Household participation in the Food Stamp and WIC programs increases the nutrient intakes of preschool children

Relationship between Food Security, Nutrition Security, and Diabetes: The Role of Supplemental Nutrition Assistance Program Participation

Background

Inadequate nutrition and poor diet quality are associated with a heightened risk of diabetes. The connection between food insecurity measures and diabetes has been established, with evidence indicating that Supplemental Nutrition Assistance Program (SNAP) participation contributes to reductions in food insecurity. Recently developed nutrition security measures, defined as the ability to acquire healthful foods to prevent diseases, and their association with diabetes and SNAP participation are not yet understood.

Objectives

This study aimed to assess the relationship between food security and nutrition security in relation to diabetes overall and by SNAP participation and nutrition security as potential modifiers.

Methods

Secondary data analysis of cross-sectional pilot study data collected from adults in 5 US states (N = 517). Logistic regression mixed models included moderation analysis and clustering effects by state to address site-level confounding.

Results

Higher nutrition security scores among adults, after adjusting for confounders, were significantly associated with lower odds of diabetes risk (adjusted odds ratio = 0.59; 95% confidence interval: 0.40, 0.87; P value = 0.008). Statistically significant interaction effect of differences according to SNAP participation was observed for nutrition security (Phomogeneity/interaction = 0.021), adjusting for age, gender, race/ethnicity, education, employment, National School Lunch Program, Special Supplemental Nutrition Program for Women, Infants, and Children, food pantry use, household with children, survey mode, and food security. The association between food security and diabetes was not statistically significant overall. However, statistically significant interaction effect of differences according to SNAP participation was observed for food security (Phomogeneity/interaction = 0.047). Further, no interaction effect of differences in nutrition security was found between food security and self-reported diabetes/prediabetes (Phomogeneity/interaction = 0.250).

Conclusions

This study sheds light on the early exploration of the intricate relationship between nutrition security and diabetes. The findings suggest that a higher nutrition security score, after adjusting for confounders, was significantly associated with lower odds of diabetes risk. Notably, there were statistically significant interaction effects in these associations based on SNAP participation.

An Assessment of the Relationship of SNAP and Anemia Among School-Aged Children and Adolescents Living in Households With Food Insecurity

Children in food-insecure households have an increased risk of anemia. Participation in Supplemental Nutrition Assistance Programs (SNAP) has several benefits. However, it is unknown if it ameliorates anemia among school-aged children and adolescents living in food-insecure households. This study aims to assess the association of SNAP participation and anemia among children and adolescents living in households experiencing food insecurity. The sample population (n = 1635), aged 6 to 18 years, were pooled from the 2003–2014 National Health and Nutrition Examination Survey (NHANES). The exposure of interest was self-reported household SNAP participation. The outcome variable was the presence or absence of anemia, classified using the blood hematocrit concentration values. Survey weighted logistic regression was performed to calculate the odds ratio (OR) and 95% Confidence Interval (CI) of the association between participation in SNAP and anemia in food-insecure children. We found that over 80% of anemic children and adolescents, living in food-insecure households, participated in SNAP, while 63% of non-anemic children and adolescents, living in food-insecure households participated in SNAP (p = .007). Among children living in food-insecure households, SNAP participants had 3-fold increased odds of anemia compared to those who do not participate in SNAP, after adjusting for confounders (OR = 3.33, 95% CI: 1.25–8.88). In this study, SNAP participation was associated with increased odds of anemia in children and adolescents living in food-insecure households. Additional research is needed to assess if these unexpected findings are related to the adequacy of SNAP, affordability, and accessibility to healthy foods, or the household and individual food preferences in food-insecure households.

Association of WIC Participation and Growth and Developmental Outcomes in High-Risk Infants

The objective of this study was to describe the association of enrollment in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the Supplemental Nutrition Assistance Program (SNAP), and infant growth and neurodevelopmental outcomes. Z scores and Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) and Vineland Adaptive/Behavior Scale-II (VABS-II) scores represented primary outcomes. We conducted bivariate analyses and linear regression. Children who were enrolled in WIC or WIC/SNAP had weight z scores U (95% confidence interval [CI]) that were 1.32 (0.42-2.21) or 1.19 (0.16-2.23) units higher. Enrollment in WIC or WIC/SNAP was associated with a higher score (95% CI) of 11.7 U (1.2-22.2 U) or 11.5 (0.1-22.9) for Bayley-III cognitive score and 10.1 U (1.9-19.1 U) or 10.3 (0.9-19.7) for the VABS-II composite score. These findings support increased advocacy for participation in WIC or WIC/SNAP for families with high-risk infants.

The Impact of the Revised WIC Food Package on Maternal Nutrition During Pregnancy and Postpartum

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional support for pregnant and postpartum women and young children. The typical food package provided to recipient families was revised in October 2009 to include more whole grains, fruits, vegetables, and low-fat milk. Little is known about whether these revisions improved nutrition among women during this critical period of the life course. We conducted a quasiexperimental difference-in-differences analysis, comparing WIC recipients ("treatment" group) before and after the WIC policy change, while accounting for temporal trends among nonrecipients ("control" group). We examined nutritional outcomes among a cohort of 1,454 women recruited during pregnancy in 2006-2011 in Memphis and surrounding Shelby County, Tennessee. We found improvements in several measures of dietary quality and nutrient intake during pregnancy, although these did not persist into the postpartum period. Results were robust to numerous sensitivity analyses. At a time when federal WIC funding is threatened, this study provides some of the first evidence of the benefits of recent WIC revisions among low-income women.

Association between Spatial Access to Food Outlets, Frequency of Grocery Shopping, and Objectively-Assessed and Self-Reported Fruit and Vegetable Consumption

Because supermarkets are a critical part of the community food environment, the purpose of this paper is to examine the association between accessibility to the supermarket where participants were surveyed, frequency of shopping at the supermarket, and self-reported and objectively-assessed fruit and vegetable consumption. Accessibility was assessed using Geographic Information Systems (GIS) measured distance and multiple versions of the modified Retail Food Environment Index (mRFEI), including a localized road network buffer version. Frequency of shopping was assessed using self-report. The National Cancer Institute Fruit and Vegetable screener was used to calculate daily servings of fruits and vegetables. Skin carotenoids were assessed using the "Veggie Meter™" which utilizes reflection spectroscopy to non-invasively assess skin carotenoids as an objective measure of fruit and vegetable consumption. Bivariate and multivariable statistics were used to examine the associations in RStudio. There was a positive association between skin carotenoids and the Special Supplemental Nutrition Program for Women Infants and Children (WIC) and mRFEI scores, suggesting that WIC participation and a healthier food environment were associated with objectively-assessed fruit and vegetable consumption (skin carotenoids). Future research should examine these associations using longitudinal study designs and larger sample sizes.

