Marginal Food Security Research Articles

Food insecurity is linked to poorer dietary quality in prebariatric surgery patients.

Research exploring dietary quality patterns within bariatric populations is limited, despite the significance of eating behaviors for postoperative outcomes. Recent studies revealed associations between food insecurity and disordered eating behavior in bariatric patients; however, the relationship between food insecurity and dietary quality is not known. To examine the association between dietary quality and levels of food security within a sample of presurgical bariatric patients. One academic medical center in central Pennsylvania, United States of America. Patients completed three self-report measures as part of their presurgical psychological assessment process. Food security status was measured by the United States Department of Agriculture's Food Security Module, modified for self-reports. Participants also completed the Rapid Eating Assessment for Participants, short version, which is a measure of dietary quality with scores ranging from 13-39, and the Adult Eating Behavior Questionnaire. Hierarchical multiple regressions were used to assess relationships between dietary quality and food security levels, and mediation models were built to explore associations between variables. Of the 197 participants, 35.5% reported high food security, while 35.0% and 29.5% reported marginal food security and food insecurity, respectively. Compared with patients with high food security, the dietary quality scores of food-insecure patients were 1.3 points lower (95% confidence interval [CI], -3.3 to .7; P = .2) of and marginally food-secure patients were 1.2 points lower (95% CI, -2.9 to .5) than those reporting high food security (P = .2). Our findings indicate a need for further exploration into the barriers that prebariatric patients may face when attempting to adhere to pre- and postoperative dietary requirements, particularly for those reporting marginal food security and food insecurity. Future research should target postoperative outcomes, including weight gain, weight regain, and dietary adherence, among the most economically vulnerable bariatric patients.

Food Insecurity Is Associated with Increased Risk of Obesity in US College Students.

ABSTRACTBackgroundFood insecurity affects millions of Americans and college students are especially vulnerable. Little is known about the relation of food insecurity with weight status and dietary intake during this critical phase of emerging adulthood.ObjectivesWe aimed to examine the sex-specific associations of food insecurity with obesity and dietary intake among college students. The study also explored these associations by meal plan (MP) enrollment.MethodsThis cross-sectional study included 683 second-year students at 8 universities in the United States. Food security status and dietary intake were assessed using the USDA Adult Food Security Survey and the Dietary Screener Questionnaire, respectively. On-site anthropometrics were measured by researchers.ResultsThe prevalence of food insecurity at the universities ranged from 19.0% to 34.1% with a mean of 25.4% for the entire sample. Compared with high food security, marginal food security and food insecurity were associated with 3.16 (95% CI: 1.55, 6.46) and 5.13 (95% CI: 2.63, 10.00) times increased odds of obesity, respectively, exhibiting a dose–response relation. Food insecurity remained a significant predictor of obesity among both sexes after adjusting for sociodemographic variables. Food-insecure (FI) students had a significantly lower intake of fruits and vegetables and higher intake of added sugars than food-secure (FS) students. Obesity rate and added sugars consumption were higher among FI students with MPs than among FI students lacking MPs and FS students regardless of MP status. Among students with MPs, FS students had a higher intake of fruits and vegetables than FI students.ConclusionsFood insecurity was associated with obesity and poor dietary intake among both sexes. Although MP subsidies may be a reasoned approach to combat food insecurity, it should be coupled with efforts to assist students in making healthy food choices.Registered at clinicaltrials.gov as NCT02941497.

P22 Prevalence of and Characteristics Associated with Food Security Status Among International College Students

