The association of child and household food insecurity with childhood overweight status

Food Banks as a "Treasure Trove": Users' Experiences of a Western Australian Food Relief Organization

Food banks are providing crucial relief as food insecurity increases worldwide. While these services are essential for vulnerable populations, there is variability in foods available and users may experience poor nutritional quality, and an overabundance of discretionary foods, contributing to public health risks including overnutrition and obesity. Understanding how customers perceive food availability, variety, and quality is important to inform relief services and health interventions. This study reports the findings of a convergent parallel mixed-methods investigation of user experiences and perceptions of food availability, variety, and quality at a major food bank in Western Australia. Food bank customers (N = 207) at a food bank branch and mobile van locations completed a survey, with an option to complete a subsequent semi-structured interview (n = 15). Approximately 80% of the survey sample had low (48%) or very low (30%) food security, half of the sample had been using the food bank for longer than 6 months, and 77% reported the food bank as their first choice for food. Three-quarters (77%) reported financial barriers to a balanced diet in the past twelve months and described how limited availability and variety complicated shopping. Interviewees explained complex perceptions of these issues, including favouring healthy food while considering discretionary food as a "luxury" that enhanced their quality of life. Our findings suggest that food bank users experience barriers to maintaining a balanced diet, encounter variable supplies of healthy and nutritious foods, and have concerns about the impacts of frequent discretionary food consumption. These findings have implications for public health promotion.

Relationships between Food Insecurity, Self-Efficacy, and Changes in Body Mass Index among the Youth in Taiwan: Analysis from a Longitudinal Cohort Survey

BACKGROUND

Food insecurity is a heightened concern among economically disadvantaged youth, and it may contribute to the atypical body mass index (BMI) patterns frequently observed in this group. Self-efficacy seems to intervene in the negative impacts of contextual restraints. This study investigated the relationship between food insecurity, self-efficacy, and BMI trajectory among economically disadvantaged Taiwanese youth.

METHODS

We utilized three-wave longitudinal data from the Taiwan Database of Children and Youth in Poverty. The Food Insecurity Score (FIS) assessed food insecurity with a 4-item scale measuring reduced meal frequency, hunger, skipping meals, and economic constraints. Moreover, the General Self-Efficacy Scale (GSES) assessed self-efficacy, showcasing the ability to handle stress effectively and envision success scenarios, contributing to positive outcomes. By employing latent growth modeling, we were able to delineate the impacts of baseline food insecurity and self-efficacy on initial BMI and its subsequent growth trajectory.

RESULTS

Elevated baseline FIS significantly predicted higher initial BMI (coefficient = 0.420, p = 0.042). Baseline GSES was negatively associated with initial BMI (coefficient = -0.093, p < 0.001) but positively predicted the BMI growth rate (coefficient = 0.023, p = 0.011).

CONCLUSION

Enhancing self-efficacy may be an effective multidisciplinary intervention to address psychosocial and socioeconomic factors when tackling weight problems in vulnerable youth groups.

Childhood Obesity: An Updated Review

BACKGROUND

Childhood obesity is an important and serious public health problem worldwide.

OBJECTIVE

This article aims to familiarize physicians with the evaluation, management, and prevention of childhood.

METHODS

A PubMed search was conducted in May, 2021, in Clinical Queries using the key terms "obesity" OR "obese". The search included clinical trials, randomized controlled trials, case-control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to English literature and children. The information retrieved from the above search was used in the compilation of the present article.

RESULTS

Most obese children have exogenous obesity characterized by a growth rate for height above the 50th percentile, normal intelligence, normal genitalia, and lack of historical or physical evidence of an endocrine abnormality or a congenital syndrome. Obese children are at risk for dyslipidemia, hypertension, diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, psychosocial disturbances, impaired quality of life, and shorter life expectancy. The multitude of serious comorbidities necessitates effective treatment modalities. Dietary modification, therapeutic exercise, and behavioral modification are the fundamentals of treatment. Pharmacotherapy and/or bariatric surgery should be considered for obese individuals who do not respond to the above measures and suffer from a serious comorbid condition.

CONCLUSION

Childhood obesity, once established, is often refractory to treatment. Most treatment programs lead to a brief period of weight loss, followed by rapid re-accumulation of the lost weight after the termination of therapy. As such, preventive activity is the key to solving the problem of childhood obesity. Childhood obesity can be prevented by promoting a healthy diet, regular physical activity, and lifestyle modification. Parents should be encouraged to get involved in school and community programs that improve their children's nutritional status and physical activity.

Patterns of participation in summer programming among United States' elementary children from low-income urban households: Results from the project SWEAT study

Food insecurity increases among marginalized children during the summer when school is out of session. Summer programming that offers access to healthy meals and snacks may reduce the risk. There is a national call in the US for more research to assure equitable access to summer programming. The objective of this prospective observational study was to characterize patterns of participation in summer programming among elementary children from low-income urban neighborhoods of metropolitan[Blinded]. Summer programming was broadly defined (e.g., church, school, recreation center, community center). Caregivers(n = 100) received weekly text messages via TextIt during the summer (Jun-Aug 2017). They were asked: "How many days this week did [ChildName] attend a summer program? Please respond with a number from 0 to 5, where 0 - no days, 2 - 2 days, etc." Weekly counts were summed. Stepwise logistic and linear regression models were conducted to examine differences in patterns of attendance according to key sociodemographic characteristics. Mean age was 7.03 ± 0.23. 52 % identified as female, 70 % were low-income, and 80.0 % identified as Black. 51 % attended summer programming at least once; 49 % never attended. Those who attended at least once vs. not at all were more likely to be male(p < 0.01); 62.75 % males vs. 37.25 % females attended summer programming at least once, whereas 67.35 % females compared to 32.65 % males never attended. Overall mean attendance was 10.40 ± 1.43 days(out of 50). Mean + SE attendance was lower for females (7.52 + 1.76) vs. males (13.52 + 2.21)(p < 0.05), and non-Black (4.30 + 1.97) vs. Black (11.93 + 1.67)(p = 0.01) children. Future research is needed to understand barriers to participation in summer programming.

Prevalence and associations between food insecurity and overweight/obesity among native Hawaiian and Pacific Islander adolescents

OBJECTIVE

This study estimates the prevalence of, and associations between, family food insecurity and overweight/obesity among Native Hawaiian and Pacific Islander (NHPI) adolescents and explores socio-demographic factors which might have a moderation effect on the association.

DESIGN

Cross-sectional study using 2014 NHPI-National Health Interview Survey data reported by a parent or guardian. Family-level food security was assessed by the US Department of Agriculture 10-item questionnaire. BMI for age and sex ≥ 85th and 95th percentiles defined overweight and obesity, respectively, according to US Centers for Disease Control and Prevention criteria.

SETTING

The USA, including all 50 states and the District of Columbia.

PARTICIPANTS

383 NHPI adolescents aged 12-17 in the USA.

RESULTS

A third (33·5 %) of NHPI adolescents aged 12-17 were overweight (19·1 %) or obese (14·4 %); 8·1 % had low food security; and 8·5 % had very low food security. Mean family food security score was 1·06, which corresponds to marginal food security. We found no association between family food insecurity and adolescent overweight/obesity or between any other covariates and overweight/obesity, except for family Supplemental Nutrition Assistance Program (SNAP) participation. Odds of being overweight/obese were 77 % lower for adolescents in families participating in SNAP (OR: 0·23, 95 % CI: 0·08, 0·64, P = 0·007). The association between SNAP participation and lower odds of overweight/obesity was particularly pronounced for adolescent girls in food-insecure families.

