Food and nutrition insecurity: a marker of vulnerability to asthma symptoms

Association between adult food insecurity and self-reported asthma in the United States: NHANES 2003-2018

OBJECTIVE

Asthma is a chronic disease of the lungs. The development of asthma is related to various risk factors. Food insecurity is a critical social determinant of health, although there is little information on the association between adult food insecurity and asthma. The purpose of this study is to explore the potential correlation in US adults.

METHODS

The study population data were extracted from NHANES 2003-2018. Food insecurity was measured using the USDA FSSM and categorized as full, marginal, low, or very low food security. The assessment of self-reported asthma was determined by self-report questionnaires. The self-reported positive outcomes were that participants had asthma and a history of asthma attacks and asthma-related ER visits in the past year. We developed two multivariate logistic regression models. Stratified analyses were performed by gender and age.

RESULTS

A total of 38,077 participants were considered in our final analysis. Compared to participants with FFS, the ORs (95% CIs) for asthma were 1.16 (1.00-1.33), 1.42 (1.23-1.64), and 1.56 (1.34-1.80) for participants with MFS, LFS, and VLFS, respectively (Model II). Additionally, after full adjustment, individuals with VLFS had 49% greater risks of asthma attacks (OR = 1.49; 95% CI 1.13-1.97). The ORs (95% CIs) for asthma-related ER visits were 1.59 (1.14-2.23) and 1.98 (1.36-2.87) for participants with LFS and VLFS, respectively (Model II). The positive correlations remained robust when stratified by gender and age.

CONCLUSION

Our research showed that food insecurity among US adults was associated with asthma, asthma attacks, and asthma-related ER visits.

Understanding and controlling asthma in Latin America: A review of recent research informed by the SCAALA programme

Asthma is an important health concern in Latin America (LA) where it is associated with variable prevalence and disease burden between countries. High prevalence and morbidity have been observed in some regions, particularly marginalized urban populations. Research over the past 10 years from LA has shown that childhood disease is primarily non-atopic. The attenuation of atopy may be explained by enhanced immune regulation induced by intense exposures to environmental factors such as childhood infections and poor environmental conditions of the urban poor. Non-atopic symptoms are associated with environmental and lifestyle factors including poor living conditions, respiratory infections, psychosocial stress, obesity, and a diet of highly processed foods. Ancestry (particularly African) and genetic factors increase asthma risk, and some of these factors may be specific to LA settings. Asthma in LA tends to be poorly controlled and depends on access to health care and medications. There is a need to improve management and access to medication through primary health care. Future research should consider the heterogeneity of asthma to identify relevant endotypes and underlying causes. The outcome of such research will need to focus on implementable strategies relevant to populations living in resource-poor settings where the disease burden is greatest.

Childhood food insecurity and incident asthma: A population-based cohort study of children in Ontario, Canada

BACKGROUND

Childhood food insecurity has been associated with prevalent asthma in cross-sectional studies. Little is known about the relationship between food insecurity and incident asthma.

METHODS

We used administrative databases linked with the Canadian Community Health Survey, to conduct a retrospective cohort study of children <18 years in Ontario, Canada. Children without a previous diagnosis of asthma who had a household response to the Household Food Security Survey Module (HFSSM) were followed until March 31, 2018 for new asthma diagnoses using a validated administrative coding algorithm. We used multivariable Cox proportional hazard models to examine the association between food insecurity and incident asthma, and adjusted models sequentially for clinical and clinical/socioeconomic risk factors. As additional analyses, we examined associations by HFSSM respondent type, severity of food insecurity, and age of asthma diagnosis. Moreover, we assessed for interaction between food security and child's sex, household smoking status, and maternal asthma on the risk of incident asthma.

RESULTS

Among the 27,746 included children, 5.1% lived in food insecure households. Over a median of 8.34 years, the incidence of asthma was 7.33/1000 person-years (PY) among food insecure children and 5.91/1000 PY among food secure children (unadjusted hazard ratio [HR] 1.24, 95% CI 1.00 to 1.54, p = 0.051). In adjusted analyses associations were similar (HR 1.16, 95% CI 0.91 to 1.47, p = 0.24 adjusted for clinical risk factors, HR 1.24, 95% CI 0.97 to 1.60, p = 0.09 adjusted for clinical/socioeconomic factors). Associations did not qualitatively change by HFSSM respondent type, severity of food insecurity, and age of asthma diagnosis. There was no evidence of interaction in our models.

