed as TECS consultations. Overall, 74 articles were identified and used to develop the Pedi-R-MAPP which included colour-coded advice using a traffic light system; green, amber, red and purple. Eighteen participants agreed to participate in the Delphi consensus and completed both rounds of the modified Delphi survey. Agreement was reached at the first meeting on the purpose and draft sections of the proposed tool. In round-one of the online survey, 86% (n = 89/104) of statements reached consensus, whereas in round-two 12.5% (n = 13/104) of statements reached no consensus. At the second expert meeting, contested statements were discussed until agreement was reached and the Pedi-R-MAPP could be finalised.

CONCLUSION

The Pedi-R-MAPP nutrition awareness tool was developed using a modified Delphi consensus. This tool aims to support the technological transformation fast-tracked by the COVID-19 pandemic by providing a structured approach to completing a remote nutrition focused assessment, as well as identifying the frequency of follow up along with those children who may require in-person assessment.

Designing for Multilevel Behavior Change: A Father-Focused Nutrition and Physical Activity Program for Mexican-Heritage Families in South Texas Border Communities

Fathers significantly influence family functioning, as coparents and partners, and must be part of family-based approaches to behavioral health interventions or programs. But little is known regarding how to support Latino fathers in health promotion within their family systems, specifically for Latino families living in border communities. Program development was embedded in a larger community-based grant and part of a longstanding academic-community collaboration. An interdisciplinary research team applied theories related to health behavior, family systems, behavior change, and community engagement to develop a father-focused and family-centered behavioral program for Mexican-heritage fathers and children living near the Texas-Mexico border to support changes in nutrition and physical activity at the individual and family levels. Promotoras de salud (trained community health workers) delivered the program through group sessions, check-in calls, and at-home activities. Group session activities were designed to engage family triads and dyads using experiential education related to nutrition and physical activity, like cooking lessons and active play, over a six-week period. Future research can use the program approach and curricula as a roadmap for designing context-specific and culturally-relevant programs for Latino families. Additional research is needed to explore how approaches like this can support families and their health goals.

Food Insecurity and Child Development: A State-of-the-Art Review

Converging research indicates that household food insecurity impedes children from reaching their full physical, cognitive, and psychosocial potential. This state-of-the-art review examines the last decade of research to: (1) describe the impact of the severity and persistence of food insecurity on child development; (2) use a socio-ecological framework to examine significant proximal and distal factors which may interplay; and (3) outline directions for future research. We conducted a systematic review of six databases of published papers from 2011 to June 2021. The search was limited to high-income countries and children aged from birth to 12 years. From 17,457 papers, 17 studies were included in the final review. Transitioning between food security and food insecurity had a significant and lasting effect on academic/cognitive function and behavior (i.e., externalizing), however less clear relationships were seen for psychosocial outcomes and other behaviors examined (i.e., internalizing). There was significant variation in the measurement and thresholds used to define both food insecurity and child development outcomes. Subsequently, comparisons across studies are difficult. Several future recommendations, including incorporation of socio-ecological factors, is provided. In conclusion, this review supports the link between food insecurity and sub-optimal child development; however, there is an imperative to improve and extend current understanding to ameliorate the causes of food insecurity.

Experiences and Situations of Shame among Food-insecure Adolescents in South Carolina and Oregon

Shame experienced with food insecurity and participating in food assistance may affect adolescents. We investigated adolescents' experiences of shame related to food insecurity and situations for these experiences in an ethnically diverse sample of 40 adolescents aged 9-15 years from South Carolina and Oregon. In-depth interviews were recorded, transcribed, coded, and analyzed. Participants described feelings of sadness, anger, and internalized shame with food insecurity. Salient situations were participating in food assistance, seeking food assistance from others or community services, and social encounters at school among peers. Adolescents felt shame knowing that peers were aware of their food insecurity and about them participating in food assistance through school.

The association between food insecurity, diet quality, and untreated caries among US children

BACKGROUND

The aim of this study was to examine the association between food insecurity and untreated caries among US children and the potential role of diet quality as a mediator in this relationship.

METHODS

The authors analyzed data for 4,822 children aged 5 through 17 years from the National Health and Nutrition Examination Survey cycles from 2011 through 2014. The authors measured food security as household-level food security status (full, marginal, low, very low) and overall food security status (full food secure, food insecure). They measured diet quality using the Healthy Eating Index. The primary outcome measure was untreated caries (none, ≥ 1). The authors used multiple logistic regression analysis to evaluate the relationships among food insecurity, diet quality, and untreated caries. They conducted mediation analysis using the Baron and Kenny approach.

RESULTS

Food-insecure children were more likely to have untreated caries compared with their fully food-secure counterparts, after controlling for confounding variables (odds ratio [OR], 1.38; 95% [CI, 1.11 to 1.72). Specifically, children from marginal and very low food-secure households had significantly higher odds of untreated caries (OR, 1.48; 95% CI, 1.10 to 2.01) compared with children from fully food-secure households (OR, 1.59; 95% CI, 1.12 to 2.26). Diet quality was not significantly associated with untreated caries.

CONCLUSIONS

Food insecurity was negatively associated with untreated caries among US children. Diet quality was not associated with untreated caries.

PRACTICAL IMPLICATIONS

Social factors such as food insecurity should be taken into consideration when dental clinicians perform caries risk assessment because caries risk is shown to be associated with overall health and dental health.

