During the past decade, rates of food insecurity and obesity have risen, and an association has been made between these two seemingly paradoxical states Although this relationship has not been repeatedly seen in men, research suggests a correlation in women Studies have not been able to consistently show a relationship in children, because findings differ based on age, race/ethnicity, household income, and sex Several proposed hypotheses explain why a correlation between food insecurity and obesity exists in adults—especially women—but not in children This review proposes a conceptual framework linking the Food Stamp Program and other coping strategies to the food insecurity–obesity relationship This link has implications for Food Stamp Program policy changes, welfare reform, and poverty prevention

The Food Insecurity–Obesity Paradox: A Review of the Literature and the Role Food Stamps May Play

Until recently, Brazil did not have a national instrument with which to assess household food insecurity (FI). The objectives of this study were as follows: 1) to describe the process of adaptation and validation of the 15-item USDA FI module, and 2) to assess its validity in the city of Campinas. The USDA scale was translated into Portuguese and subsequently tested for content and face validity through content expert and focus groups made up of community members. This was followed by a quantitative validation based on a convenience (n = 125) and a representative (n = 847) sample. Key adaptations involved replacing the term "balanced meal" with "healthy and varied diet," to construct items as questions rather than statements, and to ensure that respondents understood that information would not be used to determine program eligibility. Chronbach's alpha was 0.91 and the scale item response curves were parallel across the 4 household income strata. FI severity level was strongly associated in a dose-response manner (P < 0.001) with income strata and the probability of daily intake of fruits, vegetables, meat/fish, and dairy. These findings were replicated in the 2 independent survey samples. Results indicate that the adapted version of the USDA food insecurity module is valid for the population of Campinas. This validation methodology has now been replicated in urban and/or rural areas of 4 additional states with similar results. Thus, Brazil now has a household food insecurity instrument that can be used to set national goals, to follow progress, and to evaluate its national hunger and poverty eradication programs.

An Adapted Version of the U.S. Department of Agriculture Food Insecurity Module Is a Valid Tool for Assessing Household Food Insecurity in Campinas, Brazil

Four components of black currant anthocyanins (BCA), delphinidin 3-O-beta-rutinoside (D3R), cyanidin 3-O-beta-rutinoside (C3R), delphinidin 3-O-beta-glucoside (D3G), and cyanidin 3-O-beta-glucoside (C3G), were found to be directly absorbed and distributed to the blood and excreted into urine as the glycosylated forms. In a rat study, following oral administration of purified D3R, C3R, and C3G (800 micromol/kg of body weight), the anthocyanins were detected in the plasma and the C(max) values were 580 +/- 410, 850 +/- 120, and 840 +/- 190 nmol/L, respectively, 0.5-2.0 h after administration. In a human study, when a mixture of BCA [6.24 micromol (3.58 mg) consisting of 2.75 micromol (1.68 mg) of D3R, 2.08 micromol (1.24 mg) of C3R, 1.04 micromol (0.488 mg) of D3G, and 0.37 micromol (0.165 mg) of C3G/kg of body weight)] was orally ingested by eight volunteers, D3R, C3R, D3G, and C3G were detected in the plasma and urine. The plasma C(max) values were 73.4 +/- 35.0, 46.3 +/- 22.5, 22.7 +/- 12.4, and 5.0 +/- 3.7 nmol/L, respectively, 1.25-1.75 h after intake, and the cumulative excretion of the four compounds in urine in the period 0-8 h after intake was 0.11 +/- 0.05% of the dose ingested. These results indicate that 3-O-beta-rutinosyl anthocyanins were directly absorbed and distributed to the blood.

Orally administered delphinidin 3-rutinoside and cyanidin 3-rutinoside are directly absorbed in rats and humans and appear in the blood as the intact forms.