<h3>Background</h3> The majority of studies on food insecurity among US college students show higher prevalence rates than the general population. Past studies have looked at characteristics associated with food security status among US college students, but have not focused specifically on international students. <h3>Objective</h3> To estimate the prevalence of and identify characteristics associated with food insecurity among international students at the University of North Carolina at Chapel Hill. <h3>Study Design, Setting, Participants</h3> This cross-sectional study used data from 263 international students attending the University of North Carolina at Chapel Hill who completed an online survey in October and November of 2016. <h3>Measurable Outcome/Analysis</h3> Food security status was assessed using the 10-item US Adult Food Security Survey Module and students were categorized as having high food security, marginal food security, or food insecurity. Self-reported demographics and other student characteristics were also assessed. Descriptive statistics were calculated. Monte Carlo Estimates for the Exact Test and ANOVA were used to assess statistical significance for the association between food security status and student characteristics. Statistical significance was considered <i>P</i> < .05. <h3>Results</h3> Among students in the sample, 51% reported high food security, 24% marginal food security, and 25% food insecurity. Characteristics significantly associated with food security status were gender, year in school, having a car, and perceived health rating. Age, years in the US, academic performance, marital status, having dependent children, living on vs off-campus, employment status, receiving financial aid, weight status, cooking frequency, perceived cooking skills, and having a meal plan were not significantly associated with food security status. <h3>Conclusions</h3> Lack of food security is a serious issue among international students at the University of North Carolina at Chapel Hill, with nearly half reporting food insecurity or marginal food security. The characteristics identified in this study as being associated with food security status can help to inform future research and interventions for addressing food security status among international students.

Impact of sex and marital status on the prevalence of perceived depression in association with food insecurity.

While both food insecurity and depression have been reported to be closely related to sex and marital status, the impact of sex and marital status on the prevalence of perceived depression in association with food security status has not been evaluated. We performed a nationwide population study using data for 19,866 adults obtained from the 2012-2015 Korean National Health and Nutrition Examination Surveys. Household food insecurity status was evaluated using the 18-item Food Security Survey Module. Perceived depression was measured using one item questionnaire or the 9-item Patient Health Questionnaire (PHQ-9). We cross-sectionally analyzed associations between perceived depression and variables, including socio-demographic factors and food security status. The prevalence of perceived depression was compared according to sex, marital status, and food security status. We applied survey sampling weights in all analyses. The overall prevalence of perceived depression was 10.5%. Prevalence rates of perceived depression in the high food security group, marginal food security group, low food security group, and very low food security group were 8.9%, 13.6%, 19.7%, and 35.0%, respectively (P < 0.001). Of total participants, 1.8% were categorized as having both perceived depression and food insecurity. After adjusting for confounding covariates, female sex (adjusted odds ratio [aOR]; 2.37), never married (aOR; 1.37), divorced/widowed/separated (aOR; 1.50), low food security (aOR; 1.72), and very low food security (aOR; 3.65) were associated with increased risk of perceived depression. Men with very low food security and divorced/widowed/separated status were most likely to have perceived depression (53.2%), followed by women with very low food security and divorced/widowed/separated status (48.7%), women with very low food security and married status (42.0%), and women with low food security and divorced/widowed/separated status (33.3%). Female sex and marital status of divorced/widowed/separated were strongly associated with perceived depression. These two factors and food insecurity synergistically contributed to perceived depression.

Food Insecurity and COVID-19: Disparities in Early Effects for US Adults.

The COVID-19 pandemic has dramatically increased food insecurity in the United States (US). The objective of this study was to understand the early effects of the COVID-19 pandemic among low-income adults in the US as social distancing measures began to be implemented. On 19–24 March 2020 we fielded a national, web-based survey (53% response rate) among adults with <250% of the federal poverty line in the US (N = 1478). Measures included household food security status and COVID-19-related basic needs challenges. Overall, 36% of low-income adults in the US were food secure, 20% had marginal food security, and 44% were food insecure. Less than one in five (18.8%) of adults with very low food security reported being able to comply with public health recommendations to purchase two weeks of food at a time. For every basic needs challenge, food-insecure adults were significantly more likely to report facing that challenge, with a clear gradient effect based on severity of food security. The short-term effects of the COVID-19 pandemic are magnifying existing disparities and disproportionately affecting low-income, food-insecure households that already struggle to meet basic needs. A robust, comprehensive policy response is needed to mitigate food insecurity as the pandemic progresses.

