Food insecurity is associated with diet and bone mass disparities in early adolescent males but not females in the United States

A Scoping Review of Household Factors Contributing to Dietary Quality and Food Security in Low-Income Households with School-Age Children in the United States

Low-income and food-insecure households are at risk of poor dietary quality and even more severe food insecurity. Especially in childhood, consuming a nutritionally adequate diet is an essential driver of health, growth, and development. Household-level factors can present challenges to support the nutritional needs of low-income and food-insecure household members. The aim of this scoping review is to identify the contributing household factors to dietary quality and food security in US households of school-aged children 5 to 19 years and synthesize the evidence around emergent themes for application to future interventions. The scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Extension for Scoping Reviews using search terms addressing food insecurity, low income, and dietary behaviors in the database PubMed. Screening by 3 independent reviewers of the title, abstract, and full study phases identified 44 studies. The 5 themes around which the studies grouped were: parental behaviors, child/adolescent behaviors, food procurement behaviors, food preparation behaviors, and household environment factors. Most studies were cross-sectional (n = 41, 93%) and focused on parental behaviors (n = 31, 70%), followed by food preparation and procurement behaviors. The themes identified were interrelated and suggest that incorporating education on parent and child behaviors that influence food procurement and preparation, along with strengthening organization and planning in the household environment, may hold promise to improve dietary quality and food security among food-insecure and low-income households. The findings can be used to inform future nutrition education interventions aimed at improving dietary quality and food security in households with school-aged children.

The prevalence and predictors of household food insecurity among adolescents in Canada

OBJECTIVES

Household food insecurity is almost four times more prevalent among adolescents than among older adults in Canada, and it adversely affects their health. Our objective was to describe the sociodemographic and geographic patterning of household food insecurity among adolescents.

METHODS

Our analytic sample comprised all 12-17-year-old respondents to the 2017-2018 Canadian Community Health Survey with complete data on household food insecurity (n = 8416). We used bivariate and multivariable logistic regression models to identify respondent- and household-level sociodemographic characteristics associated with household food insecurity.

RESULTS

The prevalence of household food insecurity among adolescents was 20.7%. The adjusted odds of food insecurity were significantly elevated among adolescents who identified as Black or Indigenous (aOR 1.80), those living with a single parent (aOR 1.60), those living with a greater number of children ≤ 5 years (aOR 1.45) or 12-17 years (aOR 1.25), those in rented accommodation (aOR 1.98), those in households with only secondary school education (aOR 1.38), and those in households reliant on social assistance (aOR 2.03). Higher before-tax income was protective (aOR 0.99). In comparison with Ontario, the adjusted odds of food insecurity among adolescents were higher in Nunavut (aOR 6.77), Northwest Territories (aOR 2.11), and Alberta (aOR 1.48), and lower in Manitoba (aOR 0.66).

CONCLUSION

The markedly higher odds of exposure to household food insecurity among adolescents who are Black or Indigenous and those living in households characterized by markers of social and economic disadvantage highlight the need for more effective policy interventions to protect vulnerable families from this hardship.

BMI, socioeconomic status, and bone mineral density in U.S. adults: Mediation analysis in the NHANES

Introduction

The mechanism by which socioeconomic status (SES) affects bone mineral density (BMD) remains unknown, and body mass index (BMI) may be a potential mediator. The purpose of this study was to investigate whether BMI mediates the relationship between SES [education level and poverty income ratio (PIR)] and lumbar BMD and the proportion it mediates.

Methods

This study included a total of 11,075 adults from the National Health and Nutrition Examination Survey (NHANES). Lumbar BMD was measured at the lumbar spine by dual-energy X-ray absorptiometry (DXA). Multivariate linear regression and smoothing curve fitting were used to investigate the relationship between SES and lumbar BMD. Mediator analysis was used to investigate the proportion of BMI mediating the association between SES and BMD.

Results

In the fully adjusted model, there was a positive correlation between SES and BMD (education level: β = 0.025, 95% CI: 0.005, 0.045; PIR: β = 0.007, 95% CI: 0.002, 0.011). Mediation analysis showed that BMI mediated the relationship between PIR, education level, and lumbar BMD with a range of mediation proportions from 13.33 to 18.20%.

Conclusion

BMI partially mediated the positive association between SES and BMD, and this association may be largely mediated by factors other than BMI.

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

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

COVID-19 epidemic lockdown-induced remarkable decrease in dairy products consumption of Iran population: does it really matter? National Food and Nutrition Surveillance

Background

The pandemic of the newly emerged coronavirus infection and its related disease, Covid-19, has influenced various aspects of human life including dietary habits. This study aimed to examine changes in dairy products consumption during Covid-19 lockdown period in a huge sample of Iranian households.

Methods

A cross-sectional descriptive-analytical study using a web-based electronic self-administered questionnaire designed to detect any changes in the consumption frequency of dairy products in the Iranian households during Covid-19 lockdown.

Results

A total of 21,290 households were enrolled. During Covid-19 epidemic lockdown, about 29%, 26% and 7% of the households had decreased their consumption frequency of milk, yogurt and cheese, respectively. The female-headed households were 21% more likely to decrease their consumption of milk, compared with male-headed households (OR = 1.21, 95% CI: 1.05–1.4). The households residing in food insecure provinces were 29%, 20% and 45% more likely to decrease their consumption of milk, yogurt and cheese as compared with those living in the food secure provinces. About 37%, 25.3%, 19.4% of those households who reported a decrease in consumption of dairy products had fully omitted them.

Conclusion

We found considerable decrement of dairy products consumption, especially milk and yogurt, in a high proportion of the studied households. Inadequate intake and, in some households, omission of dairy products can potentially bring about serious health outcomes with heavier economic burden. Further studies to track these changes over time and to evaluate their health consequences are warranted.

The relationship between diet quality and the severity of household food insecurity in Canada

OBJECTIVE

To examine the relationship between the dietary quality of Canadian children and adults and household food insecurity status.

DESIGN

Dietary intake was assessed with one 24-h recall. Households were classified as food secure or marginally, moderately or severely food insecure based on their responses to the Household Food Security Survey Module. We applied multivariable analyses of variance to determine whether % energy from ultra-processed foods, fruit and vegetable intake, Healthy Eating Index (HEI) scores, macronutrient composition and micronutrient intakes per 1000 kcal differed by food insecurity status after accounting for income, education and region. Analyses were run separately for children 1-8 years and 9-18 years and men and women 19-64 years of age.