CONCLUSIONS

The association between SNAP participation and lower odds of overweight/obesity suggests potential benefit of research to determine whether interventions to increase SNAP enrollment would improve NHPI adolescents' health outcomes.

Food insecurity, body mass index, socio-economic status, and food intake in lactating and non-lactating mothers with children under two years

BACKGROUND

food insecurity (FI) is considered as an essential public health problem which may have detrimental effects on people's health. The aim of present study was to evaluate FI, body mass index, quantity and quality of food intake in lactating and non-lactating mothers with children under two years.

METHODS

in this cross-sectional study 307 mothers (237 lactating and 70 non-lactating) were participated. Socio-economic and demographic information were gathered by questionnaires. FI of families was evaluated by the questionnaire of the United States Department of Agriculture (USDA) Household Food Security. For assessing quality and quantity of food intake of mothers, dietary diversity score (DDS), diet quality index-international (DQI-I) and nutrient adequacy ratio (NAR) were calculated. Weight and height of participants were measured and body mass index (BMI) was calculated. Finally, Chi-squared test, analysis of variance (ANOVA) and linear regression were used for statistical analysis.

RESULTS

in this study the rate of underweight, normal weight, overweight, and obesity in mothers was 0.3%, 39.2%, 42.3%, and 18.2%, respectively. Among the determinants of BMI, household food security status had the greatest effect (Beta=-1.584, P < 0.001) and mother age had the least effect (Beta = 0.101, P = 0.013). Mother's occupational and educational status, having facilities, physiological status of mother, and house size had significant correlation with NAR. Mother's occupational and educational status, and having facilities had significant relationship with DDS, too. Also, the significant correlation of Mother's education, having facilities, and physiological status of mother with DQI-I were found.

CONCLUSIONS

we found that Household food security status had the most effect on BMI of mothers. In this study, the best nutrient adequacy and dietary diversity were found in the obese group and the most diet quality was found in the normal weight group.

Experiences with Pandemic Food Access Among Clinic-Based Community Supported Agriculture Program Participants

OBJECTIVES

The COVID-19 pandemic intensified food insecurity (FI) across the country, and families with children were disproportionately affected. This study explores experiences with FI and social resources during the pandemic among families participating in a free, clinic-based community supported agriculture (CSA) program.

METHODS

Free weekly boxes of organic produce from local farms were distributed to pediatric caregivers for 12 weeks at two pediatric outpatient centers associated with a children's hospital in a low-income, urban area. Demographics and a two-question FI screen were collected. Caregivers were purposively selected to participate in semi-structured interviews about experiences with FI and community or federal nutrition programs during the pandemic. Interviews were recorded and transcribed. Content analysis with constant comparison was used to code interviews inductively and identify emerging themes.

RESULTS

The 31 interviewees were predominantly female; more than half were Black, FI, and SNAP beneficiaries. Study participants were more likely to have repeat participation in the CSA program. Interviews elucidated four major themes of barriers to food access during the pandemic: (1) fluctuations in price, availability, and quality of food; (2) financial strain; (3) faster consumption with all family members home; (4) shopping challenges: infection fears, store closures, childcare. SNAP, WIC, and school meal programs were generally facilitators to food access. Increased SNAP allotments were particularly useful, and delays of mailed WIC benefits were challenging.

CONCLUSIONS FOR PRACTICE

This qualitative study describes facilitators and barriers to food access among clinic-based CSA program participants during the pandemic. The findings highlight areas for further exploration and potential policy intervention.

The Portuguese economic crisis is associated with socioeconomic and sex disparities on children's health-related behaviors and obesity: A cross-sectional study

OBJECTIVES

Our objective was to examine the relationship between the 2008 and 2015 economic crisis and children's physical activity (PA) outcomes, eating behaviors and obesity prevalence, while considering sex inequalities and familial socioeconomic status.

METHOD

This is a cross-sectional study, including data collected in 2016/2017 among 5134 children aged 6-11 years (mean age: 8.11 ± 1.24; 50.0% boys). Children's height, weight, and waist circumference were objectively measured. Children's sleep- and screen-time, participation in organized sports, and specific dietary habits were reported parental-reported using a standardized questionnaire. An economic crisis impact score, with data from 10 indicators of economic needs in the family, was used to characterize the crisis' impact.

RESULTS

First, the prevalence of overweight and obesity was higher in children whose families had a higher impact of the crisis. Second, children's intake of fruit and high-fat food, screen-time, sleep-time, and participation in organized sports differed according to the level of impact of the economic crisis. Third, the association between health-related behaviors and the impact of the economic crisis was stronger for girls compared to boys.

CONCLUSION

Our findings give us an indication of how economic crises may drive changes in health outcomes.

Social Determinants of Cardiovascular Health in US Adolescents: National Health and Nutrition Examination Surveys 1999 to 2014

Background Cardiovascular health (CVH) is suboptimal in US adolescents. Social determinants of health (SDOH) may affect CVH. We examined SDOH by race and ethnicity and assessed for associations between SDOH and CVH among US adolescents. Methods and Results We analyzed data from the National Health and Nutrition Examination Survey for 3590 participants aged 12 to 19 years from 1999 to 2014. SDOH variables were chosen and an SDOH score assigned (range, 0-7 points; higher=more favorable). CVH was classified according to American Heart Association criteria. We estimated population prevalence and used multivariable linear and polytomous logistic regression for associations between SDOH and CVH. SDOH varied by group, with the non-Hispanic White group (n=1155) having a higher/better mean SDOH score compared with non-Hispanic Black (n=1223) and Mexican American groups (n=1212). Associations between SDOH and CVH differed between racial and ethnic groups (interaction P<0.0001). For the non-Hispanic White group, each additional favorable SDOH variable was associated with a CVH score higher/better by 0.3 points (β, 0.3, P<0.0001), 20% higher odds for moderate (versus low) CVH (odds ratio [OR], 1.2 [95% CI, 1.1-1.4]), and 80% higher odds for high/favorable (versus low) CVH (1.8 [1.5-2.1]). Associations between SDOH and CVH were more modest among the Mexican American group (β, 0.12, P=0.001; OR 1.1 [1.0-1.2] for moderate CVH; OR, 1.3 [1.1-1.6] for high CVH) and were not significant among the non-Hispanic Black group (β, 0.07; P=0.464). Conclusions SDOH and CVH were more favorable for non-Hispanic White adolescents compared with non-Hispanic Black and Mexican American adolescents. SDOH were strongly associated with CVH among the non-Hispanic White group. Racially and culturally sensitive public policy approaches may improve CVH in US adolescents.