Food Insecurity: A Constant Factor in the Lives of Low-Income Families in Scotland and England

During the school summer holidays, pressures on the already tight budgets of low-income families are compounded, particularly when the safety net of free school meals is removed. The main aim of the current study was to investigate how low-income parents and carers feed their families during term time when children receive free school meals and if, and how, strategies differ during the school summer holidays. A secondary aim was to investigate the role of holiday activity and food programmes in supporting parents and carers to feed their children during the school summer holidays. We used purposive sampling to recruit a total of 21 parents (N = 20 Female, N = 1 Male) whose children attended free summer holiday clubs in Scotland and England during summer 2017. Participants were asked about their food and shopping habits during the school term and if, and how they differed during the school summer holidays when free school meals were not available. The findings suggest that food insecurity is a constant factor in the lives of low-income parents in England and Scotland, and that the stages of food insecurity and the strategies employed to mitigate its effects appear to be cyclical, aligning with the Food and Agriculture Organisation's (FAO) food insecurity continuum and the school academic year. During term time, parents and carers worried about food, suggesting they were experiencing mild food insecurity, despite their children being in receipt of free school meals. As the school holidays approached, moderate food insecurity was experienced as parents reported that they began "provisioning," storing food and reducing household expenditure. During the summer holidays, food did not last, and parental food acquisition habits became more intense. Parents downgraded food brands and bought reduced price items of food. Ultimately, parents self-sacrificed their own nutritional intake by only buying food their children would eat and parents often skipped meals or only ate their children's leftovers. However, children's attendance at holiday club helped make the food at home last longer and once school resumed, parents returned to their less intense, but constantly coping approach to food shopping. The findings of this study suggest that food insecurity is a constant factor in the lives of low-income families who simply do not have enough household income to prevent them from experiencing food insecurity, even when initiatives such as free school meals and access to holiday club provision with food and activities are in place.

How Do Disadvantaged Children Perceive, Understand and Experience Household Food Insecurity?

Food insecurity is associated with reduced physical, social, and psychological functioning in children. There has been sparse research into child food insecurity that incorporates children’s own perspectives, as adults are often interviewed as child proxies. While a nuanced, child-centred understanding of food insecurity is needed to inform effective policy and program responses, little is known about Australian children’s firsthand understanding or experience of household food insecurity. This study aimed to fill this gap by inviting preadolescent children’s perspectives. Eleven participants aged 10–13 years (seven girls and four boys) took part in the study and were recruited from an Australian charity school holiday camp that targets severely disadvantaged youth. Children took part in individual semi-structured interviews that incorporated drawings and emoji scales. Qualitative interviews were audio recorded, transcribed, and analysed using thematic techniques. Four themes emerged from the data analysis, children had: (i) financial understanding; (ii) awareness of food insecurity and coping mechanisms; (iii) sharing, empathy, and compassion for food insecure families; and (iv) described the nature of ‘food’ preparation. This study provides a child-centric analysis, demonstrating how children’s agency is enacted and constrained in food insecure contexts. This child-derived understanding of food insecurity provides a critical basis from which to build effective approaches to assess and respond to this significant social issue.

Potassium Control of Plant Functions: Ecological and Agricultural Implications

Potassium, mostly as a cation (K+), together with calcium (Ca2+) are the most abundant inorganic chemicals in plant cellular media, but they are rarely discussed. K+ is not a component of molecular or macromolecular plant structures, thus it is more difficult to link it to concrete metabolic pathways than nitrogen or phosphorus. Over the last two decades, many studies have reported on the role of K+ in several physiological functions, including controlling cellular growth and wood formation, xylem-phloem water content and movement, nutrient and metabolite transport, and stress responses. In this paper, we present an overview of contemporary findings associating K+ with various plant functions, emphasizing plant-mediated responses to environmental abiotic and biotic shifts and stresses by controlling transmembrane potentials and water, nutrient, and metabolite transport. These essential roles of K+ account for its high concentrations in the most active plant organs, such as leaves, and are consistent with the increasing number of ecological and agricultural studies that report K+ as a key element in the function and structure of terrestrial ecosystems, crop production, and global food security. We synthesized these roles from an integrated perspective, considering the metabolic and physiological functions of individual plants and their complex roles in terrestrial ecosystem functions and food security within the current context of ongoing global change. Thus, we provide a bridge between studies of K+ at the plant and ecological levels to ultimately claim that K+ should be considered at least at a level similar to N and P in terrestrial ecological studies.

Marginal, Low, and Very-Low Food Security among Children Are Associated with Intake of Select Dietary Factors during Summer

BACKGROUND

School meals are associated with improved food security status and dietary intake. Children receiving free and reduced-price school meals lose access to these meals during the summer. The association between food security status and dietary intake in these children during summer is unclear.

OBJECTIVE

To examine the association between food security status (high, marginal, low, and very-low food security) among children and intake of select dietary factors during summer in children certified for free and reduced-price school meals by age group (3 to 4 years, 5 to 8 years, 9 to 12 years, and 13 to 17 years).

DESIGN

Cross-sectional analysis.

PARTICIPANTS/SETTING

Secondary data from 11,873 children aged 3 to 17 years in the control group of the US Department of Agriculture Summer Electronic Benefit Transfer for Children Demonstration Project.

MAIN OUTCOME MEASURES

Consumption of total fruits and vegetables; fruits and vegetables, excluding fried potatoes; whole grains; added sugars; added sugars, excluding cereals; added sugars from sugar-sweetened beverages; and dairy products assessed using questions from the 2009-2010 National Health and Nutrition Examination Survey Multifactor Diet Screener.

STATISTICAL ANALYSIS

Multiple linear regression.

RESULTS

For the majority of age groups, marginal food security, low food security, and very-low food security were associated with lower fruit and vegetable consumption and low food security and very-low food security were associated with lower dairy consumption, with children from households with very-low food security having the lowest consumption. Children from households with very-low food security consumed 0.73 (95% CI -0.93 to -0.53) to 0.99 (95% CI -1.59 to -0.39) cup equivalents less per day of fruits and vegetables and 0.49 (95% CI -0.65 to -0.34) to 0.68 (95% CI -1.07 to -0.29) cup equivalents less per day of dairy compared with children from households experiencing high food security.

CONCLUSIONS

Lower food security was associated with reduced consumption of fruits and vegetables and dairy products during summer in children from low-income households.

Food Insecurity and Sugar-Sweetened Beverage Consumption Among WIC-Enrolled Families in the First 1,000 Days

OBJECTIVE

Determine the association between household food insecurity and habitual sugar-sweetened beverage (SSB) consumption among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-enrolled families during the first 1,000 days.

