Food insecurity and the risk of undernutrition complications among children and adolescents: A systematic review and meta-analysis

Household food and water insecurity and its association with diarrhoea, respiratory illness, and stunting in Ecuadorian children under 5 years

Household food and water insecurity has been previously associated with adverse health consequences in children. However, these relationships are understudied in middle-income Latin American populations such as in Ecuador, where a high prevalence of food and water insecurity has been reported. Using cross-sectional data from 2018 Ecuadorian National Health and Nutrition Survey, we examined the association of household food insecurity (HFI), household water insecurity (HWI), and concurrent HFI-HWI with diarrhoea, respiratory illness (RI), and stunting in 20,510 children aged ≤59 months. HFI was measured using the Food Insecurity Experience Scale. HWI was defined when households responded negatively to one or more of four drinking water indicators. Maternal caregivers reported on child diarrhoea and RI episodes during the previous 2 weeks. Measured length or height was used to assess stunting. We constructed log-binomial regression models to estimate the associations of HFI, HWI, and concurrent HFI-HWI with child outcomes. Moderate-severe HFI was associated with a higher prevalence of diarrhoea (PR = 1.39; 95% CI: 1.18, 1.63) and RI (PR = 1.34; 95% CI: 1.22, 1.47), HWI with a higher prevalence of RI (PR = 1.13; 95% CI: 1.04, 1.22), and concurrent HFI-HWI with a higher prevalence of diarrhoea (PR = 1.30; 95% CI: 1.05, 1.62) and RI (PR = 1.45; 95% CI: 1.29, 1.62). Stunting was not associated with HFI, HWI nor concurrent HFI-HWI. These findings suggest that HFI and HWI can independently and jointly act to negatively affect children's health. Policies and interventions aimed at alleviating both food and water insecurity are needed to bring sustained health improvements in Ecuadorian children.

Evidence for Policies and Practices to Address Global Food Insecurity

Food insecurity affects an estimated 691-783 million people globally and is disproportionately high in Africa and Asia. It arises from poverty, armed conflict, and climate change, among other demographic and globalization forces. This review summarizes evidence for policies and practices across five elements of the agrifood system framework and identifies gaps that inform an agenda for future research. Under availability, imbalanced agriculture policies protect primarily staple food producers, and there is limited evidence on food security impacts for smallholder and women food producers. Evidence supports the use of cash transfers and food aid for affordability and school feeding for multiple benefits. Food-based dietary guidelines can improve the nutritional quality of dietary patterns, yet they may not reflect the latest evidence or food supplies. Evidence from the newer food environment elements, promotion and sustainability, while relatively minimal, provides insight into achieving long-term impacts. To eliminate hunger, our global community should embrace integrated approaches and bring evidence-based policies and practices to scale.

Food insecurity and coping strategies associate with higher risk of anxiety and depression among South African households with children

OBJECTIVE

To investigate food insecurity and related coping strategies, and their associations with the risk of anxiety and depression, among South African households with children.

DESIGN

Nationally representative cross-sectional study. Tools for assessing food insecurity, coping strategies, risk of anxiety and depression were assessed from the Community Childhood Hunger Identification Project, Coping Strategies Index, Generalised Anxiety Disorder-7 and Patient Health Questionnaire-9, respectively. We used ordered logistic regression to test associations of food insecurity and coping strategies with the risk of anxiety and depression. Moderating effects of each coping strategy were tested in the associations of food insecurity with anxiety and depression.

SETTING

South Africa, post COVID-19 restrictions, May-June 2022.

PARTICIPANTS

1,774 adults, weighted to 20,955,234 households.

RESULTS

Food insecurity prevalence was 23·7 % among households with children. All coping strategies were used to some extent, but relying on less preferred and less expensive foods was the most used strategy (85·5 % of food-insecure households). Moving to a higher level of food insecurity was associated with >1·6 greater odds of being in a higher risk of anxiety and depression. Sending a household member to beg for food was the strongest associated factor (OR = 1·7, P < 0·001). All coping strategies partly moderated (lessened) the associations of food insecurity with a higher risk of anxiety and depression.

CONCLUSIONS

Food insecurity among households with children was high following the COVID-19 pandemic. Collaborative efforts between government, private sector and civil society to eradicate food insecurity should prioritise poorer households with children, as these populations are the most vulnerable.

Worse becomes the worst: obesity inequality, its determinants and policy options in Iran

Background

This tracked obesity inequality and identified its determinants among the population of Iran. In addition, it examined the impact of implemented policies on these inequalities.

Methods

This study was performed in two phases. First, we conducted a rapid review of the disparity in obesity prevalence in Iran. Then we investigated the main determinants of this inequality in a qualitative study. In addition, we examined Iran's policies to deal with obesity from the perspective of equality. We conducted 30 Semi-structured interviews with various obesity stakeholders selected through a purposive snowball sampling method between November 25, 2019, and August 5, 2020. In the inductive approach, we used the content analysis method based on the Corbin and Status framework to analyze the data using MAXQDA-2020. The consolidating criteria for reporting a Qualitative Study (COREQ-32) were applied to conduct and report the study.

Results

Inequalities in the prevalence of obesity in terms of place of residence, gender, education, and other socioeconomic characteristics were identified in Iran. Participants believed that obesity and inequality are linked through immediate and intermediate causes. Inequality in access to healthy foods, physical activity facilities, and health care are the immediate causes of this inequality. Intermediate factors include inequality against women, children, and refugees, and inequality in access to information, education, and financial resources. Policymakers should implement equity-oriented obesity control policies such as taxing unhealthy foods, subsidizing healthy foods, providing healthy and free meals in schools, especially in disadvantaged areas, and providing nutrient-rich foods to low-income families. Also, environmental re-engineering to increase opportunities for physical activity should be considered. Of course, for the fundamental reduction of these inequalities, the comprehensive approach of all statesmen is necessary.

Conclusion

Obesity inequality is a health-threatening issue in Iran that can prevent achieving human development goals. Targeting the underlying causes of obesity, including inequalities, must be considered.

Household food insecurity and physical activity behaviour in Ecuadorian children and adolescents: findings from the Ecuador 2018 National Health and Nutrition Survey (ENSANUT-2018)

OBJECTIVE

Ecuador has a high prevalence of household food insecurity (HFI) and is undergoing nutritional and epidemiologic transition. Evidence from high-income countries has reported negative or null associations between HFI and physical activity (PA) in children. It remains uncertain whether the same is true of those from low- and middle-income countries like Ecuador whose environmental and socio-demographic characteristics are distinct from those of high-income countries. We aimed to investigate the association of HFI with PA, sedentary behaviour (SB) and anthropometric indicators in children.

DESIGN

Cross-sectional analysis of data from the nationally representative 2018 Ecuadorian National Health and Nutrition Survey. Data were collected on HFI, PA, SB, socio-demographic characteristics and measured height and weight. Unadjusted and adjusted linear, log-binomial and multinomial logistic regression analyses assessed the relationship of HFI with PA, SB, stunting and BMI-for-age.

SETTING

Ecuador.

PARTICIPANTS

23 621 children aged 5-17 years.

RESULTS

Marginal and moderate-severe HFI was prevalent in 24 % and 20 % of the households, respectively. HFI was not associated with PA, SB, stunting nor underweight. Moderate-severe HFI was associated with a lower odds of overweight and obesity. However, adjustment for household assets attenuated this finding for overweight (adjusted OR:0·90, 95 % CI: 0·77, 1·05) and obesity (adjusted OR: 0·88, 95 % CI: 0·71, 1·08).

CONCLUSION

HFI is a burden in Ecuadorian households, but is not associated with PA, SB nor anthropometric indicators in children aged 5-17 years. However, a concerning prevalence of insufficient PA was reported, emphasising the critical need for evidence-based interventions aimed at promoting PA and reducing SB.

Methods for Assessing Health Outcomes Associated with Food Insecurity in the United States College Student Population: A Narrative Review

In the United States, college students experience disproportionate food insecurity (FI) rates compared to the national prevalence. The experience of acute and chronic FI has been associated with negative physical and mental health outcomes in this population. This narrative review aims to summarize the current methodologies for assessing health outcomes associated with the experience of FI in college students in the United States. To date, assessing the health outcomes of FI has predominately consisted of subjective assessments, such as self-reported measures of dietary intake, perceived health status, stress, depression, anxiety, and sleep behaviors. This review, along with the emergence of FI as an international public health concern, establishes the need for novel, innovative, and objective biomarkers to evaluate the short- and long-term impacts of FI on physical and mental health outcomes in college students. The inclusion of objective biomarkers will further elucidate the relationship between FI and a multitude of health outcomes to better inform strategies for reducing the pervasiveness of FI in the United States college student population.