"The Shelves Are Bare": The Impact of COVID-19 on Families Enrolled in a Pediatric Produce Prescription Program

Objectives A large pediatric clinic in Flint, Michigan, implemented a produce prescription program for youth to address enduring challenges with food access and food insecurity. Approximately 18 months later, on March 23, 2020, the State of Michigan issued a "stay home, stay safe" executive order in response to the COVID-19 pandemic. This study sought to (1) explore caregiver experiences with access to and utilization of the prescription program during COVID-19; and (2) understand perceived changes in the food environment during the "stay home, stay safe" executive order. Methods Researchers collected data through recorded, semi-structured telephone interviews with caregivers of children who received at least one produce prescription and had previously enrolled in a preliminary effectiveness study on the prescription program. We transcribed the recordings verbatim for textual analysis. Examining the qualitative data using thematic analysis, we identified patterns across transcripts and formulated illustrative themes. Results Fifty-six caregivers (mean age, 41.3 ± 10.3 years) participated in interviews. The majority were female (91%), African American (70%), and Flint residents (75%). Recurrent themes, each centered around changes in the food environment resulting from COVID-19, emerged: (1) produce prescription access and utilization; (2) food access constraints; (3) food shopping adjustments; and (4) food insecurity stress. Perceived consequences of COVID-19 included increased anxiety related to food shopping and food insecurity alongside challenges accessing and utilizing the produce prescription program. Conclusions This study highlights the many ramifications of the COVID-19 pandemic on vulnerable families. More comprehensive efforts are necessary to address substantial barriers to healthy food access and affordability caused by the recent pandemic.

Household food insecurity and its association with overweight and obesity in children aged 2 to 14 years

BACKGROUND

The objective was to estimate the prevalence of household food insecurity (HFI) depending on sociodemographic factors and its association with lifestyle habits and childhood overweight and obesity.

METHODS

Data was collected from 1,938 children aged 2 to 14 years who participated in the "Study about Malnutrition" of the Community of Madrid. Weight and height were obtained through physical examination. Body mass index was calculated as weight/height² (kg/m²) and the criteria of the WHO were used for determining conditions of overweight and obesity. The participants' parents answered a structured questionnaire about their diet, lifestyle (physical activity and screen time), and food insecurity. The diet quality was assessed with the Healthy Eating Index in Spain and food insecurity, defined as the lack of consistent access to sufficient food for a healthy life, was measured via three screening questions and the Household Food Insecurity Access Scale (HFIAS). Odds Ratios (ORs) and Relative Risk Ratios (RRRs) were estimated using logistic regression models and adjusted for confounding variables.

RESULTS

The overall prevalence of HFI was 7.7% (95% CI: 6.6‒9.0), with lower values in children 2 to 4 years old (5.7%, 95% CI: 4.0‒8.1) and significantly higher values in households with low family purchasing power [37.3%; OR: 8.99 (95% CI: 5.5‒14.6)]. A higher prevalence of overweight (33.1%) and obesity (28.4%) was observed in children from families with HFI, who presented a lower quality diet and longer screen time compared to those from food-secure households (21.0% and 11.5%, respectively). The RRR of children in families with HFI relative to those from food-secure households was 2.41 (95% CI: 1.5‒4.0) for overweight and 1.99 (95% CI: 1.2‒3.4) for obesity.

CONCLUSION

The prevalence of HFI was high in the paediatric population, especially in households with low family purchasing power. HFI was associated with lower diet quality and higher prevalence of childhood overweight and obesity. Our results suggest the need for paediatric services to detect at-risk households at an early stage to avoid this dual burden of child malnutrition.

Obesity in Adolescents: Understanding the Combined Role of Food Security and Emotional and Behavioral Disorders

PURPOSE

To examine the associations and interactions between levels of food security and emotional and behavioral disorders with obesity in adolescents.

METHODS

Multiple logistic regression modeling was used to analyze the association of adolescent obesity with levels of food security and emotional and behavior disorders in children aged 12-17 years using data from National Health Interview Survey 2016-2018 combined years. Presence of emotional and behavioral disorders within food security categories was added to logistic regression modeling to examine interactions.

RESULTS

When added individually to multiple logistic regression models, marginal and low food security, Attention Deficit Hyperactivity Disorder (ADHD) and anxiety were associated with increased odds of obesity, but very low food security and depression were not. Within the group of adolescents with very low food security, those with anxiety, depression, or ADHD had a nearly two to three-fold increase in odds of obesity compared to adolescents with very low food security and no emotional and behavioral disorders. A similar increase in the odds of obesity with the presence of anxiety, depression, or ADHD was not seen in the adolescents with high food security.

DISCUSSION

This study finds a significant interaction between food security level and emotional and behavioral disorders. The distinction that very low food security in adolescents is only associated with obesity when either anxiety, depression or ADHD are present, but not independently, is an important contribution to understanding complex interactions contributing to obesity.

Farm to Families: Clinic-based Produce Provision to Address Food Insecurity During the Pandemic

With rising rates of food insecurity (FI) during the pandemic, we implemented a clinic-based, community-supported agriculture program at 2 outpatient centers in low-income areas associated with an urban children's hospital and evaluated (1) the program's ability to reach FI families without preceding eligibility criteria, and (2) caregiver experiences and preferences for programming. Free boxes of produce were distributed weekly to caregivers of pediatric patients during a 12 week pilot period. Ability to reach the target population was measured by number of participating families and caregiver demographic information. We purposively sampled 31 caregivers for semistructured interviews on a rolling basis to understand program preferences. Content analysis with constant comparison was employed to code interviews inductively and identify emerging themes. Of 1472 caregivers who participated in the program, nearly half (48.3%) screened positive for FI, and 45% were receiving federal food assistance. Although many caregivers were initially "surprised" by the clinic-based program, they ultimately felt that it reinforced the hospital's commitment to "whole health" and perceived it to be safer than other food program settings during the pandemic. Several programmatic features emerged as particularly important: ease and efficiency of use, kindness of staff, and confidentiality. This advocacy case study demonstrates that a community-supported agriculture program in the clinical setting is an acceptable approach to supporting food access during the pandemic, and highlights caregiver preferences for a sustainable model. Furthermore, our data suggest that allowing families to self-select into programming may streamline operations and potentially facilitate programmatic reach to families who desire assistance.

Designing the Interventions to Mitigate the Barriers of Coordination in Handling Food Security: Insight from Central Java Province

This study aims to identify the underlying barriers that may prevent public policy coordination among stakeholders in dealing with food security in Central Java Province and suggest recommendations to enhance the coordination. This study used primary data from a questionnaire that the six government agencies’ experts filled out. These experts were asked to identify the relevance and the importance of each barrier and formulate a suitable policy recommendation. There were three data processing techniques used in this study: Content Validity Analysis, Interpretative Structural Modelling (ISM) Method, and Delphi Method. The result of the Content Validity Analysis indicated 22 valid barriers. The result of the ISM method indicated eight barriers occupied the topmost level (complicated problems, insufficient sharing of information, ambiguities and lack of clarity, gap of coordination implementations between the rules and policies with the actual practice, fewer budget allocations, different aims and priorities, lack of motivation to collaborate among stakeholders from various disciplines, and weak of infrastructure). The result of the ISM method also indicated three “very significant” barriers: inadequate human resources, the limited capability of the regional government, and lack of communication and high specialization in multisector collaboration. Then, the result of the Delphi Method indicated several recognize policies to mitigate those barriers. Moreover, related to the limitation of this study, future studies should focus on the barriers in diverse places nations or compare different regions or countries; include more experts from the various stakeholder group, and test the recognized policies in the real world.

Experiencing Household Food Insecurity During Adolescence Predicts Disordered Eating and Elevated Body Mass Index 8 Years Later

PURPOSE

Growing evidence indicates that experiencing household food insecurity during adolescence is associated with disordered eating and elevated body mass index (BMI). However, little is known about the temporal nature of these relationships. The current longitudinal study examined how adolescent experiences of household food insecurity are related to disordered eating and weight status 8 years later.