METHODS

Cross-sectional analysis of pregnant women and mothers of infants aged under 2 years in the WIC was performed. Families recruited sequentially at consecutive visits completed food insecurity and beverage intake questionnaires; estimated logistic regression models controlled for sociodemographic characteristics.

RESULTS

Of 394 Hispanic/Latino mothers and 281 infants, 63% had household food insecurity. Food insecurity significantly increased odds of habitual maternal (unadjusted odds ratio (OR), 2.39; 95% CI, 1.27-4.47; P = .01) and infant SSB consumption (OR, 2.05; 95% CI, 1.15-3.65; P = .02), and the relationship was not attenuated by maternal age, education, or foreign-born status.

CONCLUSIONS AND IMPLICATIONS

Food insecurity increased odds of habitual SSB consumption in WIC families. Interventions to curb SSB consumption among WIC-enrolled families in the first 1,000 days in the context of household food insecurity are needed.

Food Insecurity and Pediatric Malnutrition Related to Under- and Overweight in the United States: An Evidence Analysis Center Systematic Review

Both food insecurity and malnutrition are associated with adverse health outcomes in the pediatric population. However, the research on the relationship between these factors has been inconsistent, leading to uncertainty regarding whether or how evaluation of food insecurity should be incorporated into nutrition screening or the nutrition care process. The objective of this systematic review was to determine the association between food insecurity and malnutrition related to undernutrition or overnutrition (defined by anthropometrics) in the pediatric population in the United States. A literature search was conducted using Medline, Embase, and CINAHL databases for studies published from January 2002 through November 2017. A total of 23 studies (19 cross-sectional and 4 prospective cohort studies) met inclusion criteria and were included in qualitative analysis. In 6 studies, there was no overall relationship between food insecurity and underweight. All included studies examined the relationship between food insecurity status and overweight/obesity and results were mixed, with large cross-sectional studies demonstrating a positive relationship between food insecurity and overweight/obesity. There were no clear patterns according to subpopulation. Evidence quality was graded as fair due to heterogeneity in how food insecurity was measured and populations included as well as inconsistency in results. Use of a 2-item food insecurity screening tool may allow for efficient, effective screening of food insecurity in order to identify potential contributors overweight and obesity.

Food insecurity is associated with lower adherence to the Mediterranean dietary pattern among Lebanese adolescents: a cross-sectional national study

PURPOSE

To derive dietary patterns (DPs) of Lebanese adolescents (10-18 years) and evaluate associations between identified DPs and household food insecurity (HFI).

METHODS

Data on adolescents (n = 693) were drawn from a national survey conducted in 2015 on a representative sample of Lebanese households with children. In addition to a sociodemographic questionnaire, data collection included the validated Arabic-version of the Household Food Insecurity Access Scale, used to evaluate HFI. Dietary intake was assessed using a 187-item validated food frequency questionnaire. Associations between HFI scores and DPs were examined using multiple linear regressions.

RESULTS

HFI was observed in 55.2% of the study sample. Two DPs were derived among adolescents: Western and Lebanese-Mediterranean (LM). The Western DP was characterized by higher consumption of sweetened beverages, fast foods, sweets, and refined grains, whereas the LM DP was characterized by higher intakes of fruits, vegetables, dairy products, and whole grains. Scores of the Western DP were negatively associated with fiber, calcium, iron, and vitamins A and D, while the LM DP scores were positively correlated with fiber, proteins, iron, calcium, and vitamins A and D (p < 0.01). LM DP scores were also negatively correlated with total fat, saturated and polyunsaturated fats, p < 0.05. After adjustment for sociodemographics, multiple linear regression showed that higher HFI scores were associated with lower adherence to LM DP among adolescents (β = - 0.026, 95% CI - 0.046, - 0.006).

CONCLUSIONS

HFI was associated with lower adherence to the Mediterranean pattern among Lebanese adolescents. Preventive strategies are needed to promote better diet quality among food-insecure youth.

Relationship between food insecurity and high blood pressure in a national sample of children and adolescents

OBJECTIVES

To determine the relationship between food insecurity (FI) and high blood pressure (BP) in a national cohort of children and adolescents.

METHODS

A cross-sectional analysis of children aged 8-17 years in the 2007-2014 National Health and Nutrition Examination Survey (NHANES; unweighted N = 7125). FI over the preceding 12 months was assessed using the USDA Household Food Security Scale in NHANES. We defined high BP as (i) systolic or diastolic BP ≥ 90% for age < 13 years or ≥ 120/80 mmHg for age ≥ 13 years measured at one visit or (ii) reported hypertension diagnosis or current antihypertensive medication use. We used multivariable logistic regression to determine the association between household and child-specific FI and high BP, controlling for age, sex, race, and household income, accounting for the complex NHANES survey design.

RESULTS

The study population was 14.4% black, 21.3% Hispanic, and 49.4% female with a mean age of 12.6 years (SD 2.9). 20.3% had FI and 12.8% had high BP. High BP was more common in household FI vs. food-secure subjects (15.3% vs. 12.1%, p = 0.003). Adjusted analysis confirmed that household FI and child FI were associated with high BP (OR 1.26, 95% CI 1.04-1.54; OR 1.42, 95% CI 1.03-1.96, respectively).

CONCLUSIONS

Household and child FI were associated with an increased likelihood of high BP in a large nationally representative cohort of children and adolescents. FI may have a significant impact on cardiovascular health during childhood. Further research is warranted to better define how FI contributes to health disparities.