SETTING

Ten provinces in Canada.

PARTICIPANTS

Respondents to the 2015 Canadian Community Health Survey-Nutrition, aged 1-64 years, with complete food insecurity data and non-zero energy intakes, N 15 909.

RESULTS

Among adults and children, % energy from ultra-processed foods was strongly related to severity of food insecurity, but no significant trend was observed for fruit and vegetable intake or HEI score. Carbohydrate, total sugar, fat and saturated fat intake/1000 kcal did not differ by food insecurity status, but there was a significant negative trend in protein/1000 kcal among older children, a positive trend in Na/1000 kcal among younger children and inverse associations between food insecurity severity and several micronutrients/1000 kcal among adults and older children.

CONCLUSIONS

With more severe household food insecurity, ultra-processed food consumption was higher, and diet quality was generally lower among both adults and children.

Food Insecurity among Adolescent Students from 95 Countries Is Associated with Diet, Behavior, and Health, and Associations Differ by Student Age and Sex

Background

Adolescents' developmental tasks and challenges vary based on age, sex, and social context. Food insecurity affects adolescents, but existing research has been limited to a few country contexts and has treated adolescence as a singular developmental moment with limited consideration of potential differences in how food insecurity relates to developmental experiences based on adolescent age and sex.

Objectives

We aimed to describe relations between student-reported food insecurity and students' profiles of nutritional, physical activity, school absenteeism, health/mental health, and victimization experiences, and how these differ by student age and sex.

Methods

Using cross-sectional data from the Global School-based Student Health Survey, we examined adolescent reports of their food security among 337,738 students 11-18 y old from 95 countries. We identified their profiles of focal experiences, and used mixed-effects linear and logistic regression models to examine differences in these profiles by student food insecurity and how these differ by student age and sex.

Results

Of students, 25.5% aged 11-14 y compared with 30% aged 15-18 y reported food insecurity in the past 30 d. Food insecurity was associated with less frequent fruit and vegetable intake; more frequent soft drink intake; worse mental health; less physical activity; more missed school; higher odds of smoking, drinking, and using drugs; and more bullying victimization and sexual partners. Food insecurity was associated with reduced age- and sex-specific protection: greater substance use among younger adolescents, more sexual partners among older females, and greater worry among younger males. Food insecurity was also associated with increased age-specific risk: greater soft drink consumption among younger adolescents.

Conclusions

Across countries, adolescent food insecurity was associated with poorer nutritional, mental health, behavioral, and relationship profiles; these associations differed with student age and sex. Food insecurity interventions should attend to adolescent developmental stage and the gendered contexts through which adolescents navigate daily life.

Association of food insecurity with dietary intakes and nutritional biomarkers among US children, National Health and Nutrition Examination Survey (NHANES) 2011-2016

BACKGROUND

Food insecurity is associated with poorer nutrient intakes from food sources and lower dietary supplement use. However, its association with total usual nutrient intakes, inclusive of dietary supplements, and biomarkers of nutritional status among US children remains unknown.

OBJECTIVE

The objective was to assess total usual nutrient intakes, Healthy Eating Index-2015 (HEI-2015) scores, and nutritional biomarkers by food security status, sex, and age among US children.

METHODS

Cross-sectional data from 9147 children aged 1-18 y from the 2011-2016 NHANES were analyzed. Usual energy and total nutrient intakes and HEI-2015 scores were estimated using the National Cancer Institute method from 24-h dietary recalls.

RESULTS

Overall diet quality was poor, and intakes of sodium, added sugars, and saturated fat were higher than recommended limits, regardless of food security status. Food-insecure girls and boys were at higher risk of inadequate intakes for vitamin D and magnesium, and girls also had higher risk for inadequate calcium intakes compared with their food-secure counterparts, when total intakes were examined. Choline intakes of food-insecure children were less likely to meet the adequate intake than those of their food-secure peers. No differences by food security status were noted for folate, vitamin C, iron, zinc, potassium, and sodium intakes. Food-insecure adolescent girls aged 14-18 y were at higher risk of micronutrient inadequacies than any other subgroup, with 92.8% (SE: 3.6%) at risk of inadequate intakes for vitamin D. No differences in biomarkers for vitamin D, folate, iron, and zinc were observed by food security status. The prevalence of iron deficiency was 12.7% in food-secure and 12.0% in food-insecure adolescent girls.

CONCLUSIONS

Food insecurity was associated with compromised intake of some micronutrients, especially among adolescent girls. These results highlight a need for targeted interventions to improve children's overall diet quality, including the reduction of specific nutrient inadequacies, especially among food-insecure children. This study was registered at clinicaltrials.gov as NCT03400436.

Eggs as an affordable source of nutrients for adults and children living in food-insecure environments

Food insecurity affects an estimated 12% of households in the United States. Adults and children who experience food insecurity are increased risk for development of metabolic diseases such as type 2 diabetes, obesity, and cardiovascular disease. The negative health outcomes associated with food insecurity are multifactorial; however, many of them may be caused by limited nutritional intake and poor diet quality. Dietary intake of eggs may be an applicable solution for food-insecure families who are challenged by limited nutritional intake. Eggs contain a variety of nutrients that support metabolic health. For instance, eggs are a complete source of high-quality protein and contain 16 vitamins and minerals. Furthermore, eggs are cost efficient. When comparing the relationship between foods on the basis of calories and unit cost, the energy cost of eggs is significantly less when compared with that of other animal-protein foods such as meat, poultry, and fish. However, dietary intake of eggs is controversial in regard to cardiovascular health. Thus, the aim of this review is to summarize the role of eggs in the diet and the impact eggs have on health for adults and children living in a food-insecure environment.

Food Insecurity Among Older Adults: 10-Year National Trends and Associations with Diet Quality

BACKGROUND/OBJECTIVES

Food insecurity has emerged as a critical health issue for older adults. Food insecurity has been shown to disrupt healthy eating patterns, but these associations have not been widely studied among older adults. The objectives of the present study were to: (1) examine national trends in food insecurity across a 10-year period, and (2) evaluate the associations between food insecurity and multiple diet quality indices in a recent and nationally representative sample of adults aged 60 or older.