CONCLUSIONS

Food insecure children have numerous medical and social challenges. However, in this large population-based study, we did not observe that childhood food insecurity was associated with an increased risk of incident asthma when adjusted for important clinical and socioeconomic confounders.

[Evaluation indicators of Food and Nutritional Insecurity and associated factors: systematic review]

The scope of this paper was to systematically investigate the indicators used in the evaluation of food and nutritional insecurity and associated factors in Brazilian studies. After selection in the databases using search terms and reverse search, 89 articles were included. The majority of the articles evaluated food and nutritional insecurity according to the indicator of perception, using the Brazilian Scale of Food Insecurity (83.1%), the American Scale (5.62%) and isolated questions (2.25%). The other articles evaluated the presence of malnutrition among children (1.12%), expenditure on food (1.12%), adult-equivalent dietary intake (1.12%), protocols (2.25%), and prediction models (2.25%). Food and nutritional insecurity (measured by the different indicators) was associated with socioeconomic and demographic factors, health and lifestyle conditions, food consumption and nutritional status, based on families, specific age groups, beneficiaries of government programs, among others, as sample units. The majority of the studies merely evaluated the food dimension of the insecurity, thereby increasing the difficulty in evaluating this complex situation.

A systematic review and meta-analysis estimating the population prevalence of comorbidities in children and adolescents aged 5 to 18 years

Evidence for the health impact of obesity has largely focussed on adults. We estimated the population prevalence and prevalence ratio of obesity-associated comorbidities in children and adolescents aged 5 to 18 years. Five databases were searched from inception to 14 January 2018. Population-based observational studies reporting comorbidity prevalence by weight category (healthy weight/overweight/obese) in children and adolescents aged 5 to 18 years from any country were eligible. Comorbidity prevalence, stratified by weight category, was extracted and prevalence ratios (relative to healthy weight) estimated using random effects meta-analyses. Of 9183 abstracts, 52 eligible studies (1 553 683 participants) reported prevalence of eight comorbidities or risk markers including diabetes and nonalcoholic fatty liver disease (NAFLD). Evidence for psychological comorbidities was lacking. Meta-analyses suggested prevalence ratio for prediabetes (fasting glucose ≥ 100 mg/dL) for those with obesity relative to those of a healthy weight was 1.4 (95% confidence interval [CI], 1.2-1.6) and for NAFLD 26.1 (9.4-72.3). In the general population, children and adolescents with overweight/obesity have a higher prevalence of comorbidities relative to those of a healthy weight. This review provides clinicians with information when assessing children and researchers a foundation upon which to build a comprehensive dataset to understand the health consequences of childhood obesity.

Household food insecurity is associated with asthma control in Peruvian children living in a resource-poor setting

Rationale: Prior evidence suggests that there may be an association between asthma and food insecurity. We sought to describe the prevalence of food insecurity access, defined as having sufficient resources for appropriate foods in Lima, Peru, and evaluate its association with asthma status and control.Methods: We analyzed data from 553 children with asthma and 268 healthy controls aged nine to 19 years living in two peri-urban communities in Lima, Peru, in 2013. We used the Household Food Insecurity Access Scale to assess food insecurity. We defined uncontrolled asthma as an asthma control test score ≤19. We used multivariable logistic regressions to determine the relationship between asthma outcomes and food insecurity adjusting for age, sex, socioeconomic status, body mass index, and setting.Results: Average age was 14.2 years (SD 2.7). There was a high prevalence of household food insecurity in our study: 330 participants (40.2%) were food insecure, and average food insecurity access score was 2.7 points (SD 4.2). While being food insecure was not associated with asthma status (OR = 1.23, 95% CI 0.85 to 1.79; p = 0.28), it was associated with a higher odds of having uncontrolled asthma (OR = 2.01, 95% CI 1.13 to 3.59; p = 0.02). Each one-unit increase in food insecurity score (higher scores indicating more insecurity) was associated with 8% higher odds of having uncontrolled asthma (OR = 1.08, 95% CI 1.02 to 1.14; p < 0.01).Conclusions: Worse asthma control was associated with food insecurity. Future studies are needed to better understand the role of food security in determining the success of treatment strategies.