METHODS

A population-based sample of ethnically/racially and socioeconomically diverse participants (n = 1,340) were surveyed as adolescents (mean age = 14.5 years) and as young adults (mean age = 22.0 years). Parents/caregivers completed the six-item U.S. Household Food Security Survey Module at baseline.

RESULTS

Household food insecurity was common at baseline (37.8% of sample). In analyses adjusted for ethnicity/race and parental education, adolescent food insecurity longitudinally predicted a higher new onset of binge eating (food insecure: 21.3% vs. food secure: 16.2%, p = .038) and BMI ≥30 kg/m² (food insecure: 15.9% vs. food secure: 11.0%, p = .024), but not unhealthy weight control behaviors in young adulthood. The majority of adolescents with unhealthy weight control behaviors and elevated BMI still had these problems in young adulthood, but persistence was not associated with adolescent household food insecurity for any outcome.

DISCUSSION

Results of this longitudinal study suggest that household food insecurity during adolescence is a risk factor for disordered eating and elevated BMI in young adulthood, highlighting a need to comprehensively address these intersecting problems.

Examining Associations Between Food Insecurity, Inhibitory Control, and Body Mass Index in Preschoolers

OBJECTIVE

This study examines relations between food insecurity, inhibitory control, and body mass index (BMI) in early childhood.

METHOD

The sample comes from an evaluation of a state-funded prekindergarten program and includes 126 children (mean age = 4.73 yrs, female = 42%) from families with low incomes. Parents reported on their child's food insecurity. Child inhibitory control was assessed using a performance-based task, and children's height and weight were objectively collected at the same time as the inhibitory control assessment. A regression model was used to test whether inhibitory control moderated the association between food insecurity and BMI. The model included a large battery of covariates and adjusted for clustering at the classroom level. Ad hoc analyses were conducted to examine the robustness of findings to different conceptualizations of food insecurity based on the US Department of Agriculture's categories for severity.

RESULTS

A significant interaction revealed that inhibitory control moderated the association between food insecurity and children's BMI percentile. Investigation of the simple slopes suggested that greater food insecurity was related to a higher BMI percentile among children who demonstrated stronger inhibitory control. In addition, results from ad hoc analyses examining categories of food insecurity indicated that experiencing very low food security was also related to a higher BMI among children with average and strong inhibitory control.

CONCLUSION

This study makes a unique contribution to the existing literature by examining relations among food insecurity, inhibitory control, and BMI during a critical period in children's physical and brain development. Findings have implications for public health efforts to address childhood obesity among populations with low incomes.

Food Insecurity and Cardiometabolic Markers: Results From the Study of Latino Youth

OBJECTIVES

Hispanic/Latino youth bear a disproportionate burden of food insecurity and poor metabolic outcomes, but research linking the two in this diverse population is lacking. We evaluated whether lower household and child food security (FS) were adversely associated with a metabolic syndrome (MetS) composite variable and clinically measured cardiometabolic markers: waist circumference, fasting plasma glucose, triglycerides, high-density lipoprotein cholesterol, and systolic and diastolic blood pressure.

METHODS

This cross-sectional study included 1325 Hispanic/Latino youth aged 8 to 16 years from the Hispanic Community Children's Health Study/Study of Latino Youth, a study of offspring of adults enrolled in the Hispanic Community Health Survey/Study of Latinos. Multivariable regression analyses were used to assess relationships between household FS (high, marginal, low, very low) and child FS (high, marginal, low/very low) status, separately, and our dependent variables, adjusting for participant age, sex, site, parental education, and poverty-income ratio.

RESULTS

For both FS measures, youth in the lowest FS category had significantly lower high-density lipoprotein cholesterol than those with high FS (household FS: -3.17, 95% confidence interval [CI]: -5.65 to -0.70, child FS: -1.81, 95% CI: -3.54 to -0.09). Low/very low versus high child FS was associated with greater fasting plasma glucose (β = 1.37, 95% CI: 0.08 to 2.65), triglycerides (β = 8.68, 95% CI: 1.75 to 15.61), and MetS expected log counts (β = 2.12, 95% CI: 0.02 to 0.45).

CONCLUSIONS

Lower FS is associated with unfavorable MetS-relevant cardiometabolic markers in Hispanic/Latino youth. These findings also support the use of a child-level versus a household-level measure to capture the health implications of food insecurity in this population.

Effects of parental public health insurance eligibility on parent and child health outcomes

Many states expanded their Medicaid programs to low-income adults under the Affordable Care Act (ACA). These expansions increased Medicaid coverage among low-income parents and their children. Whether these improvements in coverage and healthcare use lead to better health outcomes for parents and their children remains unanswered. We used longitudinal data on a large, nationally representative cohort of elementary-aged children from low-income households from 2010 to 2016. Using a difference-in-differences approach in state Medicaid policy decisions, we estimated the effect of the ACA Medicaid expansions on parent and child health. We found that parents' self-reported health status improved significantly post-expansion in states that expanded Medicaid through the ACA by 4 percentage points (p < 0.05), a 4.7% improvement. We found no significant changes in children's use of routine doctor visits or parents' assessment of their children's health status. We observed modest decreases in children's body mass index (BMI) of about 2% (p < 0.05), especially for girls.

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.

Physical development and mental health in South African perinatally HIV-positive adolescents on antiretroviral therapy and their caregivers with and without household food insecurity

Background

Perinatally acquired HIV-infected (PHIV+) adolescents have shown impairments in neurocognitive function and mental health problems compared with their peers. The contribution of food insecurity to such impairments has not been explored.

Objectives

The aim of this report has been to explore the contribution of food insecurity to neurocognitive impairment and mental health problems in adolescents with perinatally-acquired HIV infection.

Method

A total of 248 PHIV+ adolescents and healthy controls aged between 9 and 12 years completed a neuropsychological battery, the Childhood Behaviour Checklist (CBCL) and the Becks Youth Inventory. Head circumference, body mass index (BMI), height for age (HAZ), Tanner pubertal staging, albumin, haemoglobin, CD4 and viral loads were also measured. Participants’ caregivers were interviewed about their mental health and household food security. T-tests were used to assess for differences in food secure and food insecure households.

Results

Caregivers of PHIV+ adolescents reported higher levels of depressive symptoms and household food insecurity. Increased food insecurity was associated with more behavioural problems in adolescents, as well as lower haemoglobin and albumin levels, faster processing speed and increased Tanner staging in boys. Body mass index and HAZ were not affected by food insecurity.

Conclusion

These findings suggest that household food insecurity is associated with some altered behavioural, physical and physiological outcomes, which could complicate and compound the existing difficulties in PHIV+ households.

Changes in prevalence of overweight in adolescents living in areas highly vulnerable to food insecurity

This study ascertained changes, over 5 years, in the prevalence of overweight in adolescents and associations with socio-demographic variables and food insecurity. Two cross-sectional population-based studies were conducted with 511 (2005) and 314 (2010) adolescents resident in Campos Elíseos (Duque de Caxias-RJ). Overweight was evaluated by sex and age specific cut-off points of BMI (weight/height²). The prevalence of food insecurity was investigated using the Brazilian Food Insecurity Scale. Logistic regression was used to determine the association between changes in overweight over time and sex, age, skin colour, and food insecurity. Overweight was found to increase significantly, between 2005 and 2010, in boys who were younger (from 20.1% to 49.5%), black or brown (22.2% to 37.3%), those with per capita income of up to half a minimum wage (13.6% to 32.5%) and those experiencing moderate or severe food insecurity (9.2% to 36.3%). It was concluded that overweight increased significantly in adolescents living in an area of food insecurity, and that younger, black or brown, lower-income adolescents, and those living with moderate and severe food insecurity, were more exposed to that increase.

