Food sufficiency status and sleep outcomes in older adults: the National Health and Aging Trends Study (NHATS)

BACKGROUND

Studies investigating the relationship between food insecurity and sleep among older populations are limited. This study aimed to cross-sectionally examine the associations between food sufficiency status and sleep outcomes in a nationally representative sample of older adults.

METHODS

Our study included 1,665 older adults (≥ 65 years), using data from the 2013 and 2014 National Health and Aging Trends Study (NHATS). Food insufficiency was determined via participants' experience and utilization of food assistance programs (FAP). Sleep outcomes, including nighttime and total sleep hours, sleep latency, and sleep quality, were derived from self-reported data. Multivariable linear regression and logistic regression models were used to estimate the associations between food sufficiency status and sleep outcomes.

RESULTS

In 2013-2014, 86.1% of older adults were classified as food sufficient without FAP, 9.85% as food sufficient with FAP, and 4.08% as food insufficient. Adjusting for sociodemographic characteristics, food sufficient older adults with FAP reported more total sleep hours (𝛽 = 0.31, 95% CI: -0.02, 0.64) than those participants who are food sufficient without FAP. Further adjusting for health factors, food sufficient participants with FAP had more nighttime sleep hours and greater total sleep hours compared to those participants food sufficient without FAP. Compared to those deemed as food sufficient without FAP, food sufficient participants with FAP had lower odds of having longer sleep latency (OR = 0.50, 95% CI: 0.28, 0.89), after further adjusting for physical function performance.

CONCLUSIONS

Among older adults, food sufficiency with FAP is associated with greater total sleep hours, greater nighttime sleep hours, and lower odds of longer sleep latency. Our findings may help inform nutrition food assistance programs targeting older populations.

Studying the impact of COVID-19 mitigation policies on childhood obesity, health behaviors, and disparities in an observational cohort: Protocol for the COVID-19 Family Study

BACKGROUND

COVID-19 pandemic control policies, including school closures, suspended extra-curricular activities, and social distancing, were introduced to prevent viral transmission, and disrupted children's daily routines, health behaviors, and wellness. This observational cohort study among 697 families with children or adolescents, based on the Family Stress Model, aims to: 1) evaluate pre- to during-pandemic changes in child health behaviors (diet, physical activity, sleep) and weight gain, 2) identify mechanisms explaining the changes, and 3) determine projected healthcare costs on weight gain and obesity. Each aim includes an examination by racial and ethnic, socioeconomic, and geographic disparities.

METHODS

The study employs a mixed methods design, recruiting children and their caregivers from two obesity prevention trials halted in 2020. Enrolled participants complete annual surveys to assess child health behaviors, family resources, routines, and demographics, and home environment in 2020-2022. Height and weight are measured annually in 2021-2022. Annual semi-structured interviews are conducted within a subsample to understand mechanisms of observed changes. Multilevel mixed models and mediation analyses are used to examine changes in child health behaviors and weight gain and mechanisms underlying the changes. Qualitative data are analyzed within and across time points and integrated with quantitative findings to further explain mechanisms. Markov models are used to determine healthcare costs for unhealthy child behaviors and weight gain.

CONCLUSION

Findings from this study will aid in understanding pandemic-related changes in child health behaviors and weight status and will provide insights for the implementation of future programs and policies to improve child and family wellness.

Perceptions of Parental Support for Physical Activity and Healthy Eating among School-age Children During COVID-19 pandemic

Family routines play a key role in promoting child health behaviors. This study 1) describes changes in children's perceptions of physical activity (PA) and healthy eating family routines across three time points: pre-pandemic (2017-2020), early pandemic (2020), and mid-pandemic (2021); and 2) explores how sex, age, and pandemic-related economic stressors relate to changes. Children's perceptions of family routines were assessed using four subscales adapted from the Comprehensive Home Environment Survey: PA-policies, Diet-policies, Diet-rules, and PA-Diet-role-model. Linear mixed models assessed changes in perceptions and associated factors (child age and sex; caregiver(s) job loss during pandemic). Children (N=277) were aged 9.3-15.5y at pandemic onset (March 2020), dichotomized by median age (12.1y) as younger and older. Children's perceptions of PA-policies (pre-pandemic mean=15.4) and Diet-policies (pre-pandemic mean=26.3) increased significantly from pre- to early (b=1.2 and 2.3, respectively) and mid-pandemic (b=1.0 and 1.2, respectively). Diet-rules (pre-pandemic mean=10.8) decreased significantly from pre- to early (b=-1.1) and mid-pandemic (b=-2.0), with no PA-Diet-role-model changes. Younger children had a greater increase in perceived PA-policies and Diet-policies across the pandemic. Females (59.9%) had a greater decrease in perceived Diet-rules across the pandemic and less increase in Diet-policies and PA-Diet-role-model from pre- to early pandemic. Children whose caregiver(s) lost employment (51.8%) perceived a greater increase in PA-policies. Overall, children reported increased parental policies to support PA and healthy eating and decreased parental rules for diet during the pandemic. Future research is needed to understand how changes in family routines relate to PA and healthy eating behaviors.

Effects of the termination of LC30 imidacloprid stress on the multigeneration adaptive strategies of Aphis glycines population

Aphis glycines Matsumura (Hemiptera: Aphididae) is a major soybean pest that often poses a serious threat to soybean production. Imidacloprid is one of the commonly used insecticides to control the soybean aphid. To investigate the effect of termination of imidacloprid stress on the adaptive strategies of soybean aphid populations, we studied the growth, development, and related metabolism changes when the stress was terminated after 24 generations of imidacloprid stress on A. glycines. The results show that the A. glycines population accelerated its recovery and expanded its population size across generations. The longevity of the adults of the recovering population in the F12, F18, and F24 generations, respectively, was 1.11, 1.15, and 1.11 times longer than the control, while the fecundity was 10.38%, 11.74%, and 11.61% higher than that of the control. The net reproductive rate (R 0) of the recovering population was always significantly higher than that of the control in the F1 to F24 generations. In addition, metabolisms related to the regulation of cell proliferation and oocyte meiosis were significantly upregulated in the recovering population. Even when the imidacloprid pressure disappeared, intergenerational stimuli still affected the adaptive strategies of soybean aphid populations. This effect was manifested as inhibiting the growth and development of the soybean aphid in the early generations and improving the fecundity of the soybean aphid in the later generations. Adaptive soybean aphid populations would surge in the absence of imidacloprid pressure. This study provides an important reference for exploring the adaptability of the A. glycines population under termination of stress from low lethal concentrations of imidacloprid across generations. It also provides important data for monitoring the population dynamics of A. glycines in the field and analyzing the degree of pharmacodynamic stress.

Food Insufficiency, Supplemental Nutrition Assistance Program (SNAP) Status, and 9-Year Trajectory of Cognitive Function in Older Adults: The Longitudinal National Health and Aging Trends Study, 2012-2020

BACKGROUND

Despite findings from cross-sectional studies, how food insecurity experience/Supplemental Nutrition Assistance Program (SNAP) status relates to cognitive decline over time has not been fully understood.

OBJECTIVES

We aimed to investigate the longitudinal associations between food insecurity/SNAP status and cognitive function in older adults (≥65 y).

METHODS

Longitudinal data from the National Health and Aging Trends Study 2012-2020 were analyzed (n = 4578, median follow-up years = 5 y). Participants reported food insecurity experience (5-item) and were classified as food sufficient (FS, no affirmative answer) and food insufficient (FI, any affirmative answer). The SNAP status was defined as SNAP participants, SNAP eligible nonparticipants (≤200% Federal Poverty Line, FPL), and SNAP ineligible nonparticipants (>200% FPL). Cognitive function was measured via validated tests in 3 domains, and the standardized domain-specific and combined cognitive function z-scores were calculated. Mixed-effect models with a random intercept were used to study how FI or SNAP status was associated with combined and domain-specific cognitive z-scores over time, adjusting for static and time-varying covariates.

RESULTS

At baseline, 96.3% of the participants were FS and 3.7% were FI. In a subsample (n = 2832), 10.8% were SNAP participants, 30.7% were SNAP eligible nonparticipants, and 58.6% were SNAP ineligible nonparticipants. Compared with the FS group in the adjusted model (FI vs. FS), FI was associated with faster decline in the combined cognitive function scores [-0.043 (-0.055, -0.032) vs. -0.033 (-0.035, -0.031) z-scores per year, P-interaction = 0.064]. Cognitive decline rates (z-scores per year) in the combined score were similar in SNAP participants (β = -0.030; 95% CI: -0.038, -0.022) and SNAP ineligible nonparticipants (β = -0.028; 95% CI: -0.032, -0.024), both of which were slower than the rate in SNAP eligible nonparticipants (β = -0.043; 95% CI: -0.048, -0.038; P-interaction < 0.0001).

CONCLUSIONS

Food sufficiency and SNAP participation may be protective factors preventing accelerated cognitive decline in older adults.

Promising trends and influencing factors of complementary feeding practices in Côte d'Ivoire: An analysis of nationally representative survey data between 1994 and 2016

Poor complementary feeding (CF) challenges early childhood growth. We examined the trends and influencing factors of CF practices among children aged 6-23 months in Côte d'Ivoire. Using data from Demographic and Health Surveys (DHS, 1994-2011) and Multiple Indicator Cluster Surveys (MICS, 2000-2016), the trends and predictors of World Health Organization-United Nations International Children's Emergency Fund CF indicators including the timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD) and minimum acceptable diet (MAD) were determined. Using 2016 MICS data, we applied multivariate logistic regression models to identify factors associated with CF indicators. Between 1994 and 2016, the mean proportion of children aged 6-8 months achieving INTRO was 56.9% and increased by about 25% points since 2006. Over 2011-2016, the proportion of children aged 6-23 months meeting MMF, MDD and MAD increased from 40.2% to 47.7%, 11.3% to 26.0% and 4.6% to 12.5%, respectively. Older children and those from urban households had higher odds of meeting MDD and MAD. Maternal TV watching was associated with higher odds of meeting MDD. The secondary or higher education levels of mothers significantly predicted higher odds of meeting INTRO and MDD. Currently, breastfeeding was also positively associated with odds of meeting MMF and MAD. Children from poorer households had lower odds of meeting MMF, MDD and MAD. Despite the improvements, CF practices remain suboptimal in Côte d'Ivoire. Influencing factors associated with CF were distributed across individual, household and community levels, calling for future programmes and policies to implement multi-level strategies to improve young children's diet in Côte d'Ivoire.

Food Insecurity and Mental Well-Being in Immigrants: A Global Analysis

INTRODUCTION

This study estimates the prevalence of food insecurity, mental well-being, and their associations among immigrants and compares the food insecurity-mental well-being associations with nonimmigrants globally and by region.

METHODS

The Gallup World Poll data from 2014 to 2019 were analyzed in 2021. A total of 36,313 immigrants and 705,913 nonimmigrants were included. Food insecurity was measured by the Food Insecurity Experience Scale. Mental well-being was assessed using the Negative Experience Index and Positive Experience Index. A community attachment index was used to measure the living environment. Multilevel mixed-effect linear models were used to examine how the Negative Experience Index/Positive Experience Index was associated with food insecurity and the community attachment index in immigrants and nonimmigrants, adjusting for sociodemographic characteristics, survey years, and country fixed effects. The modifying effects of immigration status on food insecurity-mental well-being associations were tested.

RESULTS

The weighted proportion of food insecurity among global immigrants was 38.6% during 2014-2019. In the pooled adjusted model, food insecurity was dose-responsively associated with greater Negative Experience Index and lower Positive Experience Index than the food-secure ref (p<0.001 for trend). Similar dose-response associations were observed in nonimmigrants and in region-specific analyses. Community attachment marginally affected the food insecurity-mental well-being associations (all p≤0.001 for interaction). Immigration status significantly modified the food insecurity-mental well-being associations in all analyses (all p=0.01 for interaction), and immigrants experienced poorer mental well-being than nonimmigrants at the same level of community attachment and food insecurity.

CONCLUSIONS

Food insecurity is prevalent and is associated with poor mental well-being in immigrants worldwide. Future interventions are needed to alleviate food insecurity and promote community attachment to improve mental health among immigrants, especially in Asian and Pacific countries.

Food Insecurity and the Trajectory of Cognitive Function: A Longitudinal Study Using Data From the National Health and Aging Trends Study, 2012–2020

Objectives

Despite plausible mechanisms, the association of food insecurity with trajectories of cognitive decline over time has only been investigated in a few studies. Our study aims to examine the longitudinal associations between food insecurity and cognitive function in a large nationally representative sample of older adults (≥65 y).

Methods

Cohort data from the National Health and Aging Trends Study 2012–2020 were analyzed (n = 5,524). In 2012, participants reported their food insecurity experience due to financial, social, and functional limitations (5 items) and their utilization of food assistance programs (FAP, 2 items). Participants were then classified as food secure (FS) without FAP, FS with FAP, and food insecure (FI). Cognitive function was measured via validated tests in three domains, i.e., immediate and delayed memory, executive function, and orientation. All individual test scores were standardized into z-scores, the mean of which was calculated as a combined cognitive function z-score. Mixed-effect models with a random intercept were used to examine how baseline food insecurity was associated with the combined and individual cognitive z-scores over time. Models were adjusted for baseline sociodemographic variables, cognitive z-score, depressive and anxiety symptoms, BMI, diabetes, and hypertension.

Results

In 2012, 86.4% of the participants were FS without FAP, 10.6% were FS with FAP, and 3.0% were FI. In adjusted models, except for executive function z-score, cognitive decline over time was significant in all cognitive function z-scores (beta coefficients ranged from −0.06 to −0.03 SD per year, all p-values < 0.001). Baseline food insecurity status was not associated with any baseline cognitive z-scores; however, it was associated with cognitive decline in combined cognitive function z-score (p for interaction = 0.0002) and orientation z-score (p for interaction < 0.0001).

Conclusions

Compared to participants who were FS without FAP, older adults who were FS using FAP or FI had faster deterioration of cognitive function as observed in the combined and the orientation cognitive z-scores.

Funding Sources

The Broadhurst Career Development Professorship for the Study of Health Promotion and Disease Prevention (MN). The National Institute of Mental Health: K01MH115794 (MJB).

Daily Food Insecurity Predicts Lower Positive and Higher Negative Affect: An Ecological Momentary Assessment Study

Food insecurity (FI) is a dynamic phenomenon, and its association with daily affect is unknown. We explored the association between daily FI and affect among low-income adults during a 2-seasonal-month period that covered days both pre- and during the COVID-19 pandemic. A total of 29 healthy low-income adults were recruited during fall in 2019 or 2020, 25 of whom were followed in winter in 2020 or 2021. Daily FI (measured once daily) and affect (measured 5 times daily) were collected over the 2nd−4th week in each month. Time-Varying-Effect-Models were used to estimate the association between daily FI and positive/negative affect (PA/NA). Overall, 902 person-days of daily-level data were collected. Daily FI was associated with lower PA in the 3rd and 4th week of fall and winter and with higher NA in the second half of winter months. Similar patterns of FI-affect relations were found pre- and during COVID-19 in the second half of a given month, while unique patterns of positive affect scores in the 2nd week and negative scores in the 1st week were only observed during COVID days. Our study supports a time-varying association between FI and affect in low-income adults. Future large studies are needed to verify the findings; ultimately, better understanding such associations may help identify, target, and intervene in food insecure adults to prevent adverse mental health outcomes.

Daily food insecurity is associated with diet quality, but not energy intake, in winter and during COVID-19, among low-income adults

BACKGROUND

Food insecurity (FI) is a dynamic phenomenon. Experiences of daily FI may impact dietary outcomes differently within a given month, across seasons, and before or during the COVID-19 pandemic.

OBJECTIVES

The aims of this study were to investigate the association of short-term FI with dietary quality and energy 1) over six weeks in two seasonal months and 2) before and during the COVID-19 pandemic.

METHODS

Using an ecological momentary assessment framework on smartphones, this study tracked daily FI via the 6-item U.S. Adult Food Security Survey Module and dietary intake via food diaries in 29 low-income adults. A total of 324 person-days of data were collected during two three-week long waves in fall and winter months. Generalized Estimating Equation models were applied to estimate the daily FI-diet relationship, accounting for intrapersonal variation and covariates.

RESULTS

A one-unit increase in daily FI score was associated with a 7.10-point (95%CI:-11.04,-3.15) and 3.80-point (95%CI: -6.08,-1.53) decrease in the Healthy Eating Index-2015 (HEI-2015) score in winter and during COVID-19, respectively. In winter months, a greater daily FI score was associated with less consumption of total fruit (-0.17 cups, 95% CI: -0.32,-0.02), whole fruit (-0.18 cups, 95%CI: -0.30,-0.05), whole grains (-0.57 oz, 95%CI: -0.99,-0.16) and higher consumption of refined grains (1.05 oz, 95%CI: 0.52,1.59). During COVID-19, elevated daily FI scores were associated with less intake of whole grains (-0.49 oz, 95% CI: -0.88,-0.09), and higher intake of salt (0.34 g, 95%CI: 0.15,0.54). No association was observed in fall nor during the pre-COVID-19 months. No association was found between daily FI and energy intake in either season, pre-COVID 19, or during-COVID-19 months.

CONCLUSION

Daily FI is associated with compromised dietary quality in low-income adults in winter months and during the COVID-19 period. Future research should delve into the underlying factors of these observed relationships.

Daily Food Insecurity and Heart Rate Variability Among Healthy Low-Income Adults: A Longitudinal Pilot Study Over Two Seasonal Months

Objectives

Food insecurity (FI) is prevalent among low-income adults and is related to increased stress. Heart rate variability (HRV) is associated with adverse health and a known indicator for stress vulnerability. However, the relationship between FI and HRV is unclear. Our study aims to study the associations between FI and ultra-short-term HRV (5 minutes) at daily basis.

Methods

A total of 22 healthy low-income adults were recruited in fall 2019 and 18 were followed up in winter 2020. Data on FI and HRV were collected over a 3-week-long wave in each surveyed month (2nd – 4th week). Daily FI was assessed using the adapted USDA adult module on the provided smartphones. Each day, a 5-minute heart rate was recorded using the Polar H7 sensor, yielding a number of HRV metrics in two domains. SDNN, Rmssd, and pNN50 are time-domain metrics quantifying the amount of variability in interbeat interval (the higher the ‘better’). LF/HF Ratio is a frequency-domain metrics estimating the distribution of power into frequency bands (the lower the ‘better’). The Time Varying Effect Models were used to estimate the association between daily FI and ultra-short-term HRV metrics as a function of study day.

Results

A total of 606 person-days (response rate = 72.1%) of data in FI and HRV was collected. In fall, higher FI score was significantly associated with lower lnRmssd at day 19 (b = −0.13) and 20 (b = −0.12), lower Pnn50 at day 20 (b = −0.13), and higher LF/HF ratio from day 1 to 5 (b ranges 0.29–0.88). In winter, higher FI score was related to lower lnRmssd at day 18 (b = −0.24) and 19 (b = −0.27), lower Pnn50 from day 17 to 19 (b ranges −10.99 to −7.79), and higher LF/HF ratio from day 9 to 11 (b ranges 0.78–1.22) and day 18 to 20 (b ranges 1.17–2.40).

Conclusions

Across the 2 months spanning two seasons, our pilot study found that daily FI was significantly and consistently associated with suboptimal time-domain HRV metrics in the last few days of the study months. Results for the frequency-domain also support a time-varying impact of FI on HRV. The preliminary results support a potential more profound impact of FI on stress vulnerability, particularly by the end of the months.

Funding Sources

The National Center for Advancing Translational Sciences, National Institutes of Health (UL1TR002014) and the Broadhurst Career Development Professorship for the Study of Health Promotion and Disease Prevention.

Trends and Influencing Factors of Complementary Feeding Practices in Niger: An Analysis of National Surveys From 2000 – 2018

Objectives

To examine the trends and influencing factors of suboptimal complementary feeding (CF) practices among children aged 6–23 months in Niger using national data from 2000 to 2018.

Methods

Using data from the 2000 Multiple Indicator Cluster Survey, 2012 Demographic and Health Surveys (DHS), and 2018 Standardized Monitoring and Assessment of Relief and Transitions survey in Niger, the trends and predictors of WHO-UNICEF CF indicators including timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD) were estimated. Using the most completed data in CF and influencing factors (available from 2012 DHS), multilevel logistic regression models were applied to identify

factors at the individual, household and community levels that were associated with meeting INTRO, MMF, MDD, and MAD.

Results

The weighted proportion of children aged 6–8 months meeting INTRO increased from 56.0% in 2000 to 84.4% in 2018. The weighted proportion of children meeting MMF (51.3% to 77.9%), MDD (9.8% to 14.2%), and MAD (5.6% to 10.9%) also increased between 2012 - 2018. At the individual level, children with mothers who were employed had higher odds of meeting all four indicators as compared to those whose mothers were unemployed. Older child age and maternal exposure to media were significantly associated with higher odds of meeting MMF, MDD, and MAD. Maternal education and child birth weight greater or smaller than average (reference) were positively associated with the odds of meeting MMF and MAD, and antenatal iron supplementation and currently breastfeeding were positively associated with the odds of achieving MDD and MAD. At the household level, the odds of meeting MMD and MAD were higher among children from wealthier households. At the community level, the odds of meeting INTRO and MMF were higher among children from communities with greater access to health services.

Conclusions

Despite the improvement in CF practices since 2000, only 10% of children from 6–23 months received minimum acceptable diets. Factors associated with CF were distributed across individual, household and community levels, suggesting the need for multi-level strategies to improve child nutrition in Niger.

Funding Sources

UNICEF West and Central Africa Regional Office (Grant # 43279190).

Food Insecurity and Affective Well-Being in Low-Income Adults: An Ecological Momentary Assessment Study Over Two Months

Objectives

Food insecurity is a dynamic phenomenon within a given month and across seasons. It remains unknown how food insecurity influences low-income adults’ day-to-day affective well-being, which is associated with long-term mental and physical health. In this pilot study, we explored the association between daily food insecurity and affect over a 2-month period (spanning 2 seasons) in a sample of low-income adults in Central Pennsylvania.

Methods

A total of 22 healthy low-income adults were recruited during the fall months (September, October, or November) in 2019, 18 of whom were also followed in the winter months (February or March) in 2020. Using an ecological momentary assessment framework administered on smart phones over a three-week-long wave (2nd – 4th week) in each survey month, daily food insecurity (once daily), and positive and negative affect (5 times daily) were collected. Time Varying Effect Models were used to estimate the association between levels of daily food insecurity and daily aggregated positive/negative affect as a function of study day, adjusting for gender, race/ethnicity, employment, and poverty status.

Results

A total of 713 person-days (84.9% of what was possible) of daily-level data was collected. Food insecurity was reported in 42.9% and 36.0% of participants in the fall and winter months, respectively. Greater daily food insecurity was associated with significantly lower positive affect scores in the 3rd week of the fall months (β ranged from −1.40 (95% CI −2.62, −0.18) to −3.17 (95% CI: −5.93, −0.42)) and in the 4th week of the winter months (β ranged from −2.24 (95% CI: −4.08, −0.39) to −2.84 (95% CI: −4.28, −1.40)). No consistent association was identified between daily food insecurity and negative affect.

Conclusions

Daily food insecurity was associated with lower positive affect in the second half of the months in both fall and winter seasons. Future large observational studies should verify our study findings in order to better identify, target, and intervene in food insecure adults who are at-risk of adverse mental health outcomes.

Funding Sources

The National Center for Advancing Translational Sciences, National Institutes of Health (UL1TR002014) and the Broadhurst Career Development Professorship for the Study of Health Promotion and Disease Prevention.

Daily Food Insecurity and Its Impact on Diet Quality in Low-Income Adults in Two Seasons: An Ecological Momentary Assessment Study

Objectives

Chronic food insecurity (FI) is common in low-income adults and is associated with a suboptimal diet. The dynamicity of FI in the short term in relation to diet is not well understood. We aim to examine if there are seasonal shifts in the relationship between FI and diet.

Methods

Low-income adults (with a household income &lt;185% federal poverty line) were recruited in Central Pennsylvania. An ecological momentary assessment model on smartphones was used to collect daily FI and diet data over two three-week long waves: one during a fall month, and one during a winter month. An adapted USDA adult module was used to assess daily FI (“food secure” if module score = 0 or “food insecure” if module score &gt;0). A food record was recorded on smartphones and verified by a trained dietitian via phone calls on Sunday, Monday, and Tuesday. For each subject, daily caloric intake was calculated using the Nutrition Data System for Research software. Daily Healthy Eating Index 2015 (HEI-2015) score and food group intake were calculated. Generalized estimating equation (GEE) models were used to estimate the associations between daily FI and dietary outcomes, accounting for within-person correlation and adjusting for gender, race/ethnicity, employment, and poverty status.

Results

22 participants were recruited in fall 2019, 18 were followed up in winter 2020, with a total of 290 person-days (response rate = 80.64%) of data. Higher FI scores in the winter, but not in the fall, were associated with lower HEI-2015 score [b (95%CI)] [−9.06 (−14.15, −3.96)]. Higher FI in winter was associated with decreased intake of total fruit ([−0.24 (−0.44, −0.05)], whole fruit [−0.27 (−0.48, −0.06)], and whole grain [−0.52 (−1.03, −0.01)]. Higher FI in the fall months was associated with increased dairy consumption [0.65 (0.08, 1.22)]. FI was not associated with calorie intake in either season.

Conclusions

This pilot study found that higher daily FI was associated with lower diet quality in the winter, but not fall, which may be driven by shifts in food accessibility and altered coping strategies across seasons.

Funding Sources

The National Center for Advancing Translational Sciences, National Institutes of Health (UL1TR002014) and the Broadhurst Career Development Professorship for the Study of Health Promotion and Disease Prevention.

Promising Trends of Complementary Feeding Practices in Côte D'lvoire: An Analysis of Nationally Representative Survey Data Between 1994–2016

Objectives

Poor complementary feeding practices pose a major challenge for early childhood growth and development in Côte d'Ivoire, where more than 20% children under five suffer from stunting. We aimed to examine the trends and risk factors of suboptimal complementary feeding among children aged 6–23 months in Côte d'Ivoire.

Methods

We estimated the country-level prevalence, trends, and risk factors of four complementary feeding indicators: introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). Data was extracted from Demographic and Health Surveys (1994 to 2011) and Multiple Indicator Cluster Surveys (2000–2016) to estimate the complementary feeding indicators for children between 6 to 23 months in Côte d'Ivoire. Multilevel logistic regression models were used to identify factors associated with these complementary feeding indicators in 2016.

Results

On average, 59.2% of children aged 6–8 months achieved INTRO between 1994–2016. In 2016, the proportion of children aged 6–8 months meeting INTRO was 65.5% showing an increase of around 15 percentage points from 2006. Between 2011 – 2016, the proportion of children aged 6–23 months meeting MMF, MDD, and MAD also increased from 40.2% to 47.7%, 11.3% to 26.0%, and 4.6% to 12.5%, respectively. Child age (MDD, MAD), maternal education (INTRO), and breastfeeding status (MMF, MAD) were significantly and positively associated with achieving at least one of the complementary feeding practices: INTRO, MMF, MDD, and MAD. Higher household wealth was significantly associated with greater odds of achieving all four complementary feeding criteria compared to poorer households

Conclusions

Suboptimal complementary feeding practices remain a problem and disparities in complementary feeding still exist in Côte d'Ivoire. However, complementary feeding practices have improved in the past decade. Additional research is needed to understand the policy and programmatic efforts that may explain the promising trends of complementary feeding practices in Côte d'Ivoire.

Funding Sources

UNICEF West and Central Africa Regional Office and Bill & Melinda Gates Foundation (Grant # 43279190).

Psychosocial Risk Factors for Food Insecurity in Puerto Ricans Living in the USA from Baseline to 5-Year Follow-Up

BACKGROUND

Food insecurity is prevalent among Puerto Rican adults in the USA and is associated with adverse psychosocial outcomes. However, the direction of this association has not been established in this understudied population.

OBJECTIVES

In this study, we aimed to examine the longitudinal association between a group of psychosocial risk factors and subsequent food insecurity in a cohort of Puerto Rican adults.

METHODS

Secondary analysis was conducted using data from the prospective Boston Puerto Rican Health Study. A total of 517 Puerto Rican participants aged 45-75 y in the Boston area who were food secure at baseline, and who completed food security surveys at baseline and 5 y were included. Psychosocial factors, including depressive symptoms, stress, tangible social support, and acculturation were assessed with validated instruments. Multivariable logistic regression models were used to examine the risk of food insecurity at 5 y, as a function of psychosocial factors at baseline and their changes over 5 y, adjusting for age, sex, education, baseline and change in total annual household income, and in family size.

RESULTS

The cumulative incidence of food insecurity at 5 y was 12.6%. The odds of incident food insecurity was significantly associated with baseline depressive symptom score [OR = 1.78 (1.16, 2.76) per each 10 score units], with change in depressive symptom score [OR = 1.50 (1.07, 2.09) per each 10-unit increase], and with change in perceived stress [OR = 1.59 (1.01, 2.51) per each 10-unit increase], after adjusting for potential confounders.

CONCLUSION

In this cohort of Puerto Rican adults, depressive symptoms at baseline, and increases in depressive symptoms and perceived stress over 5 y were associated with a higher risk of food insecurity. Psychosocial health and environment appear to play important roles in predicting risk of food insecurity in the Puerto Rican community.

Food Insecurity and Mental Health Status Among Immigrants in High-Income Countries Between 2014–2017

Objectives

To assess the prevalence and trend of food insecurity (FI), mental wellbeing and their associations in the understudied immigrants living in high-income countries between 2014–2017.

Methods

Using nationally representative Gallup World Poll data from 2014 to 2017, a total of 15,343 immigrants from 48 World Bank defined high-income countries were included. Individual FI status was measured by the Food Insecurity Experience Scale (FIES) and categorized into food secure and mild, moderate and severe FI groups. Mental wellbeing was assessed by the Negative Experience Index (NEI, the greater the worse) and the Positive Experience Index (PEI, the greater the better). Multiple linear regression models were used to examine the association between FI and NEI/PEI, adjusting for age, gender, marital status, education, employment status, annual household income, residency, household size, and the number of children younger than 15 y in the household.

Results

The prevalence of FI in immigrants decreased from 38.4% in 2014 to 28.9% in 2017 globally (p-trend &lt;0.001). During 2014–2017, the overall mental wellbeing in immigrants improved as the mean (SD) NEI decreased from 32.8 (1.1) to 27.8 (0.5) and PEI increased from 63.1 (1.1) to 73.2 (0.5), respectively (both p-trend &lt;0.001). In the pooled adjusted model, FI was dose-responsively associated with greater NEI in mild (12.8 [11.7, 14.1]), moderate (20.5 [18.7,22.3]), and severe FI groups (28.3 [26.1, 30.5]) as compared to the food secure referent. By year analyses revealed that the gap in NEI between immigrants in the severe FI and food secure group widened by ∼10 points from 22.7 [14.7, 30.8] in 2014 to 32.3 [28.24, 36.38] in 2017. The dose-responsive association and its trend over time was less clear in PEI.

Conclusions

Progressive FI is significantly associated with poor mental wellbeing among immigrants in high income countries. Despite the improvement in food security and mental health status in immigrants, severely food insecure immigrants have had worsened mental wellbeing in recent years. Future policies are required to address disparities in food access and mental health in vulnerable immigrants.

Funding Sources

FAO's Voices of the Hungry Project for having granted access to the full GWP data set and supporting materials, which allowed the present study to be conducted.

Understanding Complementary Feeding Practices in Children 6–23 Months in the West and Central Africa Region: A Mixed Methods Regional Analysis of 24 Countries

Objectives

1) To describe the trends of complementary feeding since 2010; 2) to understand the factors influencing the sub-optimal feeding practices; and 3) to generate recommendations to inform future interventions.

Methods

Mixed methods study with an iterative, two phase design. Phase 1: quantitative data analysis of 13 key complementary feeding indicators reported in 68 national survey reports from 2010 to 2018. Phase 2: semi-structured qualitative interviews with 14 regional informants (UN, Government, NGO, and donor communities). We conducted a literature review of grey and peer-reviewed publications in 2010–2019 to contextualize the results.

Results

Phase 1. Across 24 WCAR countries, mean continued breastfeeding at 1y was 89%, but halved to 44% by 2y. Introduction of complementary foods occurred in 64% of children 6–8 mos. Minimum meal frequency in children 6–23 mos increased over time from 27% to 38% while minimum dietary diversity and minimum acceptable diet were stagnant (22% and 10%, respectively) since 2010. Intake of nutrient rich foods (vitamin A, animal source, iron-rich) were reported in about half of children, respectively. The proportion of children (only reported for &lt; 5 y) receiving vitamin A (66%), or iron supplements (15%), or iodized salt (79%) varied. Phase 2. Regionally, we identified policy, community, institutional, household, interpersonal, and individual level barriers. Additionally, non-modifiable factors including environmental shocks/hazards and security issues (i.e., violence), were said to disrupt food systems. From a systems perspective, major facilitators to optimal complementary feeding fell within the ‘health and nutrition’ or ‘food system’ sectors; fewer were ascribed to ‘WASH’ or ‘social protection’. Preliminary recommendations from key informants and supported by the literature review were largely multi-sectorial, yet a strong emphasis was placed on the policy level.

Conclusions

Since 2010, complementary feeding practices in WCAR have remained nearly unchanged. Inter-related factors influencing complementary feeding distribute across levels and sectors, suggesting the need for more multi-sectorial, integrated intervention strategies to improve child nutrition in WCAR.

Funding Sources

Bill & Melinda Gates Foundation funding to UNICEF-WCARO.

Food Insecurity and Cognitive Function in Middle to Older Adulthood: A Systematic Review

Food insecurity (FI) may limit cognitive functioning during aging. The goal of this systematic review was to summarize existing evidence linking FI and general or specific cognitive functions in middle and older adulthood. A systematic search of human studies published between 1 January 2000 and 30 April 2018 was conducted in PubMed, PsycINFO, and CAB Direct. Four independent reviewers assessed the eligibility of identified articles and conducted data extraction and data quality assessment. Ten studies were included in the review, including 1 cluster-randomized controlled trial, 2 longitudinal studies, and 7 cross-sectional studies. Three studies reported the association between early-life FI experience and a global cognitive function measure. Nine studies reported later-life FI experience in relation to global or specific cognitive functions. The results suggest an adverse association between FI experienced in early or later life and global cognitive function; and between later-life FI and executive function and memory. Findings from the review are preliminary because of sparse data, heterogeneity across study populations, exposure and outcome assessments, and potential risk of bias across studies. Future studies are recommended to better understand the role of FI in cognitive function, with the goal of identifying possible critical windows for correction of FI in vulnerable subpopulations to prevent neurocognitive deficit in adulthood.

Psychosocial Risk Factors of Food Insecurity in Puerto Ricans Living in the U.S. from Baseline to 5-year Follow Up (P04-041-19)

Objectives

Food insecurity is prevalent among Puerto Ricans (PR) in the U.S. and is associated with worse mental health problems. However, the direction of the association cannot be determined from previous cross-sectional studies. In this study, we aim to explore the longitudinal associations between a group of psychosocial factors and changes in food insecurity status over 5 years among PR population.

Methods

A total of 923 participants from the Boston Puerto Rican Health Study Cohort who completed both the baseline and 5-year interviews were included. Food insecurity (FI) was accessed by the 10-item USDA food-security/hunger scale. Acculturation was indicated by the constructed scale obtained from 7 questions on the use of English and/or Spanish for daily activities. Depression was measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Stress was measured by the Perceived Stress Scale (PSS). Social support from participant's network was characterized by type (emotional and tangible support), duration, and frequency of the support. Social and community support and assistance were accessed by reported numbers of social services used and social activities engaged in. Th number of good and bad major life events were calculated by counting affirmed events on a researcher-provided list. Multivariable logistic regression was applied to assess the association between psychosocial factors and becoming FI over 5 years, adjusting for age, gender, education level, and household income.

Results

The prevalence of FI at baseline and 5-y was 27.4% and 16.5%, respectively. Over the 5 years, 11.5% of subjects became FI and 65.9% had no change in FI status. In the adjusted model, we observed that depression [OR = 1.04 (1.00, 1.08)] and stress score at baseline [OR = 1.07 (1.01, 1.13)] and their increment scores from baseline to 5-year [Depression: OR = 1.03 (1.00, 1.06); stress score: OR = 1.06 (1.02,1.10)] significantly increased the odds of becoming FI.

Conclusions

The onset of and worsened depression and stress may increase the risk of food insecurity among Puerto Ricans. There is likely a vicious cycle between adverse psychosocial environment, poor mental health and food insecurity in vulnerable minorities in the U.S.

Funding Sources

The Summer 2018 Undergraduate Research Award from the College of Health and Human Development, Penn State.