Child-Report of Food Insecurity Is Associated with Diet Quality in Children

Food insecurity (FI) is adversely associated with physical and mental wellbeing in children. The mechanism underlying this association is assumed to be dietary intake; however, evidence has been mixed. This study examined the relationship between self-reported FI and dietary quality among low-income children. Cross-sectional data were used from TX Sprouts, a school-based cooking, gardening, and nutrition intervention. A sample of 598 children completed two 24-h dietary recalls and a questionnaire including an adapted version of the 5-item Child Food Security Assessment (CFSA). Food security was categorized as food secure or FI based on summed CFSA scores. Dietary quality was assessed using the Health Eating Index-2015 (HEI-2015). Mixed effects linear regression models examined associations between FI and dietary quality. Children were 64% Hispanic, 55% female, and were 9.2 years old on average. Adjusting for sociodemographic characteristics, BMI percentile, and energy intake, FI was associated with lower HEI-2015 total scores (β = −3.17; 95% CI = −5.28, −1.06; p = 0.003). Compared to food secure children, FI children had lower greens and beans (2.3 vs. 1.9, p = 0.016), seafood and plant protein (2.0 vs. 1.6, p = 0.006), and added sugar (7.4 vs. 8.0, p = 0.002) component scores. Interventions targeting low-income and FI children should investigate ways to improve dietary quality.

Indirect Effects of Food Insecurity on Body Mass Index Through Feeding Style and Dietary Quality Among Low-Income Hispanic Preschoolers

OBJECTIVE

To investigate whether food insecurity affects child body mass index (BMI) through parental feeding demandingness and/or responsiveness and dietary quality 18 months later among low-income Hispanic preschoolers.

DESIGN

Secondary analysis of data at baseline and 18 months afterward.

SETTING

Houston, TX.

PARTICIPANTS

Hispanic parent-preschooler dyads (n = 137).

VARIABLES

Food insecurity (6-item Household Food Security Survey), child BMI (BMI z-score), child dietary quality (Healthy Eating Index), and parental feeding demandingness and responsiveness (Caregiver's Feeding Style Questionnaire).

ANALYSIS

Ordinary least-squares regression models and 95% bootstrapped confidence intervals (CIs) to estimate effects.

RESULTS

Controlling for baseline child BMI, maternal acculturation, and maternal BMI, total indirect effects of food insecurity on child BMI through feeding demandingness, responsiveness, and subsequent child dietary quality were estimated to be 0.001 (95% bias-controlled bootstrap CI, -0.01 to 0.01). Confidence intervals for all indirect pathways straddled 0. As food insecurity worsened, child dietary quality 18 months after baseline improved (c = 1.06; 95% CI, 0.41-1.71).

CONCLUSIONS AND IMPLICATIONS

Food insecurity had no influence on child BMI through feeding demandingness/responsiveness and/or child dietary quality. Additional research is needed to examine why food insecurity had a protective effect on dietary quality 18 months later. This finding suggests the adoption of coping mechanisms.

Inflammation and Stress Biomarkers Mediate the Association between Household Food Insecurity and Insulin Resistance among Latinos with Type 2 Diabetes

BACKGROUND

Household food insecurity (HFI) is a stressor that is associated with type 2 diabetes (T2D). However, little is known about HFI and the insulin resistance (IR) underlying T2D, and the mechanisms involved.

OBJECTIVE

We examined the cross-sectional association between HFI and IR among low-income Latinos with T2D and tested whether inflammation and stress hormones mediated this association.

METHODS

HFI was measured with the 6-item US Household Food Security Survey module. IR was calculated from fasting plasma blood glucose and serum insulin. Inflammation was indicated by high-sensitivity C-reactive protein (hsCRP), and stress hormones included urinary cortisol, metanephrine, and normetanephrine. To test for an indirect effect of HFI on homeostasis model assessment of IR, a parallel multiple mediation model was run with biological markers that significantly differed between food security status-entered as mediators in the model. We used 95% bias-corrected bootstrap CIs, with 10,000 bootstrap samples, to assess the significance of the indirect effects.

RESULTS

The 121 participants with T2D were primarily Puerto Rican (85.8%), aged mean = 60.7 y, and 74% were female. Eighty-two (68%) were classified as food insecure. Compared with food-secure individuals, food-insecure individuals had a significantly higher IR [mean difference (Δ) = 7.21, P = 0.001], insulin (Δ = 9.7, P = 0.019), glucose (Δ = 41, P < 0.001), hsCRP (Δ = 0.8, P = 0.008), cortisol (Δ = 21, P = 0.045), and total cholesterol (Δ = 29, P = 0.004). Groups did not differ on other lipids, metanephrine, normetanephrine, or A1c. The mediation model showed a significant direct effect of HFI on hsCRP (P = 0.020) and on cortisol (P = 0.011). There was a direct effect of cortisol (P = 0.013), hsCRP (P = 0.044), and HFI on IR (P = 0.015). The total combined indirect effect of HFI through cortisol and hsCRP indicated partial mediation.

CONCLUSIONS

Among Latinos with T2D, HFI is associated with IR partially through inflammation and stress hormones. Interventions to ameliorate HFI and mitigate its effects on inflammation, stress, and IR are warranted. This trial was registered at clinicaltrials.gov as NCT01578096.

Inflammation and Stress Biomarkers Mediate the Association between Household Food Insecurity and Insulin Resistance among Latinos with Type 2 Diabetes

BACKGROUND

Household food insecurity (HFI) is a stressor that is associated with type 2 diabetes (T2D). However, little is known about HFI and the insulin resistance (IR) underlying T2D, and the mechanisms involved.

OBJECTIVE

We examined the cross-sectional association between HFI and IR among low-income Latinos with T2D and tested whether inflammation and stress hormones mediated this association.

METHODS

HFI was measured with the 6-item US Household Food Security Survey module. IR was calculated from fasting plasma blood glucose and serum insulin. Inflammation was indicated by high-sensitivity C-reactive protein (hsCRP), and stress hormones included urinary cortisol, metanephrine, and normetanephrine. To test for an indirect effect of HFI on homeostasis model assessment of IR, a parallel multiple mediation model was run with biological markers that significantly differed between food security status-entered as mediators in the model. We used 95% bias-corrected bootstrap CIs, with 10,000 bootstrap samples, to assess the significance of the indirect effects.