The Great Recession weighted on Portuguese children: A structural equation modeling approach considering eating patterns

OBJECTIVES

Further evidence on how the Great Recession was associated with childhood obesity is needed, particularly when the world is facing a new and severe economic downturn caused by the COVID-19 pandemic. This study explores: (1) the direct association of the 2008's economic crisis with eating patterns and body mass index (BMI), among children, independently of their socioeconomic status (SES), and (2) the indirect association between the crisis and children's BMI, by using eating patterns as mediators.

METHODS

A sample of children (n = 8472, mean age: 7.17 years old, 50.8% male) was recruited in schools from the cities of Porto, Coimbra and Lisbon, Portugal. Children's height and weight were objectively measured; BMI was calculated. Other data were collected by a parental questionnaire. A structural equation modeling studied the associations between the economic crisis impact, eating patterns, and BMI; model was adjusted for SES.

RESULTS

Children in families that reported a greater impact of the economic crisis showed higher consumption of unhealthy food items and lower consumption of healthy foods, regardless of SES. Indirectly, children whose parents scored higher in the economic crisis impact had higher BMI mediated by a higher consumption of cakes/chocolates and lower intake of vegetables/salads.

CONCLUSIONS

The economic crisis was associated with higher BMI and unhealthy eating patterns. Efforts to promote healthy diets and weight are needed at a population level rather than for specific social classes, particularly in the face of a new economic crisis caused by the COVID-19 pandemic.

Anthropometric characteristics of children living in food-insecure households in the USA

OBJECTIVE

This study provides information on food insecurity and child malnutrition in a technologically advanced nation.

DESIGN

Population-based study using multistage probability cluster sampling design to collect survey data. Multivariable regression models were used to determine associations between food security status and various malnutrition indices.

SETTING

We used a national sample from the US National Health and Nutrition Examination Survey 2011-2014.

PARTICIPANTS

The anthropometric and demographic data sets of 4121 children <7 years old were analysed for this study.

RESULTS

Food-insecure infants younger than 6 months had shorter upper arm length (-0·4 cm, P = 0·012) and smaller mid-upper arm circumference (-0·5 cm, P = 0·004); likewise those aged 6 months-1 year had shorter upper arm length (-0·4 cm, P = 0·008), body length (-1·7 cm, P = 0·007) and lower body weight (-0·5 kg, P = 0·008). Food-insecure children younger than 2 years were more likely to be underweight (OR: 4·34; 95 % CI 1·99, 9·46) compared with their food-secure counterparts. Contrariwise, food-insecure children older than 5 years were more likely to be obese (OR: 3·12; 95 % CI 1·23, 7·96).

CONCLUSIONS

Food insecurity associates with child growth deficits in the USA. Food-insecure infants and young children are generally smaller and shorter, whereas older children are heavier than their food-secure counterparts, implying a double burden of undernutrition-overnutrition associated with child food insecurity. Child food and nutrition programmes to improve food insecurity should focus on infants and children in the transition ages.

Food Insecurity and Eating Pathology in Adolescents

Adolescence is a critical period for the emergence of eating disorders, and food insecurity may be related to eating pathology and weight, as evidenced in adults. However, little is known about food insecurity and eating pathology during this developmental period, and associations between food insecurity and body mass index (BMI) are mixed. Therefore, we examined associations between food insecurity and BMI percentile, self-reported eating-related pathology and binge eating, and subgroup differences by race/ethnicity. In a subset, we examined the relationship between food insecurity and real-world hunger, food craving, and loss-of-control eating using ecological momentary assessment (EMA). Fifty-eight adolescents at two sites (clinical sample, n = 38, BMI percentile ≥ 70th; community sample, n = 20, all BMI strata) completed self-report questionnaires. Adolescents were 15.2 ± 2.1 years old, 62% female, 50% Black, 34.5% Hispanic, with BMI percentile = 80.5 ± 25.8 (range 4-99). In the full sample, food insecurity was associated with greater BMI (p < 0.01), higher shape/weight overvaluation (p = 0.04), and greater number of binge eating episodes among those reporting at least one binge episode (p < 0.01), with significant relationships for BMI percentile, shape/weight overvaluation, body dissatisfaction, and binge episode frequency among Hispanic adolescents only (each p < 0.01). As in adults, food insecurity may be a risk factor for eating pathology, particularly for Hispanic teens.

Acceptability and Willingness to Pay for a Meal Kit Program for African American Families with Low Income: A Pilot Study

Food insecurity is a persistent issue among individuals with low income and is associated with various nutrition- and health-related consequences. Creative approaches to increasing food access should be investigated as possible solutions. Meal kits, which are boxes or bags of fresh and shelf-stable ingredients for one or more meals, along with a step-by-step recipe showing how to cook each meal at home, may serve as a creative solution. Meal kits have historically been marketed to higher-income demographics. The purpose of this pilot study was to investigate the utilization, acceptability, and willingness to pay for a healthy meal kit program among African American main food preparers with children and low income (n = 36). Participants received a healthy meal kit with three recipes and ingredients, a cooking incentive, and a nutrition handout weekly for six weeks. Data were collected on participants’ use, acceptability, and willingness to pay for the meal kits and analyzed using descriptive statistics. The intervention was highly utilized, and participants reported high acceptability ratings for most recipes. After the intervention, participants were willing to pay $88.61 ± 47.47 for a meal kit with three meals, each with four portions, which was higher than indicated at baseline and similar to the cost to produce the kits. Meal kits may offer a creative solution to improving food access if affordable for families with low income.

Early Life Exposure to Food Insecurity is Associated with Changes in BMI During Childhood Among Latinos from CHAMACOS

Early life exposures have been associated with obesity later in life. We aim to assess the association between early life exposure to food insecurity and change in BMI throughout childhood and adolescents. Food security status and growth variables from 243 Mother-child dyads from the Center for the Health Assessment of Mothers and Children of Salinas study were assessed 7 times over a 12-year period. Generalized log linear models with Poisson distributions and linear regression models were implemented to assess the associations between early life food insecurity and obesity and growth. Early life food insecurity was associated with a 0.43 (0.01, 0.82) kg/m2 decrease in BMI from age 2 to 3.5, and a 0.92 kg/m2 (0.38, 1.46) increase in BMI among boys from ages 3.5 to 5, after adjusting for covariates. Sex and age modify the association between early life exposure to food insecurity and BMI.

Influence of a Pediatric Fruit and Vegetable Prescription Program on Child Dietary Patterns and Food Security

Limited access to fresh foods is a barrier to adequate consumption of fruits and vegetables among youth, particularly in low-income communities. The current study sought to examine preliminary effectiveness of a fruit and vegetable prescription program (FVPP), which provided one USD 15 prescription to pediatric patients during office visits. The central hypothesis was that exposure to this FVPP is associated with improvements in dietary patterns and food security. This non-controlled longitudinal intervention trial included a sample of caregiver–child dyads at one urban pediatric clinic who were exposed to the FVPP for 1 year. Patients received one USD 15 prescription for fresh produce during appointments. A consecutive sample of caregivers whose children were 8–18 years of age were invited to participate in the study. Dyads separately completed surveys that evaluated food security and dietary behaviors prior to receipt of their first prescription and again at 12 months. A total of 122 dyads completed surveys at baseline and 12-month follow-up. Approximately half of youth were female (52%), and most were African American (63%). Mean caregiver-reported household food security improved from baseline to 12 months (p < 0.001), as did mean child-reported food security (p = 0.01). Additionally, child-reported intake of vegetables (p = 0.001), whole grains (p = 0.001), fiber (p = 0.008), and dairy (p < 0.001) improved after 12 months of exposure to the FVPP. This study provides evidence that pediatric FVPPs may positively influence food security and the dietary patterns of children.