Food Security Status is Associated with Academic Performance in Undergraduate and Graduate Students

Abstract Objectives To assess the association between food security status and outcomes related to academic performance in undergraduate and graduate students. Methods This cross-sectional analysis used data from 4897 students from the University of North Carolina at Chapel Hill who completed an online questionnaire in October and November of 2016. Food security status was assessed using the 10-item US Adult Food Security Survey Module. Students were classified as experiencing high food security, marginal food security, or food insecurity. Students rated their perceived academic performance using a 4-item academic performance scale (APS) that included items related to overall progress towards graduating on time, class attendance, attention span, and understanding of concepts taught in class. Students also self-reported GPA, whether they had taken fewer classes to save tuition money, and demographic information. Multinomial logistic regression and multiple linear regression assessed the association between food security status and academic performance-related outcomes separately for undergraduate and graduate students. GPA was only examined for sophomores, juniors, and seniors. Statistical significance was considered P &amp;lt; .05. Results The proportion of students reporting high food security, marginal food security, and food insecurity was 52%, 25%, and 23%, respectively, for undergraduate students and 62%, 17% and 21%, respectively, for graduate students. GPA was negatively associated with experiencing marginal food security (P = .009) and food insecurity (P &amp;lt; .001). APS scores were negatively associated with marginal food security and food insecurity for both undergraduate and graduate students (P &amp;lt; .001). Undergraduate and graduate students who experienced marginal food security and food insecurity were significantly more likely to select lower ratings for perceived academic performance on each APS scale item and report sometimes or often taking fewer classes to save tuition. Conclusions Experiencing marginal food security and food insecurity were negatively associated with outcomes related to academic performance among both undergraduate and graduate students. Funding Sources University of North Carolina at Chapel Hill Food for All micro-grant.

Food Insecurity, Perception of the Neighborhood Food Environment, and Dietary Quality Among Mexican Immigrant Women

Abstract Objectives Migration to the US has been associated with food insecurity and detrimental changes in diet quality. How these changes affect women in context of their neighborhood food environment has not been thoroughly explored. This study aimed to assess if food insecurity is associated with diet quality and to explore if perceived food availability moderates this purported association in a sample of Mexican immigrant women. Methods Mexican-born women (n = 57, 41 ± 7 y) residing in a southwestern US metropolitan area for &amp;gt;1 y self-reported food security status, monthly fast-food frequency, and their perception of fruit, vegetables, and low-fat product availability within their neighborhood via survey. Diet was assessed using the Southwest Food Frequency Questionnaire to estimate intake of fruit, vegetables, salty snacks, sugar, and healthy eating index (HEI)-2015 score. Independent samples t-tests compared dietary outcomes between women classified as food secure (n = 41; high or marginal food security) and food insecure (n = 16; low or very low food security). A moderation analysis assessed the effect of the perception of the neighborhood food environment on the relationship between food security and HEI-2015 score. Results Fifty four % of participants worked full time and 42% had a monthly household income &amp;lt;$2000. Relative to women classified as food secure, participants experiencing food insecurity had lower HEI-2015 (61 ± 8 vs. 66 ± 6; P = 0.03). Albeit not significantly different, women experiencing food insecurity reported lower intake of fruit (236 ± 178 vs. 294 ± 239 g), vegetables (303 ± 188 vs. 331 ± 199 g), and salty snacks (6 ± 5 vs. 8 ± 10 g), as well as higher intake of sugar (99 ± 55 vs. 96 ± 56 g) and fast food (2.5 ± 2.5 vs. 1.8 ± 1.7 times per month). Among women experiencing food insecurity, there was a trend for a lower perception of neighborhood fruit, vegetable and low-fat product availability being associated with lower HEI-2015 scores (54 ± 6) relative to those who perceived moderate (63 ± 6) or high (65 ± 8) neighborhood availability of those foods (P = 0.07). Conclusions Findings suggest a need for better understanding of how neighborhood food availability may affect diet quality among Mexican immigrant women experiencing food insecurity. Funding Sources CONACYT, Mexico, and Program for Transborder Communities.

Sex Differences in the Association Between Food Insecurity and Obesity Among College Students

