Dietary Quality and Usual Intake of Underconsumed Nutrients and Related Food Groups Differ by Food Security Status for Rural, Midwestern Food Pantry Clients

Prevalence of micronutrient inadequacy differs by severity of food insecurity among adults living in Canada in 2015

Household food insecurity is generally associated with poorer quality diets in Canada, but whether household food insecurity heightens the probability of inadequate micronutrient intakes is unknown. The objective of this research was to investigate how prevalence of micronutrient inadequacy differed by severity of household food insecurity among adults in Canada. Using the 2015 Canadian Community Health Survey Nutrition, this study included participants aged 19-64 years who completed up to two 24 h dietary recalls and provided details about household food insecurity (n = 9486). Children and older adults were not included due to sample size limitations. Usual micronutrient intake distributions were estimated by a four-level measure of food insecurity status using the National Cancer Institute method. Welch's t tests assessed differences in prevalence of inadequacy for selected micronutrients. Prevalence differed for some micronutrients among those living in marginally and moderately food insecure compared to food-secure households. The greatest differences in prevalence of inadequacy were observed between severely food-insecure and food-secure households: vitamin A (60.0%, SE = 11.9 vs. 40.6%, SE = 2.7, p < 0.0001), vitamin B6 (42.7%, SE = 9.1 vs. 12.8%, SE = 2.5, p < 0.0001), folate (39.4%, SE = 10.0 vs. 15.9%, SE = 2.2, p < 0.0001), vitamin C (63.3%, SE = 5.2 vs. 29.1%, SE = 2.8, p < 0.0001), calcium (78.6%, SE = 6.4 vs. 58.7%, SE = 1.3, p < 0.0001), magnesium (75.6%, SE = 9.5 vs. 48.7%, SE = 1.2, p < 0.0001), and zinc (34.9%, SE = 10.0 vs. 23.2%, SE = 2.4, p = 0.0009). Apparent underreporting also differed by severity of food insecurity, with increased underreporting observed with worsening food insecurity. The probability of inadequate micronutrient intakes among adults rises sharply with more severe household food insecurity in Canada.

Campus Food Pantry Use May Improve Daily Frequency of Fruit and Vegetable Intake Among California University Students Experiencing Food Insecurity

BACKGROUND

University students are at increased risk for both food insecurity and suboptimal fruit and vegetable (F/V) intake. Campus food pantries (CFP) have been a common intervention in response to student food insecurity, but there have been few evaluations of the effectiveness of this strategy on improving students' dietary intake.

OBJECTIVE

To examine differences in the frequency of F/V intake by food security status, and whether the number of monthly CFP visits was associated with frequency of F/V intake among university students who were CFP clients.

DESIGN

Cross-sectional PARTICIPANTS: The study population included 1,188 university students across the 10-campus University of California system who had accessed their CFP or Basic Needs Center.

MAIN MEASURES

United States Department of Agriculture (USDA) 6-item short food security module, monthly CFP visits, and self-reported frequency of F/V intake (daily).

STATISTICAL ANALYSES PERFORMED

T-tests were performed to compare differences in mean daily frequency of F/V intake by food security status. Generalized linear models were used to examine associations between monthly CFP visits and mean daily frequency of F/V intake. Using a post hoc Wald test, an interaction term (monthly CFP visits × food security status) was included to the models to determine whether food security status modified associations.

RESULTS

Students experiencing food insecurity consumed total F/V 0.48 fewer times per day compared with students who were food secure (2.64 ± 2.11 vs 3.12 ± 2.01; P < .001). Among students experiencing food insecurity, each monthly CFP visit was associated with higher daily frequencies of intake for total F/V (β = 0.06), whole fruit (β = 0.03), 100% fruit juice (β = 0.01), and leafy greens (β = 0.01); however, no associations were found among the food-secure group.

CONCLUSIONS

Findings suggest that CFPs may be supporting students in need of nutritional assistance increase their daily frequency of F/V intake. Future studies are needed to validate these findings to inform investment in campus food pantries and support university students in need of nutritional assistance.

Construct validity of the Charitable Food Nutrition Index

Background

Food pantries are an important source of food for those facing food insecurity. The Charitable Food Nutrition Index (CFNI) was developed for research and practice to measure the nutritional quality of assortments of foods in this setting.

Objective

The study assessed the construct validity of the CFNI using secondary data from a group-randomized food pantry intervention in Minnesota.

Methods

The CFNI was calculated for each client cart post-intervention (n = 187; 85 intervention, 102 control). CFNI scores were based on the proportion of items in each client cart ranked "green," "yellow," or "red" using the Healthy Eating Research Nutrition Guidelines for the Charitable Food System. An implementation score assessing intervention fidelity was measured for each pantry (n = 11; 5 intervention, 6 control) based on the four intervention subcomponents: aesthetics/use of space; healthy food prominence and appeal; unhealthy food de-emphasis; and stocking standards. Mixed linear models were used to test whether: (a) client carts from pantries in the intervention condition had higher CFNI scores than those in the control condition, and (b) higher implementation scores were associated with higher CFNI scores.

Results

In adjusted models, clients from intervention group pantries had higher CFNI scores, reflecting a healthier assortment of foods compared with clients from control group pantries (p = 0.022). CFNI scores were positively associated with greater fidelity to the intervention (p = 0.020).

Conclusions

The CFNI was sensitive enough to detect the effects of the intervention in the expected directions. These findings support its construct validity and utility as a measure in the charitable food system.

A systematic literature review of indicators measuring food security

Measurement is critical for assessing and monitoring food security. Yet, it is difficult to comprehend which food security dimensions, components, and levels the numerous available indicators reflect. We thus conducted a systematic literature review to analyse the scientific evidence on these indicators to comprehend the food security dimensions and components covered, intended purpose, level of analysis, data requirements, and recent developments and concepts applied in food security measurement. Data analysis of 78 articles shows that the household-level calorie adequacy indicator is the most frequently used (22%) as a sole measure of food security. The dietary diversity-based (44%) and experience-based (40%) indicators also find frequent use. The food utilisation (13%) and stability (18%) dimensions were seldom captured when measuring food security, and only three of the retrieved publications measured food security by considering all the four food security dimensions. The majority of the studies that applied calorie adequacy and dietary diversity-based indicators employed secondary data whereas most of the studies that applied experience-based indicators employed primary data, suggesting the convenience of collecting data for experience-based indicators than dietary-based indicators. We confirm that the estimation of complementary food security indicators consistently over time can help capture the different food security dimensions and components, and experience-based indicators are more suitable for rapid food security assessments. We suggest practitioners to integrate food consumption and anthropometry data in regular household living standard surveys for more comprehensive food security analysis. The results of this study can be used by food security stakeholders such as governments, practitioners and academics for briefs, teaching, as well as policy-related interventions and evaluations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40066-023-00415-7.

A Qualitative Study to Compare Barriers to Improving Food Security among Households with Young Children in the U.S. as Perceived by Different Types of Stakeholders before and during COVID-19

This qualitative study aimed to determine the perceived barriers of different community stakeholders’ to providing resources for improving food security in households with young children in the U.S. Community stakeholders working with low-income families with children 0–3 years of age in Florida were recruited to represent healthcare (n = 7), community/policy development (n = 6), emergency food assistance (n = 6), early childhood education (n = 7), and nutrition education (n = 6) sectors. In 2020, one-on-one interviews were conducted with each stakeholder in via Zoom, using an interview script based on the PRECEDE–PROCEED model and questions to capture the impacts of COVID-19. The interviews were audio-recorded, transcribed verbatim, and analyzed using a deductive thematic approach. A cross-tab qualitative analysis was used to compare data across categories of stakeholders. Healthcare professionals and nutrition educators indicated stigma, community/policy development stakeholders indicated a lack of time, emergency food assistance personnel indicated a limited access to food, and early childhood professionals indicated a lack of transportation as the main barriers to food security prior to COVID-19. COVID-19 impacts included the fear of virus exposure, new restrictions, lack of volunteers, and a lack of interest in virtual programming as barriers to food security. As perceived barriers may vary with respect to providing resources to improve food security in families with young children and the COVID-19 impacts persist, coordinated policy, systems, and environmental changes are needed.

Dietary Costs among Midwestern Adult Food-Pantry Users by Food-Security Status

Evidence of the relationship between dietary cost, diet quality, and socio-economic status is mixed. No studies have directly evaluated food-security status and dietary cost. This study investigated whether food-pantry clients with low and very low food-security status had less expensive daily diets than food-secure clients by comparing total cost, cost per gram, and cost per calorie of total daily dietary intake both per person and by individual food item, followed by evaluations of each food group. Mixed-model regression and Tukey-Kramer comparisons were used to compare food-security groups. There was no clear association between food-security status and cost of daily diet. Analyzed per person, total price and price per gram showed significant differences between low food-secure and food-secure groups. When analyzing individual food items, prices per calorie were significantly different between food-secure and very low food-secure groups. The directionality of the relationships by food-security status was inconsistent. Per person, those with lower food security had lower mean prices, and for individual foods this association was reversed. Therefore, the metric of food cost and the unit of analysis are critical to determining the relationship between food-security status and dietary cost.

Grocery Purchase Changes Were Associated With A North Carolina COVID-19 Food Assistance Incentive Program

Many low-income Americans experience food insecurity, which may have been exacerbated by economic instability during the early stages of the COVID-19 pandemic in 2020. In this study we assessed the impact of Healthy Helping, a short-term fruit and vegetable incentive program aimed at alleviating food insecurity and improving diet quality for Supplemental Nutrition Assistance Program participants, on grocery purchases, using transaction data from a large supermarket chain in North Carolina. We compared Healthy Helping participants' purchases of key food groups before and during the program with purchases by control shoppers participating in federal food assistance programs during the same period. Healthy Helping enrollment was associated with a $26.95 increase in monthly spending on fruit, vegetables, nuts, and legumes-an increase of 2.5 grams of fiber per 1,000 kilocalories purchased-and other shifts in the composition of food purchases, relative to control shoppers. These findings suggest that the program increased healthy food purchases while also increasing dollar sales at participating retailers. On average, participants did not use the full benefit; future research should explore factors associated with non- or underuse of benefits, to inform program design and outreach.

Food Insecurity and Less Frequent Cooking Dinner at Home Are Associated with Lower Diet Quality in a National Sample of Low-Income Adults in the United States during the Initial Months of the Coronavirus Disease 2019 Pandemic

BACKGROUND

Food insecurity is a critical public health problem in the United States that has been associated with poor diet quality. Cooking dinner more frequently is associated with better diet quality.

OBJECTIVE

This study aimed to examine how food insecurity and dinner cooking frequency are associated with diet quality during the initial months of the coronavirus disease 2019 pandemic.

DESIGN

This cross-sectional study analyzed data from a national web-based survey (June 23 to July 1, 2020).

PARTICIPANTS/SETTING

Participants were 1,739 low-income (<250% of the federal poverty level) adults in the United States.

MAIN OUTCOME MEASURES

The outcome was diet quality, measured by the Prime Diet Quality Score (PDQS-30D). The PDQS-30D is a food frequency questionnaire-based, 22-component diet quality index.

STATISTICAL ANALYSES PERFORMED

Food security status (high, marginal, low, or very low) and frequency of cooking dinner (7, 5 to 6, 3 to 4, or 0 to 2 times/week) were evaluated in relation to PDQS-30D scores (possible range = zero to 126) in age- and sex and gender-, and fully adjusted linear regression models. Postestimation margins were used to predict mean PDQS-30D score by food security status and dinner cooking frequency. The interaction between food security status and frequency of cooking dinner was also tested.

RESULTS

Overall, the mean PDQS-30D score was 51.9 ± 11 points (possible range = zero to 126). The prevalence of food insecurity (low/very low) was 43%, 37% of the sample cooked 7 times/week and 15% cooked 0 to 2 times/week. Lower food security and less frequent cooking dinner were both associated with lower diet quality. Very low food security was associated with a 3.2-point lower PDQS-30D score (95% CI -4.6 to -1.8) compared with those with high food security. Cooking dinner 0 to 2 times/week was associated with a 4.4-point lower PDQS-30D score (95% CI -6.0 to -2.8) compared with cooking 7 times/week. The relationship between food insecurity and diet quality did not differ based on cooking dinner frequency.

CONCLUSIONS

During the initial months of the coronavirus disease 2019 pandemic food insecurity and less frequently cooking dinner at home were both associated with lower diet quality among low-income Americans. More research is needed to identify and address barriers to low-income households' ability to access, afford and prepare enough nutritious food for a healthy diet.

Validating a Nutrition Ranking System for Food Pantries Using the Healthy Eating Index-2015

In 2020, charitable food organizations began adopting Healthy Eating Research (HER) nutrition guidelines, which rank individual foods in tiers (e.g., green, yellow, or red) based on each food’s nutrient profile. This study aimed to validate this HER tier-ranked system against the Healthy Eating Index-2015 (HEI) and develop a formula to summarize the percentages of tier-ranked foods in an overall nutritional quality index that correlated with HEI. Using secondary data of foods selected by clients in 16 Minnesota food pantries (n = 503 “client carts”), we generated an HEI score and percentages of green, yellow, and red foods for each cart. As validation, we tested the association between HEI scores and the percentages of tier-ranked foods and compared the means of the tier-ranked variables using quintiles of the HEI scores. HEI scores were positively associated with percentages of green foods and negatively associated with percentages of red foods. Next, we used statistical learning to generate weights to maximize the correlation of the tier-ranked variables and the HEI scores and used these weights to create an index. The index demonstrated a moderate-to-strong correlation with HEI and can be used as a single measure to summarize the overall nutritional quality for sets of tier-ranked foods.

A randomized study of food pantry environment-level change following the SuperShelf intervention

The charitable food system is rapidly evolving. Interventions that target the food pantry environment and use behavioral economics are in high demand, but can be difficult to implement in a low-resource setting. This is an analysis of secondary, environment-level outcomes in a food pantry intervention (SuperShelf); the study evaluates whether the intervention resulted in measurable changes to the food pantry environment and improved diet quality of the food available to clients, compared with a control group of food pantries. Eleven food pantries were randomized to an intervention (n = 5) or control (n = 6) condition and completed baseline and one-year follow-up measures between 2018 and 2020. The intervention addressed healthy food supply and the appeal of healthy foods using behavioral economics. Assessments included manager surveys, intervention fidelity, food inventory, and food supply tracked over 5 days. Measures included change in intervention fidelity (range 0-100) with four subcomponents; Healthy Eating Index scores (HEI-2015, range 0-100) with 13 subcomponents; and Food Assortment Scoring Tool scores (FAST, range 0-100). Descriptive analyses and t-tests examined pre-post changes within and between intervention arms. Average fidelity scores increased from baseline to follow-up in the intervention group compared with the control group (p < .001), as did FAST scores (p = .02). Average HEI-2015 Total scores increased in the intervention group by 6.3 points and by 1.6 points in the control group, but the difference in change between groups was not statistically significant (p = .56). The intervention was implemented with high fidelity at five sites, with some evidence of change in the nutritional quality of the food available on the shelf to clients.

Women's health: optimal nutrition throughout the lifecycle

Sex differences are an important consideration when researching and establishing policies for nutrition and optimal health. For women's health, there are important physiologic, neurologic, and hormonal distinctions throughout the lifecycle that impact nutritional needs. Distinct from those for men, these nutritional needs must be translated into appropriate nutrition policy that aims to not only avoid overt nutritional deficiency, but also to promote health and minimize risk for chronic disease. Through a series of webinars, scientific experts discussed the advances in the understanding of the unique nutritional needs, challenges and opportunities of the various life stages for women across the life course and identified emerging nutritional interventions that may be beneficial for women. Nevertheless, there is concern that existing nutrition policy intended for women's health is falling short with examples of programs that are focused more on delivering calories than achieving optimal nutrition. To be locally effective, targeted nutrition needs to offer different proposals for different cultural, socio-economic, and geographic communities, and needs to be applicable at all stages of growth and development. There must be adequate access to nutritious foods, and the information to understand and implement proven nutritional opportunities. Experts provided recommendations for improvement of current entitlement programs that will address accessibility and other social and environmental issues to support women properly throughout the lifecycle.

Applying the Healthy Eating Index-2015 in a Sample of Choice-Based Minnesota Food Pantries to Test Associations Between Food Pantry Inventory, Client Food Selection, and Client Diet

BACKGROUND

Food pantry clients are at a high risk for diet-related chronic disease and suboptimal diet. Relatively little research has examined diet quality measures in choice-based food pantries where clients can choose their own food.

OBJECTIVE

This study tested whether the diet quality scores for food at the pantry were associated with client food selection scores, and whether client food selection scores at the pantry were associated with client diet intake scores.

DESIGN

This cross-sectional regression analysis, part of a larger evaluation study (SuperShelf), used baseline data from client and food pantry surveys, food pantry inventories, assessments of client food selections ("client carts"), and single 24-hour client dietary recalls.

PARTICIPANTS/SETTING

The analysis includes 316 clients who completed a survey (282 of whom completed a dietary recall measure) from one of 16 choice-based Minnesota food pantries during 2018-2019. Adult English, Spanish, or Somali-speaking clients were eligible in the case that they had selected food on the day of recruitment at their food pantry visit.

MAIN OUTCOME MEASURES

A Healthy Eating Index-2015 (HEI-2015) Total score and 13 subcomponent scores were calculated for: pantry food inventories of food available on the shelf, client carts, and a 24-hour client dietary recall.

STATISTICAL ANALYSIS

Descriptive statistics were generated for client and food pantry characteristics, and for HEI-2015 Total score and subcomponent scores. Linear regression models tested the association between HEI-2015 Total score and subcomponent scores for food pantry inventory and client carts, and for client carts and dietary recalls, adjusted for covariates.

RESULTS

Food pantry inventory HEI-2015 Total score averaged 65.1, client cart Total score averaged 60.8, and dietary recall Total score averaged 50.9. The diet quality scores for inventory were not associated with client cart scores, except for Added Sugars (P = .005). Client cart HEI-2015 Total score was positively associated with client diet HEI-2015 Total score (P = .002) and associations for Total Fruits, Whole Fruits, Total Vegetables, Greens and Beans, Whole Grains, Seafood and Plant Proteins, and Added Sugars subcomponents were statistically significant.

CONCLUSIONS

In choice-based Minnesota food pantries, the diet quality of food selected by clients was positively associated with client diet quality.

Differences in reporting food insecurity and factors associated with differences among Latino fathers and mothers

BACKGROUND

Food security status has been assessed as a representative score for households; however, different members in the same household may perceive and report food insecurity differently. A high prevalence of food insecurity has been reported among Latino households, therefore understanding differences in reporting food insecurity by Latino father-mother dyads may improve accuracy of assessment and plans to address food insecurity. This study aimed to 1) determine demographic characteristics and/or food-related factors associated with perceptions of food security status among Latino father-mother dyads, and 2) identify factors associated with discordance in perceptions of food insecurity between dyads.

METHODS

Baseline data were used from a community-based, youth obesity prevention program among Latino families (n = 106 father-mother dyads). Food security was assessed with a 2-item food insecurity screen. Logistic regression models were used to evaluate associations between reporting food security status and predictor variables for fathers, mothers, and dyad-discordant responses.

RESULTS

Food insecurity was reported by 39% of fathers and 55% of mothers. Adjusted odds of reporting food insecurity were significantly higher for fathers perceiving their neighborhood was unsafe vs. safe (OR: 3.7, p < 0.05) and reporting lower vs. higher household income (OR: 3.2, p < 0.05). Adjusted odds of reporting food insecurity were significantly higher for mothers perceiving their neighborhood was unsafe vs. safe (OR: 4.1, p < 0.01) and reporting lower vs. higher home availability of fruit and vegetable (OR: 5.5, p < 0.01). Dyad discordance in reporting food security status occurred in 24% of the dyads. Adjusted odds of dyad discordant reports of food insecurity status were significantly higher for dyads reporting discordant responses regarding previous nutrition education (OR: 3.4, p < 0.05) and higher home fruit and vegetable accessibility (OR: 3.1, p < 0.05) compared to dyads reporting concordant responses. Among the 28 dyads who reported discordant nutrition education participation, 21 reported that fathers had never participated but mothers had participated more than once.

CONCLUSIONS

Differential factors were associated with reporting food security among Latino father-mother dyads. Nutrition education for fathers that improves awareness of home food supplies and a better understanding of how food accessibility influences maternal perceptions may improve dyad discordance in reporting household food security.

Food Insecurity and Cardiovascular Disease Risk

Purpose of Review

This review examines the current epidemiological evidence for the relationship between levels of food insecurity and cardiovascular disease (CVD) outcomes among US adults > 17 years.

Recent Findings

Review of recent literature revealed that reduced food security was associated with decreased likelihood of good self-reported cardiovascular health and higher odds of reporting CVD-related outcomes such as coronary heart disease, angina, heart attack, peripheral arterial disease, and hypertension.

Summary

Existing evidence suggests a compelling association between each level of reduced food security and CVD risk with a particularly strong association between very low food security and CVD risk. Policies and public health-based strategies are needed to identify the most vulnerable subgroups, strengthen and enhance access to food assistance programs, and promote awareness and access to healthful foods and beverages to improve food security, nutrition, and cardiovascular health.