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

CONTEXT\nKnowledge about ethnic differences in cardiovascular disease (CVD) risk factors among children and young adults from national samples is limited.\n\n\nOBJECTIVE\nTo evaluate ethnic differences in CVD risk factors, the age at which differences were first apparent, and whether differences remained after accounting for socioeconomic status (SES).\n\n\nDESIGN\nThird National Health and Nutrition Examination Survey, 1988-1994.\n\n\nSETTING\nEighty-nine mobile examination centers.\n\n\nPARTICIPANTS\nA total of 2769 black, 2854 Mexican American, and 2063 white (non-Hispanic) children and young adults aged 6 to 24 years.\n\n\nMAIN OUTCOME MEASURES\nEthnicity and household level of education (SES) in relation to body mass index (BMI), percentage of energy from dietary fat, cigarette smoking, systolic blood pressure, glycosylated hemoglobin (HbA1c), and non-high-density lipoprotein cholesterol (non-HDL-C [the difference between total cholesterol and HDL-C]).\n\n\nRESULTS\nThe BMI levels were significantly higher for black and Mexican American girls than for white girls, with ethnic differences evident by the age of 6 to 9 years (a difference of approximately 0.5 BMI units) and widening thereafter (a difference of >2 BMI units among 18- to 24-year-olds). Percentages of energy from dietary fat paralleled these findings and were also significantly higher for black than for white boys. Blood pressure levels were higher for black girls than for white girls in every age group, and glycosylated hemoglobin levels were highest for black and Mexican American girls and boys in every age group. In contrast, smoking prevalence was highest for white girls and boys, especially for those from low-SES homes (77% of young men and 61% of young women, aged 18-24 years, from low-SES homes were current smokers). All ethnic differences remained significant after accounting for SES and age.\n\n\nCONCLUSION\nThese findings show strong ethnic differences in CVD risk factors among youths of comparable age and SES from a large national sample. The differences highlight the need for heart disease prevention programs to begin early in childhood and continue throughout young adulthood to reduce the risk of atherosclerosis.

Ethnic variation in cardiovascular disease risk factors among children and young adults : Findings from the Third National Health and Nutrition Examination Survey, 1988-1994.

Background: Household food insecurity, a measure of income-related problems of food access, is growing in Canada and is tightly linked to poorer health status. We examined the association between household food insecurity status and annual health care costs. Methods: We obtained data for 67 033 people aged 18–64 years in Ontario who participated in the Canadian Community Health Survey in 2005, 2007/08 or 2009/10 to assess their household food insecurity status in the 12 months before the survey interview. We linked these data with administrative health care data to determine individuals’ direct health care costs during the same 12-month period. Results: Total health care costs and mean costs for inpatient hospital care, emergency department visits, physician services, same-day surgeries, home care services and prescription drugs covered by the Ontario Drug Benefit Program rose systematically with increasing severity of household food insecurity. Compared with total annual health care costs in food-secure households, adjusted annual costs were 16% ($235) higher in households with marginal food insecurity (95% confidence interval [CI] 10%–23% [$141–$334]), 32% ($455) higher in households with moderate food insecurity (95% CI 25%–39% [$361–$553]) and 76% ($1092) higher in households with severe food insecurity (95% CI 65%–88% [$934–$1260]). When costs of prescription drugs covered by the Ontario Drug Benefit Program were included, the adjusted annual costs were 23% higher in households with marginal food insecurity (95% CI 16%–31%), 49% higher in those with moderate food insecurity (95% CI 41%–57%) and 121% higher in those with severe food insecurity (95% CI 107%–136%). Interpretation: Household food insecurity was a robust predictor of health care utilization and costs incurred by working-age adults, independent of other social determinants of health. Policy interventions at the provincial or federal level designed to reduce household food insecurity could offset considerable public expenditures in health care.