Abstract Objectives This study aimed to assess the association between food insecurity and obesity and to examine whether it varies by sex. Methods A cross-sectional study was conducted in spring 2017 among college students from eight U.S. institutions. Participants (n = 683) completed the USDA Adult Food Security Survey and had their weight and height measured by researchers. Multivariate logistic regression models were used to estimate the sex-specific associations between food insecurity and obesity (BMI ≥ 30 kg/m2), after adjusting for socioeconomic covariates. Results Overall, 25.4% of students identified as food insecure and 10.5% were obese. The prevalence of obesity increased as the level of food insecurity increased, from 5.2% for those with high food security, 13.4% for those with marginal food security, to 17.4% and 21.6% for students with low and very low food security. In logistic regression analysis, marginal, low and very low food security students had an odds ratio of 2.83 (95% CI: 1.43, 5.57), 3.86 (95% CI: 1.88, 7.91), and 5.05 (95% CI:, 2.44, 10.48) of obesity compared to students with high food security, exhibiting a dose-response relationship. Among females, having marginal (OR = 4.21, 95% CI: 1.70, 9.75), low (OR = 4.51, 95% CI: 1.40, 12.47), or very low food security (OR = 7.08, 95% CI: 2.60, 18.41) predicted higher odds of obesity compared to female students with high food security. Among males, those with low food security had higher odds of obesity (OR = 6.40, 95% CI: 1.78, 20.7). Conclusions The association between food insecurity and obesity in U.S. college students remained after adjustment for multiple socio-economic factors. Overall, food insecure females experienced an increase in the risk of obesity as food insecurity increased; however, only males with low food security had an increased risk of obesity. Programs directed toward obesity prevention need to address any level of food insecurity as a risk factor in females, and target males with low food security. Although beyond the scope of this study, it is possible that programs to reduce food insecurity may help prevent obesity in college students. Funding Sources This material is based upon work that is supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, under award number 2014–67,001-21,851.

Exploring the Relationship Between Attendance at USDA Summer Food Service Program Sites and Baseline Household Food Security Status: Results from the Project SWEAT Study

Abstract Objectives Explore the relationship between attendance at USDA Summer Food Service Program (SFSP) sites and baseline household food security status. Methods Two elementary schools in low-income urban neighborhoods of Columbus, OH were recruited. Families with children at these schools in grades pre-kindergarten through fifth were invited to participate. Caregivers completed a demographic survey at the end of school year 1 (baseline [t0]). Household food security was assessed at t0 using the USDA 6-item Short Form Food Security Module and based on responses participants were categorized as living in high marginal food security (HMFS), low food security (LFS), or very low food security (VLFS) households. Child attendance at USDA SFSP sites was collected via weekly text messages to caregivers using the online TextIt© platform. ANOVA was conducted to determine differences in attendance level by household food security status. Results 113 children representing 78 families enrolled. Mean age was 7.10 ± 0.21 yr, 79.65% were African American, 72.73% were low-income, and mean annual income was $28,222. Approximately 27% of families (n = 21) reported living in LFS (n = 10, 14.82%) or VLFS (n = 11, 12.10%) households. Overall mean attendance at summer programming was 10.40 ± 1.43 days (out of 50 possible days) and attendance by household food security status was 10.51 ± 1.61 (HMFS), 19.00 ± 6.15 (LFS), and 5.70 ± 2.85 (VLFS) days with a significant difference (P = 0.04) between LFS and VLFS households. Conclusions Children in VLFS (vs HMFS and LFS) households, who are at increased risk for hunger during the summertime window of risk, are attending sites offering the USDA SFSP least frequently. Future research and programmatic efforts should be targeted at children from the most vulnerable households to ensure food security during the summertime window of risk. Funding Sources USDA NC-NECE.

Household Food Insecurity and the Association with Cumulative Biological Risk among Lower-Income Adults: Results from the National Health and Nutrition Examination Surveys 2007-2010.

Household food insecurity has been associated with adverse health outcomes; however, the mechanisms underlying these associations are not well-defined. Using data from 5005 adults from the 2007–2010 National Health and Nutrition Examination Surveys (NHANES), we examined associations between household food insecurity and cumulative biological risk, a measure of the body’s physiological response to chronic stress. Household food security was assessed using the 18-item Household Food Security Survey Module. Marginal food security refers to 1–2 positive responses, and food insecurity refers to ≥3 positive responses. The cumulative biological risk scores were calculated based on the distributions of ten biomarkers from the cardiovascular, metabolic, and immune systems. Elevated biological risk was defined as a risk score of ≥3. Multivariable regression models were used to examine associations between food security and cumulative biological risk scores, adjusting for sociodemographic characteristics. After multivariable adjustment, food insecurity was associated with a 0.14-unit higher cumulative biological risk score (95% CI 0.05–0.22, p-trend = 0.003) and higher odds of elevated biological risk (OR 1.20, 95% CI 1.05–1.37, p-trend = 0.003). These associations differed by gender. Among women, food insecurity was associated with 0.30-unit higher cumulative biological risk score (95% CI 0.14–0.45, p-trend = 0.0004) and higher odds of elevated biological risk (OR 1.61, 95% CI 1.29–2.00, p-trend < 0.0001). These associations were not observed in men. Women experiencing food insecurity demonstrated elevated levels of biological risk. These findings support the hypothesis that food insecurity may be associated with women’s chronic health outcomes through the pathway of chronic stress. Further research is needed to understand why these associations were not observed in men.

