Food insecurity and its socioeconomic and health determinants in pregnant women and mothers of children under 2 years of age, during the COVID-19 pandemic: A systematic review and meta-analysis

A dynamic online nomogram for predicting depression risk in cancer patients based on NHANES 2007-2018

BACKGROUND

Cancer, recognized as a significant global public health issue, exhibits a notably elevated prevalence of depression among its patient population. This study aimed to construct a nomogram to predict depression risk in cancer patients.

METHODS

In this study, the training set comprises 70 % of the dataset, while the test set comprises 30 %. On the training set, we employed the least absolute shrinkage and selection operator (LASSO) regression in conjunction with multivariable logistic regression to identify key variables, subsequently constructing a prediction model. ROC curves, calibration tests, and decision curve analysis (DCA) were used to evaluate model performance.

RESULTS

A total of 2604 participants were included in this study. The nomogram predictors encompassed age, poverty-income ratio (PIR), sleep disorder, and food security. We have developed a web-based dynamic nomogram incorporating these factors (available at https://xiaoshuweiya.shinyapps.io/DynNomapp/). The area under the model's ROC curve (AUC) was 0.803 and 0.766 when evaluated on the training and test sets, respectively. These AUC values highlight the model's robustness and reliability in making accurate predictions across different datasets. The calibration curves demonstrated consistency between the model's predicted and actual results. Additionally, the decision curve analysis further substantiated the potential clinical utility of the nomograms.

CONCLUSIONS

This study developed a nomogram to help clinicians identify high-risk populations for depression among cancer patients, providing a scientific method for early detection and assessment of depression risk.

The health status of South African youth joining Youth Employment Initiatives: a health promotion opportunity

Youth Employment Initiatives (YEIs) support young adults to enhance their employability but infrequently consider their health. This study assessed the physical and mental health of South African youth starting YEIs to understand the need for integrated health service components. Youth (18-35 years, n = 193, 76% female, mean age 24.6 ± 3.6 years) were recruited using a purposive sampling strategy from the YEI programme within South Africa. Sociodemographic and health data were collected by survey, with a subsample (n = 90) undergoing cardiometabolic assessment. One-third of youth reported thoughts of suicide or self-harm in the past 2 weeks, with significantly higher levels of depression and anxiety in youth under 25 years. Obesity levels and blood pressure were significantly higher in youth 25-35 years (68% overweight/obese, 26% hypertensive). Our findings support the urgent need for integrated physical and mental health support within youth programmes to reduce both the future and current burden of non-communicable diseases.

Impact of Consultation with Registered Dietitians on Reducing Inappropriate Weight Gain in Pregnant Patients with Food Insecurity

Background/Objectives: Screening for food insecurity, while common practice in pediatric populations, remains novel in pregnancy. Food insecurity during pregnancy is associated with medical comorbidities that in turn confer additional obstetric risks to the maternal-fetal dyad. Few studies have evaluated the impact of interventions for patients with food insecurity in the prenatal period. This study first demonstrates the ease of FI screening in pregnancy using the Hunger Vital Sign™ and next assesses if providing patients with a referral to a registered dietician decreases the incidence of inappropriate weight gain in pregnant patients with food insecurity. Methods: A retrospective chart review was conducted from November 2019 to March of 2021 at a United States Northeast inner-city hospital-based clinic to identify patients with food insecurity in the prenatal period. All pregnant patients who screened positive for food insecurity were given an educational pamphlet with resources and offered a referral to a registered dietician. We compared the incidence of appropriate weight gain among these patients depending on whether they attended an appointment with a registered dietician. We defined appropriate weight gain following the recommendations of the Institute of Medicine (IOM) based on pre-pregnancy body mass index. Inferential statistics were performed to compare differences using univariate statistics, and multivariate regression was conducted to control for confounders, with an alpha of 0.05. Results: In total, 139 patients screened positive for food insecurity (FI); 52 (37.4%) attended an appointment with a registered dietician. Overall, 88 (61.9%) patients had inappropriate weight gain during pregnancy. Fewer patients who attended a visit with a registered dietician had inappropriate weight gain than those who did not attend a visit (27 [30.7%] vs. 61 [69.3%], p = 0.031, respectively). Both study groups' demographics, comorbidities, and postpartum outcomes were comparable. Conclusions: We found that for pregnant individuals with food insecurity, consultation with a registered dietician was associated with a decrease in the incidence of inappropriate weight gain during pregnancy.