DESIGN

Cross-sectional analysis of the 2007-2016 National Health and Nutrition Examination Surveys.

SETTING

Nationally representative sample of the United States.

PARTICIPANTS

The analytic sample was comprised of 5,097 adults aged 60 or older, with household incomes at or below 300% of the federal poverty level.

MEASUREMENTS

Household food security was measured using the 18-item US Household Food Security Survey Module. Diet was assessed using two 24-hour dietary recalls. Multivariate linear and logistic regression models examined the associations between household food security and three evidence-based diet quality indices, adjusting for sociodemographic and health characteristics.

RESULTS

Across the 10-year period, food insecurity increased significantly from 5.5% to 12.4% among older adults; this increase was more pronounced among lower-income older adults. From the linear regression models, food insecurity was associated with lower scores on the Healthy Eating Index (β = -1.90, 95% confidence interval (CI) = -3.70, -0.09), the Alternate Healthy Eating Index-2010 (β = -1.47, 95% CI = -2.51, -0.44), and the Mediterranean Diet Score (β = -0.54, 95% CI = -1.06, -0.01) after multivariate adjustment. Further adjustment for the presence of chronic medical conditions did not attenuate these results.

CONCLUSION

Food insecurity is associated with lower overall diet quality among older adults, supporting the need for clinical efforts to identify those at risk of food insecurity and public health efforts to alleviate food insecurity and promote healthy eating behaviors among older adults.

Family meal characteristics in racially/ethnically diverse and immigrant/refugee households by household food security status: A mixed methods study

While there is some research examining frequency of family meals by food insecurity (FI) status, there is little research examining other family meal characteristics (e.g., type of food served at meal, emotional atmosphere) or parent feeding practices by FI status. If food and money is scarce, it may be that the broader family meal environment looks different in families with continuous access to food (food secure, FS) compared to families with FI. Using ecological momentary assessment (EMA) and qualitative data, this study explores meal characteristics and parent feeding practices at nearly 4000 family meals in a low-income, racially/ethnically diverse and immigrant/refugee sample. For 8 days, participants (i.e., parents of 5-7-year-old children) completed a survey every time they shared a meal with their child. Additionally, parents completed a qualitative interview regarding family meals. There were many meal characteristics statistically correlated with a family being FI, including: who prepared the meal and how the meal was prepared, the makeup of people at the meal, the meal location and meal atmosphere, and the food served at the meal. Qualitative data illuminated many of these findings from EMA meal surveys. Quantitatively, families with FI and FS reported similar parent feeding practices during family meals. Qualitatively, families with FI and FS reported differences in (1) parent feeding practices; (2) food served at family meals; (3) challenges to having family meals; and 4) adults' role in the family meal. This study provides suggestions for interventionists working with families, including helping families identify time management strategies, including fruits and vegetables into family meals on a budget, reducing screen time at family meals while improving the meal's emotional atmosphere, and developing positive parent feeding practice strategies.

Bone mass and dietary intake in children and adolescents with type 1 diabetes mellitus

OBJECTIVES

To evaluate the bone mineral density (BMD) in children/adolescents with type 1 diabetes mellitus (T1DM) and its association with the nutritional intake, metabolic control, and physical activity level of this population.

METHODS

Study including 34 patients with T1DM and 17 controls. Assessments included the participants disease history, intake of macronutrient, calcium, phosphorus and magnesium, physical activity level, total body and lumbar spine BMD and serum levels of glycated hemoglobin, vitamin D, calcium, phosphorus, magnesium, osteocalcin and C-terminal telopeptide.

RESULTS

Total body and lumbar spine BMD z-scores were normal in all but two participants in the T1DM group. The T1DM group had significantly lower total body BMD z-score values (p < 0.001) and levels of osteocalcin, C-terminal telopeptide, calcium, phosphorus, and magnesium. Intake of macronutrients and calcium was inadequate in both groups. Participants in the T1DM group were more sedentary (88%) and had inadequate metabolic control (91%) and low vitamin D levels (82%). Bone mass in the T1DM group was influenced by body mass index (BMI), pubertal stage, disease duration, calcium intake, and physical activity level.

CONCLUSIONS

Bone mass in patients with T1DM was adequate but lower than controls and was influenced by BMI, pubertal stage, disease duration, calcium consumption, and physical activity level.

Frequently Consumed Foods and Energy Contributions among Food Secure and Insecure U.S. Children and Adolescents

Food insecurity is associated with nutritional risk in children. This study identified and compared the most frequently consumed foods, beverages, and food groups and their contributions to energy intake among U.S. children and adolescents (6–11, 12–17 years) by food security status. Dietary intake from the day-1, 24-h dietary recall, and household child food security status were analyzed in the 2007–2014 National Health and Nutrition Examination Survey (n = 8123). Foods and beverages were classified into food categories, ranked, and compared by weighted proportional frequency and energy contribution for food security groups by age. Significant differences between household child food security groups were determined using the Rao-Scott modified chi-square statistic. The weighted proportional frequency of beverages (including diet, sweetened, juice, coffee, and tea) and their energy was significantly higher among food insecure compared with food secure while the reverse was true for water frequency among 12–17 years. Beverage and mixed dish frequency were higher among food insecure compared with food secure 6–11 years while the reverse was true for frequency and energy from snacks. Frequency-differentiated intake patterns for beverages and snacks by food security across age groups may inform dietary recommendations, population-specific dietary assessment tools, interventions, and policy for food insecure children.

Adolescent food insecurity: A review of contextual and behavioral factors

OBJECTIVE

The purpose of this review is to examine recent research on contextual and behavioral factors that will lead to better understanding of adolescent food insecurity and health outcomes.

DESIGN

A literature search for peer-reviewed, English language, research articles published between 2009 and 2019, using CINAHL, Embase^® , Pubmed, and the Cochrane Library.

SAMPLE

The final sample represents thirty studies on food insecurity with a sample including adolescents, and that employ a measure of food insecurity.

RESULTS

Variables of interest and results on topics such as weight-related factors, maternal parenting and behaviors, mental health, and adolescent-level behavioral factors are summarized.