Relations Among Low-Income Preschool Children’s Self-Regulation, Marginal Food Security, and Parent Stress

ABSTRACT Research Findings: Marginal food security is less studied relative to food insecurity but may also have adverse effects on family outcomes. The present study examined whether parental stress mediated the relationship between marginal food security (MFS) and preschool-aged children’s observed self-regulation at three early education centers located in two urban cities in a Midwestern state. Primary caregivers (81.3% mothers) completed an adapted version of the Parenting Stress Index-Short Form and a two-question screener from the USDA Annual Food Security Survey. Children’s aged 37-70 months, M= 54, SD = 6.46; 57% boys) self-regulation skills were directly assessed. Approximately one-third (39.75%) of the present sample were considered MFS, as they reported being “worried that food would not last” in the past 12 months. MFS families had significantly higher levels of parental stress than food secure families. Additionally, MFS indirectly affects children’s observed self-regulation skills through parental stress, even after controlling for the effect of child age, sex, and family structure. Practice or Policy: Implications of this finding for early intervention and food support programs are discussed.

Food insecurity in females with phenylketonuria.

SummaryPhenylketonuria (PKU) is a genetic disorder characterized by insufficient metabolism of phenylalanine. Depending on severity, patients follow a low‐phenylalanine diet and may consume medical food (MF) and low‐protein modified foods; dietary and medical treatment can be expensive. This study assessed prevalence of food insecurity (FI), the lack of resources to access enough nutritious food to have an active, healthy life, in females with PKU and examined associations with diet and metabolic control. Participants were recruited from a research‐based camp in 2018. Adult and adolescent modules of the USDA Household Food Security survey were utilized to categorize participants as food secure [high food security (FS) or marginal FS] or food insecure (low FS or very low FS); results were compared to the general U.S. population. Dietary intake via three‐day food records and plasma amino acids were also assessed. Thirty females 11‐58 years of age (mean = 21.4 years) participated. Twelve (40%), including seven adolescents (44%) and five adults (36%), were FI compared to the U.S. prevalence of 11.1%. MF protein intake was significantly lower in those with very low FS compared to high FS and low FS (P = .04). Age and intact protein intake were significantly higher in those with very low FS compared to high FS (P < .05). Our study suggests adolescent and adult females with PKU have a higher prevalence of FI than the general U.S. population. Those with very low FS were older, consumed more dietary phenylalanine and intact protein, and less MF protein. Clinicians should consider screening for FI in patients with PKU.

The importance of precision: differences in characteristics associated with levels of food security among college students.

To estimate the prevalence of high, marginal, low and very low food security among a sample of college students and identify characteristics associated with the four different food security status levels and note differences in associations from when food security status is classified as food-secure v. food-insecure. Cross-sectional online survey. A large public university in North Carolina. 4829 college students who completed an online survey in October and November 2016. Among study participants, 56·2% experienced high, 21·6% experienced marginal, 18·8% experienced low and 3·4% experienced very low food security. Characteristics significantly associated with food security status when using the four-level variable but not two-level variable were age, international student status and weight status. Characteristics that significantly differed between the marginal and high food security groups included age, race/ethnicity, year in school, international student status, employment status, financial aid receipt, perceived health rating, cooking frequency and participation in an on-campus meal plan. Characteristics with differences in significant associations between the low and very low food security groups were gender, international student status, having a car, weight status and participation in an on-campus meal plan. Even where similarities in the direction of association were seen, there were often differences in magnitude. We found differences in characteristics associated with food security status when using the four-level v. two-level food security status variable. Future studies should look separately at the four levels, or at least consider separating the marginal and high food-secure groups.