Prevalence of Food Insecurity during Pregnancy in Latin American and the Caribbean Countries: A Systematic Review

In Latin American and Caribbean (LAC) countries, women are particularly affected by food insecurity (FI). This gender gap can be amplified at certain key periods in life, particularly during pregnancy, with negative consequences on maternal and infant health. In the current geopolitical and health context, it is essential to take stock of the prevalence of FI among pregnant women in this region and the associated economic and psychosocial determinants. From 168 publications identified on Pubmed and Scopus, this systematic review selected 13 publications in 7 LAC countries. Although the published data only described the situation before the COVID-19 pandemic (2009-2019), the prevalence of FI in this population was already worrying, ranging from 28.2% to 64.9%. Only 4 of 13 studies investigated socioeconomic and psychosocial determinants among mothers in this region. Thus, the factors most frequently reported concerned mothers' demographic characteristics (advanced age and ethnic minority), household socioeconomic characteristics (low income, poorest wealth quartile, precarious housing, and welfare recipients), the absence of a stable partner, and a low education level. High prevalences of FI have also been associated with mental distress during pregnancy. In conclusion, few recent studies (notably none since the COVID-19 pandemic) have been published in this region on the issue of FI among women during pregnancy. Yet, this knowledge is essential to the development of a logical framework for the implementation and evaluation of public health programs aimed at women and children. By reducing the FI of mothers in the LAC region, we will contribute to reducing the social inequalities in health that often manifest themselves very early in life. This study was registered at PROSPERO as CRD42024513321 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=513321).

Food security during pregnancy: A qualitative content analysis study in Iran

Food security during pregnancy is crucial for safeguarding the health of expectant mothers and optimizing prenatal outcomes. Food insecurity can manifest in varying degrees, ranging from moderate disruptions to the quality and diversity of diet to severe cases that disrupt dietary patterns and reduce overall food intake. Limited information exists regarding food security among pregnant women in Iran. Therefore, this qualitative study aims to investigate food security during pregnancy from the perspectives of pregnant women (n = 17) and experts in food security (n = 6). Data were collected through purposeful sampling and 23 semi-structured interviews. The data analysis process occurred concurrently with data collection, employing a conventional content analysis approach. The findings underwent rigorous evaluation based on credibility, confirmability, dependability, transferability and authenticity. The results revealed that access to quality foods in pregnancy depends on the sustainability of food resources, economic access to food, the family's food budget, pregnant women's utilization of food due to pregnancy conditions, their nutritional literacy and cultural practices. Pregnant women employ various strategies to cope with food insecurity and require social and governmental support to manage it effectively. Therefore, it is suggested that health care authorities initially assess the level of food security among pregnant women and subsequently, through equitable food distribution, reform culture and increase food literacy, providing practical and informative educational programmes, and structured support, improve their food security.

COVID-19 Pandemic Impact on the Birth Weight of Children Born in a Brazilian Metropolis

OBJECTIVE

To assess the birth weight of newborns whose mothers gave birth during the COVID-19 pandemic.

METHODS

A cross-sectional study based on data collected from medical records and through postnatal interviews to assess maternal and neonatal health outcomes (n = 470) during the pandemic. All participants were assisted in three Brazilian public hospitals in 2020. Multinomial logistic regression was performed to assess factors associated with birth weight.