A Smartphone App for Families With Preschool-Aged Children in a Public Nutrition Program: Prototype Development and Beta-Testing

Background

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the United States provides free supplemental food and nutrition education to low-income mothers and children under age 5 years. Childhood obesity prevalence is higher among preschool children in the WIC program compared to other children, and WIC improves dietary quality among low-income children. The Children Eating Well (CHEW) smartphone app was developed in English and Spanish for WIC-participating families with preschool-aged children as a home-based intervention to reinforce WIC nutrition education and help prevent childhood obesity.

Objective

This paper describes the development and beta-testing of the CHEW smartphone app. The objective of beta-testing was to test the CHEW app prototype with target users, focusing on usage, usability, and perceived barriers and benefits of the app.

Methods

The goals of the CHEW app were to make the WIC shopping experience easier, maximize WIC benefit redemption, and improve parent snack feeding practices. The CHEW app prototype consisted of WIC Shopping Tools, including a barcode scanner and calculator tools for the cash value voucher for purchasing fruits and vegetables, and nutrition education focused on healthy snacks and beverages, including a Yummy Snack Gallery and Healthy Snacking Tips. Mothers of 63 black and Hispanic WIC-participating children ages 2 to 4 years tested the CHEW app prototype for 3 months and completed follow-up interviews.

Results

Study participants testing the app for 3 months used the app on average once a week for approximately 4 and a half minutes per session, although substantial variation was observed. Usage of specific features averaged at 1 to 2 times per month for shopping-related activities and 2 to 4 times per month for the snack gallery. Mothers classified as users rated the app’s WIC Shopping Tools relatively high on usability and benefits, although variation in scores and qualitative feedback highlighted several barriers that need to be addressed. The Yummy Snack Gallery and Healthy Snacking Tips scored higher on usability than benefits, suggesting that the nutrition education components may have been appealing but too limited in scope and exposure. Qualitative feedback from mothers classified as non-users pointed to several important barriers that could preclude some WIC participants from using the app at all.

Conclusions

The prototype study successfully demonstrated the feasibility of using the CHEW app prototype with mothers of WIC-enrolled black and Hispanic preschool-aged children, with moderate levels of app usage and moderate to high usability and benefits. Future versions with enhanced shopping tools and expanded nutrition content should be implemented in WIC clinics to evaluate adoption and behavioral outcomes. This study adds to the growing body of research focused on the application of technology-based interventions in the WIC program to promote program retention and childhood obesity prevention.

Use of a mixed-method approach to evaluate the implementation of retention promotion strategies in the New York State WIC program

This research assessed the implementation of strategies piloted at 10 Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics aimed at increasing retention in the program, by enhancing participants' shopping experiences. Under WIC Retention Promotion Study: Keep, Reconnect, Thrive (WIC RPS), clinics were recruited and assigned to implement one or a combination of strategies: a standardized Shopping Orientation (SO) curriculum, a Guided Shopping Tour (GST), and a Pictorial Foods Card (PFC) from November 2012 through August 2013. This paper presents results from the process evaluation of the retention strategies, using a mixed-methods comparative case study design employing WIC administrative data, interviews, and focus groups. Qualitative data were inductively coded, analyzed and mapped to the following implementation constructs: organizational capacity, fidelity, allowable adaptations, implementation challenges, and participant responsiveness, while quantitative data were analyzed using SAS to assess reach and dose. Several sites implemented the SO and PFC interventions with the necessary fidelity and dose needed to assess impact on participants' shopping experiences. Sites that were assigned the GST strategy struggled to implement this strategy. However, use of the standardized SO enabled staff to use a "consistent list of shopping tips" to educate participants about the proper use of checks, while use of the PFC increased participants' awareness of the variety of WIC-allowable foods. During follow-up telephone calls, 91 percent of participants reported the shopping tips as helpful. Future analyses will assess the impact of enhanced shopping experience on retention at intervention sites.

Beyond Food Access: The Impact of Parent-, Home-, and Neighborhood-Level Factors on Children's Diets

Despite the growth in empirical research on neighborhood environmental characteristics and their influence on children’s diets, physical activity, and obesity, much remains to be learned, as few have examined the relationship between neighborhood food availability on dietary behavior in children, specifically. This analysis utilized data from a community-based, cross-sectional sample of children (n = 199) that was collected in New Orleans, Louisiana, in 2010. This dataset was linked to food environment data to assess the impact of neighborhood food access as well as household and parent factors on children’s diets. We observed a negligible impact of the neighborhood food environment on children’s diets, except with respect to fast food, with children who had access to fast food within 500 m around their home significantly less likely (OR = 0.35, 95% CI: 0.1, 0.8) to consume vegetables. Key parental and household factors did play a role in diet, including receipt of public assistance and cooking meals at home. Children receiving public assistance were 2.5 times (95% CI: 1.1, 5.4) more likely to consume fruit more than twice per day compared with children not receiving public assistance. Children whose family cooked dinner at home more than 5 times per week had significantly more consumption of fruit (64% vs. 58%) and vegetables (55% vs. 39%), but less soda (27% vs. 43%). Findings highlight the need for future research that focuses on the dynamic and complex relationships between built and social factors in the communities and homes of children that impact their diet in order to develop multilevel prevention approaches that address childhood obesity.

Neurotoxicants, Micronutrients, and Social Environments

SUMMARY—Systematic research evaluating the separate and interacting impacts of neurotoxicants, micronutrients, and social environments on children's cognition and behavior has only recently been initiated. Years of extensive human epidemiologic and animal experimental research document the deleterious impact of lead and other metals on the nervous system. However, discrepancies among human studies and between animal and human studies underscore the importance of variations in child nutrition as well as social and behavioral aspects of children's environments that mitigate or exacerbate the effects of neurotoxicants.

In this monograph, we review existing research on the impact of neurotoxic metals, nutrients, and social environments and interactions across the three domains. We examine the literature on lead, mercury, manganese, and cadmium in terms of dispersal, epidemiology, experimental animal studies, effects of social environments, and effects of nutrition.

Research documenting the negative impact of lead on cognition and behavior influenced reductions by the Center for Disease Control in child lead-screening guidelines from 30 micrograms per deciliter (μg/dL) in 1975 to 25 μg/dL in 1985 and to 10 μg/dL in 1991. A further reduction is currently being considered. Experimental animal research documents lead's alteration of glutamate-neurotransmitter (particularly N-methyl-D-aspartate) activity vital to learning and memory. In addition, lead induces changes in cholinergic and dopaminergic activity. Elevated lead concentrations in the blood are more common among children living in poverty and there is some evidence that socioeconomic status influences associations between lead and child outcomes. Micronutrients that influence the effects of lead include iron and zinc.

Research documenting the negative impact of mercury on children (as well as adults) has resulted in a reference dose (RfD) of 0.1 microgram per kilogram of body weight per day (μg/kg/day). In animal studies, mercury interferes with glutamatergic, cholinergic, and dopaminergic activity. Although evidence for interactions of mercury with children's social contexts is minimal, researchers are examining interactions of mercury with several nutrients.