Association between Household Food Insecurity and Asthma in Korean Adults

Household food insecurity has been associated with noncommunicable diseases. The aim of this study was to investigate the association between household food insecurity and asthma in Korean adults. Household food security statuses were classified into three groups: Food-secure household, food-insecure household without hunger, and food-insecure household with hunger. The odds ratios and 95% confidence intervals for the presence of asthma according to household food security status were calculated using multiple logistic regression analyses after adjusting for confounding factors. A total of 14,770 participants were included in the analysis. The prevalence of asthma was 2.6% in those with a secure food status, 3.2% in those with an insecure food status without hunger, and 7.6% in those with an insecure food status with hunger (p < 0.001). Compared with that in participants with a household food secure status, the odds ratios (95% confidence intervals) for asthma were 1.12 (0.73–1.73) in those with a food-insecure household without hunger status and 2.44 (1.33–4.46) in those with a food-insecure household with hunger status after additionally adjusting for confounding factors. We found that household food insecurity with hunger was significantly associated with asthma prevalence in Korean adults. Implementation of household food security screening and public health intervention could be helpful to prevent and reduce asthma in adults.

Timing of household food insecurity exposures and asthma in a cohort of US school-aged children

OBJECTIVE

Food insecurity is positively associated with asthma, the most common chronic childhood disease, yet directionality is unclear. The objective was to determine the association between exposure to food insecurity in early childhood and the odds of asthma later in childhood.

DESIGN

Data from four waves of the Early Childhood Longitudinal Study-Kindergarten (ECLS-K) cohort, a prospective, dual-frame, multistage probability cluster sampling study of school-aged US children were entered in multivariate logistic regression models, adjusted for covariates. Exposures to food insecurity were based on parental responses to the validated USDA 18-item module at each wave.

SETTING

Public and private primary and secondary schools between 1998 and 2007.

PARTICIPANTS

At its inception (1999), the ECLS-K had 20 578 kindergarteners; by the spring of eighth grade (2007), the cohort dropped to 9725 due to attrition. Children missing an exposure, outcome or confounding variable were excluded, final n=6731.

PRIMARY OUTCOME MEASURE

Child's diagnosis of asthma by a healthcare professional as reported by the parent.

RESULTS

Household food insecurity (vs food security) in the year before kindergarten and in second grade had a higher odds of asthma by 18% (95% CI 1.17 to 1.20) and 55% (95% CI 1.51 to 1.55). After removing asthmatics before third grade from the model, food insecurity in second grade was associated with higher odds of asthma at fifth or eighth grades (OR 1.55; 95% CI 1.53 to 1.58), whereas food insecurity in the year before kindergarten had a lower odds at fifth or eighth grades.

CONCLUSIONS

Food insecurity in the year before kindergarten and in second grade were associated with a higher odds of asthma in third grade. Food insecurity in second grade retained the signal for increased odds of asthma after third and through eighth grades. Additional research is needed to explore childhood windows of vulnerability to asthma.

Food and nutritional insecurity in Brazil and its correlation with vulnerability markers

This study aimed to analyze space-time distribution of the prevalence of food and nutritional insecurity (FNI) in the Brazilian Federative Units and their correlation with vulnerability markers. This is an ecological study, with data from the National Household Sample Survey (2004, 2009 and 2013) and Atlas Brazil (2010). A time analysis of the spatial distribution of FNI prevalence was performed. Moran's Index was used in bivariate spatial analysis. The prevalence of FNI have decreased along the years studied and showed a negative and moderate spatial correlation with the Human Development Index; a positive and moderate correlation with the percentage of the extremely poor, child mortality, social vulnerability index, human capital social vulnerability index; and positive and strong correlation with income and work social vulnerability index. We can conclude that there was a lower prevalence of FNI in the analyzed years and that the Brazilian territory showed two distinct patterns: territories with higher FNI prevalence and worse conditions as regards income, work and child health in the North and Northeast; and territories with lower FNI prevalence and lower vulnerability in the Midwest, Southeast and South.