RESULTS

The 121 participants with T2D were primarily Puerto Rican (85.8%), aged mean = 60.7 y, and 74% were female. Eighty-two (68%) were classified as food insecure. Compared with food-secure individuals, food-insecure individuals had a significantly higher IR [mean difference (Δ) = 7.21, P = 0.001], insulin (Δ = 9.7, P = 0.019), glucose (Δ = 41, P < 0.001), hsCRP (Δ = 0.8, P = 0.008), cortisol (Δ = 21, P = 0.045), and total cholesterol (Δ = 29, P = 0.004). Groups did not differ on other lipids, metanephrine, normetanephrine, or A1c. The mediation model showed a significant direct effect of HFI on hsCRP (P = 0.020) and on cortisol (P = 0.011). There was a direct effect of cortisol (P = 0.013), hsCRP (P = 0.044), and HFI on IR (P = 0.015). The total combined indirect effect of HFI through cortisol and hsCRP indicated partial mediation.

CONCLUSIONS

Among Latinos with T2D, HFI is associated with IR partially through inflammation and stress hormones. Interventions to ameliorate HFI and mitigate its effects on inflammation, stress, and IR are warranted. This trial was registered at clinicaltrials.gov as NCT01578096.

Inflammation and Stress Biomarkers Mediate the Association between Household Food Insecurity and Insulin Resistance among Latinos with Type 2 Diabetes

Background

Household food insecurity (HFI) is a stressor that is associated with type 2 diabetes (T2D). However, little is known about HFI and the insulin resistance (IR) underlying T2D, and the mechanisms involved.

Objective

We examined the cross-sectional association between HFI and IR among low-income Latinos with T2D and tested whether inflammation and stress hormones mediated this association.

Methods

HFI was measured with the 6-item US Household Food Security Survey module. IR was calculated from fasting plasma blood glucose and serum insulin. Inflammation was indicated by high-sensitivity C-reactive protein (hsCRP), and stress hormones included urinary cortisol, metanephrine, and normetanephrine. To test for an indirect effect of HFI on homeostasis model assessment of IR, a parallel multiple mediation model was run with biological markers that significantly differed between food security status—entered as mediators in the model. We used 95% bias-corrected bootstrap CIs, with 10,000 bootstrap samples, to assess the significance of the indirect effects.

Results

The 121 participants with T2D were primarily Puerto Rican (85.8%), aged mean = 60.7 y, and 74% were female. Eighty-two (68%) were classified as food insecure. Compared with food-secure individuals, food-insecure individuals had a significantly higher IR [mean difference (Δ) = 7.21, P = 0.001], insulin (Δ = 9.7, P = 0.019), glucose (Δ = 41, P < 0.001), hsCRP (Δ = 0.8, P = 0.008), cortisol (Δ = 21, P = 0.045), and total cholesterol (Δ = 29, P = 0.004). Groups did not differ on other lipids, metanephrine, normetanephrine, or A1c. The mediation model showed a significant direct effect of HFI on hsCRP (P = 0.020) and on cortisol (P = 0.011). There was a direct effect of cortisol (P = 0.013), hsCRP (P = 0.044), and HFI on IR (P = 0.015). The total combined indirect effect of HFI through cortisol and hsCRP indicated partial mediation.

Conclusions

Among Latinos with T2D, HFI is associated with IR partially through inflammation and stress hormones. Interventions to ameliorate HFI and mitigate its effects on inflammation, stress, and IR are warranted. This trial was registered at clinicaltrials.gov as NCT01578096.

Food-Insecure Household's Self-Reported Perceptions of Food Labels, Product Attributes and Consumption Behaviours

Dietary compromises related to food insecurity profoundly undermine health and constitute a serious public health issue, even in developed nations. The aim of this study was to explore the impact of food labelling and product attributes on the purchasing choices of food-insecure households in Australia. An online survey containing 19 food choice and 28 purchasing behaviours questions was completed by 1056 adults responsible for household grocery shopping. The short form of the US Household Food Security Survey Module was used as the food security indicator. Multinomial logistic regression modelling was employed to analyse the survey data. Respondents were classified as having either high-marginal (63.4%, n = 670), low (19.8%, n = 209) or very low (16.8%, n = 177) food security. Respondents with low or very low food security status were less likely to self-report understanding the information on the back of packaging (p < 0.001), find information on food labels useful (p = 0.002) or be influenced by product nutrition information (p = 0.002). Convenience (p < 0.001), organic (p = 0.027) and supermarket-branded products (p < 0.001) were more likely to be rated as important by food-insecure respondents when compared to their food-secure counterparts. When asked to rate “how healthy” their diet was, high–marginal FS respondents were twice as likely describe their diet as healthy than very low FS respondents (p = 0.001).

Bridging the Gaps Through Nurse-Led Nutrition Education to Underserved Children

Although children residing in impoverished rural communities located along the Texas-Mexico border are at disproportionately high risk of unhealthy eating, limited resources may prevent devoting sufficient attention to school-based nutrition education. The purpose of this quasi-experimental study was to examine the teaching effectiveness of graduate nursing students on fourth-grade student learning about healthy eating. Purposive sampling was used to select 213 predominately Hispanic fourth-grade students enrolled in one of three low-socioeconomic status underserved elementary schools located in rural South Texas. Ten graduate nursing students implemented the Creating Healthy Eating Choices for Kids Nutrition Curriculum to approximately 40 fourth-graders per group who attended weekly 45- to 50-minute sessions for 6 weeks. The MyPlate standardized tests were administered before and following the intervention. Results showed a significant improvement in learning on all program modules for fourth-graders from each school ( p = .000). Results support the value of creating a strategic partnership between a university school of nursing and key community leaders as a feasible method of providing nutrition education for fourth-graders enrolled in schools with limited resources.

Added Sugar and Dental Caries in Children: A Scientific Update and Future Steps

Excess added sugars, particularly in the form of sugar-sweetened beverages, is a leading cause of tooth decay in US children. Although added sugar intake is rooted in behavioral and social factors, few evidence-based, theory-driven socio-behavioral strategies are currently available to address added sugar intake. Dental health professionals are in a position to help identify and address problematic sugar-related behaviors in pediatric patients and advocate for broader upstream approaches, including taxes, warning labels, and policy changes, that can help reduce added sugar intake, prevent tooth decay, and improve health outcomes in vulnerable child populations.