Research on the effects of cadmium and manganese on child cognition and behavior is just beginning. Experimental animal research links cadmium to learning deficits, manganese to behaviors characteristic of Parkinson's disease, and both to altered dopaminergic functioning.

We close our review with a discussion of policy implications, and we recommend interdisciplinary research that will enable us to bridge gaps within and across domains.

Nutrition Assistance Programs: Cause or Solution to Obesity

Three nutrition assistance programs-Supplemental Nutrition Assistance Program (SNAP), Special Nutrition Program for Women, Infants and Children (WIC), and National School Lunch Program (NSLP)-serve as the backbone of the nutrition safety net in the USA. These programs have been successful in achieving many of their initial goals of improving food purchases, food intake, and/or nutritional status of low-income, vulnerable Americans. The emphasis in these programs has now broadened to also include an obesity prevention focus. Recent changes in program components demonstrate the revised objectives of the program. SNAP, WIC, and NSLP increase economic access to an adequate diet but access alone is unlikely to be the total solution to obesity prevention. An ecological approach, incorporating the nutrition programs, appears to be a more promising strategy to leverage the impact of SNAP, WIC, and NSLP.

Revised WIC Food Package and Children's Diet Quality

BACKGROUND AND OBJECTIVES

In October 2009, the Special Supplemental Nutrition Program for Women, Infant, and Children (WIC) food package was revised to include more fruits, vegetables, whole grains, and lower-fat milk. We examined the impact of the WIC food package revisions on the diet quality of children in households using WIC.

METHODS

A total of 1197 children aged 2 to 4 years from low-income households were studied from before and after the policy implementation (using the 2003-2008 and 2011-2012 National Health and Nutrition Examination Survey). The Healthy Eating Index-2010 (HEI-2010) was calculated using two 24-hour diet recalls. Linear regression was used to examine the difference in HEI-2010 score attributable to the food package change, adjusting for baseline and secular trends among WIC participants and nonparticipants, as well as child and household characteristics. Component scores of the HEI-2010 index were analyzed with generalized linear models.

RESULTS

Average HEI-2010 scores for participants and nonparticipants were 52.4 and 50.0 at baseline, and 58.3 and 52.4 after the policy change, respectively. The WIC food package revisions were associated with an adjusted average of 3.7 additional HEI-2010 points (95% confidence interval, 0.6-6.9) for WIC participants compared with nonparticipants. In particular, the revisions were associated with a 3.4-fold relative increase (95% confidence interval, 1.3-9.4) in the Greens and Beans component score for WIC participants compared with nonparticipants.

CONCLUSIONS

Results from this national sample indicate that the WIC food package revisions were associated with higher diet quality for children participating in WIC.

Did the 2009 American Recovery and Reinvestment Act affect dietary intake of low-income individuals?

This paper examines the relationship between increased Supplemental Nutritional Assistance Program (SNAP) benefits following the 2009 American Recovery and Reinvestment Act (ARRA) and the diet quality of individuals from SNAP-eligible compared to ineligible (those with somewhat higher income) households using data from the 2007-2010 National Health and Nutrition Examination Survey. The ARRA increased SNAP monthly benefits by 13.6% of the maximum allotment for a given household size, equivalent to an increase of $24 to $144 for one-to-eight person households respectively. In the full sample, we find that these increases in SNAP benefits are not associated with changes in nutrient intake and diet quality. However, among those with no more than a high school education, higher SNAP benefits are associated with a 46% increase in the mean caloric share from sugar-sweetened beverages (SSBs) and a decrease in overall diet quality especially for those at the lower end of the diet quality distribution, amounting to a 9% decline at the 25th percentile.

Use of a new availability index to evaluate the effect of policy changes to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on the food environment in New Orleans

OBJECTIVE

Changes to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) occurred in 2009 when supplemental foods offered through the programme were updated to align with current dietary recommendations. The present study reports on a new index developed to monitor the retail environment's adoption of these new food supply requirements in New Orleans.

DESIGN

A 100-point WIC Availability Index (WIC-AI) was derived from new minimum state stocking requirements for WIC vendors. A sample of supermarkets, medium and small food stores was assessed in 2009 before changes were implemented and in 2010 after revisions had gone into effect. WIC-AI scores were utilized to compare differences in meeting requirements by store type, WIC vendor status and year of measurement.

SETTING

Supermarkets, medium and small WIC and non-WIC food stores in New Orleans, Louisiana, USA.

RESULTS

At baseline supermarkets had the highest median WIC-AI score (93·3) followed by medium (69·8) and small food stores (48·0). Small WIC stores had a higher median WIC-AI score at baseline than small non-WIC stores (66·9 v. 38·0). Both medium and small WIC stores significantly increased their median WIC-AI scores between 2009 and 2010 (P<0·01). The increased median WIC-AI score in small food stores was largely attributed to increased availability of cereals and grains, juices and fruit, and infant fruit and vegetables.

CONCLUSIONS

The WIC-AI is a simple tool useful in summarizing complex food store environment data and may be adapted for use in other states or a national level to inform food policy decisions and direction.

Nutritional impacts of a fruit and vegetable subsidy programme for disadvantaged Australian Aboriginal children

Healthy food subsidy programmes have not been widely implemented in high-income countries apart from the USA and the UK. There is, however, interest being expressed in the potential of healthy food subsidies to complement nutrition promotion initiatives and reduce the social disparities in healthy eating. Herein, we describe the impact of a fruit and vegetable (F&V) subsidy programme on the nutritional status of a cohort of disadvantaged Aboriginal children living in rural Australia. A before-and-after study was used to assess the nutritional impact in 174 children whose families received weekly boxes of subsidised F&V organised through three Aboriginal medical services. The nutritional impact was assessed by comparing 24 h dietary recalls and plasma carotenoid and vitamin C levels at baseline and after 12 months. A general linear model was used to assess the changes in biomarker levels and dietary intake, controlled for age, sex, community and baseline levels. Baseline assessment in 149 children showed low F&V consumption. Significant increases (P< 0·05) in β-cryptoxanthin (28·9 nmol/l, 18 %), vitamin C (10·1 μmol/l, 21 %) and lutein–zeaxanthin (39·3 nmol/l, 11 %) levels were observed at the 12-month follow-up in 115 children, although the self-reported F&V intake was unchanged. The improvements in the levels of biomarkers of F&V intake demonstrated in the present study are consistent with increased F&V intake. Such dietary improvements, if sustained, could reduce non-communicable disease rates. A controlled study of healthy food subsidies, together with an economic analysis, would facilitate a thorough assessment of the costs and benefits of subsidising healthy foods for disadvantaged Aboriginal Australians.

Food insecurity is associated with greater acute care utilization among HIV-infected homeless and marginally housed individuals in San Francisco

BACKGROUND

Food insecurity, or the uncertain availability of nutritionally adequate, safe foods, has been associated with poor HIV outcomes. There are few data on the extent to which food insecurity impacts patterns of health-care utilization among HIV-infected individuals.