RESULTS

Low and insufficient birth weight reached 9.8% and 25.7% prevalence, respectively. COVID-19 symptoms were reported by 8% of participants. Low birth weight was more often observed in premature children (OR: 70.9; 95% CI: 16.4-305.8) delivered by cesarean sections (OR: 7.70; 95% CI: 2.33-25.4). Insufficient weight was more frequent in premature children (OR: 5.59; 95% CI: 1.53-20.4) and children whose mothers did not exercise during pregnancy (OR: 2.85; 95% CI: 1.38-5.89). Women presenting higher gestational weight gain had a lower chance of delivering babies with insufficient weight (OR: 0.94; 95% CI: 0.90-0.99).

CONCLUSIONS

Inadequate birth weight was associated with prematurity, delivery type, lower gestational weight gain, and maternal physical inactivity during the pandemic. According to the results, it is necessary to have adequate prenatal care and promote a healthy lifestyle during pregnancy.

Experiences of Pregnant and Parenting Adolescents and Young Women During COVID-19 Pandemic: A Mixed-Methods Study Among Girls and Women in Kenya

PURPOSE

This study examines the experiences of pregnant/parenting adolescents and young women during the first two years of the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

This explanatory sequential mixed-methods study leverages quantitative data collected among a cohort of adolescents and young people aged 15-22 years in three Kenyan counties; Nairobi, Kisumu, and Kilifi at three time points (2020, 2021, 2022), and two rounds of qualitative interviews in the same settings conducted in 2020 and 2022.

RESULTS

Among 2337 (2020), 1438 (2021), and 1669 (2022) respondents, pregnant/parenting adolescents and youth comprised 140 (6%), 101 (7%), and 83 (5%) individuals, respectively. Across the three time points, the experience of depressive symptoms was similar between pregnant/parenting adolescents and those not pregnant/parenting. Pregnancy and parenting was associated with twice the odds of skipping health services (adjusted odds ratio [aOR] 2.18, 95% confidence interval [CI] 1.43-3.35), in 2020, and 85% higher odds (aOR 1.85, 95% CI 1.14-3.02) in 2021, and 90% higher odds of skipping meals (aOR 1.90, 95% CI 1.19-3.03) in 2022. Qualitative findings indicated experiences of psychological distress, food insecurity, and inadequate access to health care services among pregnant/parenting young people during the pandemic.

DISCUSSION

The pandemic increased pre-existing challenges associated with adolescent and young people's health, predisposing young pregnant/parenting women to greater adversity than their nonpregnant/parenting counterparts. Targeted and responsive approaches during emergencies and crises such as social protection, food security, and mental health programs for this group of vulnerable people are required and need to be integrated into disaster response plans.

Uncovering the drivers of food insecurity in Cameroon: insights from a nationwide cross-sectional analysis

BACKGROUND

Despite global efforts to achieve zero hunger, food insecurity remains a critical challenge in several African countries, including Cameroon. This study aims to identify sociodemographic predictors of food insecurity across Cameroon through a comprehensive, nationwide cross-sectional analysis.

METHODS

Data for this study were drawn from the 2018 Cameroon Demographic and Health Survey (CDHS). Food insecurity levels were evaluated using the Food Insecurity Experience Scale (FIES). To estimate the probabilities of moderate and severe food insecurity among different sociodemographic groups, logistic regression models were applied, with results expressed as average marginal effects (AME).

RESULTS

The findings reveal that approximately 24.86% of participants experienced moderate food insecurity, while 28.96% faced severe food insecurity. Among men, the proportion experiencing severe food insecurity was 38.8%, compared to 24.3% for women. Multivariable regression analysis showed that severe food insecurity was less likely among women [AME = 0.84, 95% CI = 0.83,0.86], Muslims [AME = 0.91, 95%CI = 0.90,0.93], individuals with higher education levels (secondary education: AME = 0.93, 95%CI = 0.90,0.95; higher education: AME = 0.87, 95%CI = 0.85,0.90), those owning land (either alone or jointly) [AME = 0.92, 95%CI = 0.89,0.96], wealthiest households (moderate food insecurity: AME = 0.91, 95%CI = 0.88,0.93; severe food insecurity: AME = 0.73, 95%CI = 0.70,0.75), female-headed households [AME = 0.97, 95%CI = 0.96,0.99], and rural residents [AME = 0.97, 95%CI = 0.95,0.98].