Environmental factors of food insecurity in adolescents: A scoping review protocol

Food insecurity in recent years has increased worldwide due to many planetary events such as the COVID-19 pandemic, geopolitical conflicts, the climate crisis, and globalization of markets. Adolescents are a particularly vulnerable group to food insecurity, as they enter adulthood with less parental supervision and greater personal autonomy, but less legislative or institutional protection. The experience of food insecurity in adolescents is influenced by several environmental factors at different levels (interpersonal, organizational, community, and societal), although they are not usually addressed in the design of interventions, prioritizing the individual behavioural factors. We present a scoping review protocol for assessing and identifying the environmental factors that could influence adolescents' food insecurity. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and the PRISMA guidelines for Scoping Reviews (PRISMA-ScR) to prepare the protocol. The search strategy will be performed in the following databases: Pubmed/Medline, EMBASE, Biblioteca Virtual de Salud, EBSCOHost, Scopus, Web of Science, and Cochrane Library Plus. The reference list of the included studies will also be hand-searched. Grey literature will be search through the electronic database Grey Literature Report, and local, provincial, national, and international organisations' websites. Assessment of eligibility after screening of titles, abstract and full text, and the resolution of discrepancies will be performed by three independent reviewers. This scoping review will contribute to refine the "logic model of the problem" which constitutes the first step in the intervention mapping protocol. The "logic model of the problem" from the intervention mapping protocol will serve to classify and analyse the environmental factors. The findings from this review will be presented to relevant stakeholders that have a role in shaping the environmental factors.

Food insecurity screening and local food access: Contributions to nutritional outcomes among children and adults with cystic fibrosis in the United States

BACKGROUND

As the nutritional status of people with CF (PwCF) is associated with their socioeconomic status, it is important to understand factors related to food security and food access that play a role in the nutritional outcomes of this population. We assessed the contributions of CF program-level food insecurity screening practices and area-level food access for nutritional outcomes among PwCF.

METHODS

We conducted a cross-sectional analysis of 2019 data from the U.S. CF Patient Registry (CFFPR), linked to survey data on CF program-level food insecurity screening and 2019 patient zip code-level food access. Pediatric and adult populations were analyzed separately. Nutritional outcomes were assessed with annualized BMI percentiles (CDC charts) for children and BMI (kg/m2) for adults, with underweight status defined as BMIp <10% for children and BMI <18.5 kg/m2 for adults, and overweight or obese status defined as BMIp >85% for children and BMI >25 kg/m2 for adults. Analyses were adjusted for patient sociodemographic and clinical characteristics.

RESULTS

The study population included 11,971 pediatric and 14,817 adult PwCF. A total of 137 CF programs responded to the survey, representing 71% of the pediatric sample and 45% of the CFFPR adult sample. The joint models of nutritional status as a function of both program-level food insecurity screening and area-level food access produced the following findings. Among children with CF, screening at every visit vs less frequently was associated with 39% lower odds of being underweight (OR 0.61, p = 0.019), and the effect remained the same and statistically significant after adjusting for all covariates (aOR 0.61, p = 0.047). Residence in a food desert was associated both with higher odds of being underweight (OR 1.66, p = 0.036; aOR 1.58, p = 0.008) and with lower BMIp (-4.81%, p = 0.004; adjusted -3.73%, p = 0.014). Among adults with CF, screening in writing vs verbally was associated with higher odds of being overweight (OR 1.22, p = 0.028; aOR 1.36, p = 0.002) and higher BMI (adjusted 0.43 kg/m2, p = 0.032). Residence in a food desert was associated with higher odds of being underweight (OR 1.48, p = 0.025).

CONCLUSIONS

Food insecurity screening and local food access are independent predictors of nutritional status among PwCF. More frequent screening is associated with less underweight among children with CF, whereas screening in writing (vs verbally) is associated with higher BMI among adults. Limited food access is associated with higher odds of being underweight in both children and adults with CF, and additionally with lower BMI among children with CF. Study results highlight the need for standardized, evidence-based food insecurity screening across CF care programs and for equitable food access to optimize the nutritional outcomes of PwCF.

Causes and consequences of child growth faltering in low-resource settings

Growth faltering in children (low length for age or low weight for length) during the first 1,000 days of life (from conception to 2 years of age) influences short-term and long-term health and survival1,2. Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-age z-scores of up to 0.40 and weight-for-length z-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions.

The Health and Nutritional Status of Children (10-18 years) Belonging to Food Insecure Households: The Korea National Health and Nutrition Examination Survey (2012-2019)

To research the health and nutritional status in Korean children and adolescents belonging to food insecure households (FI), the preregistered secondary data of 18 items from the Food Security Evaluation in the Korea National Health and Nutrition Examination Survey (KNHANES; 2012-2019) were used. Comparative analyses (food security group [FS], (n = 3150) vs. FI, (n = 405) of household characteristics, health status (anthropometrics, clinics, mentality), and nutritional status (nutrient intake, diet-quality, and pattern) were performed in children (boys: 1871, girls: 1684) aged 10-18 years. The FI comprised higher proportions of participants from low-income families, basic livelihood-security recipients, and vulnerability (characteristics: female household heads, aged ≥50, single, unemployed, with low education and unmet healthcare needs). Compared to FS, boys had higher abdominal obesity and alcohol use, whereas girls had lower high-density-lipoprotein cholesterol (HDLc) and mental vulnerability (self-perceived obesity despite FS-similar anthropometry) in FI. Inadequate protein intake among boys and girls, and high carbohydrate and inadequate fat intake among girls were especially found in the FI status. From the results of a nutrition quality test, Vit-A in boys, and protein, niacin, and iron intakes in girls were insufficient, respectively. Health-nutritional policies to improve children's lifestyles should reinforce FI-based intake of deficient nutrients.

Socio-economic and agricultural factors associated with stunting of under 5-year children: findings from surveys in mountains, dry zone and delta regions of rural Myanmar (2016-2017)

OBJECTIVE

The study's objective was to investigate multiple underlying social, economic and agricultural determinants of stunting among under-five children in three distinct ecological areas in rural Myanmar.

DESIGN

Repeated cross-sectional surveys in three states of Myanmar.

SETTING

Rural households in Chin (mountainous), Magway (plains) and Ayeyarwady (delta).

PARTICIPANTS

From two purposively selected adjacent townships in each state, we randomly selected twenty villages and, in each village, thirty households with under-five children. Households in the first survey in 2016 were revisited in late 2017 to capture seasonal variations.

RESULTS

Stunting increased from 40·4 % to 42·0 %, with the highest stunting prevalence in Chin state (62·4%). Univariate Poisson regression showed factors contributing to child stunting varied across the regions. Adjusted Poisson regression models showed that child's age and short maternal stature (aRR = 1·14 for Chin, aRR = 1·89 for Magway and aRR = 1·86 for Ayeyarwady) were consistently associated with child stunting across three areas. For Chin, village-level indicators such as crop consumption (aRR = 1·18), crop diversity (aRR = 0·82) and land ownership (aRR = 0·89) were significantly associated with stunting. In Magway, the number of household members (aRR = 1·92), wealth status (aRR = 0·46), food security status (aRR = 1·14), land ownership (aRR = 0·85) and in Ayeyarwady, women's decision-making (aRR = 0·67) and indicators related to hygiene (aRR = 1·13) and sanitation (aRR = 1·45) were associated with stunting.

CONCLUSIONS

Area-specific factors were associated with stunting. Maternal short stature and child age were consistent determinants of stunting. A multi-sectoral local approach, including improvements in transport, is needed to address the intergenerational malnutrition problem.

Financial adversity and subsequent health and wellbeing during the COVID-19 pandemic in the UK: A qualitative interview study

Aims

There are concerns that the economic impacts of the COVID-19 pandemic, including employment inactivity and job loss, will have consequences for the UK population's health and wellbeing. However, there is limited qualitative research into how financial adversity contributes to poor health outcomes in this context. This study aimed to explore forms of financial adversity experienced during the pandemic and their subsequent impacts for health and wellbeing.

Methods

Qualitative semi-structured interviews with 20 people who experienced a form of financial adversity during the pandemic and six service providers employed in social welfare support services. Data were analysed using reflexive thematic analysis.

Results

Two main sources of financial adversity were identified: reductions in household incomes and increased living costs which engendered emotional and physical burdens. Coping strategies included increased financial borrowing, support from informal and formal networks and cutting back on energy use, food and non-essential items.

Conclusion

Our study highlighted exposure to multiple financial adversities because of the pandemic and how these experiences led to poor mental and physical health. The findings underline the importance of measures attending to the immediate needs of individuals, including accessible, co-located financial and psychological services, as well as broader measures that seek to reduce social and economic inequalities.

Prevalence and correlates of stunting and thinness among adolescent students in Lideta subcity, Addis Ababa, Ethiopia: a cross-sectional study

OBJECTIVES

To determine the prevalence of stunting and thinness and associated factors among adolescents attending public schools in Lideta subcity, Addis Ababa, Ethiopia, in 2021.

DESIGN

Cross-sectional.

SETTING

Public schools in Lideta subcity, Addis Ababa, Ethiopia.

ELIGIBILITY

Adolescents from grades 5-12 in public schools and students whose parents gave consent for participation.

DATA ANALYSIS

Bivariate and multivariable logistic regression analyses were used to examine the association between the independent variables and stunting and thinness. Using a 95% CI and adjusted OR (AOR), factors with a p value of less than 0.05 were determined to have a significant association.

OUTCOME MEASURES

The prevalence of stunting and thinness, as well as the factors associated with stunting and thinness, were secondary outcomes.

RESULTS

The overall prevalence of stunting and thinness was 7.2% (95% CI: 5.3% to 9.3%) and 9% (95% CI: 6.8% to 11.4%), respectively. Stunting was associated with a larger family size (AOR=3.76; 95% CI: 1.58 to 8.94), low dietary diversity (AOR=2.87; 95% CI: 1.44 to 5.74), food insecurity (AOR=2.81; 95% CI: 1.38 to 5.71) and a lower wealth index (AOR=3.34; 95% CI: 1.51 to 7.41). On the other hand, thinness was associated with maternal education in those who were unable to read and write (AOR=2.5; 95% CI: 1.97 to 8.11), inadequate dietary diversity (AOR=4.81; 95% CI: 2.55 to 9.07) and larger family size (AOR=2.46; 95% CI: 1.14 to 5.29).

CONCLUSION

Adolescent stunting and thinness were common in Addis Ababa's public schools. Family size, dietary diversity and food security were the main factors associated with both thinness and stunting. Therefore, to solve the problem of adolescent stunting and thinness, the administration of Addis Ababa city should prioritise minimising food insecurity while boosting productivity to enhance adolescent nutritional diversity. Moreover, nutritional education should be strengthened by healthcare providers working at public schools as well as health extension workers.

Food security and diet quality among urban poor adolescents in Kuala Lumpur, Malaysia

BACKGROUND/OBJECTIVES

This study aimed to examine the food security status of urban poor adolescents and its association with diet quality.

SUBJECTS/METHODS

A cross-sectional survey was conducted among 188 adolescents aged 13-18 yrs living in Kuala Lumpur, Malaysia. Household food insecurity and dietary intake data were collected using the Radimer/Cornell hunger and food insecurity instrument and 2-day 24-h dietary recalls, respectively. Diet quality was determined using the Malaysian Healthy Eating Index (HEI). Weight and height were measured and body mass index-for-age, as well as height-for-age z scores were calculated.

RESULTS

The present study revealed that 47.9% of the adolescents experienced household food insecurity, 24.5% experienced individual food insecurity, 18.6% household food security, and 9.0% child hunger. The mean score of diet quality was 56.83 ± 10.09, with a significantly lower HEI score among food insecure adolescents (household food insecure, individual food insecure, and child hunger) than household food secure adolescents (P = 0.001). The differences between food secure and food insecure households were found to be significant for energy (P = 0.001) and nutrients including proteins (P = 0.006), carbohydrates (P = 0.005), dietary fiber (P = 0.001), folate (P < 0.001), and vitamin C (P = 0.006). The multiple linear regression showed that adolescents who experienced food insecurity (β = -0.328; P = 0.003) were found to be significantly associated with poor diet quality (F = 2.726; P < 0.01), wherein 13.3% of the variation in the diet quality was explained by the food security status.

CONCLUSIONS

Experiencing food insecurity contributed to poor diet quality among urban poor adolescents. Further longitudinal studies are needed to comprehensively understand this association to improve food insecurity and diet quality among urban poor communities.

Food insecurity is associated with multiple psychological and behavioural problems among adolescents in five Caribbean countries

The study aimed to assess associations between food insecurity and multiple psychological and behavioural problems among adolescents in five Caribbean countries. Data from national and cross-sectional school health surveys from 9,956 adolescents (15 years, median age) in Trinidad and Tobago, Suriname, Jamaica, Anguilla and the Dominican Republic in 2016-2017 were analyzed in 2016-2017. Results show that the prevalence of moderate (rarely or sometimes) past-month food insecurity was 35.9% and severe (mostly or always) food insecurity was 4.6%. Severe food insecurity among adolescents ranged from 2.9% in Dominican Republic to 11.2% in Suriname. In adjusted logistic regression analyses, the higher severity of food insecurity was associated with negative psychological outcomes (loneliness, suicidal ideation, suicide plan, suicide attempt, anxiety, current tobacco use and any trouble from alcohol use) and negative behavioural outcomes (truancy, bullied, physically attacked, physical injury, and multiple sexual partners). Two out of five adolescents experienced some form of food security. Food interventions, such as school feeding programmes, are warranted to reduce negative psychosocial outcomes.

Food insecurity and its determinants among adults in North and South India

BACKGROUND

Food insecurity is a major public health problem worldwide. In India, there are limited food insecurity assessment studies using a conventionally accepted method like the Food Insecurity Experience Scale (FIES), developed by the Food and Agricultural Organization (FAO). This study aims to measure food insecurity using the FIES and explore its determinants and association with body mass index (BMI) among Indian adults.  METHODS: In a cross-sectional study, we used FIES to measure food security in a sample of 9005 adults residing in North and South India. Using questionnaires, socio-demographic factors, dietary intake and food security data were collected. The dietary diversity scores (FAO-IDDS) and food insecurity scores (FAO-FIES) were calculated. Body size was measured and BMI was calculated.  RESULTS: The mean age of the study participants was 52.4 years (± 11.7); half were women and half resided in rural areas. Around 10% of the participants reported having experienced (mild or moderate or severe) food insecurity between October 2018 and February 2019. Dietary diversity (measured by FAO's Individual Dietary Diversity Scores, IDDS) was low and half of the participants consumed ≤ 3 food groups/day. The mean BMI was 24.7 kg/m². In the multivariate analysis, a lower IDDS and BMI were associated with a higher FIES. The place of residence, gender and wealth index were important determinants of FIES, with those residing in South India, women and those belonging to the poorest wealth index reporting higher food insecurity.

CONCLUSION

Food security is understudied in India. Our study adds important evidence to the literature. Despite having marginal food insecurity, high prevalence of low diet quality, especially among women, is disconcerting. Similar studies at the national level are warranted to determine the food insecurity situation comprehensively in India and plan appropriate policy actions to address it effectively, to attain the key Sustainable Development Goals (SDG).

Income precarity and child and parent weight change during the COVID-19 pandemic: a cross-sectional analysis of the Ontario Parent Survey

OBJECTIVES

To describe child and parent weight change during the pandemic, overall and by income precarity.

DESIGN

A cross-sectional online survey was conducted.

SETTING

Caregivers of children 0-17 years of age living in Ontario, Canada, during the COVID-19 pandemic from May 2021 to July 2021.

PARTICIPANTS

A convenience sample of parents (n=9099) with children (n=9667) living in Ontario were identified through crowdsourcing.

PRIMARY OUTCOME MEASURE

Parents recalled, for themselves and their child, whether they lost weight, gained weight or remained the same over the past year. OR and 95% CI were estimated using multinomial logistic regression for the association between income precarity variables and weight loss or gain, adjusted for age, gender and ethnicity.

RESULTS

Overall, 5.5% of children lost weight and 20.2% gained weight. Among adolescents, 11.1% lost weight and 27.1% gained weight. For parents, 17.1% reported weight loss and 57.7% reported weight gain. Parent weight change was strongly associated with child weight change. Income precarity measures, including job loss by both parents (OR=7.81, 95% CI 5.16 to 11.83) and disruption to household food supply (OR=6.05, 95% CI 4.77 to 7.68), were strongly associated with child weight loss. Similarly, job loss by both parents (OR=2.03, 95% CI 1.37 to 3.03) and disruption to household food supply (OR=2.99, 95% CI 2.52 to 3.54) were associated with child weight gain.

CONCLUSIONS

Weight changes during the COVID-19 pandemic were widespread and income precarity was strongly associated with weight loss and weight gain in children and parents. Further research is needed to investigate the health outcomes related to weight change during the pandemic, especially for youth, and the impacts of income precarity.

Food insecurity and outcomes during COVID-19 pandemic in sub-Saharan Africa (SSA)

The outbreak of COVID-19 led to the implementation of lockdowns and social distancing regulations to curb the spread of infections. Consequently, the lockdowns impeded the movement of smallholder farmers, agricultural inputs, and food products thereby disrupting the food supply chains in SSA. Therefore, this paper examines the relationship between food security indicators (accessibility, availability, utilization, stability) and COVID-19. This study uses ordinary least square regression (OLS) models to study the relationship between the food security indicators and COVID-19. The study considers 9 out of 48 sub-Saharan African countries (Benin, Burkina Faso, Cameroon, Chad, Madagascar, Mali, Mauritania, Nigeria, Senegal) due to data availability restrictions. The result of the analysis indicated that a rise in COVID-19 levels negatively impacts all the 4 indicators of food security without exception. This paper underscores the need to consider the disruptions of food security indicators such as diet, nutritional content, access and availability, affordability, and food supply chains. Moreover, the paper discusses mitigating strategies that may alleviate SSA’s food security amidst the COVID-19 pandemic. We recommend that SSA countries invest in quality agricultural and food production infrastructure and supporting industries that contribute directly to the food supply chain, such as agro-processing, fertilizer production and transport. Another important dimension of the COVID-19 and food insecurity syndemic is the income shocks that occurred as a consequence of the COVID-19 outbreak. Like many factories, companies, and service providers closed shop (especially the informal sector), people lost their incomes as a result of loss of employment and, in many instances, no social protection. Therefore, we recommend that SSA governments develop affordable, sustainable, and targeted social protection/insurance systems that extend to the informal sector of the economy.

The nutritional quality of food parcels provided by food banks and the effectiveness of food banks at reducing food insecurity in developed countries: a mixed-method systematic review

BACKGROUND

Research indicates that food parcels provided by food banks are nutritionally poor. Food insecurity and the use of food banks are both rising, with detrimental effects on the dietary intake and health of users. This mixed-method systematic review aims to investigate the current nutritional adequacy of pre-packaged food parcels and whether using food banks reduces the food insecurity and improves the dietary intake of their users.

METHODS

A mixed-method systematic literature review, restricted to articles published from 2015, was conducted using eight electronic databases, four grey literature databases and eight relevant websites. Quantitative findings, investigating the nutritional quality of food parcels and/or their impact on dietary intake or food insecurity, were presented narratively. Qualitative findings reporting the views of food bank users regarding food from food banks underwent thematic synthesis. These independent syntheses were integrated using configurative analysis and presented narratively.

RESULTS

Of 2189 articles, 11 quantitative and 10 qualitative were included. Food parcels were inconsistent at meeting nutritional requirements and often failed to meet individual needs, including cultural and health preferences. Using food banks improved food security and dietary quality of users, allowing otherwise unachievable access to food. However, food insecurity remained, and is explained by limited food variety, quality and choice. The mixed-method findings support interventions to ensure consistent, adequate nutrition at food banks, including catering for individual needs.

CONCLUSIONS

Food banks are a lifeline for those severely food insecure. However when used alone, food banks struggle to eliminate the heightened food insecurity of their users. Efforts to improve the nutritional quality of food parcels could improve the experiences and diet-related outcomes of those requiring food banks.

Diet and Nutrients Intakes during Infancy and Childhood in Relation to Early Puberty: A Systematic Review and Meta-Analysis

The onset of puberty has become earlier over the decades, and nutrients and diet are related to the timing of puberty onset. Hence, we aimed to investigate the association between diet or nutrients in infancy, childhood and early puberty. PubMed, Embase, and Cochrane library were searched systematically up to 15 April 2022. The pooled relative risks (RRs) or regression coefficients (beta) were estimated using the random-effect model or fixed-effect model according to the heterogeneity between studies. Twenty-two articles on diet or nutrients in childhood and six about breastfeeding in infancy were included. The prolonged breastfeeding duration in infancy could reduce the risk of early menarche (beta 0.31, 95% CI: 0.01, 0.60, p = 0.045). The high intake of yogurt was associated with a 35% reduction in the risk of earlier menarche (RR 0.65, 95% CI: 0.47, 0.89, p = 0.008). Girls with severe food insecurity experienced later menarche (RR 0.81, 95% CI: 0.67, 0.98, p = 0.027). Conversely, due to the high intake of protein, the risk of early menarche increased by 8% (RR 1.08, 95% CI: 1.01, 1.16, p = 0.016). High intake of yogurt, longer duration of breastfeeding, and food insecurity decreased the possibility of earlier menarche, while high intake of protein increased that risk. As a modifiable factor, diet and nutrients in infancy and childhood provide new insights into the future prevention of early puberty.

Household Resilience to Food and Nutrition Insecurity during COVID-19 in Tanzania

We examine food and nutrition security and the household's ability to respond adequately to shock and stressors during the COVID-19 pandemic. Specifically, we assess household resilience to food insecurity and its relation to future food security. We use two survey rounds collected during the pandemic - before and after the second wave of the pandemic-from the vulnerable population living in slums in Tanzania. The findings reveal that many households have low resilience to shock. We find that COVID-19 reduced access to food in 68% of the households and left about 30% without any food to eat. We also find that micronutrient consumption significantly declined among households who reported food insecurity following the second wave of COVID-19. We also find that the probability of experiencing food insecurity reduced with the initial resilience level. High resilient households have a higher likelihood of maintaining or diversifying more their diets even when are exposed to shock. The disruption of income-generating activities was found as a leading pathway through which COVID-19 affected household food security. The findings suggest that with persisting COVID-19 pandemic and the low level of micronutrients consumption, the nutrition of children and adult household members of the vulnerable population is at stake.

Social determinants of health associated with the experience of hunger among Brazilian adolescents

The aim of this study was to identify social determinants of health associated with the experience of hunger among school-age adolescents in Brazil. We conducted a cross-sectional study with a sample of 16,526 adolescents using data from the 2015 National School-based Student Health Survey. Experience of hunger was determined based on the answer to the question "In the last 30 days, how often have you been hungry because there wasn't enough food at home?" The social determinants of health were analyzed using Poisson regression with robust variance. The prevalence of the experience of hunger was 22.8% (95%CI: 21.9-23.7). The experience of hunger was directly associated with being male (PR = 1.12; 95%CI: 1.07-1.16); not being overweight (PR = 1.08; 95%CI: 1.04-1.13 ); irregular consumption of beans (PR = 1.20; 95%CI: 1.13-1.26), vegetables (PR=1.16; 95%CI: 1.09-1.22) and fruit (PR = 1.19; 95%CI: 1.13-1.24); body dissatisfaction (PR = 1.26; 95%CI: 1.18-1.35); and not regularly eating lunch or dinner with parents or guardians (PR = 1.41; 95%CI: 1.32-1.52). An inverse association was found between the experience of hunger and maternal education level and living in the Mid-West, Southeast and South. The findings show that the experience of hunger among Brazilian adolescents coexists with risky eating behaviors, body dissatisfaction, and social inequality.

Modified body mass index z-scores in children in New York City during the COVID-19 pandemic

OBJECTIVES

Determine whether the negative impact of the COVID-19 pandemic on weight gain trajectories among children attending well-child visits in New York City persisted after the public health restrictions were reduced.

STUDY DESIGN

Multicenter retrospective chart review study of 7150 children aged 3-19 years seen for well-child care between 1 January 2018 and 4 December 2021 in the NYC Health and Hospitals system. Primary outcome was the difference in annual change of modified body mass index z-score (mBMIz) between the pre-pandemic and early- and late-pandemic periods. The mBMIz allows for tracking of a greater range of BMI values than the traditional BMI z-score. The secondary outcome was odds of overweight, obesity, or severe obesity. Multivariable analyses were conducted with each outcome as the dependent variable, and year, age category, sex, race/ethnicity, insurance status, NYC borough, and baseline weight category as independent variables.

RESULTS

The difference in annual mBMIz change for pre-pandemic to early-pandemic = 0.18 (95% confidence interval [CI]: 0.15, 0.20) and for pre-pandemic to late-pandemic = 0.04 (95% CI: 0.01, 0.06). There was a statistically significant interaction between period and baseline weight category. Those with severe obesity at baseline had the greatest mBMIz increase during both pandemic periods and those with underweight at baseline had the lowest mBMIz increase during both pandemic periods.

CONCLUSION

In NYC, the worsening mBMIz trajectories for children associated with COVID-19 restrictions did not reverse by 2021. Decisions about continuing restrictions, such as school closures, should carefully weigh the negative health impact of these policies.

The association between food insecurity and gestational weight gain: A systematic review and meta-analysis

Gestational weight gain has been one of the most important risk factors for adverse maternal, perinatal, and long-term outcomes. Our systematic review and meta-analysis aimed to incorporate the evidence regarding the association between gestational weight gain and food insecurity (FI). We performed a systematic review and meta-analysis on the possible association between FI and insufficient or excessive gestational weight gain by conducting a systematic search in PubMed, Scopus, ISI, and Google Scholar from January 1, 1990 until February 1, 2022. Odds Ratio (OR) was pooled using a random-effects model. Standard methods were used for the assessment of heterogeneity and publication bias. Data included fifteen studies with 7651 individual participants from different countries pooled for the meta-analysis. Of the fifteen studies included in the final meta-analysis, seven had a cross-sectional and eight had a longitudinal design. In the pooled analysis, FI had significant relationship with both inadequate (OR = 1.49; 95% CI = 1.26 to 1.76) and excessive weight gain in pregnancy (OR = 1.27; 95% CI = 1.05 to 1.54). In conclusion, FI during pregnancy was directly associated with both inadequate and excessive gestational weight gain. Therefore, changes at a policy level should be considered to increase food security in pregnant women.

The Mediating Effect of Sleep Duration on the Association between Food Insecurity and Childhood Obesity

Background: Childhood obesity has increased globally during the past four decades. Food insecurity could heighten the risk of obesity. However, little is known about the underlying mechanism. This study aims to investigate the mediating role of sleep duration in the association between food insecurity and childhood obesity and whether there are differences by age, sex, and race/ethnicity. Method: Data from the National Survey of Children's Health for the years 2016-2020 were used, including children 10-17 years of age. We employed causal mediation analysis within a counterfactual framework to decompose the total effect of food insecurity into natural direct and indirect effects and estimate the proportion mediated. Result: The prevalence of obesity was 15.8% in our study sample. Children with food insecurity had 78% higher odds [odds ratio (OR) = 1.78, 95% confidence interval (CI): 1.70-1.86] of having obesity compared with children who were food secure. Overall, only 6.13% of this association was mediated by sleep duration. The association between food insecurity and obesity was stronger in females (OR = 1.96, 95% CI: 1.84-2.10) than males (OR = 1.66, 95% CI: 1.56-1.75), but the proportion mediated by sleep duration was larger in males (7.13%) than females (5.22%). Evidence of mediation was more pronounced in children 10-11 years of age and non-Hispanic Asian children (proportion mediated = 14.85% and 11.21%, respectively). Conclusion: Food insecurity is associated with an increased prevalence of obesity among children. Although a small proportion of this association is mediated by sleep duration, these results suggest that sleep should be considered when assessing the link between food insecurity and childhood obesity.

Social Determinants of Obesity and Stunting among Brazilian Adolescents: A Multilevel Analysis

(1) Background: The purpose of this study was to identify the prevalence of obesity and stunting among Brazilian adolescents and its associations with social determinants of health (individual, family, and school), grounded on the necessity of investigating the determinants of nutritional problems within this population. (2) Methods: A population-based survey was administered to 16,556 adolescents assessed by the 2015 National School Health Survey. Multivariate models of obesity and stunting were estimated from Multilevel Poisson Regressions. (3) Results: The prevalence of obesity among Brazilian adolescents (10.0%; 95% CI: 9.4–10.6) was associated directly with indifference or dissatisfaction with body image, with eating breakfast four or fewer days a week, living with up to four people in the household, studying in private schools, and being from the South region, and was inversely associated with being female, 15 years old or older, with having the highest nutritional risk eating pattern, dining at fast-food restaurants, and eating while watching television or studying. The prevalence of stunting (2.3%; 95% CI: 2.0–2.8) was directly associated with the age of 15 years or older, and inversely associated with the lower number of residents living in the household, maternal education—decreasing gradient from literate to college level education, studying in urban schools, and being from the South and Central-West regions. (4) Conclusions: Obesity in adolescence presented behavioral determinants. Stunting and obesity have structural social determinants related, respectively, to worse and better socioeconomic position among Brazilian adolescents.

Association of adverse childhood experiences (ACEs) with obesity and underweight in children

PURPOSE

The aim of the study was to test the hypothesis that adverse childhood experiences (ACEs) are related to both obesity and underweight from childhood, and that the association of ACEs with weight abnormalities is modulated by type of ACEs, sex and socioeconomic status (SES) indices.

METHODS

The relations between ACEs (0 vs ≥ 1), ACE accumulation and ACE type with weight status and z scores BMI were assessed in 503 children aged 6-12 years from Poznan, Poland. The effects of interaction of ACEs with sex and SES on z scores BMI were included in the analyses.

RESULTS

ACEs were significantly related to both obesity and underweight, in unadjusted analysis, and when sex and SES indices, such as size of place of residence, people per room in household, and parental education were controlled. The relation of ACEs with z scores BMI was modulated by ACE type, parental subjective assessment of economic situation of a family and parental education. ACE accumulation was not related to an increase of obesity or underweight rate, or z scores BMI.

CONCLUSION

The study implicates the need for both obesity and underweight prevention in individuals with adverse experiences as early as in childhood.

LEVEL OF EVIDENCE

III: evidence obtained from well-designed cohort study.

Thailand Prevalence and Profile of Food Insecurity in Households with under Five Years Children: Analysis of 2019 Multi-Cluster Indicator Survey

This study aimed to estimate the prevalence and profile of food insecurity in households with children under 5 years old using the Food Insecurity Experience Scale (FIES) in Thailand. We integrated FIES into the 2019 Multiple Indicator Cluster Surveys (MICS). A total of 861 households were successfully interviewed with FIES. The Rasch model was applied to examine the validity and reliability. Multiple logistic regression was used to assess the association between socio-economic status and prevalence of food insecurity, adjusting for geographical regions and characteristics of households. We found that FIES measurement is valid as Infit falls within the normal range of 0.7−1.3 and is reliable (Rasch reliability value of 0.81). The overall prevalence of moderate or severe food insecurity was 2.79%. The wealthiest households were less likely to suffer from food insecurity than the poorest households (adjusted OR: 0.07; 95% CI: 0.02−0.34; p-value < 0.05). Households with children under 5 years old living in rural areas had lower food insecurity severity scores. We recommend social protection policies such as food and nutrition subsidies or conditional cash transfer to poor households with children under the age of 5.

Social determinants of health associated with the experience of hunger among Brazilian adolescents

Abstract The aim of this study was to identify social determinants of health associated with the experience of hunger among school-age adolescents in Brazil. We conducted a cross-sectional study with a sample of 16,526 adolescents using data from the 2015 National School-based Student Health Survey. Experience of hunger was determined based on the answer to the question “In the last 30 days, how often have you been hungry because there wasn’t enough food at home?” The social determinants of health were analyzed using Poisson regression with robust variance. The prevalence of the experience of hunger was 22.8% (95%CI: 21.9-23.7). The experience of hunger was directly associated with being male (PR = 1.12; 95%CI: 1.07-1.16); not being overweight (PR = 1.08; 95%CI: 1.04-1.13 ); irregular consumption of beans (PR = 1.20; 95%CI: 1.13-1.26), vegetables (PR=1.16; 95%CI: 1.09-1.22) and fruit (PR = 1.19; 95%CI: 1.13-1.24); body dissatisfaction (PR = 1.26; 95%CI: 1.18-1.35); and not regularly eating lunch or dinner with parents or guardians (PR = 1.41; 95%CI: 1.32-1.52). An inverse association was found between the experience of hunger and maternal education level and living in the Mid-West, Southeast and South. The findings show that the experience of hunger among Brazilian adolescents coexists with risky eating behaviors, body dissatisfaction, and social inequality.

Conceptualising household food insecurity in Northern Ireland: risk factors, implications for society and the economy, and recommendations for business and policy response

Household food insecurity in developed nations has been identified as a significant public health concern. Although various research on the topic exists, such as contributors to food insecurity, and implications for individual physical and mental health outcomes; there is currently a lack of consideration as to how individual implications of food insecurity such as poor physical and mental health can consequently impact on business and the wider economy. In addition, there is a lack of conceptual literature related to food insecurity. Stakeholder interviews (n = 19) were conducted, and data were used to inform the conceptual model (risk factors, potential implications for individuals, the economy and business, and opportunities for business and policy response). The main suggested implications related to business and the economy were reduced contribution to the workforce and the economy, and increased cost pressures on the National Health Service. Business responses suggested included the inclusion of initiatives to address food insecurity in corporate social responsibility strategies, and further involvement of food businesses/retailers in redistributing surplus food. Policy responses suggested included policies relating to welfare, wages and work contracts, food redistribution incentives, sustainability, and community interventions in disadvantaged areas. The resulting model is unique in conceptualising food insecurity in the Northern Ireland context, with applicability to the UK and other developed nations.

Household Food Insecurity, Level of Nutritional Adequacy, and Nutritional Status of Toddlers in the Coastal Area of Central Tapanuli Regency

BACKGROUND: The food security and livestock service office of North Sumatra Province (2020) noted that almost a third of the area or 35% of the subdistricts in Central Tapanuli Regency are food-insecure areas. AIM: This study aims to determine the level of family food insecurity, the level of nutritional adequacy, and the nutritional status of children under 5 in the coastal area of Central Tapanuli Regency. METHODS: This research is part of a dissertation study entitled Positive Deviance in Household Food Insecure in Improving the Nutritional Status of Toddlers in the Coastal Area of Central Tapanuli Regency. The steps in this research are to identify the level of household food insecurity, level of nutritional adequacy, and nutritional status of children under 5. The research was conducted by interviewing respondents (mothers of toddlers) and taking anthropometric measurements of 59 children under 5 purposively in the coastal area of Central Tapanuli Regency. RESULTS: Most of the occupations of the head of the family are fishers (78.0%) and the household food insecurity status as much as 81.4% is food insecure. The nutritional status of children under 5 in the less category is 50.8%, the nutritional status of stunting is 35.6%, and wasting is 10.2%. There is a significant relationship between family food insecurity and the level of adequacy of nutrients: Energy (p = 0.000; odds ratio [OR] = 38.000) and protein (p = 0.002; OR = 10.929). There is a significant relationship between household food insecurity and nutritional status of weight for age (p = 0.0039; OR = 6.300). CONCLUSION: Household food insecurity is related to the level of nutritional adequacy (energy and protein) and nutritional status of weight for age.

Food Insecurity, Nutritional Inequality, and Maternal–Child Health: A Role for Biocultural Scholarship in Filling Knowledge Gaps

Food insecurity, a significant contributor to nutritional inequality, disproportionately affects women and children in low- and middle-income countries. The magnitude of the problem has inspired research on its impacts on health, especially on nutritional status and, more recently, mental well-being. Current research is dominated by surveillance-type studies that emphasize access, one of food security's four dimensions. Findings are inconclusive regarding the association between food insecurity and women and children's nutritional status, but some evidence indicates that it is a key contributor to mental distress in women. To understand these inconsistent findings, we emphasize the need for research on the strategies that people use to cope with inadequate access to food. We contend that biocultural approaches that recognize the importance of local contexts and the role of broader political-economic factors in shaping them are well suited for addressing current knowledge gaps.

Food Insecurity and Sleep Disturbance Among 223,561 Adolescents: A Multi-Country Analysis of Cross-Sectional Surveys

This study was to investigate the association between food insecurity (FI) and sleep disturbance among adolescents. Based on the cross-sectional data of the Global School-based Student Health Survey, this study analyzed self-reported data from adolescents in 68 countries. Multivariate logistic regression and meta-analysis were used to evaluate the association between FI and sleep disturbance. The final sample included 223,561 adolescents. The prevalence of severe FI and sleep disturbance was 6.4% and 8.0%, respectively. Severe FI was significantly associated with a higher risk of sleep disturbance in 48 of the 68 countries after adjusting for covariates, with a pooled OR (95% CI) of 1.94 (1.79–2.09). Overall, the association between FI and sleep disturbance was similar across countries and gender, though a large level of heterogeneity existed across upper- and middle-income countries. Identifying adolescents suffering from FI and remedying the FI severity may be important to improve sleep quality in global adolescents.

Association between the food security status and dietary patterns with polycystic ovary syndrome (PCOS) in overweight and obese Iranian women: a case-control study

Background

Polycystic ovary syndrome (PCOS), as one of the significant endocrine disorders, is common among women worldwide. Food insecurity (FI) and unhealthy dietary patterns can negatively affect reproductive health. The effects of the lifestyle modifications, especially dietary components, on PCOS are contradictory. The aim was the assessment of association between PCOS with food security status and dietary patterns among overweight or obese women.

Methods

This case-control study was performed on 240 overweight and obese women with and without PCOS (ratio 1:1) referred to the infertility clinic of Arash Hospital, Tehran, Iran. The general and socioeconomic characteristics, anthropometrics (weight, height, body mass index (BMI), waist circumference, hip circumference), physical activity, food security status, and dietary intakes (or patterns) were assessed using valid questionnaires, scales, stadiometer, and tape meter. The significant p-value was < 0.05.

Results

The prevalence of FI was 60% in women with PCOS and 30% in healthy women. PCOS risk was positively related to FI, quasi-western dietary patterns, low economic levels, waist circumference, and menstrual age and negatively with physical activity and healthy dietary patterns, even after controlling the potential confounders (P <  0.05). PCOS women had a higher intake of saturated fats, monounsaturated fats, oleic acid, fluorine, sucrose, and caffeine and a lower intake of vitamins A, B₅, B₆, B₁₂, C, and D, potassium, proteins, carbohydrates, cholesterols, docosahexaenoic acid, potassium, carotenes, lutein, beta-cryptoxanthin, lycopene, calcium, iron, thiamine, riboflavin, niacin, tetra- and dihydrofolate, biotin, phosphorus, magnesium, zinc, copper, fiber (total, insoluble, and crude), glucose, galactose, fructose, and lactose compared to the healthy women (P <  0.05).

Conclusions

FI, quasi-western dietary patterns, low economic levels, and waist circumference were significantly associated with the higher risk of PCOS. The lifestyle changes, especially dietary patterns, may be an essential strategy for reducing PCOS. Further studies are warranted to confirm these findings and to identify the underlying mechanisms.

Governmental programmes associated with food insecurity among communities of descendants of enslaved blacks in Brazil

OBJECTIVE

To assess the access to government programmes and their association with food insecurity (FI) in families from quilombolas communities in Brazil.

DESIGN

An analysis of secondary data from the 2011 Quilombolas Census was performed in Brazilian territories. The Brazilian Household Food Insecurity Measurement Scale (Escala Brasileira de Insegurança Alimentar, EBIA) was used to assess the household FI status. The relationships of governmental programmes with the levels of FI were estimated using logistic regression models.

SETTING

Greater national survey census of food and nutritional security of the recognised Quilombolas Brazilian territories.

PARTICIPANTS

Totally, 8743 quilombolas families.

RESULTS

The prevalence of household FI was 86·1 % (moderate/severe FI: 55·9 %, 95 % CI 54·8, 56·9). After adjustment for socio-demographic variables, access to rural development programmes (Food Acquisition Program: OR: 0·6, 95 % CI 0·4, 0·8, P-value < 0·01) and health programmes (Center for Family Health Support: OR: 0·5, 95 % CI 0·5, 0·7, P-value < 0·001) is inversely and significantly associated with moderate/severe FI. The Brazilian conditional cash transfer programme (Bolsa Família) was associated with quilombolas families with moderate/severe levels of FI (OR: 3·3, 95 % CI 2·8, 4·0, P-value < 0·001).

CONCLUSIONS

The prevalence of FI was high among quilombolas families. Despite reduced participation in governmental programmes, rural development, agriculture and conditional cash transfer programmes are fundamental to the autonomy of quilombolas communities. In spite of the low participation, when families are able to access these programmes, the study revealed the importance of these initiatives in reducing the likelihood of severe levels of FI.

Illicit Drug Use in Canada and Implications for Suicidal Behaviors, and Household Food Insecurity: Findings from a Large, Nationally Representative Survey

Background and Aims: Illicit drug use is an ongoing health and social issue in Canada. This study aimed to investigate the prevalence of illicit drug use and its implications for suicidal behaviors, and household food insecurity in Canada. Design: Cross-sectional population survey. Setting: Canada, using the 2015–2016 Canadian Community Health Survey, a nationally representative sample selected by stratified multi-stage probability sampling. Participants: A total of 106,850 respondents aged ≥ 12 years who had completed information on illicit drug use. Measurements: Illicit drug use was assessed through a series of questions about illicit drug use methods. Respondents who reported lifetime illicit drug use but no past-year use were considered to have prior illicit drug use. In this survey, illicit drug use included cannabis use. Findings: Overall, the prevalence of lifetime, past-year, and prior illicit drug use was 33.2% (9.8 million), 10.4% (3.1 million), and 22.7% (6.7 million), respectively. In models adjusting for sociodemographic covariates, prior illicit drug use was significantly associated with increased odds of past-year suicidal ideation (adjusted odds ratio [AOR] 1.21, 95% CI 1.04–1.40), and plans (1.48, 1.15–1.91), and past-year household food insecurity (1.27, 1.14–1.41), and the odds were much higher among prior injecting drug users than prior non-injecting drug users. No significant correlation was found between prior illicit drug use and past-year suicidal attempts, but there was a strong association between past-year illicit drug use and past-year suicidal attempts. Conclusions: Our findings suggest that even after people have stopped taking illicit drugs, prior illicit drug use, especially for prior injecting drug use, continues to be associated with increased risks of subsequent suicidal ideation, and plans, and household food insecurity.

Household Food Insecurity, Hair Cortisol, and Adiposity Among Tsimane' Hunter-Forager-Horticulturalists in Bolivia

OBJECTIVES

This study examined how household food insecurity (HFI) and chronic stress relate to adiposity among Tsimane' hunter-forager-horticulturalists in remote Bolivia with limited access to energy-dense processed foods that promote weight gain among industrialized populations.

METHODS

Retrospective cross-sectional data on HFI (via the Household Food Insecurity Access Scale [HFIAS]), hair cortisol concentration (HCC), adiposity (BMI, body fat percentage [%BF]), and sociodemographics were collected from 171 men, 164 women, and 167 children. Linear mixed-effects models tested linear, quadratic, joint, and interactive relationships between adiposity measures and both the HFIAS score and HCC.

RESULTS

Among children, each 3-point HFIAS score increase was associated with a 0.44-point higher %BF (SE = 0.22, P = 0.04). However, each 20% increase in HCC was associated with a -0.29-point difference in %BF (SE = 0.12, P = 0.01). Among men, a slight curvilinear relationship emerged between HFIAS and BMI. HFIAS and HCC were unrelated to adiposity measures among women. HCC did not modify relationships between HFIAS and adiposity in any subgroup.

CONCLUSIONS

These findings from a remote, small-scale population suggest that positive associations between HFI and adiposity are not isolated to contexts of industrialized food environments and heavy reliance on processed foods. However, these dynamics and the role of stress appear to differ by sex and age group.

Associations between exposure to heavy metals and the risk of chronic kidney disease: a systematic review and meta-analysis

We performed a systematic review and meta-analysis to examine the relationship between heavy metals (HMs) exposure and the risk of chronic kidney disease (CKD). Databases of Web of Science, Embase, MEDLINE, and Scopus were searched through June 2020 to identify studies assessing the relationships between exposure to HMs (i.e. cadmium, lead, arsenic, mercury) and the risk of CKD, evaluated by decreased estimated glomerular filtration rate (eGFR) and/or increased proteinuria risks in adults (≥18 years). Data were pooled by random-effects models and expressed as weighted mean differences and 95% confidence intervals. The risk of bias was assessed by the Newcastle-Ottawa scale (NOS). Twenty-eight eligible articles (n = 107,539 participants) were included. Unlike eGFR risk (p = 0.10), Cadmium exposure was associated with an increased proteinuria risk (OR = 1.35; 95% CI: 1.13, 1.61; p < 0.001; I² = 79.7%). Lead exposure was associated with decreased eGFR (OR = 1.12; 95%CI: 1.03, 1.22; p = 0.008; I² = 87.8%) and increased proteinuria (OR = 1.25; 95% CI: 1.04, 1.49; p = 0.02; I² = 79.6) risks. Further, arsenic exposure was linked to a decreased eGFR risk (OR = 1.55; 95% CI: 1.05, 2.28; p = 0.03; I² = 89.1%) in contrast to mercury exposure (p = 0.89). Only two studies reported the link between arsenic exposure and proteinuria risk, while no study reported the link between mercury exposure and proteinuria risk. Exposure to cadmium, lead, and arsenic may increase CKD risk in adults, albeit studies were heterogeneous, warranting further investigations. Our observations support the consideration of these associations for preventative, diagnostic, monitoring, and management practices of CKD.

No Association Between Suicidality and Weight Among School-Attending Adolescents in the United Arab Emirates

Previous data on the link between weight and suicidality is heterogenous. We aim to investigate the potential association between weight and suicidality among adolescents in the United Arab Emirates (UAE). We hypothesize that an association exists between weight and suicidality, with those at both extremes of weight suffering higher rates of suicidal ideation, planning and attempts. The 2016 UAE Global School Health Survey (GSHS) was used. Weight categories based on the World Health Organization Body Mass Index charts were generated. Suicidality measures were based on questions on suicide ideation, planning, and attempt. Univariate and multivariate binary logistic regression were used. Overall, 3.6, 21.4, and 17.5% of students were found to be underweight, overweight, and obese, respectively. In total, 492 students (14.6%) reported suicidal ideation, 397 (11.8%) reported planning, and 389 (11.4%) reported attempts within the twelve months prior to the survey. In the multivariate logistic regression, being female, older, and of lower socioeconomic status were significantly associated with increased suicidal ideation, planning and attempts. Increased parental involvement was associated with decreased suicidality. The association between weight category and suicidality did not reach statistical significance. A significant proportion of Emirati teens are under- or over-weight, with one in seven and one in nine having considered or attempted suicide, respectively. However, this study finds no significant association between weight and suicide ideation, planning, or attempts. This may be due to cultural differences in weight perception. Further research into this association can aid in tailoring suicide prevention interventions.

Potential role of neglected and underutilized plant species in improving women's empowerment and nutrition in areas of sub-Saharan Africa

In the context of the nutrition transition, women in sub-Sahara Africa are a critical target group from a nutrition standpoint, and they experience significant discrimination in food production. Food-based, women-centered strategies are recommended to address nutrient gaps, and to educate and empower women. In this context, local natural resources, such as neglected and underutilized plant species (NUS), may contribute to adding nutritional value, enriching diet diversity, and ensuring nutrition security. The aim of the current narrative review is to investigate the nutritional status of the sub-Saharan African population and the potential role of local agriculture strategies in improving food production and diet diversity and in expanding income-generating activities for women. The nutritional properties of the most important regional NUS are also discussed.

Food Insecurity and Bullying Victimization Among 170,618 Adolescents in 59 Countries

Background: Bullying victimization can impose long-lasting impacts on adolescent's current and subsequent well-being. Understanding the correlates of bullying victimization and how to prevent its occurrence is an urgent need. Food insecurity, an indicator of low socioeconomic status, may be related to bullying victimization. However, research on the association between food insecurity and bullying victimization is limited. Using a representative global sample, this study aimed to investigate the association between food insecurity and bullying victimization in adolescents and whether the association varied between country income levels, sexes, and age groups. Methods: Using cross-sectional, school-based data by 170,618 adolescents in 59 countries from the Global School-based Student Health Survey, multivariable logistic regression and meta-analysis were conducted to investigate the overall, country-stratified, sex-stratified, and age-stratified associations. Results: The prevalence of bullying victimization was 33.3%. In the total sample, adolescents with food insecurity showed significantly higher odds for bullying victimization than those without no food insecurity with a pooled odds ratio (OR) being 1.37 (1.28, 1.47). Further, the association was stronger in higher-income countries, females, and older adolescents. Conclusions: Bullying victimization is prevalent among global adolescents with food insecurity being a significant correlate. The identification of adolescents with perceptions of food insecurity and remedying this condition may be important to reduce the prevalence of bullying. This highlights the need to design and implement sex- and age-specific interventions focusing on remedying food insecurity and bullying victimization among in-school adolescents by taking country income levels into account.

Prevalence and Determinants of Stunting and Thinness/Wasting Among Schoolchildren of Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Several studies have been carried out assessing the prevalence of undernutrition and possible determinants among schoolchildren in Ethiopia, but there is a lack of systematically gathered and analyzed information.

OBJECTIVE

This systematic review and meta-analysis aimed to summarize epidemiological data on undernutrition and possible determinants among schoolchildren in Ethiopia.

METHODS

We conducted a systematic review using open access articles that report the prevalence of stunting and wasting/thinness among schoolchildren from PubMed Central, Scopus, and Science direct. The pooled prevalence was determined using a random-effect model while heterogeneities between studies were evaluated by I ² test.

RESULTS

A total of 24 716 schoolchildren were included in the 39 eligible articles. The prevalence of stunting and wasting/thinness among schoolchildren in Ethiopia were 23.1% (95% CI: 19.0-27.0) and 22% (95% CI: 17-26), respectively. There was a marked difference in the prevalence of stunting and wasting/thinness across regions of Ethiopia. The risk of stunting was increased with meal frequency ≤3 times a day (odds ratio [OR] = 3.02, 95% CI: 1.90-4.14), age >10 years (OR = 2.16, 95% CI: 1.47-2.85), and family size ≥5 (OR = 1.88, 95% CI: 1.40-2.35). Similarly, the risk of wasting/thinness was increased with male sex (OR = 2.06, 95% CI: 1.54-2.58), low family income (OR = 2.16, 95% CI: 1.30-3.01), and age >10 years (OR = 1.78, 95% CI: 0.74-2.82).

CONCLUSION

This study revealed that more than one-fifth of schoolchildren are stunted or wasted/thin in Ethiopia. Large family size, male sex, and student age were consistently associated with stunting and wasting/thinness among schoolchildren. This study highlights the importance of an integrated effort to reduce undernutrition in Ethiopia.

Association Between Breastfeeding and Child Stunting in Mexico

Background

Globally, the prevalence of child stunting has been decreasing over the past decades. However, in low- and middle-income countries such as Mexico, stunting is still the most prevalent form of undernutrition affecting a large number of children in the most vulnerable conditions. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child stunting.

Objective

To examine the association between breastfeeding (defined as never breastfed, any breastfeeding for <6 months, and any breastfeeding for ≥6 months) and other individual-, household-, and area-level factors with child stunting (defined as length/height-for-age-z-score for sex under -2 standard deviations of the World Health Organization child growth standards' median) in Mexico.

Methods

Secondary data analysis using the 2012 Mexican Health and Nutrition Survey, which allowed representativeness of rural and urban areas at national level and among 4 regions in Mexico. Our subset included data on 2,089 singleton Mexican children aged 6-35 months with information on previously identified risk and protective factors for stunting. We conducted fixed- and mixed-effects logistic regression models sequentially controlling for each level of factors.

Findings

Overall, 12.3% of children were stunted and 71.1% were breastfed for ≥6 months. Any breastfeeding and being female were consistent protective factors against child stunting across all models. In contrast, child low birthweight, maternal short stature, higher number of children aged <5 years per household, and moderate to severe food insecurity were consistent risk factors for child stunting across all models.

Conclusions

According to our findings, efforts to reduce child stunting in Mexico should include prenatal strategies aiming to prevent low birthweight offspring particularly among short-stature women, moderate to severe food insecure households, families with a higher number of children aged <5 years, and indigenous communities. Postnatal components should include multilevel strategies to support breastfeeding.

Using mobile phone data helps estimate community-level food insecurity: Findings from a multi-year panel study in Nepal

Household food insecurity remains a major policy challenge in low-income countries. Identifying accurate measures that are relatively easy to collect has long been an important priority for governments seeking to better understand and fund solutions for communities in remote settings. Conventional approaches based on surveys can be time-consuming and costly, while data derived from satellite imagery represent proxies focused on biological processes (such as rainfall and crop growth) lack granularity in terms of human behaviors. As a result, there has recently been interest in tapping into the large digital footprint offered by mobile phone usage. This paper explores empirical relationships between data relating to mobile phones (ownership and spending on service use), and food insecurity in rural Nepal. The work explores models for estimating community-level food insecurity through aggregated mobile phone variables in a proof-of-concept approach. In addition, sensitivity analyses were performed by considering the performance of the models under different settings. The results suggest that mobile phone variables on ownership and expenditure can be used to estimate food insecurity with reasonable accuracy. This suggests that such an approach can be used in and beyond Nepal as an option for collecting timely food insecurity information, either alone or in combination with conventional approaches.

The Relationship between Food Insecurity and Risk of Overweight or Obesity in under 18 Years Individuals: A Systematic Review and Meta-Analysis

OBJECTIVE

Food insecurit (FI) has been considered as reason for childhood and adolescent overweight/obesity (OW/OB). Hence, this study was undertaken to assess these relationships.

DESIGN

Related articles were found by searching the Web of Science, Scopus, PubMed and Embase databases until October 2019. Odds ratio (OR) was analized by a random-effects model. Standard methods were used for assessment of heterogeneity and publication bias. Data were available from 32 studies. The risk ratios of 139,762 participants were pooled from these articles for the meta-analysis.

RESULTS

This study domenstrated that children and adolescents in food-insecure condition are not at risk of OW/OB (OR = 1.02 95% CI: 0.99, 1.05). However, subgroup analysis indicated that FI related with inhanced risk of OW/OB in adolescents living in developed countries (OR = 1.14; 95% CI: 1.02, 1.27). Other subgroup analysis indicated that severe FI increased the risk of OW/OB among adolescents (OR = 1.24 95% CI: 1.03-1.49). In addition, we found that lower economic development significantly decreased risk of OW/OB among under 6 year children (OR = 0.88; 95% CI: 0.84, 0.93).

CONCLUSIONS

Our results showed that higher FI degrees were related with more risks of OW/OB among adolescents (12-18 years). Moreover, the country economic levels had effect on the association between FI and risk of OW/OB.

Dietary Inflammatory Index and the Risk of Frailty Among Older Adults: A Systematic Review and Meta-Analysis

A systematic review and meta-analysis was conducted to comprehensively examine the association between Dietary Inflammatory Index (DII®) score and risk of frailty. Frailty risk were available from five studies comprising 13,908 older adults. Furthermore, frailty related parameters were extacted from two studies with 7,539 individuals. A pooled adjusted odds ratio analysis indicated that there was an association between DII® score and frailty risk (OR = 1.24, 95%CI: 1.6-1.33, P < 0.001, I² = 0.0%). The results of frailty related parameters demonstrated that DII® score was associated with weakness risk (OR = 1.12, 95%CI: 1.05-1.19, P = 0.014, I² = 0.0%), but not other frailty-related parameters including exhaustion, low BMI or low physical activity. The results of this meta-analysis suggest that older adults who exhibit higher DII® scores have an increased frailty risk. Further prospective cohort studies with longer follow-up periods, are needed to support this possible association between DII® score and frailty risk.

Current Status of Malnutrition and Stunting in Pakistani Children: What Needs to Be Done?

Malnutrition is one of the greatest health challenges that affects about 2 billion people globally. Multiple factors including poverty, food insecurity, maternal health and nutritional status, mother's age at marriage and educational status, low birthweight or small for gestational age (SGA), premature births, suboptimal breastfeeding practices, unhealthy dietary and lifestyle patterns, health and immunization status of children, socioeconomic status of family, environmental and household conditions, together with cultural practices and myths, play vital role in affecting the growth of children at early age. Although child stunting has declined in Pakistan, the reduction rate is only 0.5%, which is very low. This may be due to ineffective or inappropriate intervention programs as they are mostly addressing only one issue at a time and don't use the multi-sector approach to address numerous determinants of stunting. It is therefore important to initiate cost-effective multi-tiered intervention approaches to be implemented at pre-conception, pregnancy and early postpartum stages to prevent the problems of malnutrition and stunting in Pakistani children. This review discusses the etiology of child malnutrition and stunting in Pakistan, role of various determinants of stunting and what type of intervention strategies and approaches should be developed and implemented to deal with these problems. Key teaching pointsMalnutrition is one of the greatest global health challenges.Poverty, food insecurity, socioeconomic status, unhealthy dietary patterns, maternal health and nutritional status, low birthweight, suboptimal breast feeding, environmental conditions, cultural practices and myths, are the main factors for child malnutrition and stunting in Pakistan.The slow reduction rate in child stunting may be due to inappropriate intervention programs.Cost-effective multi-tiered intervention approaches must be implemented at pre-conception, pregnancy and early postpartum stages to prevent child malnutrition and stunting in Pakistan.A holistic approach comprising nutrition and WASH interventions, together with strategies to improve the socioeconomic status be developed and implemented to resolve this dilemma.