CONCLUSION

Food insecurity is associated with poor adolescent health and mental health. All adolescents should be screened for food insecurity, involving pediatric and mental health care settings. Future research on adolescent food insecurity should explore parent and parenting factors, household composition and family dynamics, psychological factors, health behaviors, and stress; peer influences might also be an important area of research with adolescents. While previous research has relied on parents' reports, adolescents'experiences are unique, and they are willing and reliable research participants; they should be included in future food insecurity research.

Understanding the Psychological Distress of Food Insecurity: A Qualitative Study of Children's Experiences and Related Coping Strategies

BACKGROUND

Food insecurity, a condition of inadequate household food availability, affects 15.7% of US households with children. Food insecurity is generally believed to affect the quantity and quality of food consumed. However, an understudied but important aspect of the experience of food insecurity is psychological distress.

OBJECTIVE

To critically explore the psychological distress associated with children's food insecurity using children's own reports of their experiences.

DESIGN

In-depth qualitative interviews conducted with children to better understand the psychological distress associated with food insecurity.

PARTICIPANTS/SETTING

Sixty children (aged 7 to 14 years) were recruited from the San Francisco Bay Area. Children were eligible in the case that they spoke English fluently and their parent reported any experience of household food insecurity during the past year.

RESULTS

Children discussed six themes related to the psychological distress associated with food insecurity: worrying about not having enough food, worrying about their parents' well-being, anger and frustration about not having enough food, embarrassment about their family's food situation, strain on the family's dynamics due to food insecurity, and sadness over not having enough food. After describing their experiences, children described strategies they employed to tolerate or cope with food insecurity, including distracting from or using their imagination to cope with food insecurity, increasing tolerance of their family's food situation, and appreciating their parents for providing food and resources.

CONCLUSIONS

Food insecurity contributes to children's psychological distress. Given the known effects of chronic stress in childhood, the psychological distress of food insecurity may represent an important mechanism by which food insecurity adversely influences children's growth and development and deserves investigation in future studies.

Children's Dietary Quality and Micronutrient Adequacy by Food Security in the Household and among Household Children

Children's food-security status has been described largely based on either the classification of food security in the household or among household children, but few studies have investigated the relationship between food security among household children and overall dietary quality. Our goal was to examine children's dietary quality and micronutrient adequacy by food-security classification for the household and among household children. Data from 5540 children (2-17 years) from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 were analyzed. Food-security status was assessed using the U.S. Household Food Security Survey Module and categorized into high, marginal, low, and very low food security for the households and among household children. Dietary quality and micronutrient adequacy were characterized by the Healthy Eating Index (HEI) 2015 and Mean Adequacy Ratio (MAR; based on total nutrient intakes from diet and dietary supplements), respectively. The HEI 2015 scores did not substantially vary by either food-security classification, but the MAR was greater in high compared to very low food security in households and among household children; a linear relationship was found only among household children. In general, very good agreement was observed between the classifications, but the strength of agreement differed by children's age, race/Hispanic origin, and family income. In conclusion, micronutrient adequacy, but not dietary quality, significantly differed by food-security status. While the agreement between food security in the household and among household children is very good, classification of food security among household children may be more sensitive to detecting differences in exposure to nutrients.

Canadian newcomer children's bone health and vitamin D status

Adequate calcium intake and supply of vitamin D during childhood play important roles in ensuring adequate bone mass gain to achieve optimal peak bone mass. The Healthy Immigrant Children study employed a mixed-method cross-sectional study design to characterize the health and nutritional status of 300 immigrant and refugee children aged 3-13 years who had been in Canada for less than 5 years. This paper presents bone mineral content and vitamin D status data along with qualitative data that deepen the understanding of newcomer bone health status. A significantly higher percentage of refugee children (72.3%) had insufficient (<50 nmol/L) or deficient (<30 nmol/L) serum vitamin D compared with immigrants (53.2%). Vitamin D deficiency was most common among ethnic minority girls. Newcomer children with higher intakes of vitamin D, younger newcomer children, and those from western Europe or the United States had higher serum vitamin D levels. Immigrants had significantly higher mean total body bone mineral content compared with refugees. Total body fat, serum vitamin D, calcium intake, height, height by calcium intake, total body fat by calcium intake, and total body fat by height predicted total body bone mineral content levels. Vitamin D deficiency among newcomer children may be related to lack of knowledge regarding children's vitamin D requirements in the Canadian environment, dietary habits established in country of origin, low income that limits healthy dietary choices, and lifestyle habits that limit exposure to sunlight. Results suggest a need to screen newcomer children and pregnant women for vitamin D deficiency and support early intervention.

Household Food Insufficiency and Children Witnessing Physical Violence in the Home: Do Family Mental Illness and Substance Misuse Moderate the Association?

Objectives Research to date indicates that parents and children residing in food insufficient homes incur a host of negative health outcomes. Recently, studies have suggested that these homes are also at risk of violence between family members. Our objective is to examine the link between household food insufficiency and physical violence in the home using a recent, nationally representative sample, and to determine whether family mental illness and/or substance misuse inform this association. Methods A sample of nearly 50,000 children and families from the 2016 National Survey of Children's Health were employed in the study. Information concerning household access to food, experiences of violence between parents/adults, and associated mental health and substance use risk factors were available in the data. Logistic regression, employed in a hierarchical fashion, was utilized to analyze the data. Results Household food insufficiency was associated with an increased risk of children witnessing physical violence in the home, and this was especially pronounced in the case of moderate-to-severe food insufficiency. Findings also indicated that family mental illness and substance misuse partly attenuated this association and that household food insufficiency was more strongly associated with violence in the home in the absence of mental health and substance use risk factors. Conclusions for Practice Polices aimed at diminishing food insufficiency may have important collateral benefits in the form of reductions in family violence, and these benefits appear to extend to families that are otherwise at low risk of family violence.

The role of neighborhoods in household food insufficiency: Considering interactions between physical disorder, low social capital, violence, and perceptions of danger

RATIONALE

Food insecurity is a significant public health concern, with implications for community and individual health and well-being. Although a growing body of literature points to the role of neighborhoods in household food insecurity, studies using nationally representative samples to explore interactions between neighborhood risks - including violence and danger - are lacking.