Associations between food insecurity and psychotropic medication use among women living with HIV in the United States

Psychotropic prescription rates continue to increase in the United States (USA). Few studies have investigated whether social-structural factors may play a role in psychotropic medication use independent of mental illness. Food insecurity is prevalent among people living with HIV in the USA and has been associated with poor mental health. We investigated whether food insecurity was associated with psychotropic medication use independent of the symptoms of depression and anxiety among women living with HIV in the USA. We used cross-sectional data from the Women's Interagency HIV Study (WIHS), a nationwide cohort study. Food security (FS) was the primary explanatory variable, measured using the Household Food Security Survey Module. First, we used multivariable linear regressions to test whether FS was associated with symptoms of depression (Center for Epidemiologic Studies Depression [CESD] score), generalised anxiety disorder (GAD-7 score) and mental health-related quality of life (MOS-HIV Mental Health Summary score; MHS). Next, we examined associations of FS with the use of any psychotropic medications, including antidepressants, sedatives and antipsychotics, using multivariable logistic regressions adjusting for age, race/ethnicity, income, education and alcohol and substance use. In separate models, we additionally adjusted for symptoms of depression (CESD score) and anxiety (GAD-7 score). Of the 905 women in the sample, two-thirds were African-American. Lower FS (i.e. worse food insecurity) was associated with greater symptoms of depression and anxiety in a dose-response relationship. For the psychotropic medication outcomes, marginal and low FS were associated with 2.06 (p < 0.001; 95% confidence interval [CI] = 1.36-3.13) and 1.99 (p < 0.01; 95% CI = 1.26-3.15) times higher odds of any psychotropic medication use, respectively, before adjusting for depression and anxiety. The association of very low FS with any psychotropic medication use was not statistically significant. A similar pattern was found for antidepressant and sedative use. After additionally adjusting for CESD and GAD-7 scores, marginal FS remained associated with 1.93 (p < 0.05; 95% CI = 1.16-3.19) times higher odds of any psychotropic medication use. Very low FS, conversely, was significantly associated with lower odds of antidepressant use (adjusted odds ratio = 0.42; p < 0.05; 95% CI = 0.19-0.96). Marginal FS was associated with higher odds of using psychotropic medications independent of depression and anxiety, while very low FS was associated with lower odds. These complex findings may indicate that people experiencing very low FS face barriers to accessing mental health services, while those experiencing marginal FS who do access services are more likely to be prescribed psychotropic medications for distress arising from social and structural factors.

Household Food Insecurity and Dietary Saturated Fat in Rural Appalachia

Purpose: To explore the relationship between food insecurity and dietary saturated fat intake in rural Central Appalachia. Design: Cross-sectional analysis of baseline data from a longitudinal interventional studySample: Baseline assessment of dietary saturated fat intake and food security in volunteers who had resided in rural Central Appalachia for at least five years and were enrolled in a cooking skills class.Method: Volunteers (n=56, 89.3% female) completed the USDA Household Food Security Survey Module (HFSSM) and Diet History Questionnaire-II. Average age was 56.5 (range 18-76) years. Average intake of saturated fat was calculated using DietCalc software. Food security was measured using the HFSSM. Descriptive and inferential statistical analyses were conducted using SAS, v. 9.3 with an alpha level of .05.Findings: High or marginal food security was experienced by 75% with 25% of participants experiencing low/very low food security. Average daily saturated fat was 26 grams. Significant findings included greater saturated fat consumption in men; lower saturated fat consumption with older age; older age being associated with lower food insecurity; and no association between food insecurity and saturated fat intake. Average daily saturated fat gram intake was significantly lower for females than males; the group means were 23.6 (SD = 12.4) and 49.6 (SD = 15.0) for these two groups, respectively (t = 4.8, P &lt; .001). For every 10-year increase in age, there was a 2.7 gram decrease in daily saturated fat intake.Conclusions: Historical food traditions and method of food preparation likely contribute to the lack of an association between high food security and saturated fat intake in rural Appalachia. Food insecurity was not associated with saturated fat intake in our sample. Additional research is needed to determine to the full impact of food insecurity on dietary fat intake in Appalachia.Keywords:&nbsp;&nbsp;Food Insecurity, Appalachian Region, Fatty Acids Saturated, Poverty DOI:&nbsp;&nbsp;http://dx.doi.org/10.14574/ojrnhc.v19i1.568 Acknowledgments:&nbsp;&nbsp;This study was funded by the National Institute of Nursing Research Grant 5K23NR014883-02.