Chronic Stress and Food Insecurity: Examining Key Environmental Family Factors Related to Body Mass Index Among Low-Income Mexican-Origin Youth

Low-income children of Mexican immigrants are at high risk for obesity. Drawing on a sample of 104 Mexican American children (Mage = 8.39 years; 61% female), this longitudinal study considered relations between food insecurity and chronic stress (ie, parent report and hair cortisol measurement) on body mass index (BMI) and examined whether stress moderated associations between food insecurity and BMI. Analyses revealed that undocumented status was associated with food insecurity and chronic stress but not when accounting for poverty. Food insecurity was only associated with higher BMI for children with the highest hair cortisol. Results suggest that chronic stress may impact body weight among food-insecure children.

Child food insecurity in the UK: a rapid review

Background

Food insecurity (FI) is a multifaceted, socioeconomic problem involving difficulties accessing sufficient, safe and nutritious food to meet people’s dietary requirements and preferences for a healthy life. For children experiencing FI, there are some potentially negative developmental consequences and it is, therefore, important to understand the links between FI and children’s health and well-being as well as any strategies undertaken to address FI. The overall objective of this assessment was to determine the nature, extent and consequences of FI affecting children (aged ≤ 18 years) in the UK.

Objective

To determine the nature, extent and consequences of FI affecting children (aged ≤ 18 years) in the UK.

Data sources

The databases searched on 4 December 2017 included MEDLINE (including In-Process & Other Non-Indexed Citations and E-pub ahead of print files), EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Commonwealth Agricultural Bureaux (CAB) abstracts, The Cochrane Library, Education Resources Information Centre (ERIC), PsycINFO, the Social Science Citation Index and the Applied Social Sciences Index and Abstracts (ASSIA).

Methods

A rapid review of the current published and unpublished literature was conducted, including all study designs from specified high-income countries in children aged ≤ 18 years. Searches were conducted of major health-care, nutrition, education and social science databases from 1995 onwards, and websites of relevant UK and international organisations. Final searches were undertaken in December 2017.

Results

In total, 109 studies were selected. Only five studies were conducted in the UK, four of which provided qualitative data. Possible factors associated with child FI were identified, for example socioeconomic status, material deprivation, living in public housing and having unemployed or poorly educated parents. Children’s health, well-being and academic outcomes were all negatively affected by FI. The mediating effects of family stressors and parenting practices in the relationship between FI and children’s health and well-being outcomes were not clear. Food assistance programmes were generally effective in mitigating FI and improving nutritional outcomes (including hunger) in the short term, but did not eradicate FI, eliminate its effects on children’s health or have an impact on academic outcomes. No reports assessing the prevalence of child FI in the UK or the cost-effectiveness and sustainability of interventions to tackle FI were identified.

Limitations

There was a lack of consistency in how FI was defined and measured across studies. Most of the studies used indirect measurements of child FI through parental reports. The majority of studies were conducted in North America. Only five studies were conducted in the UK. Thirty potentially relevant studies were not included in the review as a result of time and resource constraints. Most studies were observational and caution is advised in interpreting their results.

Conclusions

A number of factors that were related to child FI were identified, as were negative associations between child FI and physical, mental and social outcomes. However, these findings should be interpreted with caution because of the correlational nature of the analyses and the fact that it is difficult to determine if some factors are predictors or consequences of FI.

Future research

There is an urgent requirement for the development of a reliable instrument to measure and monitor child FI in the UK and for well-designed interventions or programmes to tackle child FI.

Study registration

This study is registered as PROSPERO CRD42017084818.

Funding

The National Institute for Health Research Public Health Research programme. The Health Services Research Unit is core-funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

Pathways of Association from Stress to Obesity in Early Childhood

OBJECTIVE

The objective of this study is to critically review the literature on early life stress in relation to obesity in humans, including the multiple biological and behavioral mechanisms through which early life stress exposure (birth to the age of 5 years) may associate with obesity risk during childhood.

METHODS

A review of the literature was conducted to identify studies on associations between early childhood stress and risk for obesity and the mechanisms of association. Multiple databases (PubMed, PsycInfo, Google Scholar) were used in the search as well as a "snowball" search strategy. All study designs were included.

RESULTS

Early life stress and adverse childhood experiences are associated with obesity and overweight in adults. Evidence is less consistent in children. Studies vary in the nature of the stress examined (e.g., chronic vs. acute), sample characteristics, and study designs. Longitudinal studies are needed, as the effects of early life stress exposure may not emerge until later in the life-span. Early life stress exposure is associated with biological and behavioral pathways that may increase risk for childhood obesity.

CONCLUSIONS

There is evidence that early life stress is associated with multiple biological and behavioral pathways in children that may increase risk for later obesity. Little work has detailed the interconnections among these mechanisms across development or identified potential moderators of the association. Mapping the mechanisms connecting early life stress exposure to obesity risk in young children longitudinally should be a priority for obesity researchers. Recommendations for developmentally sensitive approaches to research that can inform obesity prevention strategies are presented.

Measures of low food variety and poor dietary quality in a cross-sectional study of London school children

BACKGROUND/OBJECTIVES

The use of simple screening tools to measure nutritional adequacy in a public health context in developed countries are currently lacking. We explore the relationship between food variety and nutrient intake of London school children using a simple tool with potential use for screening for inadequate diets.

SUBJECTS/METHODS

A cross-sectional survey was carried out in 2010. The survey included 2579 children aged 7-10 years in 52 primary schools in East London in the United Kingdom. The analysis included 2392 children (93% of the original sample). Food variety was assessed as the total number of listed foods recorded over 24 h using the validated Child and Diet Assessment Tool (CADET) comprising 115 listed foods divided into 16 food categories. Dietary quality was determined by the proportion of children meeting recommended intakes of individual micronutrients, namely, calcium, iron, zinc, folate, vitamin A and vitamin C.