OBJECTIVE

The present study examines whether interactions between physical disorder, low social capital, and violence/danger in the neighborhood have significant implications for the risk of household food insufficiency using a large, nationally representative sample of U.S. children and their families.

METHOD

Data are from the 2016 National Survey of Children's Health, a survey of a cross-sectional weighted probability sample of U.S. children from 0 to 17 years of age. Multinomial logistic regression techniques were used to analyze the data.

RESULTS

Neighborhood risk factors interacted to predict household food insufficiency, with the confluence of low social capital and violence/danger yielding the strongest effects.

CONCLUSIONS

Our findings suggest that food hardship should be addressed within the context of neighborhood revitalization. The risk of food insufficiency among children and families in especially high-risk ecological contexts might be ameliorated with the provision of informal and formal sources of nutrition assistance and support.

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.

Poor Dietary Guidelines Compliance among Low-Income Women Eligible for Supplemental Nutrition Assistance Program-Education (SNAP-Ed)

The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program aims to improve nutritional intakes of low-income individuals (<185% poverty threshold). The objective of this study was to describe the compliance with Dietary Guidelines for Americans (DGA) recommendations for fruits, vegetables, and whole grains among SNAP-Ed eligible (n = 3142) and ineligible (n = 3168) adult women (19–70 years) nationwide and SNAP-Ed participating women in Indiana (n = 2623), using the NHANES 2007–2012 and Indiana SNAP-Ed survey data, respectively. Sensitivity analysis further stratified women by race/ethnicity and by current SNAP participation (<130% poverty threshold). Nationally, lower-income women were less likely to meet the fruit (21% vs. 25%) and vegetable (11% vs. 19%) guidelines than higher-income women, but did not differ on whole grains, which were ~5% regardless of income. The income differences in fruit and vegetable intakes were driven by non-Hispanic whites. Fewer SNAP-Ed-eligible U.S. women met fruit (21% vs. 55%) and whole grain (4% vs. 18%) but did not differ for vegetable recommendations (11% vs. 9%) when compared to Indiana SNAP-Ed women. This same trend was observed among current SNAP participants. Different racial/ethnic group relationships with DGA compliance were found in Indiana compared to the nation. Nevertheless, most low-income women in the U.S. are at risk of not meeting DGA recommendations for fruits (79%), vegetables (89%), and whole grains (96%); SNAP-Ed participants in Indiana had higher compliance with DGA recommendations. Increased consumption of these three critical food groups would improve nutrient density, likely reduce calorie consumption by replacing high calorie choices, and improve fiber intakes.

Association between kindergarten and first-grade food insecurity and weight status in U.S. children

OBJECTIVE

The aim of this study was to determine if food insecurity is an independent risk factor for obesity in U.S. children.

METHODS

We analyzed data from a nationally representative sample of children participating in the Early Childhood Longitudinal Study-Kindergarten Cohort 2011. Statistical analyses were performed to evaluate longitudinal associations between food security and body mass index (BMI) z-score. All regression models included race/ethnicity, household income, and parental education. Survey and anthropometric data was collected from teachers and parents of 8167 U.S. children entering kindergarten in fall 2010 with regular follow-up through third grade. Complete data regarding food security, socioeconomic assessment, and BMI z-score data were included for statistical analyses. All analyses were weighted to be nationally representative.

RESULTS

Children with household food insecurity had increased obesity prevalence from kindergarten through grade 3; for example, at kindergarten, with food insecurity 16.4% (95% confidence interval [CI], 13.7-19) versus food secure 12.4% (95% CI, 11.3-13.6). Adjusted means analysis showed first-grade food insecurity was significantly correlated with increased BMI z-score in first through third grades; for example, at first grade, with food insecurity 0.6 (95% CI, 0.5-0.7) versus food secure 0.4 (95% CI, 0.4-0.5). Logistic regression showed first-grade food insecurity was correlated with increased risk for obesity in that grade (odds ratio 1.4; 95% CI, 1.1-2).

CONCLUSION

Obesity is more prevalent among food-insecure children. First-grade food insecurity is an independent risk factor for longitudinal increases in BMI z-score. There are differences in the association between food insecurity and weight status between kindergarten and first grade.

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.

Exploring the association of urban or rural county status and environmental, nutrition- and lifestyle-related resources with the efficacy of SNAP-Ed (Supplemental Nutrition Assistance Program-Education) to improve food security

OBJECTIVE

To investigate the association of policy, systems and environmental factors with improvement in household food security among low-income Indiana households with children after a Supplemental Nutrition Assistance Program-Education (SNAP-Ed) direct nutrition education intervention.

DESIGN

Household food security scores measured by the eighteen-item US Household Food Security Survey Module in a longitudinal randomized and controlled SNAP-Ed intervention study conducted from August 2013 to April 2015 were the response variable. Metrics to quantify environmental factors including classification of urban or rural county status; the number of SNAP-authorized stores, food pantries and recreational facilities; average fair market housing rental price; and natural amenity rank were collected from government websites and data sets covering the years 2012-2016 and used as covariates in mixed multiple linear regression modelling.

SETTING

Thirty-seven Indiana counties, USA, 2012-2016.

SUBJECTS

SNAP-Ed eligible adults from households with children (n 328).

RESULTS

None of the environmental factors investigated were significantly associated with changes in household food security in this exploratory study.

CONCLUSIONS

SNAP-Ed improves food security regardless of urban or rural location or the environmental factors investigated. Expansion of SNAP-Ed in rural areas may support food access among the low-income population and reduce the prevalence of food insecurity in rural compared with urban areas. Further investigation into policy, systems and environmental factors of the Social Ecological Model are warranted to better understand their relationship with direct SNAP-Ed and their impact on diet-related behaviours and food security.

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.

Food Security and Leukocyte Telomere Length in Adult Americans

Background and Purpose

Leukocyte telomere length (LTL) is a biomarker of biologic age. Whether food security status modulates LTL is still unknown. We investigated the association between food security and LTL in participants of the 1999–2002 US National Health and Nutrition Examination Survey (NHANES).

Methods

Analysis of covariance (ANCOVA) was used to evaluate the association between food security categories and LTL controlling for sex, race, and education and accounting for the survey design and sample weights.

