Assessing and Monitoring Nutrition Security to Promote Healthy Dietary Intake and Outcomes in the United States

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.

Pathways and policy options for food and nutrition gaps in arid agricultural farming systems in the Tigray Region, north Ethiopia

Food and nutrition security is a major global challenge especially indeveloping countries.Agriculture is main means of livelihoods and hunger is drastically increasing from time to time especially due to effects of climate change, conflict and other manmade and natural calamities in these countries. Similarly, the Tigray Region is one of the Ethiopia's most food and nutrition insecure regions with agriculture serving as the main source of income and employment. This study was therefore conducted to fill the gap in understanding the socioeconomic situation, bio-physical environment, institutional setting and policy landscape by analysing the existing circumstances in Tigray Region. This research employed quantitative data sets collected from 300 randomely selected Productive Saftey Net Program (PSNP) beneficiarieries and Non-PSNP households using probability proportional to size. The Household Dietary Diversity Score (HDDS) used as a proxy measure to nutrition security as our data is 24 h recall and food gap months as proxy to food security. Besides, Principal Component Analysis (PCA) method is used to construct household asset index. The results of the study revealed that there are clear and significant differences of the PSNP and Non-PSNP households, and gender in land holding (p<0.01%), asset ownership(p<0.01%), food gap months(p<0.01%), dietary diversity(p<0.01%), exposure to hazards and risks, copping strategies, yield, access to agricultural extension services, access to improved varieties (varietal diversification). The male headed households, and Non-PSNP households are better off than the female headed and PSNP households' counterparts. Thus, provision of practical training, conducting farmer's participatory research, field days, promoting and creating access to farmers' preferred high yielding improved varieties and management practices available in the research and extension consortium, support in research and development that develops and disseminate appropriate technologies to help farmers to lower their food gap months is highly important. In addition, sustainable intensification, off-farm employment alternatives, and engaging in agribusiness activities that create resilient livelihood options to those resource poor farm households, strengthening the formal and informal seed system would help to reduce food gap months, improve HDDS, build resilience of the food and nutrition insecure households. Therefore, customized extension services and packages are important for addressing the food and nutrition security gaps by setting goal, outcome and output indicators for future interventions in the research and development arena in filling food gap months, dietary diversity and household asset building through collaboration among relevant stakeholders in the food system.

Development and validation of an occurrence-based healthy dietary diversity (ORCHID) score easy to operationalise in dietary prevention interventions in older adults: a French study

Healthy diet and dietary diversity have been associated with healthy ageing. Several scores have been developed to assess dietary diversity or healthy diets in epidemiological studies, but they are not adapted to be used in the context of preventive nutrition interventions. This study aimed to develop an occurrence-based healthy dietary diversity (ORCHID) score easy to implement in the field and to validate it using dietary data from older participants in the latest French food consumption survey (INCA3). The ORCHID score was made of several components representing the consumption occurrences of twenty food groups, in line with French dietary guidelines. The score was then validated using dietary data (namely three 24-h recalls and a food propensity questionnaire) from 696 participants aged 60 years and over in the INCA3 survey. Score validity was evaluated by describing the association of the score with its components, as well as with energy intakes, solid energy density (SED) and the probability of adequate nutrient intakes (assessed by the PANDiet). Higher scores were associated with more points in healthy components such as 'fruits' and 'vegetables' (r = 0·51, and r = 0·54, respectively). The score was positively associated with the PANDiet (r = 0·43) and inversely associated with SED (r = -0·37), while no significant association was found with energy intakes. The ORCHID score was validated as a good proxy of the nutritional quality of French older adults' diets. It could therefore be a useful tool for both public health research and nutrition interventions.

Properties of the Household Food Security Survey Module Scale in Young Adults with Diabetes

BACKGROUND

The Household Food Security Survey Module (HFSSM) was not tailored to people with chronic diseases or young adults (YAs).

OBJECTIVES

We aim to evaluate whether the 18-item HFSSM meets assumptions underlying the scale among YAs with diabetes.

METHODS

Data from 1887 YAs with youth-onset type 1 diabetes or type 2 diabetes were used from the SEARCH for Diabetes in Youth Study, 2016-2019, and on 925 who returned for the SEARCH Food Security Cohort Study, 2018-2021, all of whom had completed the HFSSM. Guttman scaling properties (affirmation of preceding less severe items) and Rasch model properties (probability to answer an item based on difficulty level) were assessed.

RESULTS

Items 3 (balanced meals) and 6 (eating less than one should) were affirmed more frequently than expected (nonmonotonic response pattern). At 1.2%-3.5%, item nonresponse was rare among type 1 diabetes but higher among type 2 diabetes (range: 3.1%-10.6%). Items 9 (not eating the whole day) and 3 did not meet the Guttman scaling properties. Rasch modeling revealed that item 3 had the smallest difficulty parameter. INFIT indices suggested that some responses to item 3 did not match the pattern in the rest of the sample. Classifying household food insecurity (HFI) based on items 1 and 2 compared with other 2-item combinations, including item 3, revealed a substantial undercount of HFI ranging from 5% to 8% points.