RESULTS

The mean number of CADET-listed foods consumed daily by children was 17.1 (95% CI: 16.8, 17.5). Children who consumed fewer than 11 foods on the collection day had particularly low nutrient intakes. Children consuming three different vegetables and two different fruits on average consumed 19-20 listed foods. It was estimated between 4 and 20% of children did not meet the recommended levels for individual micronutrients during the period of data collection.

CONCLUSIONS

A simple method using food counts to assess daily food variety may help public health nutritionists identify groups of children at risk of inadequate diets.

Parental feeding practice is associated with child’s body mass index in Thai school-aged children

Purpose

Parental feeding practice (PFP) plays an important role in child’s eating behavior and weight status, but less information is available about its role in the Thai family setting. The purpose of this paper is to examine the influence of PFP on child’s gender and body mass index (BMI).

Design/methodology/approach

Participants included 227 parents-child dyads from the suburban area of Nakhon Pathom province, Thailand. Children aged 9-12 years and parents who were either child’s mother, father or grandfather/grandmother were enrolled in the study. Body weight, height, waist circumference and body fat were measured in all children. Eating behavior of each child was assessed by using child’s eating questionnaire. Parents also provided their feeding practices in child feeding questionnaires. Information on household food security was also obtained from children’s parents.

Findings

There was significant difference in eating behaviors and home environment between child’s genders. For child’s eating behavior, mean total eating scores of girls were significantly greater (p=0.002) than that of boys and that the inappropriate home environment was more found in families of boys than girls. Regarding feeding practice, parents used more food restriction (p=0.008) and monitoring on child’s eating (p=0.042) in girls than boys. Parents put more pressure to eat on the normal weight than obese children (p=0.001). Regression analysis revealed that, apart from parental BMI and household income, PFPs have a significant impact (15.6 percent explained variance) on child’s BMI.

Originality/value

This study highlights the importance of being aware of child’s gender and weight status when feeding practices were provided to them. Nutrition education for parents should take account for parents’ perceptions and concerns as well as the modification of feeding practices to improve children’s eating behaviors.

Evidence for the age-specific relationship of food insecurity and key dietary outcomes among US children and adolescents

Approximately 6·5 million US children live in food-insecure households, meaning that they have restrained access to the types and amounts of foods they usually eat. The nutrient demands of growth and general sub-par dietary intake of US children by age highlight the importance and difficulty of attaining recommended amounts of critical dietary components to promote health and prevent disease. Evaluation of the evidence for a relationship of food insecurity with key dietary outcomes for the specific stages of child growth at 1–5 years, 6–11 years and 12–19 years has not been previously documented. Bradford Hill criteria of strength, consistency and dose–response were applied to aid evaluation. A comprehensive search of original research on US children using food-security assessment measures indexed to January 2017 was completed and identified sixteen studies that evaluated the relationship of food insecurity with key dietary outcomes. Evidence for a strong, consistent and dose–response relationship of food insecurity with lower vegetable intake compared with food security was determined among children aged 1–5 years and strong and consistent evidence of higher added sugar intake among food-insecure children aged 6–11 years compared with food-secure children was apparent. Adolescent-focused evidence was sparse but revealed adolescence as the paediatric age stage where food insecurity has the most potential for negative impact on child dietary intake. A discussion of future research opportunities includes strengthening the evidence through longitudinal study designs, inclusion of additional nutrients of concern, and stronger mitigation of bias and error.

Dietary quality and household food insecurity among Mexican children and adolescents

Seventy percent of Mexican households experience some level of food insecurity (FI). Studies have shown positive associations between FI and poor dietary quality. As far as it is known, this is the first time the Healthy Eating Index (HEI-2010) has been used to assess dietary quality of children and adolescents in Mexico, and to examine if FI is related to it. The objective of this research is to assess dietary quality and its association with FI among Mexican children and adolescents from a nationally representative cross-sectional sample. We analyzed data from 4635 2-19-year-old Mexican children and adolescents participating in the Mexican National Health and Nutrition Survey (Ensanut 2012). FI was measured using the Latin American and Caribbean Household Food Security Scale (ELCSA) and dietary quality with the HEI-2010. We examined the association between FI and dietary quality using multivariate linear regressions. Dietary quality was worst as FI became more severe among children and adolescents compared with their counterparts living in households with food security. Specifically, FI had a negative association with fruits, vegetables, and protein foods, and a positive association with refined grains consumption. Dairy intake was negatively associated with FI among older children and adolescents. Added sugars were not associated with FI, but intake was excessive across the population at 15% of total daily energy intake. Decreasing FI may help improve dietary quality of Mexican children and adolescents.

Very Low Food Security in US Households Is Predicted by Complex Patterns of Health, Economics, and Service Participation

Background: Very low food security (VLFS) happens at the intersection of nuanced and complex patterns of risk characteristics across multiple domains. Little is known about the idiosyncratic situations that lead households to experience VLFS.Objective: We used classification and regression tree (CART) analysis, which can handle complex combinations of predictors, to identify patterns of characteristics that distinguish VLFS households in the United States from other households.Methods: Data came from 3 surveys, the 2011-2014 National Health Interview Survey (NHIS), the 2005-2012 NHANES, and the 2002-2012 Current Population Survey (CPS), with sample participants aged ≥18 y and households with income <300% of the federal poverty line. Survey participants were stratified into households with children, adult-only households, and older-adult households (NHIS, CPS) or individuals aged 18-64 y and individuals aged ≥65 y (NHANES). Household food security was measured with the use of the 10-item US Adult Food Security Scale. Variables from multiple domains, including sociodemographic characteristics, health, health care, and participation in social welfare and food assistance programs, were considered as predictors. The 3 data sources were analyzed separately with the use of CART analysis.Results: Household experiences of VLFS were associated with different predictors for different types of households and often occurred at the intersection of multiple characteristics spanning unmet medical needs, poor health, disability, limitation, depressive symptoms, low income, and food assistance program participation. These predictors built complex trees with various combinations in different types of households.Conclusions: This study showed that multiple characteristics across multiple domains distinguished VLFS households. Flexible and nonlinear methods focusing on a wide range of risk characteristics should be used to identify VLFS households and to inform policies and programs that can address VLFS households' various needs.