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.

Longitudinal outcomes of body mass index in overweight and obese children with chronic kidney disease

BACKGROUND

Longitudinal changes in body mass index (BMI) among overweight and obese children with chronic kidney disease (CKD) are not well characterized. We studied longitudinal trajectories and correlates of these trajectories, as results may identify opportunities to optimize health outcomes.

METHODS

Longitudinal changes in age-sex-specific BMI z-scores over 1851 person-years of follow-up were assessed in 524 participants of the Chronic Kidney Disease in Children Study. A total of 353 participants were categorized as normal (BMI > 5th to < 85th percentile), 56 overweight (BMI ≥ 85th to 95th percentile) and 115 obese (BMI ≥ 95th percentile) based on the average of three BMI measurements during the first year of follow-up. Studied covariates included age, sex, race, CKD etiology, corticosteroid usage, household income, and maternal education.

RESULTS

In unadjusted analysis, BMI z-scores decreased over time in elevated BMI groups (overweight: mean = - 0.06 standard deviations (SD) per year, 95% CI: - 0.11, - 0.01; obese: mean = - 0.04 SD per year, 95% CI: - 0.07, - 0.01). Among obese children, only age was associated with change in BMI z-score; children < 6 years had a mean decrease of 0.19 SD during follow-up (95% CI: - 0.30, - 0.09). Socioeconomic factors were not associated with change in BMI.

CONCLUSION

Overweight and obese children with CKD demonstrated a significant annual decline in BMI, though the absolute change was modest. Among obese children, only age < 6 years was associated with significant decline in BMI. Persistence of elevated BMI in older children and adolescents with CKD underscores the need for early prevention and effective intervention.

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.

Social Capital as a Positive Social Determinant of Health: A Narrative Review

Social determinants of health influence child health behavior, development, and outcomes. This paper frames social capital, or the benefits that a child receives from social relationships, as a positive social determinant of health that helps children exposed to adversity achieve healthy outcomes across the life course. Children are uniquely dependent on their relationships with surrounding adults for material and nonmaterial resources. We identify and define three relevant aspects of social capital: 1) social support, which is embedded in a 2) social network, which is a structure through which 3) social cohesion can be observed. Social support is direct assistance available through social relationships and can be received indirectly through a caregiver or directly by a child. A child's social network describes the people in a child's life and the relationships between them. Social cohesion represents the strength of a group to which a child belongs (eg, family, community). Pediatric primary care practices play an important role in fostering social relationships between families, the health care system, and the community. Further research is needed to develop definitional and measurement rigor for social capital, to evaluate interventions (eg, peer health educators) that may improve health outcomes through social capital, and to broaden our understanding of how social relationships influence health outcomes.

Sleep, Food Insecurity, and Weight Status: Findings from the Family Life, Activity, Sun, Health, and Eating Study

Background: Shorter sleep duration and lower sleep quality have been previously associated with greater obesity risk among adult samples. Food insecurity has also been found to impact sleep patterns and obesity. Yet few studies have explored associations between sleep, food insecurity, and obesity in adolescent populations, who may have more irregular sleep patterns. Thus, the objectives of this study were to determine associations between measures of sleep, food insecurity, and weight status. Methods: Data were obtained from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study, an online cross-sectional study of parent and adolescent (12-17-year old) dyads. Participants were drawn from a Consumer Opinion Panel representative of the general population of the United States with respect to sex, education, income, age, household size, and region. First, multinomial logistic regression analyses were conducted to determine associations between sleep measures (adolescent-reported average nighttime sleep duration, having a regular bedtime, and having difficulty staying asleep), food insecurity (a validated two-item parent-reported measure), and weight status (being underweight, of healthy weight, overweight, and obese). Weight status was based upon adolescent BMI z-scores using Centers for Disease Control and Prevention growth charts using information from parent report of adolescent height and weight and adolescent-reported age and sex among adolescents (N = 1544). Conditional process models were also fitted to the data to determine whether food insecurity moderates the associations between sleep measures and weight status, and to determine whether the association between food insecurity and weight status is mediated by average sleep duration. Results: Compared to those with food security, a greater percentage of those with food insecurity reported having difficulties staying asleep and a longer average sleep duration. Multinomial logistic regression models demonstrated that having a regular bedtime was associated with lower odds of having obesity, having difficulties staying asleep was associated with greater odds of being underweight, and having food insecurity was associated with greater odds of being overweight. Conditional process models demonstrated that food insecurity did not moderate associations between sleep measures and weight status and that average nighttime sleep duration did not mediate the association between food insecurity and weight status. Conclusions: This is one of the first studies to examine associations between sleep, food insecurity, and weight status among adolescents. Results provide additional support for the need to uncover mechanisms for how sleep and food insecurity affect pediatric obesity using longitudinal data.

Food Insecurity and Obesity in US Adolescents: A Population-Based Analysis

Background: Food insecurity and obesity are significant problems affecting adolescents. There is a paucity of recent data examining this relationship. This study utilizes a recent nationally representative sample of US adolescents to examine the relationship between obesity and food security status, as well as other risk factors. Methods: A cross-sectional analysis of 4777 US adolescents (13-18 years old) was performed using data from the National Health and Nutrition Examination Surveys 2007-2016. Prevalence of obesity based on food security status was calculated. Multivariable logistic regression was performed to examine characteristics of adolescents in relationship to obesity. Results: The prevalence of obesity among adolescents from food insecure households was significantly higher compared to those who were not, with a prevalence ratio of 1.3 (95% CI: 1.2-1.5, p < 0.0001). Food insecurity was associated with a higher unadjusted rate of obesity, with an odds ratio of 1.4 (95% CI: 1.2-1.7, p = 0.0002). After adjustment for potential confounding factors, food insecurity was no longer significantly associated with obesity (OR 1.19, 95% CI: 1.0-1.4, p = 0.08). However, other factors such as black race, Hispanic ethnicity, male sex, and households with a monthly income ≤185% of the poverty line were associated with increased odds of obesity. Conclusions: While the prevalence of obesity in adolescents from food insecure households was higher compared to those who were not, no association between the two was found when accounting for other risk factors. Data on independent food-seeking behaviors of adolescents may help clarify this complex relationship in future work.

Show or tell: Children's learning about food from action vs verbal testimony

BACKGROUND

Childhood obesity continues to be a critical health concern in the United States. Nonetheless, interventions that focus on delivering verbal lessons about food and health to children in preschool classrooms have had only modest effects.

OBJECTIVES

The present study examines the relative effectiveness of showing vs telling children about food to promote healthy eating, with a focus on unfamiliar foods and vegetables.

METHODS

Three- to six-year-old children (n = 71) were tested in a laboratory study in which they watched videos of two people eating apple-broccoli puree. One person took five bites of the food; the other said they liked the food.

RESULTS

Children did not differentiate between the food they saw someone eat and the food they heard someone talk about. Children's food intake was negatively associated with parent reports of children's eating behavior on the Food Fussiness subscale of the Child Eating Behavior Questionnaire. We found similar patterns in an analogous toy task. In an unfamiliar object task, children selected the action demonstration as the right way to use the object.