OBJECTIVE

We examined whether food insecurity was associated with hospitalizations, Emergency Department (ED) visits, and non-ED outpatient visits.

METHODS

HIV-infected, homeless and marginally housed individuals participating in the San Francisco Research on Access to Care in the Homeless (REACH) cohort underwent quarterly structured interviews and blood draws. We measured food insecurity with the validated Household Food Insecurity Access Scale, and categorized participants as food secure, mild/moderately food insecure, and severely food insecure. Primary outcomes were: (1) any hospitalizations, (2) any ED visits, and (3) any non-ED outpatient visits. Generalized estimating equations were used to estimate model parameters, adjusting for socio-demographic (age, sex, ethnicity, education, income, housing status, health insurance) and clinical variables (CD4 nadir, time on antiretroviral therapy, depression, and illicit drug use).

RESULTS

Beginning in November 2007, 347 persons were followed for a median of 2 years. Fifty-six percent of participants were food insecure at enrollment. Compared with food-secure persons, those with severe food insecurity had increased odds of hospitalizations [adjusted odds ratio (AOR) = 2.16, 95 % confidence interval (CI) = 1.50-3.09] and ED visits (AOR = 1.71, 95 % CI = 1.06-2.30). While the odds of an outpatient visit were 41 % higher for severely food insecure individuals, the effect was not statistically significant (AOR = 1.41, 95 % CI = 0.99-2.01). Mild/moderate food insecurity was also associated with increased hospitalizations (AOR = 1.56, 95 % CI = 1.06-2.30), ED visits (AOR = 1.57, 95 % CI = 1.22-2.03), and outpatient visits (AOR = 1.68, 95 % CI = 1.20-2.17).

CONCLUSIONS

Food insecurity is associated with increased health services utilization among homeless and marginally housed HIV-infected individuals in San Francisco. Increased ED visits and hospitalizations are not related to fewer ambulatory care visits among food-insecure individuals. Addressing food insecurity should be a critical component of HIV treatment programs and may reduce reliance on acute care utilization.

Food subsidy programs and the health and nutritional status of disadvantaged families in high income countries: a systematic review

Background

Less healthy diets are common in high income countries, although proportionally higher in those of low socio-economic status. Food subsidy programs are one strategy to promote healthy nutrition and to reduce socio-economic inequalities in health. This review summarises the evidence for the health and nutritional impacts of food subsidy programs among disadvantaged families from high income countries.

Methods

Relevant studies reporting dietary intake or health outcomes were identified through systematic searching of electronic databases. Cochrane Public Health Group guidelines informed study selection and interpretation. A narrative synthesis was undertaken due to the limited number of studies and heterogeneity of study design and outcomes.

Results

Fourteen studies were included, with most reporting on the Special Supplemental Nutrition Program for Women, Infants and Children in the USA. Food subsidy program participants, mostly pregnant or postnatal women, were shown to have 10–20% increased intake of targeted foods or nutrients. Evidence for the effectiveness of these programs for men or children was lacking. The main health outcome observed was a small but clinically relevant increase in mean birthweight (23–29g) in the two higher quality WIC studies.

Conclusions

Limited high quality evidence of the impacts of food subsidy programs on the health and nutrition of adults and children in high income countries was identified. The improved intake of targeted nutrients and foods, such as fruit and vegetables, could potentially reduce the rate of non-communicable diseases in adults, if the changes in diet are sustained. Associated improvements in perinatal outcomes were limited and most evident in women who smoked during pregnancy. Thus, food subsidy programs for pregnant women and children should aim to focus on improving nutritional status in the longer term. Further prospective studies and economic analyses are needed to confirm the health benefits and justify the investment in food subsidy programs.

Low-income Supplemental Nutrition Assistance Program participation is related to adiposity and metabolic risk factors

BACKGROUND

The Supplemental Nutrition Assistance Program (SNAP) is the largest federal nutrition assistance program. In recent years, SNAP participation rates increased during times of economic hardship.

OBJECTIVE

We examined whether household SNAP participation was associated with adiposity and metabolic risk factors in a representative sample of low-income US adults.

DESIGN

A cross-sectional analysis was performed with the use of data from the 2003-2006 National Health and Nutrition Examination Surveys. The study population was restricted to nonelderly adults whose household incomes fell to or <130% of the federal poverty level. Multinomial logistic and Poisson regression models were fit to examine the associations between SNAP participation and BMI, waist circumference, and metabolic risk factors among 2250 low-income adults.

RESULTS

In the previous 12 mo, 32.8% of adults received household SNAP benefits. SNAP participation was positively associated with obesity [prevalence ratio (PR): 1.58; 95% CI: 1.08, 2.31], waist circumference in men (PR for top compared with bottom quartile: 2.04; 95% CI: 1.15, 3.62; P = 0.02), and waist circumference in women (PR: 2.95; 95% CI: 1.51, 5.77; P = 0.003; P-interaction with sex = 0.11), independent of sociodemographic characteristics. SNAP participation was also related to elevated triglycerides (PR: 1.71; 95% CI: 1.33, 2.20), lower HDL cholesterol (PR: 1.23; 95% CI: 1.08, 1.41), elevated fasting glucose (≥110 mg/dL; PR: 1.63; 95% CI: 1.05, 2.52), and metabolic syndrome (PR: 1.49; 95% CI: 1.13, 1.95). Associations with triglycerides and HDL cholesterol persisted after adjustment for BMI.

CONCLUSION

Household SNAP participation was positively associated with BMI, waist circumference, and metabolic risk factors among low-income adults. These associations may be mediated by dietary intake and warrant further investigation.

Maternal health behaviors and infant health outcomes among homeless mothers: U.S. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) 2000-2007

OBJECTIVE

To determine whether participation in the Women, Infants, and Children Program is associated with improved maternal and infant health outcomes among homeless women in the Pregnancy Risk Assessment Monitoring System.

METHOD

Analyses were based on Pregnancy Risk Assessment Monitoring System participants from 31 states/cities in the United States, 2000-2007 (n=272,859). Overall, 4% of women completing the Pregnancy Risk Assessment Monitoring System survey were homeless, with 76% participating in the Women, Infants, and Children Program, a federally-funded supplemental nutrition program for low-income women and children less than 5 years old.

RESULTS

Among women in the Pregnancy Risk Assessment Monitoring System survey who reported using the Women, Infants, and Children Program, those experiencing homelessness were older, less educated, less likely to have private health insurance, and more likely to receive government assistance. Homeless women in the Women, Infants, and Children Program compared with those not in the program were significantly more likely to have a higher body mass index, to initiate breastfeeding after delivery, have prenatal care visits, have a longer gestational age, and have a greater infant birth weight.

CONCLUSION

Characteristics of homeless pregnant women choosing to participate in the Women, Infants, and Children Program are consistent with the requirements for program participation for women in general. Homeless women accessing the Women, Infants, and Children Program had better maternal and infant health outcomes.