CONCLUSIONS

Use of the HFSSM among YAs with diabetes could potentially result in biased HFI reporting and affect estimates of HFI prevalence in this population.

Direct and Indirect Effects of Food and Nutrition Security on Dietary Choice and Healthfulness of Food Choice: Causal Mediation Analysis

Background

Links between diet and food security are well established, but less is known about how food and nutrition security affect a household's ability to decide what to consume.

Objectives

This study's purpose was to quantify and compare causal pathways from 1) food and nutrition security to perceived dietary choice and 2) food and nutrition security to perceived healthfulness of food choice while testing for mediation by perceived limited availability of foods and utilization barriers to healthful meals.

Methods

Causal mediation analysis was conducted using an observational data set. Exposures included food insecurity and nutrition insecurity; mediators included perceived limited availability and utilization barriers; outcomes included perceived dietary choice and healthfulness choice; covariates included income and education.

Results

Dietary choice (range 0-4) was 0.9 to 1.1 points lower for participants with food/nutrition insecurity compared with participants with food/nutrition security (direct effects). Neither mediation nor moderation by perceived limited availability were present. Seventeen percent and 11 %, respectively, of the effects of food and nutrition security on dietary choice could be contributed to utilization barriers (mediation). Moderation by utilization barriers was present only for nutrition security (differences in dietary choice only present when barriers were low). Healthfulness choice (range 0-4) was 0.6 to 0.7 points lower for participants with food/nutrition insecurity compared with participants with food/nutrition security (direct effects). Mediation by perceived limited availability and utilization barriers was not present. Moderation was present only for nutrition security (differences in healthfulness choice only present when perceived limited availability was low; differences in healthfulness choice only present when barriers were low).

Conclusions

Food and nutrition security affect food choices, with utilization barriers acting as an intermediary step. When environmental and household utilization barriers to healthful food purchasing and preparation are high, the ability to decide what to consume does not differ between households with nutrition security and those with nutrition insecurity.

Defining a Dichotomous Indicator for Population-Level Assessment of Dietary Diversity Among Pregnant Adolescent Girls and Women: A Secondary Analysis of Quantitative 24-h Recalls from Rural Settings in Bangladesh, Burkina Faso, India, and Nepal

Background

The Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) indicator was validated as a proxy of micronutrient adequacy among nonpregnant women in low- and middle-income countries (LMICs). At that time, indeed, there was insufficient data to validate the indicator among pregnant women, who face higher micronutrient requirements.

Objective

This study aimed to validate a minimum food group consumption threshold, out of the 10 food groups used to construct MDD-W, to be used as a population-level indicator of higher micronutrient adequacy among pregnant women aged 15-49 y in LMICs.

Methods

We used secondary quantitative 24-h recall data from 6 surveys in 4 LMICs (Bangladesh, Burkina Faso, India, and Nepal, total n = 4909). We computed the 10-food group Women's Dietary Diversity Score (WDDS-10) and calculated the mean probability of adequacy (MPA) of 11 micronutrients. Linear regression models were fitted to assess the associations between WDDS-10 and MPA. Sensitivity, specificity, and proportion of individuals correctly classified were used to assess the performance of MDD-W in predicting an MPA of >0.60.

Results

In the pooled sample, median values (interquartile range) of WDDS-10 and MPA were 3 (1) and 0.20 (0.34), respectively, whereas the proportion of pregnant women with an MPA of >0.60 was 9.6%. The WDDS-10 was significantly positively associated with MPA in each survey. Although the acceptable food group consumption threshold varied between 4 and 6 food groups across surveys, the threshold of 5 showed the highest performance in the pooled sample with good sensitivity (62%), very good specificity (81%), and percentage of correctly classified individuals (79%).

Conclusions

The WDDS-10 is a good predictor of dietary micronutrient adequacy among pregnant women aged 15-49 y in LMICs. Moreover, the threshold of 5 or more food groups for the MDD-W indicator may be extended to all women of reproductive age, regardless of their physiologic status.

The Nutritional Content of Meal Images in Free-Living Conditions-Automatic Assessment with goFOODTM

A healthy diet can help to prevent or manage many important conditions and diseases, particularly obesity, malnutrition, and diabetes. Recent advancements in artificial intelligence and smartphone technologies have enabled applications to conduct automatic nutritional assessment from meal images, providing a convenient, efficient, and accurate method for continuous diet evaluation. We now extend the goFOODTM automatic system to perform food segmentation, recognition, volume, as well as calorie and macro-nutrient estimation from single images that are captured by a smartphone. In order to assess our system's performance, we conducted a feasibility study with 50 participants from Switzerland. We recorded their meals for one day and then dietitians carried out a 24 h recall. We retrospectively analysed the collected images to assess the nutritional content of the meals. By comparing our results with the dietitians' estimations, we demonstrated that the newly introduced system has comparable energy and macronutrient estimation performance with the previous method; however, it only requires a single image instead of two. The system can be applied in a real-life scenarios, and it can be easily used to assess dietary intake. This system could help individuals gain a better understanding of their dietary consumption. Additionally, it could serve as a valuable resource for dietitians, and could contribute to nutritional research.