Understanding differences between summer vs. school obesogenic behaviors of children: the structured days hypothesis

BACKGROUND

Although the scientific community has acknowledged modest improvements can be made to weight status and obesogenic behaviors (i.e., physical activity, sedentary/screen time, diet, and sleep) during the school year, studies suggests improvements are erased as elementary-age children are released to summer vacation. Emerging evidence shows children return to school after summer vacation displaying accelerated weight gain compared to the weight gained occurring during the school year. Understanding how summer days differ from when children are in school is, therefore, essential.

DISCUSSION

There is limited evidence on the etiology of accelerated weight gain during summer, with few studies comparing obesogenic behaviors on the same children during school and summer. For many children, summer days may be analogous to weekend days throughout the school year. Weekend days are often limited in consistent and formal structure, and thus differ from school days where segmented, pre-planned, restrictive, and compulsory components exist that shape obesogenic behaviors. The authors hypothesize that obesogenic behaviors are beneficially regulated when children are exposed to a structured day (i.e., school weekday) compared to what commonly occurs during summer. This is referred to as the 'Structured Days Hypothesis' (SDH). To illustrate how the SDH operates, this study examines empirical data that compares weekend day (less-structured) versus weekday (structured) obesogenic behaviors in U.S. elementary school-aged children. From 190 studies, 155 (~80%) demonstrate elementary-aged children's obesogenic behaviors are more unfavorable during weekend days compared to weekdays.

CONCLUSION

In light of the SDH, consistent evidence demonstrates the structured environment of weekdays may help to protect children by regulating obesogenic behaviors, most likely through compulsory physical activity opportunities, restricting caloric intake, reducing screen time occasions, and regulating sleep schedules. Summer is emerging as the critical period where childhood obesity prevention efforts need to be focused. The SDH can help researchers understand the drivers of obesogenic behaviors during summer and lead to innovative intervention development.

The National Health and Nutrition Examination Survey's Food Insecurity Questionnaire Completed by Children: Effects of Assessment Mode (Classroom versus Interview)

The National Health and Nutrition Examination Survey's food insecurity questionnaire was administered to 155 children (77 African American, 65 White, 13 "Other" [7 Hispanic; 6 mixed races]) in grade 4 twice, 28-32 days apart. Test-retest reliabilities were modest and somewhat similar for assessment mode (classroom, interview) and subgroup variables (gender, race, socioeconomic status, academic achievement, body mass index percentile, social desirability). As academic achievement increased, White and Other children reported less food insecurity, and African-American children reported slightly less. As social desirability increased, White and African-American children reported slightly more food insecurity, and Other children reported substantially more. Although the questionnaire may be acceptable for use with diverse groups of children in grade 4, validation is needed.

Prevalence of Food Insecurity in Low-Income Neighborhoods in West Texas

OBJECTIVE

To determine the prevalence of food insecurity and the coping strategies and to investigate the role of safety nets among low-income households in urban and rural west Texas.

DESIGN

The Core Food Security Module, an 18-item scale, was used in a cross-sectional purposeful convenience sample comparing rural and urban households, whereas the demographic survey assessed participation in food assistance/safety net programs.

SETTING

Rural and urban neighborhoods in west Texas.

PARTICIPANTS

Sample size of 191 participants from low-income households, predominantly African American and Hispanic people.

MAIN OUTCOMES MEASURES

Levels of food insecurity and use of safety nets.

ANALYSES

Comparisons between rural and urban households and between food-secure and food-insecure households were analyzed using the chi-square test of independence for categorical variables. Fisher's exact test was used whenever the number in each cell was < 5 in 2 × 2 contingency tables.

RESULTS

Prevalence of household and child food insecurity in west Texas was 63% and 43%, respectively. Forgoing balanced meals was a common coping strategy. There was high intake of affordable energy-intense foods.

CONCLUSIONS AND IMPLICATIONS

The high prevalence of food insecurity in low-income households in west Texas led to high intake of energy-intense food with low nutrients, resulting in higher prevalence of anemia, obesity, and other chronic diseases. There was low participation in safety net programs. Educational interventions on food choices are recommended.

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

Objective:

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

Data source:

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

Data synthesis:

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

Conclusions:

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

Measurement of the dimensions of food insecurity in developed countries: a systematic literature review

OBJECTIVE

Food insecurity is a salient health issue comprised of four dimensions - food access, availability, utilization and stability over time. The aim of the present study was to conduct a systematic literature review to identify all multi-item tools that measure food insecurity and explore which of the dimensions they assess.

DESIGN

Five databases were searched (CENTRAL, CINAHL plus, EMBASE, MEDLINE, TRIP) for studies published in English since 1999. Inclusion criteria included human studies using multi-item tools to measure food security and studies conducted in developed countries. Manuscripts describing the US Department of Agriculture Food Security Survey Module, that measures 'food access', were excluded due to wide acceptance of the validity and reliability of this instrument. Two authors extracted data and assessed the quality of the included studies. Data were summarized against the dimensions of food insecurity.

SETTING

A systematic review of the literature.

SUBJECTS

The majority of tools were developed in the USA and had been used in different age groups and cultures.

RESULTS

Eight multi-item tools were identified. All of the tools assessed the 'food access' dimension and two partially assessed the dimensions 'food utilization' and 'stability over time', respectively. 'Food availability' was not assessed by existing tools.

CONCLUSIONS

Current tools available for measuring food insecurity are subjective, limited in scope, with a majority assessing only one dimension of food insecurity (access). To more accurately assess the true burden of food insecurity, tools should be adapted or developed to assess all four dimensions of food insecurity.