Poverty, food insecurity, and the behavior for childhood internalizing and externalizing disorders

OBJECTIVE

This study investigated the associations of poverty and food insecurity over a 2-year period with internalizing and externalizing problems in a large, community-based sample.

METHOD

A total of 2,810 children were interviewed between ages 4 and 14 years at baseline, and between ages 5 and 16 years at follow-up. Primary caregivers reported on household income, food insecurity, and were administered the Child Behavior Checklist, from which we derived indicators of clinically significant internalizing and externalizing problems. Prevalence ratios for the associations of poverty and food insecurity with behavior problems were estimated.

RESULTS

At baseline, internalizing and externalizing problems were significantly more prevalent among children who lived in poor households than in nonpoor households, and among children who lived in food insecure households than in food-secure households. In adjusted analyses, children from homes that were persistently food insecure were 1.47 (95% CI = 1.12 to 1.94) times more likely to have internalizing problems and 2.01 (95% CI = 1.21 to 3.35) times more likely to have externalizing problems compared with children from households that were never food insecure. Children from homes that moved from food secure to insecure were 1.78 (95% CI = 1.07 to 2.94) times more likely to have externalizing problems at follow-up.

CONCLUSIONS

Persistent food insecurity is associated with internalizing and externalizing problems, even after adjusting for sustained poverty and other potential confounders. These results implicate food insecurity as a novel risk factor for child mental well-being; if causal, this represents an important factor in the etiology of child psychopathology, and potentially a new avenue for prevention.

Exploring food insecurity among young mothers (15-24 years)

PURPOSE

The purpose of this study was to explore the experience of food insecurity of young mothers (15-24 years) and identify strategies used to manage food-insecure periods.

DESIGN AND METHODS

This exploratory study used the U.S. Household Food Security Survey Module, cognitive interviewing, and individual interviews.

RESULTS

Sixteen out of 21 young mothers indicated that they fluctuated between low food insecurity (reduced desirability of diet), and all 21 participants reported some days of food insufficiency (anxiety over shortage of food). All the women reported that their children had only marginal food insecurity due to extensive strategies.

PRACTICE IMPLICATIONS

Nutrition counseling must include food insecurity assessment.

Overview of methods used to evaluate the adequacy of nutrient intakes for individuals and populations

The objective of the present paper is to review the methods of measuring micronutrient intake adequacy for individuals and for populations in order to ascertain best practice. A systematic review was conducted to locate studies on the methodological aspects of measuring nutrient adequacy. The results showed that for individuals, qualitative methods (to find probability of adequacy) and quantitative methods (to find confidence of adequacy) have been proposed for micronutrients where there is enough data to set an average nutrient requirement (ANR). If micronutrients do not have ANR, an adequate intake (AI) is often defined and can be used to assess adequacy, provided the distribution of daily intake over a number of days is known. The probability of an individual's intake being excessive can also be compared with the upper level of safe intake and the confidence of this estimate determined in a similar way. At the population level, adequacy can be judged from the ANR using the probability approach or its short cut – the estimated average requirement cut-point method. If the micronutrient does not have an ANR, adequacy cannot be determined from the average intake and must be expressed differently. The upper level of safe intake can be used for populations in a similar way to that of individuals. All of the methodological studies reviewed were from the American continent and all used the methodology described in the Institute of Medicine publications. The present methodology should now be adapted for use in Europe.

Insegurança alimentar como indicador de iniqüidade: análise de inquérito populacional

O objetivo deste trabalho foi investigar a associação da insegurança alimentar com algumas variáveis indicativas de desigualdades sociais, como renda, escolaridade, raça/cor, composição familiar, características da moradia e condições de saneamento. Para medida de segurança alimentar, aplicou-se o instrumento EBIA (Escala Brasileira de Insegurança Alimentar) a uma amostra de 456 famílias residentes em área urbana do Município de Campinas. Verificou-se que a insegurança alimentar concentrou-se em famílias com maior número de membros menores de 18 anos, vivendo em construções precárias e com alta aglomeração de moradores, sem rede de esgoto, de baixa renda (menos de dois salários mínimos), cujo responsável não freqüentou a escola, sem membros com nível universitário e nas quais os informantes referiram ter cor da pele preta. Considera-se que a medida direta de segurança alimentar por meio da EBIA seja um importante indicador para monitoramento da iniqüidade, podendo complementar um conjunto de indicadores sociais ou, mesmo de forma isolada, identificar grupos com vulnerabilidade social.

Measuring household food security: the global experience

Measuring household food insecurity represents a challenge due to the complexity and wide array of factors associated with this phenomenon. For over one decade, researchers and agencies throughout the world have been using and assessing the validity of variations of the United States Department of Agriculture Household Food Security Supplemental Module. Thanks to numerous studies of diverse design, size, and purpose, the Household Food Security Supplemental Module has shown its suitability to directly evaluate the perceptions of individuals on their food security status. In addition, challenges and limitations are becoming clearer and new research questions are emerging as the process advances. The purpose of this article is to describe the development, validation procedures, and use of the Household Food Security Supplemental Module in very diverse settings. The most common Household Food Security Supplemental Module related studies have been conducted using criterion validity, Rasch modeling and Cronbach-Alpha Coefficient. It is critical that researchers, policy makers, governmental and non-governmental agencies intensify their efforts to further develop tools that provide valid and reliable measures of food security in diverse population groups. Additional work is needed to synthesize a universally applicable tool able to capture the global human phenomenon of food insecurity.

The use of multiple logistic regression to identify risk factors associated with anemia and iron deficiency in a convenience sample of 12-36-mo-old children from low-income families

BACKGROUND

The prevalence of iron deficiency (ID) anemia among preschool-age children remains relatively high in some areas across the United States. Determination of risk factors associated with ID is needed to allow children with identifiable risk factors to receive appropriate education, testing, and follow-up.

OBJECTIVE

We aimed to evaluate risk factors associated with anemia and ID in a sample of children participating in or applying for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

DESIGN

The study was a cross-sectional study of a convenience sample of 12-36-mo-old children recruited from WIC clinics in 2 California counties (n = 498).

RESULTS

Current WIC participation by the child and a greater rate of weight gain were negatively associated, and current maternal pregnancy was positively associated with anemia (hemoglobin < 110 g/L at 12-<24 mo or < 111 g/L at 24-36 mo) after control for age, sex, and ethnicity. Maternal WIC participation during pregnancy, child age, and the intake of > or =125 mL orange or tomato juice/d were negatively associated, and being male and living in an urban location were positively associated with ID (> or =2 of the following abnormal values: ferritin < or = 8.7 microg/L, transferrin receptors > or = 8.4 microg/mL, and transferrin saturation < or = 13.2%).

CONCLUSIONS

Current WIC participation by the child and maternal WIC participation during pregnancy were negatively associated with anemia and ID, respectively. It is anticipated that the risk factors identified in this study will be included in the development of an educational intervention focused on reducing the risk factors for ID and ID anemia in young children.

