Household food insecurity and obesity risk in preschool-aged children: A three-year prospective study

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Abstract

Background: Household food insecurity (FI) is a pressing social, economic and public health issue. However, little is known regarding the effect of FI exposure during the first few years of life, the most active postnatal time for neurobiological and physiological development, on patterns of weight gain during early childhood. It is also unknown whether dietary quality would serve as a pathway through which FI affects children's weight development. Method: This was a secondary data analysis from a three-year randomized clinical trial with five hundred and thirty-four parent/child dyads. Household FI in the past year was reported by parents at baseline when children were 2–4 years of age using the USDA Household Food Security Survey Module-Six Item Short Form. Children's dietary quality at baseline was measured by the US Department of Agriculture Healthy Eating Index (HEI). Child body mass index (BMI) was measured following standardized protocols at baseline and 12-, 24-, and 36-month follow-up. A latent growth curve model was used to examine 1) the association between baseline FI and sex-and-age-adjusted BMI z-scores in children and 2) the HEI pathway between the FI- BMI association. Results: FI early in life was associated with higher baseline BMI z-scores. Children who had higher BMI at baseline maintained their higher BMI status over the next three years. Children's dietary intake quality did not explain the association between baseline FI and BMI z-scores. Conclusion: Early exposure to FI was associated with higher BMI in children as early as two years of age, setting them up for an increased likelihood of persistently high BMI-for-age in later childhood. These data suggest that the first few years may be a critical time for developing obesity risk, calling for policy and practices designed for early intervention of food insecurity.

Original languageEnglish (US)
Article number115176
JournalSocial Science and Medicine
Volume307
DOIs
StatePublished - Aug 2022

Bibliographical note

Funding Information:
Our second hypothesis that FI would be associated with a higher rate of increase in children's BMI was not supported. That is, baseline FI was not associated with the slope of BMI across the four assessment time points. This is not surprising as children's BMI remained fairly stable across assessments. That is, the age-adjusted slope of BMI z-score was relatively flat, and BMI z-scores across years seemed to be relatively set by the initial status of BMI in 2–4 years of age. This finding is consistent with Dubois et al. (2006), who showed that early FI exposure was associated with heightened overweight/obesity risk by the preschool years. However, this finding is in contradiction with Burke et al. (2016) who showed that children in food insecure households had greater growth rate in BMI compared to children in food secure households. At least two possible explanations exist for these discrepancies. First, the eligibility criteria for the present study included having a BMI percentile at or higher than the 50th percentile, while Burke et al. (2016) included children who had a lower BMI level (<50 percentile). Therefore, it is possible that baseline FI may be associated with accelerated BMI trajectories when children are not selected to already be at overweight/obesity risk. Second, the increased slope of BMI in Burke et al. (2016) was observed when children were 5, 6, 9, 11 and 14 years of age, which may be reflective of adiposity rebound, while BMI of our participants were measured from 2 to 6 years of age. Thus, even though our participants were within the adiposity rebound ages, the different age periods of measurement between our study and Burke et al., (2016) may have produced the difference. In other words, compared to the initial level of weight status, it may take longer for altered patterns of weight growth to emerge given the impact of early FI exposure.Funding/Support: This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development under the award number U01HD068990.

Funding Information:
Funding/Support: This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development under the award number U01HD068990 .

Publisher Copyright:
© 2022 Elsevier Ltd

Keywords

  • Children
  • Dietary intake
  • Food insecurity
  • Obesity

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