Gowda et al. Respond

Abstract

We are delighted that our article has stimulated novel analyses regarding the relationship between food insecurity and well-being. Theall et al. describe how there were no significant associations found between food security and inflammation among a younger age group (adolescents aged 12–17 years) of the National Health and Nutrition Examination Survey study population 1999–2006 that we used to investigate these relationships in adults (aged ≥ 18 years). The author postulates that the health risks of food insecurity in adolescence thus primarily may be related to obesity through overconsumption of lower-priced, high-caloric foods. This is an interesting hypothesis, and one that we agree with: changes in dietary intake are a major mechanism by which food insecurity may predispose to adverse health outcomes in both adults and adolescents. Two issues should be noted when examining the link between C-reactive protein (CRP) and food security in young people. First, the association between high-sensitivity CRP and adverse health outcomes is not as well established among children as among adults, and data are lacking regarding the appropriate ranges or cutoffs for these inflammatory markers among adolescents. It is also possible that our results linking food insecurity to CRP in adults result from cumulative effects of living in low-income, food-insecure households. Second, the measurement of food security may also be a limitation when focusing on adolescents. Although there are child-specific questions included in the household food-security measure, the applicability of the adult-specific questions and the interpretation of these questions by adolescents raise concerns about the validity of this measure in children.1 For example, adults in the household may buffer younger members from the household’s financial constraints. Young people’s physical well-being might not be affected until the household’s food insecurity has become severe; these situations might be rare in the United States, given the existing safety net programs.2–4 It would be interesting to know whether the analyses by Theall et al. were similar across the different measures of food insecurity (e.g., household or child food security). Using child-specific questionnaires to explore the impact of food insecurity on children and adolescent well-being is an important area of future research. Providing healthy nutrition campaigns for adolescents likely will be important, but cannot be wholly successful if not linked with programs aimed at alleviating the food-insecurity burden of their adult guardians.