Child food insecurity and iron deficiency anemia in low-income infants and toddlers in the United States

OBJECTIVE

Examine the association between child-level food insecurity and iron status in young children utilizing community-based data from the Children's Sentinel Nutrition Assessment Program (C-SNAP).

METHODS

A cross-sectional sample of caregivers of children < or =36 months of age utilizing emergency department (ED) services were interviewed between 6/96-5/01. Caregiver interviews, which included questions on child-level food security, were linked to a primary clinic database containing hemoglobin, red blood cell distribution width, mean corpuscular volume, free erythrocyte protoporphyrin and lead values. Children a priori at-risk for anemia: birthweight < or =2500 g, with HIV/AIDS, sickle cell disease, or lead values > or =10.0 ug/dL, and children < or =6 months of age were excluded from the analysis. Only laboratory tests 365 days prior or 90 days after interview were examined. Iron status was classified in four mutually exclusive categories: 1) Iron Sufficient-No Anemia (ISNA), 2) Anemia (without iron deficiency), 3) Iron Deficient-No Anemia (IDNA), 4) Iron Deficient with Anemia (IDA).

RESULTS

626 ED interviews linked to laboratory data met the inclusion criteria. Food insecure children were significantly more likely to have IDA compared to food secure children [Adjusted Odds Ratio = 2.4, 95% CI (1.1-5.2), p = 0.02]. There was no association between child food insecurity and anemia without iron deficiency or iron deficiency without anemia.

CONCLUSION

These findings suggest an association between child level food insecurity and iron deficiency anemia, a clinically important health indicator with known negative cognitive, behavioral and health consequences. Cuts in spending on food assistance programs that address children's food insecurity may lead to adverse health consequences.

Lower breastfeeding rates persist among the Special Supplemental Nutrition Program for Women, Infants, and Children participants, 1978-2003

OBJECTIVE

We set out to compare rates of breastfeeding between women who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) with those of non-WIC mothers from 1978 to 2003.

METHODS

The Ross Laboratories Mothers Survey is a national survey designed to determine patterns of milk feeding during infancy. Mothers were asked to recall the type of milk fed to their infant in the hospital and during each month of age. Rates of breastfeeding in the hospital and at 6 months of age were evaluated. Logistic regression analyses identified significant predictors of breastfeeding in 2003.

RESULTS

From 1978 through 2003, rates for the initiation of breastfeeding among WIC participants lagged behind those of non-WIC mothers by an average of 23.6 +/- 4.4 percentage points. At 6 months of age, the gap between WIC participants and non-WIC mothers (mean: 16.3 +/- 3.1 percentage points) steadily increased from 1978 through 2003 and exceeded 20% by 1999. Demographic factors that were significant and positive predictors of breastfeeding initiation in 2003 included some college education, living in the western region of the United States, not participating in the WIC program, having an infant of normal birth weight, primipary, and not working outside the home. For mothers of infants 6 months of age, WIC status was the strongest determinant of breastfeeding: mothers who were not enrolled in the WIC program were more than twice as likely to breastfeed at 6 months of age than mothers who participated in the WIC program.

CONCLUSIONS

Breastfeeding rates among WIC participants have lagged behind those of non-WIC mothers for the last 25 years. The Healthy People 2010 goals for breastfeeding will not be reached without intervention. Food package and programmatic changes are needed to make the incentives for breastfeeding greater for WIC participants.

Potential for Misclassification of Micronutrient Status in Children Participating in a Head Start Program

OBJECTIVE

To evaluate relations among measures of iron and zinc status, C-reactive protein (CRP), and leukocytes in low-income children participating in the Head Start program.

DESIGN

Cross-sectional correlational study with samples collected at Head Start centers in May 2003.

SUBJECTS/SETTING

Forty-seven children (aged 3 to 5 years) attending Head Start centers in three rural communities.

MEASURES

Zinc, ferritin, CRP, and complete blood count were analyzed in nonfasting blood samples.

STATISTICAL ANALYSES

Correlations were computed among leukocyte levels, CRP levels, and measures of micronutrient status. Children having two abnormal measures (ie, leukocytes and CRP) were compared by univariate analysis of variance with children having zero or one abnormal measure.

RESULTS

Most (72%) of the children had elevated CRP levels. Four percent were anemic (hemoglobin<11.0 g/dL [<110 g/L]); 11% had low iron stores (serum ferritin<or=15 ng/mL [<or=33.7 pmol/L]); and 77% had low iron stores when a reference value that accounts for the presence of infection was used (serum ferritin<or=30 ng/mL [<or=67.4 pmol/L]). Twenty-one percent had low plasma zinc levels. Children with two measures that indicated infection had higher serum ferritin and lower plasma zinc levels than children with zero or one indicator of infection.

CONCLUSIONS

The link between measures of infection and serum ferritin levels suggests low-income preschool children with low iron stores are not identified by the <or=15 ng/mL (<or=33.7 pmol/L) criterion. The link between zinc and infection suggests possible overestimations of zinc deficiency in low-income children. Thus, in this population, the presence of infection (as indicated by CRP levels and leukocyte counts) should be determined to assess micronutrient status.

The impact of homeless shelters on food access and choice among homeless families in Minnesota

OBJECTIVE

To determine how and where homeless families access food, and to determine factors that influence food choice.

DESIGN

Seven focus groups (90 minutes each) were conducted by two moderators and audio-taped.

SETTING

Two homeless shelters serving families.

PARTICIPANTS

Fifty-three parents or guardians (M = 11; F = 42) with children 3-12 years of age. Most participants had completed high school or higher education.

PHENOMENON OF INTEREST

Food choice and food access among homeless families.

ANALYSIS

Transcripts evaluated for consistency, coded, and evaluated for dominant themes.

RESULTS

Limited cooking and storage space, and poor meal timing and food options at the shelters resulted in participants developing strategies to alleviate hunger. Strategies used to obtain food included using food stamps, stealing food, eating food in grocery stores, pawning personal items, using savvy shopping habits, scavenging in dumpsters (obtaining items such as food from dumpsters), and sacrificing food for children.

CONCLUSIONS AND IMPLICATIONS

Homeless families find strategies to prevent food insecurity. Food stamp usage is a common strategy, but it often is insufficient to meet monthly needs, indicating the need for reevaluation of program components. The shelter environment's impact on families' food choices suggests a role for nutritionists in ensuring availability of adequate, nutritious foods. Future research is needed to evaluate the impact of the shelter environment on homeless families' overall nutritional status.