Results

We included 10,888 participants with 5228 (48.0%) being men. They were aged on average 44.1 years. In all, 2362 (21.7%) had less than high school, 2787 (25.6%) had achieved high school, while 5705 (52.5%) had done more than high school. In sex-, race-, and education-adjusted ANCOVA, average LTL (T/S ratio) for participants with high food security versus those with marginal, low, or very low food security was 1.32 versus 1.20 for the age group 25–35 years and 1.26 versus 1.11 for the 35–45 years, (p < 0.001).

Conclusion

The association between food insecurity and LTL shortening in young adults suggest that some of the future effects of food insecurity on chronic disease risk in this population could be mediated by telomere shortening.

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

PURPOSE

Prior studies showed that food insecurity may increase the odds of obesity in children and adults. We still know very little about the familial aggregation of obesity in food-insecure households or the mechanisms by which food insecurity confers an increased risk of obesity to children. The purpose of this study was to compare children and mothers from food-insecure and food-secure households in their weight status, child eating patterns/behaviors, and maternal feeding practices.

DESIGN AND METHODS

Fifty mothers of 8-10-year-old children were asked to complete questionnaires, including the U.S. Household Food Security survey, and had their own and their children's heights and weights measured.

RESULTS

The odds of a child being obese were five times higher for children from food-insecure households compared with children from food-secure households (95% confidence interval 1.15-20.8). In univariate analyses, children from food-insecure households showed significantly greater external eating, both past satiation and in the absence of hunger (p < .03), and mothers from food-insecure households expressed significantly greater concern about their children's weight and used restrictive feeding practices to a greater extent (p < .03) when compared with families from food-secure households. A greater proportion of children from food-secure households consumed three to four snacks per day (45.9 vs. 15.4%), while a higher proportion of children from food-insecure households consumed five or more snacks per day (15.4 vs. 0%; p = .02).

PRACTICE IMPLICATIONS

These findings provide further support for an association between food insecurity and childhood obesity and suggest that differences in external eating, child snacking patterns, and select maternal feeding practices may be implicated in food-insecure children's overconsumption of calories. When caring for food-insecure children, healthcare providers should screen for problematic eating patterns and feeding practices.

SNAP-Ed (Supplemental Nutrition Assistance Program-Education) Increases Long-Term Food Security among Indiana Households with Children in a Randomized Controlled Study

BACKGROUND

Food insecurity is negatively associated with US children's dietary intake and health. The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) aims to alleviate food insecurity by offering nutrition, budgeting, and healthy lifestyle education to low-income individuals and families.

OBJECTIVE

The objective of this study was to evaluate the long-term impact of the Indiana SNAP-Ed on food security among households with children.

METHODS

A randomized, controlled, parallel study design with SNAP-Ed as an intervention was carried out during a 4- to 10-wk intervention period. Intervention group participants received the first 4 Indiana SNAP-Ed curriculum lessons. Study participants (n = 575) were adults aged ≥18 y from low-income Indiana households with ≥1 child living in the household. Both treatment groups completed an assessment before and after the intervention period and 1 y after recruitment. The 18-item US Household Food Security Survey Module was used to classify the primary outcomes of food security for the household and adults and children in the household. A linear mixed model was used to compare intervention with control group effects over time on food security.

RESULTS

Mean ± SEM changes in household food security score and food security score among household adults from baseline to 1-y follow-up were 1.2 ± 0.4 and 0.9 ± 0.3 units lower, respectively, in the intervention group than in the control group (P < 0.01). The mean change in food security score from baseline to 1-y follow-up among household children was not significantly different in the intervention group compared with the control group.

CONCLUSIONS

SNAP-Ed improved food security over a longitudinal time frame among low-income Indiana households with children in this study. SNAP-Ed may be a successful intervention to improve food security.

Food Insecurity and Rural Adolescent Personal Health, Home, and Academic Environments

BACKGROUND

Food-insecure (FIS) adolescents struggle in school and with health and mental health more often than food-secure (FS) adolescents. Rural communities experience important disparities in health, but little is known about rural FIS adolescents. This study aims to describe select characteristics of rural adolescents by food-security status.

METHODS

Baseline analysis using data from a randomized trial to increase school breakfast participation (SBP) in rural Minnesota high schools. Students completed a survey regarding food security, characteristics, and home and school environments. Schools provided academic data and staff measured height and weight. Food security was dichotomized as FS vs FIS. Bivariate analysis, multivariate linear/logistic regression, and testing for interaction of food security and sex were performed.

RESULTS

Food-insecure adolescents reported poorer health, less exercise, had lower grades, and higher SBP (p < .01). Food-insecure adolescents reported marginally fewer barriers (p = .06) and more benefits of breakfast (p = .05). All associations except reported benefits remained significant after adjustment. Interactions were identified with girls' grade point average and with boys' caloric and added sugar intake.

CONCLUSIONS

Negative associations among food insecurity and positive youth development are identified in our sample. Policy and environmental strategies should address the complexities of these associations, including exploration of the role of school meals.

Food insecurity and dietary intake among US youth, 2007-2010

BACKGROUND

There is limited research describing associations between food insecurity and dietary intake.

OBJECTIVE

To examine differences in dietary intake by food security status among a nationally representative sample of children and adolescents in the USA.

METHODS

The sample included 5136 children, ages 2-15 years, from the National Nutrition and Health Examination Survey, 2007-2010. Propensity score weighting was used to improve covariate balance between food-secure and food-insecure (marginal, low or very low food security) participants. Multivariate measurement error models were used to model usual intake of various dietary components and assess differences by food security status.

RESULTS

Initial analyses using multivariate measurement error models determined there were no differences between food-insecure and food-secure children across several dietary components. In sensitivity analyses, children experiencing very low food security consumed fewer whole grains and more solid fats and added sugars compared with their food-secure counterparts. Some of these differences were attenuated after propensity score weighting, although intake of whole grains and added sugars remained significantly different.

CONCLUSIONS

Food insecurity was largely not associated with dietary intake among 2-15-year-old US children, although some differences were observed comparing food-secure children to those experiencing very low food security.

Breakfast-Skipping and Selecting Low-Nutritional-Quality Foods for Breakfast Are Common among Low-Income Urban Children, Regardless of Food Security Status

BACKGROUND

Universal access to the School Breakfast Program (SBP) is intended to help low-income and food-insecure students overcome barriers to eating breakfast. However, SBP participation is often still low despite universal access. Further information is needed with regard to these children's breakfast behaviors, and in particular breakfast behaviors among youth from food-insecure families, to inform effective breakfast interventions.

OBJECTIVES

The objective of this study was to examine breakfast behaviors among a large sample of urban students with universal access to the SBP and to identify differences in breakfast behaviors among children from food-secure compared with food-insecure households.

METHODS

A cross-sectional study of 821 fourth- through sixth-grade students and their parents from 16 schools was conducted. Students reported the foods/drinks selected and location of obtaining food/drink on the morning of data collection, parents reported household food security status using the 6-item Food Security Survey Module, and the school district provided SBP participation data during the fall semester of 2013. Multivariable linear regression models accounting for school-level clustering were used to examine differences in breakfast behaviors across 3 levels of household food security: food secure, low food secure, and very low food secure.

RESULTS

Students participated in the SBP 31.2% of possible days, with 13% never participating in the SBP. One-fifth (19.4%) of students purchased something from a corner store for breakfast, and 16.9% skipped breakfast. Forty-six percent of students were food insecure; few differences in breakfast behaviors were observed across levels of food security.

CONCLUSIONS

Despite universal access to the SBP, participation in the SBP is low. Breakfast skipping and selection of foods of low nutritional quality in the morning are common, regardless of household food security status. Additional novel implementation of the SBP and addressing students' breakfast preferences may be necessary to further reduce barriers to students obtaining a free, healthful breakfast. This trial was registered at clinicaltrials.gov as NCT01924130.

Household Food Insecurity is Associated with Childhood Asthma

BACKGROUND

In 2013, 20% of U.S. households with children experienced food insecurity. Asthma afflicts over 7 million children; prevalence has steadily increased while incidence peaks in young children. Asthma and food insecurity share the determinants of poverty and race that are associated with weight, yet limited research on the relation between food insecurity and asthma exists.

OBJECTIVE

The objective of this study was to determine the association between food insecurity and asthma in a diverse sample of children.

METHODS

Cross-sectional data from grade 3 of the Early Childhood Longitudinal Study-Kindergarten Cohort were analyzed (n = 11,099). Food security based on the USDA module and asthma diagnosis were reported by parents; anthropometric factors were measured. Multivariate logistic regression models of food security and asthma were analyzed overall and by race/ethnicity.

RESULTS

Children in food-insecure households had a 4% higher adjusted odds of asthma (95% CI: 1.02, 1.06). Adjusted odds of asthma were also higher by 70% for males (95% CI: 1.69, 1.71), 53% for non-Hispanic black (NHB) children (95% CI: 1.51, 1.54), 20% for Hispanic children (95% CI: 1.19, 1.21), 38% for overweight children (95% CI: 1.36, 1.39), 67% for obese children (95% CI: 1.65, 1.68), 23% for low-birth weight children (95% CI: 1.21, 1.24), 24% if mothers had a high school diploma (95% CI: 1.23, 1.26), and 33% if mothers had some college education (95% CI: 1.32, 1.35). High-birth weight children (OR: 0.84; 95% CI: 0.83, 0.85) and those with foreign-born mothers (OR: 0.52; 95% CI: 0.51, 0.53) had lower odds of asthma. Being food-insecure remained positively associated with asthma in non-Hispanic whites and Hispanics but was inversely associated with odds among NHBs. Odds of asthma doubled (OR: 2.00; 95% CI: 1.97, 2.03) for all children in households that were both food-insecure and poor; this relation remained positive in race/ethnicity-specific models.

CONCLUSIONS

Food insecurity is positively associated with asthma in U.S. third graders, and household poverty strengthens the association.

Promoting Food Security for All Children

Sixteen million US children (21%) live in households without consistent access to adequate food. After multiple risk factors are considered, children who live in households that are food insecure, even at the lowest levels, are likely to be sick more often, recover from illness more slowly, and be hospitalized more frequently. Lack of adequate healthy food can impair a child's ability to concentrate and perform well in school and is linked to higher levels of behavioral and emotional problems from preschool through adolescence. Food insecurity can affect children in any community, not only traditionally underserved ones. Pediatricians can play a central role in screening and identifying children at risk for food insecurity and in connecting families with needed community resources. Pediatricians should also advocate for federal and local policies that support access to adequate healthy food for an active and healthy life for all children and their families.

Use of selective serotonin reuptake inhibitors and bone mass in adolescents: An NHANES study

CONTEXT

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed medications to treat depression and anxiety. SSRIs exert their effects by inhibiting the serotonin transporter and modulating extracellular serotonin levels, a neurotransmitter that has been shown to affect bone metabolism in animals. Studies in adults suggest a negative association between SSRI use and bone mineral density (BMD), greater rates of bone loss with SSRI use and increased risk of fractures. However, the results on bone mass have been inconsistent. Furthermore, there is a dearth of studies examining an association between SSRI use and bone mass in the pediatric and adolescent age group.

OBJECTIVE

To investigate associations between SSRI use and bone mass in adolescents.

DESIGN

Cross-sectional analysis of data from the 2005-2010 National Health and Nutrition Examination Study (NHANES).

PARTICIPANTS

4303 NHANES participants aged 12-20 years. The mean age was 15.65±2.42 years.

MAIN OUTCOMES

Total femur, femoral neck and lumbar spine bone mineral content (BMC) and BMD assessed via dual-energy X-ray absorptiometry (DXA).

RESULTS

62 out of 4303 subjects used SSRIs. SSRI use was an independent predictor of bone mass after adjusting for age, gender, height and weight Z score, socioeconomic status, physical activity, serum cotinine level and race/ethnicity. After multivariable adjustment, total femur BMC was 8.8% lower among SSRI users versus non-users (mean difference 2.98 g, SE±0.105 g, p=0.0006), while total femur BMD was 6.1% lower (mean difference 0.06 g/cm2, SE±0.002 g/cm2, p=0.016). Femoral neck BMC and BMD and lumbar spine BMC were similarly negatively associated with SSRI use. Compared to nonusers, lumbar spine BMC was 7% lower among SSRI users (mean difference 0.97 g, SE±0.048g, p=0.02) and BMD was 3.2% lower (mean difference 0.03 g/cm2, SE±0.015 g/cm2, p=0.09). Sub-analysis of those individuals treated for more than 6 months yield similar results. Finally, the association of SSRIs with bone mass persisted after excluding individuals with Body Mass Index (BMI) less than 5th percentile thus accounting for the possible confounding effect of anorexia nervosa, which can be treated with SSRIs.