CONCLUSIONS

We find no evidence that action vs verbal testimony is more persuasive in guiding children's food choices, but action testimony may be persuasive in other domains. The associations between children's food intake and pickiness provide growing evidence of alignment between parent assessments of their children's typical eating behavior and children's food choices in laboratory studies.

The Relationship between Food Insecurity and Risk of Overweight or Obesity in under 18 Years Individuals: A Systematic Review and Meta-Analysis

OBJECTIVE

Food insecurit (FI) has been considered as reason for childhood and adolescent overweight/obesity (OW/OB). Hence, this study was undertaken to assess these relationships.

DESIGN

Related articles were found by searching the Web of Science, Scopus, PubMed and Embase databases until October 2019. Odds ratio (OR) was analized by a random-effects model. Standard methods were used for assessment of heterogeneity and publication bias. Data were available from 32 studies. The risk ratios of 139,762 participants were pooled from these articles for the meta-analysis.

RESULTS

This study domenstrated that children and adolescents in food-insecure condition are not at risk of OW/OB (OR = 1.02 95% CI: 0.99, 1.05). However, subgroup analysis indicated that FI related with inhanced risk of OW/OB in adolescents living in developed countries (OR = 1.14; 95% CI: 1.02, 1.27). Other subgroup analysis indicated that severe FI increased the risk of OW/OB among adolescents (OR = 1.24 95% CI: 1.03-1.49). In addition, we found that lower economic development significantly decreased risk of OW/OB among under 6 year children (OR = 0.88; 95% CI: 0.84, 0.93).

CONCLUSIONS

Our results showed that higher FI degrees were related with more risks of OW/OB among adolescents (12-18 years). Moreover, the country economic levels had effect on the association between FI and risk of OW/OB.

Household Food Security and Infant Adiposity

OBJECTIVES

Food insecurity has been associated with obesity, but previous studies are inconsistent and few included infants. We examined associations between household food security and infant adiposity and assessed the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) as effect modifiers. We hypothesized that infants from food-insecure households would have greater adiposity, with attenuation by WIC and SNAP.

METHODS

We repeatedly measured 666 infants from the southeastern United States in 2013-2017. We categorized households as high, marginal, low, or very low using the US Household Food Security Survey Module. Outcomes were BMI z score, subscapular and triceps skinfold-for-age z score, the sum of subscapular and triceps skinfolds, the ratio of subscapular and triceps skinfolds, and BMI z score ≥1 (at risk for overweight). We used covariate-adjusted repeated-measures linear and logistic regressions.

RESULTS

Of infants, 68.6% were Black and 60.5% had household incomes <$20 000. Interactions between food security and WIC and/or SNAP were not significant. Compared with infants from high food security households, infants from very low food security households had higher BMI z scores (0.18 U; 95% confidence interval [CI] 0.01 to 0.35), higher subscapular skinfold-for-age z scores (0.31 U; 95% CI 0.04 to 0.59), a higher sum of subscapular and triceps skinfolds (0.53 mm; 95% CI 0.002 to 1.07), and greater odds of being at risk for overweight (odds ratio 1.55; 95% CI 1.14 to 2.10). Infants from low food security households had greater odds of being at risk for overweight (odds ratio 1.72; 95% CI 1.17 to 2.10).

CONCLUSIONS

In larger and longer studies, researchers should examine food security and adiposity in young children.

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.

Food Security Status of Native Hawaiians and Pacific Islanders in the US: Analysis of a National Survey

OBJECTIVE

To document food insecurity prevalence among a nationally representative sample of Native Hawaiian and Pacific Islander (NHPI) adults and compare differences in food security status across races/ethnicities in the US.

METHODS

Using 2014 National Health Interview Survey and 2014 NHPI-National Health Interview Survey data, food insecurity among the NHPI population is described and food security status across racial/ethnic groups is compared using Rao-Scott chi-square and multinomial logistic regression.

RESULTS

Food insecurity prevalence was 20.5% among NHPI adults, and NHPI had significantly higher odds of experiencing low and very low food security than white individuals. Food insecurity among Hispanic individuals, black people, and other races/ethnicities was also significantly higher than that among white people. Significant variation in food security status was observed by race/ethnicity (P < .001).

CONCLUSIONS AND IMPLICATIONS

This study provides documentation of food insecurity prevalence among NHPI adults and will inform chronic disease and nutrition research and programs conducted with NHPI communities in the US.

Household food insecurity: associations with disordered eating behaviours and overweight in a population-based sample of adolescents

OBJECTIVE

To examine how household food insecurity is related to adolescent weight status and disordered eating.

DESIGN

Cross-sectional, population-based study. Adolescents self-reported unhealthy weight control behaviours, binge eating and meal frequency; weight status was measured. Household food insecurity was assessed by asking parents to respond to the validated six-item US Household Food Security Survey Module.

SETTING

Adolescents surveyed within Minneapolis/St. Paul public middle and high schools completed surveys at school, and their parents/guardians were surveyed by mail during the 2009-2010 academic year.

PARTICIPANTS

Ethnically/racially diverse, primarily low-income adolescents (mean age: 14·4 years, range: 10-22 years) and their parents/guardians (n 2285 dyads).

RESULTS

More than one-third (38·9 %) of the adolescents experienced past-year household food insecurity, 43·2 % reported disordered eating and 39·6 % were overweight. Generalised regression models showed that food insecure (FI) compared with food secure (FS) adolescents had higher prevalence of overweight (FI: 42·3 % v. FS: 37·9 %, P = 0·039), lower breakfast consumption (FI: 4·1 times/week v. FS: 4·4 times/week, P = 0·005) and greater use of unhealthy weight control behaviours (FI: 49·0 % v. FS: 39·5 %, P < 0·001) in unadjusted models. Models adjusted for parental education, ethnicity/race, sex and age found that food insecurity was associated with higher prevalence of unhealthy weight control behaviours (FI: 44·5 % v. FS: 37·8 %, P = 0·007), but not with weight status or other eating behaviours.

CONCLUSIONS

These results suggest that food insecurity may be an independent risk factor for unhealthy weight control behaviours, indicating a need to approach these intersecting issues in a comprehensive manner.

Increased Prevalence of Severe Obesity and Related Comorbidities among Patients Referred to a Pediatric Obesity Clinic during the Last Decade

BACKGROUND

Childhood obesity is a major health concern worldwide. This study examined prevalence trends in severe obesity and related comorbidities among patients referred to a tertiary pediatric obesity clinic in Israel.

METHODS

The medical files of patients aged 2-18 years with BMI >95th percentile at initial referral to our obesity clinic in 2008-2017 were reviewed for demographic, anthropometric, and cardiometabolic data. Findings were compared between patients with 2.3 > BMI-SDS ≥1.645 and BMI-SDS ≥2.33 (severe obesity), and yearly rates of severe obesity were calculated.

RESULTS

The cohort included 1,027 children (median age 10.8 years, 41.8% male) of whom 55% were severely obese. The rate of severe obesity among referrals increased from 54% in 2008 to 69% in 2017, but it seemed to plateau during the last 3 years. In between-group comparison, the severe obesity group had a significantly greater predominance of males (p = 0.002), younger age at obesity onset in males (p <0.001), higher rate of a family history of obesity (overall and in males; p = 0.002 and p = 0.01, respectively), and higher rates of obesity-related comorbidities (systolic hypertension, dyslipidemia, obstructive sleep apnea, and nonalcoholic fatty liver disease; p < 0.001).