Food insecurity affects school children's academic performance, weight gain, and social skills

Food insecurity has been associated with diverse developmental consequences for U.S. children primarily from cross-sectional studies. We used longitudinal data to investigate how food insecurity over time related to changes in reading and mathematics test performance, weight and BMI, and social skills in children. Data were from the Early Childhood Longitudinal Study-Kindergarten Cohort, a prospective sample of approximately 21,000 nationally representative children entering kindergarten in 1998 and followed through 3rd grade. Food insecurity was measured by parent interview using a modification of the USDA module in which households were classified as food insecure if they reported > or =1 affirmative response in the past year. Households were grouped into 4 categories based on the temporal occurrence of food insecurity in kindergarten and 3rd grade. Children's academic performance, height, and weight were assessed directly. Children's social skills were reported by teachers. Analyses examined the effects of modified food insecurity on changes in child outcomes using lagged, dynamic, and difference (i.e., fixed-effects) models and controlling for child and household contextual variables. In lagged models, food insecurity was predictive of poor developmental trajectories in children before controlling for other variables. Food insecurity thus serves as an important marker for identifying children who fare worse in terms of subsequent development. In all models with controls, food insecurity was associated with outcomes, and associations differed by gender. This study provides the strongest empirical evidence to date that food insecurity is linked to specific developmental consequences for children, and that these consequences may be both nutritional and nonnutritional.

Relationship of child-feeding practices to overweight in low-income Mexican-American preschool-aged children

OBJECTIVE

The purpose of this research was to examine the relationship of child-feeding practices and other factors to overweight in low-income Mexican-American preschool-aged children.

DESIGN

Cross-sectional survey with anthropometric measurements of mothers and target children. Trained bilingual staff interviewed the parents to collect data on child-feeding strategies, food patterns, child's health history, parental acculturation level, food insecurity, and other household characteristics. Subjects and setting Complete data were available from 204 low-income Mexican-American parents residing in California with at least one child aged 3 to 5 years. Outcomes measured Risk of overweight was defined as body mass index (BMI) (measured as weight [in kilograms]/height [in meters](2)) >/=85th percentile and overweight was defined as BMI >/=95th percentile. The Student t test, chi(2) test, and logistic regression were used.

RESULTS

Three variables were positively related to risk of overweight: birth weight (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.11 to 4.82), mother's BMI >/=30 (OR, 2.05; 95% CI, 1.11 to 3.79), and juice intake (OR, 2.33; 95% CI, 1.09 to 4.98). Being enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children was negatively related to risk of overweight (OR, 0.40; 95% CI, 0.21 to 0.75). Additional variables related to overweight were monthly income >$1,500 (OR, 2.33; 95% CI, 1.00 to 5.42) and child takes food from the refrigerator between meals (OR, 0.32; 95% CI, 0.13 to 0.76).

CONCLUSIONS

The results of this study suggest that biological and socioeconomic factors are more associated with overweight in Mexican-American preschool-aged children than most of the self-reported child-feeding strategies.

Special Supplemental Nutrition Program for Women, Infants, and Children participation and infants' growth and health: a multisite surveillance study

CONTEXT

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is the largest food supplement program in the United States, serving almost 7 500 000 participants in 2002. Because the program is a grant program, rather than an entitlement program, Congress is not mandated to allocate funds to serve all eligible participants. Little is known about the effects of WIC on infant growth, health, and food security.

OBJECTIVE

To examine associations between WIC participation and indicators of underweight, overweight, length, caregiver-perceived health, and household food security among infants < or =12 months of age, at 6 urban hospitals and clinics.

DESIGN AND SETTING

A multisite study with cross-sectional surveys administered at urban medical centers in 5 states and Washington, DC, from August 1998 though December 2001.

PARTICIPANTS

A total of 5923 WIC-eligible caregivers of infants < or =12 months of age were interviewed at hospital clinics and emergency departments.

MAIN OUTCOME MEASURES

Weight-for-age, length-for-age, weight-for-length, caregiver's perception of infant's health, and household food security.

RESULTS

Ninety-one percent of WIC-eligible families were receiving WIC assistance. Of the eligible families not receiving WIC assistance, 64% reported access problems and 36% denied a need for WIC. The weight and length of WIC assistance recipients, adjusted for age and gender, were consistent with national normative values. With control for potential confounding family variables (site, housing subsidy, employment status, education, and receipt of food stamps or Temporary Assistance for Needy Families) and infant variables (race/ethnicity, birth weight, months breastfed, and age), infants who did not receive WIC assistance because of access problems were more likely to be underweight (weight-for-age z score = -0.23 vs 0.009), short (length-for-age z score = -0.23 vs -0.02), and perceived as having fair or poor health (adjusted odds ratio: 1.92; 95% confidence interval: 1.29-2.87), compared with WIC assistance recipients. Rates of overweight, based on weight-for-length of >95th percentile, varied from 7% to 9% and did not differ among the 3 groups but were higher than the 5% expected from national growth charts. Rates of food insecurity were consistent with national data for minority households with children. Families that did not receive WIC assistance because of access problems had higher rates of food insecurity (28%) than did WIC participants (23%), although differences were not significant after covariate control. Caregivers who did not perceive a need for WIC services had more economic and personal resources than did WIC participants and were less likely to be food-insecure, but there were no differences in infants' weight-for-age, perceived health, or overweight between families that did not perceive a need for WIC services and those that received WIC assistance.

CONCLUSIONS

Infants < or =12 months of age benefit from WIC participation. Health care providers should promote WIC utilization for eligible families and advocate that WIC receive support to reduce waiting lists and eliminate barriers that interfere with access.

Maternal depression, changing public assistance, food security, and child health status

OBJECTIVE

To examine the association of positive report on a maternal depression screen (PDS) with loss or reduction of welfare support and foods stamps, household food insecurity, and child health measures among children aged < or =36 months at 6 urban hospitals and clinics.

METHODS

A convenience sample of 5306 mothers, whose children <36 months old were being seen in hospital general clinics or emergency departments (EDs) at medical centers in 5 states and Washington, District of Columbia, were interviewed from January 1, 2000 until December 31, 2001. Questions included items on sociodemographic characteristics, federal program participation and changes in federal benefits, child health status rating, child's history of hospitalizations since birth, household food security status, and a 3-question PDS. For a subsample interviewed in the ED, whether the child was admitted to the hospital that day was recorded.

RESULTS

PDS status was associated with loss or reduction of welfare support and food stamps, household food insecurity, fair/poor child health rating, and history of child hospitalization since birth but not low child growth status measures or admission to the hospital at the time of ED visit. After controlling for study site, maternal race, education, and insurance type as well as child low birth weight status, mothers with PDS were more likely to report fair/poor child health (adjusted odds ratio [AOR]: 1.58; 95% confidence interval [CI]: 1.33-1.88) and hospitalizations during the child's lifetime (AOR: 1.20; 95% CI: 1.03-1.39), compared with mothers without PDS. Controlling for the same variables, mothers with PDS were more likely to report decreased welfare support (AOR: 1.52; 95% CI: 1.03-2.25), to have lost food stamps (AOR: 1.56; 95% CI: 1.06-2.30), and reported more household food insecurity (AOR: 2.69; 95% CI: 2.33-3.11) than mothers without PDS.