Prevalence of Italian children living in food insecure households and their health status

Abstract Background Food insecurity poses a major threat to population’s health status. Children, if affected, are particularly vulnerable to the possible sequels of food insecurity. Considering that, we aimed to assess the prevalence of children (born in Italy, from Italian parents) living in food insecure households and the association with their health and socio-economic conditions. Methods The study was conducted from January 2017 to December 2018 in pediatric offices. Parents answered to the 18-items of the Household Food Security Index, 8 of which specifically concern children. Households were classified in 4 categories: very low, low, marginal and high food security, creating then a dichotomized variable (food secure and insecure). Pediatricians answered a dedicated questionnaire on children’s health status. We used logistic regression to assess the socio-economic variables predicting food insecurity and chi2 test to evaluate the association between food insecurity and children’s health status. Results Based on parents’ answers, among 573 households with children, 15.4% were food insecure. Food insecurity was associated to lower parent’s education and employment, worse household’s economic condition, higher number of children within a family and geographic location (living in south Italy rather than north). There was a significant association between food insecurity and the presence of visual, relational, psychomotor, dental and physical impairments in children. Conclusions Almost 1 Italian child in 7 lives in food insecure households. Children living in food insecure households have higher probability of having physical, mental and social health problems. Considering the impact on children’s health, food insecurity emerges as a public health issue and should be addressed through the appropriate measures. Key messages Food insecurity among children represents a public health issue even in a developed country such as Italy, affecting children’s present and future health. Policy makers should consider screening children for food insecurity and taking appropriate actions, especially for the at-risk population.

Dietary Quality Varies Among Adults on the Flathead Nation of the Confederated Salish and Kootenai Tribes in Montana.

Diet-related chronic disease is among the most pressing public health issues and represents a health disparity among Native American communities. A community-based participatory approach was taken to evaluate dietary quality of adult residents of the Flathead Reservationof the Confederated Salish & Kootenai Tribes in Montana (the Flathead Nation). A survey was administered to collect basic demographic information and food security status (N = 80). Dietary quality was assessed using the 24-h dietary recall method with subsequent calculation of Healthy Eating Index 2010 (HEI-2010) scores, modified HEI without a dairy category, and the Dietary Diversity Scores (DDS). Participants included 80 adults from different households across eight communities (n = 10 per community) at the Flathead Nation. Approximately 50% of participants reported low or very low food security status while the remainder scored high or marginal food security. The mean total HEI-2010 score of study participants was 45.5 out of 100 points with a range between 20.0 and 78.1. The mean DDS of study participants was 4.6 (± 1.365) out of a total of 9 points. Participants with higher DDS had significantly higher intake of dietary fiber (p < 0.0003), potassium (0.0024), and cholesterol (p < 0.0048) compared to the lower DDS group. No significant correlations were found between HEI-2010 scores with DDS, demographic information, or food security status while significant differences were found between food security status and income (p < 0.01) and enrollment in nutrition assistance programs (p < 0.03). This study highlights the need to evaluate multiple parameters of dietary quality coupled with a community-based participatory approach in order for findings to be culturally relevant and support food and nutrition interventions.

Food insecurity in a pre-bariatric surgery sample: prevalence, demographics and food shopping behaviour.

To identify the prevalence and demographic characteristics of food insecurity in a presurgical bariatric population. To date there has been no research on food insecurity in a presurgical bariatric population. Participants completed the ten-item adult food security survey module created by the US Department of Agriculture (USDA), with additional questions related to food shopping behaviours and perceived affordability of post-bariatric supplements. USDA scoring guidelines were used to classify participants as food secure, marginally food secure and food insecure. Academic medical centre bariatric surgery clinic in Central Pennsylvania, USA. Adult bariatric surgery candidates (n 174). There was a prevalence of 17·8 % for food insecurity and 27·6 % for marginal food security. Food insecurity was associated with younger age, higher BMI, non-White race/ethnicity, having less than a college education, living in an urban area, receiving Medicaid/Medicare and participating in nutrition assistance programmes. Food-insecure participants endorsed food shopping behaviours that could interfere with postsurgical dietary adherence and perceived post-bariatric supplies as unaffordable or inaccessible. These results highlight the importance of screening bariatric surgical patients for food insecurity. Further study of this important problem within the bariatric population should address effects of food insecurity and related shopping behaviours on postsurgical outcomes and inform the development of programmes to better assist these high-risk patients.