CONCLUSIONS

These findings underscore that food insecurity affects a substantial portion of the Cameroonian population, with certain sociodemographic groups more vulnerable than others. This study proposes targeted policy recommendations to address food insecurity in Cameroon, including social assistance programs for at-risk groups, investments in socioeconomic empowerment, improvements in agricultural productivity, and ongoing research to guide evidence-based interventions.

Data-driven mathematical modeling approaches for COVID-19: A survey

In this review, we successively present the methods for phenomenological modeling of the evolution of reported and unreported cases of COVID-19, both in the exponential phase of growth and then in a complete epidemic wave. After the case of an isolated wave, we present the modeling of several successive waves separated by endemic stationary periods. Then, we treat the case of multi-compartmental models without or with age structure. Eventually, we review the literature, based on 260 articles selected in 11 sections, ranging from the medical survey of hospital cases to forecasting the dynamics of new cases in the general population. This review favors the phenomenological approach over the mechanistic approach in the choice of references and provides simulations of the evolution of the number of observed cases of COVID-19 for 10 states (California, China, France, India, Israel, Japan, New York, Peru, Spain and United Kingdom).

Special Supplemental Nutrition Program for Women, Infants, and Children Enrollment and Adverse Pregnancy Outcomes Among Nulliparous Individuals

OBJECTIVE

To evaluate the relationship between changes in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) enrollment during pregnancy from 2016 to 2019 and rates of adverse pregnancy outcomes in U.S. counties in 2019.

METHODS

We conducted a serial, cross-sectional ecologic study at the county level using National Center for Health Statistics natality data from 2016 to 2019 of nulliparous individuals eligible for WIC. The exposure was the change in county-level WIC enrollment from 2016 to 2019 (increase [more than 0%] vs no change or decrease [0% or less]). Outcomes were adverse pregnancy outcomes assessed in 2019 and included maternal outcomes (ie, gestational diabetes mellitus [GDM], hypertensive disorders of pregnancy, cesarean delivery, intensive care unit [ICU] admission, and transfusion) and neonatal outcomes (ie, large for gestational age [LGA], small for gestational age [SGA], preterm birth, and neonatal intensive care unit [NICU] admission).

RESULTS

Among 1,945,914 deliveries from 3,120 U.S. counties, the age-standardized rate of WIC enrollment decreased from 73.1 (95% CI, 73.0-73.2) per 100 live births in 2016 to 66.1 (95% CI, 66.0-66.2) per 100 live births in 2019, for a mean annual percent change decrease of 3.2% (95% CI, -3.7% to -2.9%) per year. Compared with individuals in counties in which WIC enrollment decreased or did not change, individuals living in counties in which WIC enrollment increased had lower rates of maternal adverse pregnancy outcomes, including GDM (adjusted odds ratio [aOR] 0.71, 95% CI, 0.57-0.89), ICU admission (aOR 0.47, 95% CI, 0.34-0.65), and transfusion (aOR 0.68, 95% CI, 0.53-0.88), and neonatal adverse pregnancy outcomes, including preterm birth (aOR 0.71, 95% CI, 0.56-0.90) and NICU admission (aOR 0.77, 95% CI, 0.60-0.97), but not cesarean delivery, hypertensive disorders of pregnancy, or LGA or SGA birth.

CONCLUSION

Increasing WIC enrollment during pregnancy at the county level was associated with a lower risk of adverse pregnancy outcomes. In an era when WIC enrollment has decreased and food and nutrition insecurity has increased, efforts are needed to increase WIC enrollment among eligible individuals in pregnancy.

Bridging the evidence-to-action gap: enhancing alignment of national nutrition strategies in Cambodia, Laos, and Vietnam with global and regional recommendations

Nutrition policies are critical frameworks for tackling the triple burden of malnutrition, including undernutrition (i.e., stunting and wasting), overweight, and hidden hunger (i.e., micronutrient deficiencies). We examined (1) the alignment of recent National Nutrition Strategies and Action Plans (NNS) in Cambodia, Laos, and Vietnam with recent global and regional recommendations and standards with a focus on maternal, infant, and young child nutrition and (2) changes compared to the previous NNS. We extracted information regarding the context, objectives, interventions, indicators, strategies, and coordination mechanisms from the most recent NNSs in Cambodia (2019-2023), Laos (2021-2025), and Vietnam (2021-2030). Recent NNSs aimed to reduce malnutrition among priority populations and described program development, monitoring, and evaluation plans for the following interventions: breastfeeding promotion, improved complementary feeding, dietary diversity, safe water, food security, nutritional/health campaigns, strategies for vulnerable groups, and strengthening of policies related to food and nutrition. Direct interventions to improve women's general nutrition (outside of pregnancy) and adolescent nutrition were not the focus of any NNSs. Although some indicators (e.g., wasting and exclusive breastfeeding) were covered in all recent NNSs, other indicators (e.g., low birth weight and childhood overweight and obesity) were inconsistently incorporated. In comparison to the previous NNS, the following interventions were discontinued in three countries: dietary counseling, maintaining physical activity, monitoring weight gain during pregnancy, maternal micronutrient supplementation, and nutrition and HIV. Despite similarities in structure and content, the recent NNSs of Cambodia, Laos, and Vietnam do not consistently align with global and regional recommendations. Variations in the types of interventions and indicators included may reflect a shift in priorities, attention, or resources. In conclusion, the NNSs of Cambodia, Laos, and Vietnam exhibit both structural and content similarities; however, certain interventions and indicators vary across countries and differ from global and regional recommendations. Enhancing alignment while prioritizing country-specific needs, optimizing coordination, ensuring policy efficacy, and updating nutrition strategy data for cross-country comparisons and knowledge exchange is critical to ensure progress on reducing malnutrition in the region.

Trends, Prevalence, and Risk Factors of Food Insecurity Among Pregnant and Postpartum Women in the United States: Findings from the 2019-2021 National Health Interview Survey

Background: Despite the widespread food insecurity in the United States, there is limited research investigating its prevalence among pregnant women and the potential impact it has on maternal and child health outcomes. This study examined trends in the prevalence of, and investigated risk factors for, food insecurity among peripartum women, using a nationally representative sample in the United States. Materials and Methods: This cross-sectional study included pregnant and postpartum women aged 18-49 years who reported being currently pregnant or pregnant in the past 12 months and who participated in the National Health Interview Survey from 2019 to 2021. Weighted multivariable logistic regression analysis was used to estimate associations with food insecurity. Results: A total of 1,527 pregnant women, weighted to represent 5,588,192 women in the United States, were included in the analysis. Overall, from 2019 to 2021, 10.8% of peripartum women were food insecure. The prevalence of food insecurity changed substantially between 2019 and 2021 (2019: 10.6% confidence interval [95% CI: 8.7-13.5], 2020: 16.0% [95% CI: 10.9-22.8], 2021: 6.2% [95% CI: 4.2-9.1]). The adjusted odds of food insecurity were significantly higher among pregnant and postpartum women in 2020 (aOR 2.15), who had a health insurance coverage (aOR 2.98) and who had an unmet health care need in the preceding 12 months (aOR 6.52). Conclusion: We found that food insecurity was common among peripartum women between 2019 and 2021 and was exacerbated by the COVID-19 pandemic. Identifying the factors that predispose peripartum women to the risk of food insecurity can guide the development and implementation of targeted interventions aimed at reducing the adverse impact of food insecurity on perinatal and infant health.