Early childhood food insecurity linked to poor health and development, not obesity

1. Young children in food insecure households had higher odds of caregiver-reported fair or poor health and developmental risk, compared with children in food secure households.

2. There was a significant association between food insecurity and obesity in only one age group; otherwise, there were no associations between food insecurity and obesity, underweight, and stunting among young children.

Evidence Rating Level: 2 (Good)

Study Rundown: Food insecurity is a public health problem among children, and research examining associations between food insecurity and weight status have yielded inconsistent results. Furthermore, previous research has not been stratified by age or distinguished between household food insecurity and child food insecurity. In this cross-sectional study, researchers used data from surveys conducted among caregivers of children aged <4 years old. The surveys measured food insecurity, child weight and length, caregiver-reported child health and development, participation in food assistance programs, and demographic information. One quarter of the households in the sample were classified as food insecure. After adjustment for demographics, maternal BMI, and food assistance program participation, there was no significant association between food insecurity and child obesity, underweight, or stunting except for in 1 age group. Children in food insecure households had higher odds of fair or poor health and developmental risk at multiple ages.

These findings are limited by the primarily urban sample and reliance on caregiver report. Furthermore, the researchers did not adjust for multiple comparisons. Nonetheless, the study is strengthened by its large national sample and use of standardized instruments and trained interviewers. For physicians, these findings highlight the importance of early identification of childhood food insecurity for promoting future health.

Click to read the study, published today in Pediatrics

Relevant reading: Promoting Food Security for All Children

In-Depth [cross-sectional study]: Researchers used survey data from Children’s HealthWatch, a 5-city US network that monitors economic hardships. Participants included 28 184 caregivers of children <4 years of age surveyed between 2009 and 2017 in emergency departments and primary care clinics. Children were weighed and measured. They were excluded if critically ill or had private insurance. Measures included food insecurity (assessed using the US Household Food Security Survey Module), child weight and length, caregiver-reported child health and development, participation in food assistance programs, and demographic information. Multivariable logistic regression was used to model the associations between food security and weight, health, and development.

Food insecure households made up 27% of the sample. After adjustment for demographics, maternal BMI, and food assistance program participation, the odds of obesity were significantly elevated among children 25 to 36 months old in household food insecure/child food secure settings compared to those in food secure settings (adjusted odds ratio [aOR] = 1.24; 95% confidence interval [CI] 1.01-1.52). There were no other significant associations between food security and obesity, underweight, or stunting. The adjusted odds of fair or poor health were elevated across all age categories among children in food insecure settings compared to those in food secure settings. The odds of developmental risk were elevated for children in several age groups in food insecure settings.

Image: PD

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