CONCLUSIONS

Our data show an increased prevalence of severe obesity over the last decade among Israeli children and adolescents referred to an obesity clinic. This finding may reflect the trend in the general pediatric population or a change in the policy of referral to obesity clinics of pediatricians. The high rate of obesity-related comorbidities emphasizes the importance of early intervention to prevent their devastating consequences, especially in patients with severe obesity.

Coping through a drought: the association between child nutritional status and household food insecurity in the district of iLembe, South Africa

OBJECTIVE

To assess and compare the association between household food insecurity and child nutritional status over two time-points taking into consideration the effects of a severe drought.

DESIGN

The study used two cross-sectional household surveys during and after a severe drought, consistent with a natural experiment design.

SETTING

The study took place in the district of iLembe, KwaZulu-Natal, South Africa.

PARTICIPANTS

Households with children aged <5 years were invited to participate in the survey. Anthropometric measures were taken for the respective children in each of the participating households.

RESULTS

The results indicated that all forms of poor nutritional status increased over the two time-points, with the most significant increases being for stunting (P < 0·016) and obesity (P < 0·001). There was evidence of an association between increasing food insecurity and stunting (P < 0·003) at the end of the drought, but not wasting, underweight or overweight. The results indicated a strong link between chronic food insecurity and chronic undernutrition. The results also showed stronger evidence of an association between food insecurity and stunting for urban households (P < 0·001) compared to their rural counterparts (P < 0·019).

CONCLUSIONS

The negative effects of drought appear to contribute to increased rates of child stunting through higher levels of household food insecurity. Future research should assess this relationship through longitudinal studies. Interventions aimed at improving food security may assist in reducing child malnutrition, but policymakers should consider urban-rural differences as well as climatic and environmental events.

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 in Advanced Capitalist Nations: A Review

Food insecurity is a substantial problem in nearly every advanced capitalist nation, with sizable portions of residents in many affluent countries struggling to eat healthily every day. Over time, a very large literature has developed that documents food insecurity, evaluates programs meant to reduce that insecurity, and proposes solutions to attenuate the problem. The purpose of the current review is to provide a very broad overview of the food insecurity literature, including definitions, measurement, areas of study, and impacts on health. Importantly, this review suggests there are two major causes of food insecurity in the advanced nations: economic inequality and neoliberalism. The food insecurity literature suggests that diminished government responsibility in advanced capitalist nations corresponds to an increase in feeding programs run by non-profit and charitable organizations. This review concludes by suggesting that, while a massive amount of research on food insecurity currently exists, more research is still needed to address gaps in the literature when it comes to significant events, coping strategies and disadvantaged populations.

Eviction in early childhood and neighborhood poverty, food security, and obesity in later childhood and adolescence: Evidence from a longitudinal birth cohort

Eviction affects a substantial share of U.S. children, but its effects on child health are largely unknown. Our objectives were to examine how eviction relates to 1) children's health and sociodemographic characteristics at birth, 2) neighborhood poverty and food security at age 5, and 3) obesity in later childhood and adolescence. We analyzed data from the Fragile Families and Child Wellbeing Study, a longitudinal cohort of children born in 20 large U.S. cities. Children who lived in rental housing with known eviction histories and measured outcomes were included. We compared maternal and infant health and sociodemographic characteristics at the time of the child's birth. We then characterized the associations between eviction and neighborhood poverty and food security at age 5 and obesity at ages 5, 9, and 15 using log binomial regression with inverse probability of treatment and censoring weights. Of the 2556 children included in objective 1, 164 (6%) experienced eviction before age 5. Children who experienced eviction had lower household income and maternal education and were more likely to be born to mothers who were unmarried, smoked during pregnancy, and had mental health problems. Evicted and non-evicted children were equally likely to experience high neighborhood poverty at age 5 (prevalence ratio (PR) = 1.03, 95% CI 0.82, 1.29) but had an increased prevalence of low food security (PR = 2.16, 95% CI 1.46, 3.19). Obesity prevalence did not differ at age 5 (PR = 1.01; 95% CI 0.58, 1.75), 9 (PR = 1.08; 95% CI 0.715, 1.55); or 15 (PR = 1.05; 95% CI 0.51, 2.18). In conclusion, children who went on to experience eviction showed signs of poor health and socioeconomic disadvantage already at birth. Eviction in early childhood was not associated with children's likelihood of neighborhood poverty, suggesting that eviction may not qualitatively change children's neighborhood conditions in this disadvantaged sample. Though we saw evidence supporting an association with low child food security at age 5, we did not find eviction to be associated with obesity in later childhood and adolescence.

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Children who experience eviction have health and socioeconomic disadvantages at birth.

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Eviction was not associated with neighborhood poverty or childhood obesity.

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Evicted children (vs. not) had over twice the prevalence of food insecurity at age 5.

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Interventions to prevent eviction can protect children from hunger and adversity.

Exploring the association between food insecurity and food skills among school-aged children

Objective:

To examine the relationship between household food insecurity (FI) and children’s involvement in family meal choices and food preparation, used as proxies for children’s food skills, and to explore gender differences within these associations.

Design:

Households were classified as food-secure or food-insecure using the six-item, short-form Household Food Security Survey Module. Children’s involvement in family meal choices and food preparation were treated as proxies for children’s food skills. Mixed-effects multinomial logistic regression models were used.

Setting:

Public schools in Nova Scotia, Canada.

Participants:

5244 children in the fifth grade (10–11 years old) participating in the Children’s Lifestyle and School Performance Study (CLASS).

Results:

Most children reported being involved in family meal choices or food preparation at least weekly (74 and 68 %). The likelihood of helping choose family meals once a week was 33 % lower among girls from food-insecure households compared to girls from food-secure households. No differences in boys’ involvement in family meal choices were observed according to household FI status. Boys from food-insecure households were 65 % more likely than boys from food-secure households to assist with food preparation/cooking four times per week. No differences in girls’ involvement in food preparation were observed according to household FI status.

Conclusions:

Findings support that household FI is not due to a lack of food skills but most likely due to inadequate access to resources. This supports the call for upstream policies targeting the structural issues underpinning household FI such as low income.

Impact of Life Events on Short-Term Change in BMI in Early and Middle Childhood

OBJECTIVE

The accumulation of adverse events in childhood is linked to obesity, although the short-term (1 to 2 years) dynamics of weight change during life events has not been investigated.

METHODS

In the Eunice Kennedy Shriver National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, mothers reported life events in the past year when their children were 54 months, 9 years, and 11 years old. Children's height and weight were measured, and BMI-for-age z scores were calculated at 36 and 54 months and at 7, 9, 10, and 11 years. The estimated 1- and 2-year change in BMI z score of being in the highest quartile of negative and total life events was modeled using linear regression accounting for repeated measures.

RESULTS

Analyses included 1,074 children. The highest quartile of negative life events was not statistically associated with BMI z score change at 2 years compared with those below the highest quartile (estimate: 0.069, 95% CI: -0.006, 0.144). Similarly, the highest quartile of total events was not related to BMI z score change (estimate: 0.029, 95% CI: -0.054, 0.114). The developmental period of the child did not moderate the association.

CONCLUSIONS

No significant change in BMI z score was observed in 1 to 2 years for children experiencing many life events.