/pdf/association-between-household-food-insecurity-and-annual-43fy30oc0d.pdf

Association between household food insecurity and annual health care costs

Food insecurity (which can be defined as inadequate access to sufficient, safe, and nutritious food that meets individuals’ dietary needs) is concurrently associated with children’s psychological difficulties. However, the predictive role of food insecurity with regard to specific types of children’s mental health symptoms has not previously been studied. We used data from the Longitudinal Study of Child Development in Quebec, LSCDQ, a representative birth cohort study of children born in the Quebec region, in Canada, in 1997–1998 (n = 2120). Family food insecurity was ascertained when children were 1½ and 4½ years old. Children’s mental health symptoms were assessed longitudinally using validated measures of behaviour at ages 4½, 5, 6 and 8 years. Symptom trajectory groups were estimated to identify children with persistently high levels of depression/anxiety (21.0%), aggression (26.2%), and hyperactivity/inattention (6.0%). The prevalence of food insecurity in the study was 5.9%. In sex-adjusted analyses, children from food-insecure families were disproportionately likely to experience persistent symptoms of depression/anxiety (OR: 1.79, 95% CI 1.15–2.79) and hyperactivity/inattention (OR: 3.06, 95% CI 1.68–5.55). After controlling for immigrant status, family structure, maternal age at child’s birth, family income, maternal and paternal education, prenatal tobacco exposure, maternal and paternal depression and negative parenting, only persistent hyperactivity/inattention remained associated with food insecurity (fully adjusted OR: 2.65, 95% CI 1.16–6.06). Family food insecurity predicts high levels of children’s mental health symptoms, particularly hyperactivity/inattention. Addressing food insecurity and associated problems in families could help reduce the burden of mental health problems in children and reduce social inequalities in development.

/pdf/food-insecurity-and-children-s-mental-health-a-prospective-42jpa89got.pdf

Food insecurity and children's mental health: a prospective birth cohort study

Objectives: Common mental disorders are a major contributor to the burden of disease in developing countries. An assessment was carried out of whether food insecurity and exposure to stressful life events, two common features of life in sub-Saharan Africa (SSA), are associated with symptoms of mental disorders among adults. Methods: The Gilgel Gibe Growth and Development Study (GGGDS) is an ongoing cohort study in rural Ethiopia. Participants of the GGGDS were randomly selected from households from a complete census of persons living in the area. The Hopkins Symptom Checklist and the Harvard Trauma Questionnaire were used to assess anxiety and depression and post-traumatic stress symptoms. Results: Among 902 adult participants, food insecurity, stressful life events and symptoms of common mental disorders were highly prevalent. In separate multivariate models adjusting for potential confounders, food insecurity and stressful life events were independently associated with high symptoms of depression, anxiety and post-traumatic stress. Conclusions: Potentially modifiable stressors may influence variation in common mental disorders in Ethiopia, and SSA more generally. These findings suggest that the negative effects of food insecurity extend beyond nutritional outcomes and that interventions that promote food security may also positively influence adult mental health in the region.

/pdf/food-insecurity-stressful-life-events-and-symptoms-of-15bfli18pr.pdf

Food insecurity, stressful life events and symptoms of anxiety and depression in east Africa: evidence from the Gilgel Gibe growth and development study

Stressful social circumstances, particularly constrained economic resources, have been linked to behavioral problems in young children and to symptoms of depression and anxiety in mothers. Using data Mathematica collected for the Fragile Families and Child Wellbeing Study, researchers sought to determine if the prevalence of depression and anxiety in mothers and the prevalence of behavior problems in preschool-aged children are more common when mothers report being food insecure. They found that 71 percent of respondents were fully food secure, 17 percent were marginally secure, and 12 percent were insecure. Mental health problems in mothers and behavior problems in their children were twice as likely in food-insecure households, after controlling for multiple factors, including income and other forms of material hardship. Alleviating food insecurity might be one way to enhance the mental and emotional well-being of mothers and their young children.

Food Insecurity and the Risks of Depression and Anxiety in Mothers and Behavior Problems in Their PreschoolAged Children

In the United States, a disparity among racial/ethnic groups in the prevalence of obesity is one of the great concerns and enigmas in the obesity epidemic. This article seeks to determine whether there are racial/ethnic differences in the prevalence of obesity among preschool children and determine whether these differences are explained by socioeconomic factors. Using data Mathematica collected for the Fragile Families and Child Well-Being Study in 20 large U.S. cities, the researchers found that the prevalence of obesity was 25.8 percent among Hispanics, 16.2 percent among blacks, and 14.8 percent among whites. The high prevalence of obesity among Hispanics relative to blacks or whites was not explained by racial/ethnic differences in maternal education, household income, or food security.

Robert C Whitaker Shannon Phillips Sean Orzol

Papers

Food Insecurity and the Risks of Depression and Anxiety in Mothers and Behavior Problems in Their PreschoolAged Children

Food Insecurity and the Risks of Depression and Anxiety in Mothers and Behavior Problems in Their PreschoolAged Children

Obesity Among US Urban Preschool Children Relationships to Race Ethnicity and Socioeconomic Status