CONCLUSION

In this NHANES study, adolescents treated with SSRIs had lower DXA measurements of the total femur and lumbar spine compared to SSRI non-users. These findings support the need for future prospective studies to examine the effects of SSRI use on bone mass in adolescents.

Association of moderate and severe food insecurity with suicidal ideation in adults: national survey data from three Canadian provinces

PURPOSE

Although the important public health issues of food insecurity and suicide may be interconnected, they are rarely studied. Using data from a national survey, we examined whether household food insecurity was associated with suicidal ideation after adjusting for relevant covariates.

METHODS

We examined cross-sectional data from three Canadian provinces (n = 5,270) that were derived from the 2007 Canadian Community Health Survey and included adults (18+ years). Suicidal ideation was based on affirmative response to the question of whether or not the participant had seriously considered committing suicide in the previous 12 months. The Household Food Security Survey Module provided measures of moderate (indication of compromise in quality and/or quantity of food consumed) and severe (indication of reduced food intake and disrupted eating patterns) food insecurity status. Logistic regression determined associations between food insecurity and suicidal ideation with adjustment for demographics, body mass index, and presence of a mood disorder.

RESULTS

There were differences in the proportion experiencing suicide ideation according to moderate (14.7 vs 10.0 % without suicide ideation) and severe (16.4 vs 7.1 % without suicide ideation) food security (p < 0.001). With covariate adjustment, suicidal ideation was significantly associated with moderate (adjusted OR = 1.32, 95 % CI 1.06-1.64) and severe (adjusted OR = 1.77, 95 % CI 1.42-2.23) food insecurity.

CONCLUSIONS

The findings of a robust association between food insecurity and suicidal ideation suggest that interventions targeted at food security may reduce suicide-related morbidity and mortality. Longitudinal investigations that examine various dimensions of food insecurity will advance understanding of etiological pathways involved in food insecurity and suicide.

Eating- and weight-related parenting of adolescents in the context of food insecurity

BACKGROUND

Food insecurity is hypothesized to influence mothers' use of parenting strategies to regulate children's eating. Little is known about the parenting practices directed toward adolescents in food-insecure households.

OBJECTIVE

Our aim was to examine the differences in use of eating- and weight-related parenting practices among mothers of adolescents by household food-security status.

DESIGN

This was a cross-sectional study.

PARTICIPANTS/SETTING

A sociodemographically diverse sample of mothers and adolescents from the Minneapolis/St Paul, MN, metropolitan area who participated in the Eating and Activity Among Teens 2010 and Project Families and Eating and Activity Among Teens studies in 2009 to 2010 (dyad n=2,087). Seventy percent of mothers identified as nonwhite.

MAIN OUTCOME MEASURES

We examined mother-reported use of parenting practices, including pressuring children to eat, restricting high-calorie foods, and encouraging dieting.

STATISTICAL ANALYSES PERFORMED

Logistic regression models were used to determine the predicted probabilities of parenting practices among food-secure, low food-secure, and very-low food-secure households. Sociodemographic characteristics, mothers' body mass index, and adolescents' body mass index-for-age percentile were examined as confounders.

RESULTS

In unadjusted models, food-insecure mothers were more likely than food-secure mothers to frequently encourage their children to diet, comment on their child's weight, be concerned about their child's weight, use restrictive feeding practices, and use pressured feeding practices. After adjustment for sociodemographic characteristics and mothers' and children's body mass index, compared to food-secure mothers, mothers with low food security were more likely to frequently comment on their sons' weight (41.5% vs 32.9%, prevalence difference=8.6; 95% CI 0.9 to 16.3) and mothers with very low food security were more likely to be concerned about their sons' weight (48.8% vs 35.1%; prevalence difference=13.7; 95% CI 3.5 to 23.9). Mothers with very low food security were more likely to frequently use restrictive feeding practices with their daughters compared to food-secure mothers (33.0% vs 20.5%; prevalence difference=12.4; 95% CI 4.2 to 20.7).

CONCLUSIONS

Interventions to improve food-insecure adolescents' eating behaviors may benefit from supporting mothers' use of health-promoting parenting practices.

Food insecurity and dietary quality in US adults and children: a systematic review

BACKGROUND

Food insecurity is adversely associated with the physical and mental health of adults and children, and the mechanism that underlies this association has been assumed to be dietary intake of lower quality in food insecure than food secure individuals. A thorough understanding of observed associations between food insecurity and dietary quality is needed to test this assumption and may highlight pathways through which to improve the health of food-insecure adults and children.

OBJECTIVE

We systematically reviewed all evidence of associations between food insecurity and dietary quality and contrasted associations observed in adults and those for children.

DESIGN

Evidence came from studies that appeared in indexed, peer-reviewed journals and 1) sampled US residents, 2) separately sampled children and adults, 3) contained a measure of food insecurity or food insufficiency, and 4) included at least one measure of dietary quality.

RESULTS

In adults, 170 associations between food insecurity and dietary quality were tested, and 50 associations (29%) suggested an adverse association. Food-insecure adults consumed fewer vegetables, fruit, and dairy products than did food secure adults and had lower intake of vitamins A and B-6, calcium, magnesium, and zinc. In children, 130 associations were tested, and 21 associations (16%) showed an adverse association. There was substantial evidence of only lower fruit consumption in food-insecure compared with food-secure children. Reporting and publication biases may have contributed to an overestimation of the association between food insecurity and dietary quality.

CONCLUSIONS

Food insecurity is adversely associated with dietary quality in adults, particularly intakes of nutrient-rich vegetables, fruit, and dairy that promote good health. However, food insecurity was less-consistently associated with lower dietary quality in children. The idea that parents effectively shield their children from compromised dietary quality because of food shortages is supported by the evidence.