Objective: Examine the association between child-level food insecurity and iron status in young children utilizing community-based data from the Children's Sentinel Nutrition Assessment Program (C-SNAP). Methods: A cross-sectional sample of caregivers of children ≤36 months of age utilizing emergency department (ED) services were interviewed between 6/96–5/01. Caregiver interviews, which included questions on child-level food security, were linked to a primary clinic database containing hemoglobin, red blood cell distribution width, mean corpuscular volume, free erythrocyte protoporphyrin and lead values. Children a priori at-risk for anemia: birthweight ≤2500 g, with HIV/AIDS, sickle cell disease, or lead values ≥10.0 ug/dL, and children ≤6 months of age were excluded from the analysis. Only laboratory tests 365 days prior or 90 days after interview were examined. Iron status was classified in four mutually exclusive categories: 1) Iron Sufficient-No Anemia (ISNA), 2) Anemia (without iron deficiency), 3) Iron Deficient-No Anemia (IDNA), 4) Iron Deficient with Anemia (IDA). Results: 626 ED interviews linked to laboratory data met the inclusion criteria. Food insecure children were significantly more likely to have IDA compared to food secure children [Adjusted Odds Ratio = 2.4, 95% CI (1.1–5.2), p = 0.02]. There was no association between child food insecurity and anemia without iron deficiency or iron deficiency without anemia. Conclusion: These findings suggest an association between child level food insecurity and iron deficiency anemia, a clinically important health indicator with known negative cognitive, behavioral and health consequences. Cuts in spending on food assistance programs that address children's food insecurity may lead to adverse health consequences.

Child Food Insecurity and Iron Deficiency Anemia in Low-Income Infants and Toddlers in the United States

Objective To systematically review evidence from field interventions on the effectiveness of monetary subsidies in promoting healthier food purchases and consumption. Design Keyword and reference searches were conducted in five electronic databases: Cochrane Library, EconLit, MEDLINE, PsycINFO and Web of Science. Studies were included based on the following criteria: (i) intervention: field experiments; (ii) population: adolescents 12–17 years old or adults 18 years and older; (iii) design: randomized controlled trials, cohort studies or pre–post studies; (iv) subsidy: price discounts or vouchers for healthier foods; (v) outcome: food purchases or consumption; (vi) period: 1990–2012; and (vii) language: English. Twenty-four articles on twenty distinct experiments were included with study quality assessed using predefined methodological criteria. Setting Interventions were conducted in seven countries: the USA (n 14), Canada (n 1), France (n 1), Germany (n 1), Netherlands (n 1), South Africa (n 1) and the UK (n 1). Subsidies applied to different types of foods such as fruits, vegetables and low-fat snacks sold in supermarkets, cafeterias, vending machines, farmers’ markets or restaurants. Subjects Interventions enrolled various population subgroups such as school/ university students, metropolitan transit workers and low-income women. Results All but one study found subsidies on healthier foods to significantly increase the purchase and consumption of promoted products. Study limitations include small and convenience samples, short intervention and follow-up duration, and lack of cost-effectiveness and overall diet assessment. Conclusions Subsidizing healthier foods tends to be effective in modifying dietary behaviour. Future studies should examine its long-term effectiveness and cost-effectiveness at the population level and its impact on overall diet intake.

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Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments.

The goal of the present study was to examine the association of the Food Stamp Program with the food security and dietary intake of low-income children from Hartford, CT, who were enrolled in the Supplemental Food Program for Women, Infants, and Children (WIC). We compared the food and nutrition situation of low-income preschoolers who received food stamps (FS, n = 59) with that of those who did not receive food stamps (NFS, n = 40). Children were an average age of 2.7 +/- 0.6 y, and 95% were receiving WIC benefits at the time of the study. Groups were comparable in demographic characteristics, but the socioeconomic status of the FS group was lower than that of the NFS group (P < 0.05). Food security was assessed with the Radimer/Cornell hunger scale, and dietary intake was assessed with a single 24-h recall and a 14-item food frequency questionnaire. Multivariate analyses within the FS group indicated that a monthly duration of food stamps of <4 wk was a predictor of household food security (odds ratio 0.10, 95% confidence interval 0.02-0.56). Food stamp use was associated with above-median energy-adjusted intakes of vitamin B-6 (3.13, 1.16-8.45), folate (2.92, 1.09-7.81) and iron (3.72, 1.31-10.54). The NFS children were more likely to consume <8 mg iron/d (3.73, 1.09-12.80). These results suggest that the Food Stamp Program is associated with food security and preschoolers' micronutrient intake.

Jessica Peranick

Papers

Food Stamps Are Associated with Food Security and Dietary Intake of Inner-City Preschoolers from Hartford, Connecticut