CONCLUSION

Positive maternal depression screen status noted in pediatric clinical samples of infants and toddlers is associated with poorer reported child health status, household food insecurity, and loss of federal financial support and food stamps. Although the direction of effects cannot be determined in this cross-sectional survey, child health providers and policy makers should be aware of the potential impact of maternal depression on child health in the context of welfare reform.

Nutrient intakes and food choices of infants and toddlers participating in WIC

OBJECTIVES

To examine the nutrient intakes, foods consumed, and feeding patterns of infants and toddlers participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

DESIGN

Cross-sectional telephone survey, including 24-hour dietary recalls of infants' and toddlers' food and nutrient intakes, as reported by parents or other primary caregivers.

SUBJECTS

National random sample of 3,022 children ages 4 to 24 months who participated in the 2002 Feeding Infants and Toddlers study. Sample sizes by age were infants 4 to 6 months: 265 WIC participants, 597 nonparticipants; infants 7 to 11 months: 351 WIC participants, 808 nonparticipants; and toddlers 12 to 24 months: 205 WIC participants, 791 nonparticipants.

STATISTICAL ANALYSES PERFORMED

We used Statistical Analysis Software (version 8.2) to examine the breastfeeding status, infant feeding patterns, and foods consumed; the personal computer version of the Software for Intake Distribution Estimation to estimate mean usual intake of food energy and of key nutrients targeted by the WIC program; and methods recommended by the Institute of Medicine to assess nutrient adequacy.

RESULTS

Infants participating in WIC were less likely than nonparticipants to have ever been breastfed or to be currently breastfeeding, and they were more likely to be consuming formula. Mean usual nutrient intakes exceeded the adequate intake for WIC participants, and the percentage with inadequate nutrient intake was less than 1%. Reported mean energy intakes exceeded mean energy requirements, with the largest discrepancy observed for WIC participants. Sizeable proportions of WIC and non-WIC infants and toddlers did not consume fruits and vegetables on the recall day.

APPLICATIONS

WIC providers should focus nutrition education on appropriate infant and toddler feeding patterns, should continue to reinforce their message of the importance delaying the use of cow's milk until 1 year of age, and should stress the importance of fruit and vegetable consumption.

Zinc intake of US preschool children exceeds new dietary reference intakes

BACKGROUND

The recent dietary reference intakes publication provides updated information on the physiologic and dietary requirements for zinc and proposes new tolerable upper intake levels.

OBJECTIVE

We analyzed dietary intake data of US preschool children to determine the prevalence of inadequate and excessive intakes of zinc.

DESIGN

Diets of 7474 nonbreastfeeding preschool children in the Continuing Survey of Food Intakes by Individuals (1994-1996 and 1998) were analyzed for the intakes of zinc and other dietary components, and factors associated with zinc intake were examined.

RESULTS

The mean intakes of zinc by children aged < 1 y, 1-3 y, and 4-5 y were 6.6, 7.6, and 9.1 mg/d, respectively. Less than 1% of children had usual zinc intakes below the adequate intake or estimated average requirement. The percentages of children with intakes exceeding the tolerable upper intake level were 92% (0-6 mo), 86% (7-12 mo), 51% (1-3 y), and 3% (4-5 y). Controlling for age and energy intake, zinc intake was greater in 1998 than in 1994 (P < 0.0001) and was positively associated with participation in the Women, Infants, and Children Program (P < 0.001) and with the lowest income category (P < 0.001).

CONCLUSIONS

Preschool children in the United States have dietary zinc intakes that exceed the new dietary reference intakes. Zinc intakes increased during the 4 y of the study. The present level of intake does not seem to pose a health problem, but if zinc intake continues to increase because of the greater availability of zinc-fortified foods in the US food supply, the amount of zinc consumed by children may become excessive.

Research, policy, and the federal role in prevention initiatives for children

With the ability and the funds to implement programs on a national level, federal policy is a potentially potent tool in primary prevention. Despite the U.S. government's history of ambivalence toward intervening in child rearing and limited national support for primary prevention, several initiatives have been implemented for children and families with some measure of success. The successes, however, are mitigated by limitations of the initiatives themselves and by the inconclusive nature of much of the evaluation data. This review of 5 federal policy-based initiatives for children and families provides the backdrop for discussing aspects of federal prevention program design, implementation, policy, and research.

Elderly food stamp participants are different from eligible nonparticipants by level of nutrition risk but not nutrient intake

Nutrition risk, nutrient intake, and selected socioeconomic characteristics of elderly food stamp recipients were compared with elderly people who were eligible for food stamps but did not participate in the program. Data were collected by survey using a convenience sample of 200 low-income elderly people living in subsidized housing. Although there were no significant differences in food group or nutrient intake between participants and nonparticipants, overall, these low-income subjects did not meet minimum Dietary Reference Intake (DRI) standards for many nutrients and had caloric and food group serving intakes that were below recommendations. Food Stamp Program participants were at significantly higher nutrition risk than their nonparticipating peers as detected by the Nutrition Screening Initiative Checklist (P< or =.01) and other indicators of disability. It seems that those already at highest risk were in fact participating in the Food Stamp Program because those eligible but not participating had significantly higher incomes and were at significantly lower nutritional risk.

Longitudinal study of energy and nutrient intakes for infants from low-income, urban families

OBJECTIVE

To assess the energy and nutrient intakes of healthy infants from low-income families and to compare intakes with current recommendations.

DESIGN

We interviewed mother-infant pairs longitudinally when the infants were 3, 6, 9, 12, 18 and 24 months old. Food intake data were obtained by 24-hour dietary recalls. Selected nutrient intakes were calculated and compared with the Recommended Dietary Allowances (RDAs).

SUBJECTS/SETTING

Infants were the offspring of low-income, pregnant women recruited at the Albany County Department of Health, New York for the Albany Pregnancy and Infancy Lead Study, a prospective investigation of factors related to blood lead levels, including nutrition. Interviews were conducted during paediatric clinic visits.

STATISTICAL ANALYSES PERFORMED

Means and standard deviations were used to describe energy and micronutrient intakes for age groups. The probability approach was utilised to examine the prevalence of inadequate intakes.

RESULTS

Mean energy and nutrient intakes generally met or exceeded the RDA. The exceptions were vitamin D and zinc for which observed means were below the RDA at several data points. Protein consumption was exceptionally high in this sample. The highest estimated prevalences of inadequate intakes were observed for iron, zinc and vitamin D at the older ages.

CONCLUSIONS

This study identified several potential concerns about the diets of infants during the transition from infant food and formula to table foods. Low intakes of vitamin D, zinc and iron, especially at 12 and 18 months, were observed. High protein intakes were noted at all ages.

Nutrition and brain development: social policy implications

Undernutrition among young children is widespread in the United States and has a detrimental impact on brain development. This article explores the risks associated with undernutrition and the potential for recovery when diet and the environment improve. Three policy implications are discussed: (a) increasing access to federal food programs, (b) promoting breastfeeding, and (c) working toward reducing child poverty.