Social, Environmental and Behavioral Determinants of Asthma Symptoms in Brazilian Middle School Students-A National School Health Survey (Pense 2012)

Biological and psychosocial factors are recognized contributors to the worldwide burden of asthma. However, the relationship between psychosocial factors and asthma symptoms among students in low- and middle-income countries remains underexplored. We aimed to identify socioeconomic, environmental, psychosocial, family-related and lifestyle factors associated with the self-reporting of asthma symptoms in Brazilian adolescents. This is a cross-sectional study using data from the 2012 PeNSE survey (n = 109,104). We analyzed the following variables: socioeconomic conditions, demographic characteristics, lifestyle, family context and dynamics, psychosocial indicators, smoking, and exposure to violence. Our outcome variable was the self-report of asthma symptoms in the past 12 months. The prevalence of wheezing was 22.7% (21.5–23.9). After adjusting for sex, age and the variables from higher hierarchical levels, exposure to violence (feeling unsafe at school, being frequently bullied, being exposed to fights with firearms) and physical aggression by an adult in the family were the environmental factors that showed the strongest associations with self-reporting of asthma symptoms. For psychosocial indicators of mental health and social integration, feelings of loneliness and sleeping problems were the strongest factors, and among individual behavioral factors, the largest associations were found for tobacco consumption. Our findings were consistent with previous studies, showing an association between self-reported asthma symptoms and socio-economic status, family context and dynamics, psychosocial indicators of mental health, exposure to violence and social integration, as well as a sedentary lifestyle and tobacco use.

Improving the asthma disparity gap with legal advocacy? A qualitative study of patient-identified challenges to improve social and environmental factors that contribute to poorly controlled asthma

OBJECTIVE

To identify challenges that disadvantaged adults with asthma face in mitigating social and environmental factors associated with poor symptom control.

METHODS

Using a community-engaged approach, we partnered with a community health center in New Haven, CT to conduct in-person interviews and a written survey of asthmatic adults with poor symptom control. Using the constant comparative method, we analyzed participant interviews to establish emerging themes and identify common barriers to improved outcomes. Through a written survey utilizing clinically validated questions, we assessed information on access to medical care, asthma control, and selected social and environmental risk factors.

RESULTS

Twenty-one patients (mean age 47, 62% female, 71% Black, 95% insured by Medicaid) participated. The average Asthma Control Test (ACT) score was 11.6. Seventy-six percent of participants were currently employed and of those, 75% reported work-related symptoms. Among participants currently in housing, 59% reported exposure to domiciliary mice and 47% to mold. We identified three themes that summarize the challenges the study participants face: 1) Lack of knowledge about home and workplace asthma triggers; 2) Lack of awareness of legal rights or resources available to mitigate adverse conditions in the home or work environment; and 3) Fear of retaliation from landlords or employers, including threats of eviction, sexual assault, and job loss.

CONCLUSION

Patients with poorly controlled asthma in a disadvantaged urban northeast community identified common barriers in both the domestic and work environments that impeded attainment of symptom control. These challenges may be best addressed through legal advocacy for those most at risk.

Sex and Race/Ethnic Disparities in Food Security and Chronic Diseases in U.S. Older Adults

Objective: The purpose of this study was to determine the relationships among sex, race/ethnicity, and food security with the likelihood of cancer, diabetes, cardiovascular disease, and lung disease for older adults. Method: Complex sample analysis by logistic regression models for chronic diseases were conducted from National Health and Nutrition Examination Surveys, 2011 to 2012 and 2013 to 2014, for N = 3,871 adults aged ≥55 years. Results: Being female with low food security was associated with lung disease and diabetes. Poverty, rather than low food security, was associated with cardiovascular diseases. Minority status was independently associated with low food security and diabetes. Discussion: Food insecurity, sex, and race/ethnicity were associated with chronic diseases in a representative sample of U.S. older adults.