Food Insecurity Associated with Screening Positive for a Possible Eating Disorder Among Students Attending a Large, Public University in the Midwest (P04-035-19)

ObjectivesFood insecurity is a critical concern for college students. Food insecurity is associated with stress, irregular eating patterns, weight change, and depression, making it a plausible risk factor for disordered eating in college students, who are already at high risk of eating disorders. We explored the relation between food insecurity and screening positive for a possible eating disorder among students attending a large, public Midwestern university. MethodsData were collected cross-sectionally via an online survey during the Winter 2018 semester. The analytic sample totaled 762 after excluding students with missing data for exposure or outcome. The 10-item U.S. Adult Food Security Survey Module was used to measure food security status, which was classified into four categories: food security, marginal food security, low food security, and very low food security. Participants were screened for the presence of a possible eating disorder using the 5-item SCOFF questionnaire, with a positive screen defined as ≥2 affirmative answers. We used Poisson regression to model the prevalence of SCOFF positive screens and item-level affirmative responses by food security categories, adjusting for age, sex, race/ethnicity, family income, and first-generation status. ResultsA higher prevalence of positive SCOFF screens was observed among students with marginal food security (PR 1.76, 95% CI 1.67, 1.86), low food security (PR 1.62, 95% CI 1.53, 1.72), and very low food security (PR 2.79, 95% CI 2.65, 2.94), after adjusting for demographic characteristics. Food insecurity was also positively related to prevalence of affirmative responses for four SCOFF items. ConclusionsThis study shows that college students with food insecurity are more likely to screen positive for a possible eating disorder compared to food secure students. More research is needed to understand the complicated relationship between these two food-related constructs among college students. Funding SourcesThis study was supported by a grant from Poverty Solutions at the University of Michigan. One co-author was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Food Insecurity Is Associated with Higher Added Sugar and Sugar-Sweetened Beverage Intake Among Low-Income Elementary Aged Children (P04-059-19)

ObjectivesFood insecurity is adversely associated with physical and mental health and wellbeing in children. The mechanism that underlies this association is assumed to be dietary intake; however, evidence linking food insecurity to child dietary intake has been mixed. This study examined the relationship between self-reported food insecurity and dietary intake among low-income 7–12 year old children. MethodsCross-sectional data were used from TX Sprouts, a school-based cooking, gardening, and nutrition intervention in 16 central Texas schools. A sample of 680 children completed two 24-hour dietary recalls (24hDR) and a questionnaire that included an adapted version of the 5-item Child Food Security Assessment (CFSA). Four ordinal groups, High Food Security (HFS), Marginal Food Security (MFS), Low Food Security (LFS), and Very Low Food Security (VLFS), were generated based on summed scores from the CFSA. The Health Eating Index-2015 and dietary components (total energy, macronutrients, and servings of fruits, vegetables, whole grains, and sugar-sweetened beverages (SSBs)) were derived from 24hDR. Multivariate linear regression models were used to examine the associations between food security and dietary outcomes. A priori covariates included sex, age, ethnicity, and daily energy. ResultsChildren in the study were 45% male, 54% Hispanic, and had an average age of 9.3 years. Main effects of food security were significant for added sugar (P < 0.03) and SSBs (P < 0.04). Compared to children with HFS (referent), those who were LFS and VLFS consumed more added sugar (33.2 g vs. 39.9 g and 40.6 g, P < 0.03 and P < 0.003; respectively). Compared to the HFS referent group, those who were MFS and VLFS had higher mean intakes of SSBs (0.6 vs. 0.8 and 0.9 servings, P < 0.03 and P < 0.01; respectively). There were no significant associations between food security and other dietary outcomes. ConclusionsSelf-reported food insecurity among children (7–12 years of age) was associated with higher added sugar and SSB intake. Future research should assess if the positive association between food insecurity and added sugar and SSB intake contributes to adverse health outcomes. Funding SourcesThis study was supported by funding from the National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI).