Studies underscore extent of health threats from childhood food insecurity
Findings from two studies published recently in Pediatrics emphasized the negative impact that food insecurity has on child health and the role that policies and recommendations play in mitigating this impact.
One study showed that children who are food insecure experience higher rates of several chronic health conditions, including asthma and depressive symptoms, and that federal programs like the Supplemental Nutrition Assistance Program (SNAP) can help. The other demonstrated that among children aged younger than 4 years, food insecurity is associated with fair or poor developmental and health risk, supporting AAP recommendations for food insecurity screening and referrals for certain families.
“The evidence makes clear that identifying and ameliorating household food insecurity could improve children's health across several domains, including acute and chronic conditions and overall health status, and could increase children's use of needed health care services,” Margaret M.C. Thomas, MSW, a doctoral candidate at the Boston University School of Social Work and lead author of the first study, told Infectious Diseases in Children.
Impact of food insecurity
Thomas and colleagues defined food insecurity as lacking “enough food for an active, healthy life.” They noted that previous research on the subject was limited because it was based on regression analyses with only limited control for potential confounders. For their study, the researchers used the recent inclusion of a measure of household food insecurity in the nationally representative National Health Interview Survey (NHIS) to estimate the effects of food insecurity on child health.
In their analysis, they included 29,341 sample children aged 2 to 17 years from the NHIS surveys from 2013-2016 and organized children’s health outcomes into four domains: general health, chronic health, acute health and health care access. They examined the outcomes, accounting for several controls, including individual, household and neighborhood factors.
Thomas and colleagues found that household food insecurity was significantly associated with worse general health, some acute and chronic health problems and worse health care access, including heightened ED use and higher rates of foregone care, they wrote. Specifically, children in food-insecure households experienced rates of lifetime asthma diagnosis and depressive symptoms that were 19.1% and 27.9% higher compared with rates of food-secure households. Rates of foregone medical care were 179.8% higher, and rates of ED use were 25.9% higher.
The researchers noted no significant differences for most communicable diseases, such as chickenpox or ear infections, or conditions that develop gradually, including diabetes and anemia.
“The findings drive home the urgency of mitigating and eliminating food insecurity,” Thomas said. “This is clear evidence that food insecurity has wide-ranging negative effects on children's health and well-being, and as such, we should make every effort to ensure no child experiences food insecurity. My immediate recommendation is to expand the generosity of SNAP benefits and to extend SNAP benefits to more families in order to reduce food insecurity in children's households.”
Effects on younger children
The second study evaluated how food insecurity relates to obesity, underweight, stunting, health and development among children aged younger than 4 years.
Chloe R. Drennen, MD, from the University of Maryland’s School of Medicine, and colleagues found that food insecurity is associated with fair or poor health and developmental risk.
“Possible explanations are that the poor quality of food in food-insecure households increases the risk for micronutrient deficiencies, which can undermine children’s health and cognitive development; that children are exposed to the stress and anxiety that families experience in not having a consistent source of food; and that mothers recognize developmental problems among their children particularly as they age,” the researchers wrote.
For their study, they analyzed the Household Food Security Survey Module administered at medical centers in five U.S. cities to caregivers of children aged younger than 4 years. They excluded from their analysis children who were severely ill or injured and those on private health insurance. The survey defined three exposure groups — food secure, household food insecure and child food secure, and household food insecure and child food insecure. Adjusting for demographic confounders, maternal BMI and food assistance program participation, they examined relations between exposure groups and dependent variables. They stratified patients by age, from ages 0 to 12 months, 13 to 24 months, 25 to 36 months and 37 to 48 months.
Among 28,184 children, 50% were non-Hispanic African American, 34% were Hispanic and 14% were non-Hispanic white. Of these, 27% were household food insecure. Apart from one exception at ages 25 to 36 months, neither household nor child food insecurity were associated with obesity, underweight or stunting, the researchers wrote. However, both were associated with increased odds of fair or poor health and developmental risk at multiple ages.
“Screening questions (Hunger Vital Sign) rather than anthropometric criteria should be used to identify food insecurity, as recommended by the American Academy of Pediatrics,” they wrote. “Using such screening questions can help health professionals refer caregivers to nutrition assistance programs and other supports that can help families cope with economic hardships and their associated stressors.”
In a related editorial, Rachel S. Gross, MD, MS, assistant professor of pediatrics and population health, and Alan L. Mendelsohn, MD, associate professor of pediatrics and population health — both from the New York University School of Medicine and Bellevue Hospital Center — noted that the study by Drennen and colleagues underscores the need for interventions to prevent food insecurity.
“Findings from this study suggest that primary care preventive interventions need to simultaneously target parenting across feeding and developmental domains to maximally reduce poverty-related disparities,” they wrote. – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.