Household Food Insecurity Is Associated with Children's Health and Developmental Risks, But Not with Age‐Specific Obesity and Underweight
Authors: Black Maureen M , Drennen Chloe , Gallego Nailah , Coleman Sharon , Frank Deborah A 
Published: November 2023

BackgroundFood insecurity (FI) is a national public health problem. In 2014, 19.9% of children under age 6 years experienced household FI. Findings between FI and young children's growth have been inconsistent. Most investigations of FI among young children have not considered age‐specific risks.ObjectiveTo examine how household FI relates to age‐specific risk of 4 health indicators: obesity, underweight, perceived poor/fair health, and developmental risk among young children from low‐income households.MethodsCaregivers of children < age 4 without private insurance seeking services from urban medical centers in Baltimore, Boston, Little Rock, Minneapolis, or Philadelphia between 2009–2015 were recruited to Children's HealthWatch. Children were weighed and measured. Weigh‐age percentiles calculated using WHO criteria; obesity defined as weight‐age > 90%ile and underweight as weight‐age < 5%ile. Caregivers participated in interviews including socio‐demographics, FI: 18‐item USDA Food Security Survey Module, perceived poor/fair health: Third National Health and Nutrition Examination Survey, and developmental risk: Parental Evaluation of Developmental Status (among children => age 4 mos). Chi‐square analyses were used to compare age‐specific differences (< 13 mos, 13–24 mos, 25–36 mos, and 37–48 mos) in rates of obesity, underweight, poor/fair health, and developmental risk (Table 1). Separate multivariable logistic regression models were fit using the 4 health indicators and adjusting for site, mother's place of birth, race/ethnicity, employment, educational attainment, BMI, and child's low birthweight, breastfeeding history, and sex, to examine age‐specific differences with < 13 mos as the reference (Table 2, A) and to examine differences by food security status within age categories (Table 2, B).ResultsThe sample included 23,820 children, 6601 (27.7%) from FI households. Rates of obesity, underweight, poor/fair health, and developmental risk differed by age (Table 1). In adjusted analyses, the odds of risks in all 4 health indicators were higher at older ages compared with < 13 mos (Table 2, A). In adjusted analyses, the odds of obesity and underweight did not differ by food security status within age categories; odds of poor/fair health and developmental risk were higher in food insecure households compared to food secure households within each age category (except <13 mos for developmental risk) (Table 2, B).ConclusionsFI is unrelated to the obesity epidemic among children in low‐income households whereby rates of obesity double and rates of underweight decline by 50% from < 13 mos through 48 mos. FI is associated with increased odds of poor/fair health and developmental risk among young children during a period of rapid brain and physical development. Screening and prevention of FI among young children are likely to reduce health and developmental risks, but unlikely to alter the obesity epidemic.Support or Funding Informationwww.childrenshealthwatch.org
Unadjusted analyses of 4 health indicators

<13 months
13–24 months
25–36 months
37–48 months

N=1224
N=873
N=847
N=679

Obese
1224 (12.1%)
873 (13.6%)
847 (19.4%)
679 (23.1%)
p <0.001

Underweight
977 (9.7%)
654 (10.2%)
283 (6.5%)
134 (4.6%)
p<0.001

Poor/fair health
844 (8.4%)
788 (12.3%)
577 (13.2%)
396 (13.5%)
p<0.001

Developmental risk
604 (9.8%)
1222 (19.1%)
1103 (25.2%)
772 (26.2%)
p<0.001

Adjusted odds of obesity (weight‐age >90%ile), underweight (weight‐age < 5%ile, poor/fair health, and developmental risk by age (A) and by food security vs. food insecurity within age (B)

Obesity
<13 months
13–24 months
25–36 months
37–48 months

A: Age
1.00
1.10 (0.98, 1.22)
1.60 (1.42, 1.79)
1.83 (1.62, 2.08)

ref.
p=0.10
p<0.001
p<0.001

B: Food Secure (ref.) vs. Food Insecure
1.00
1.00
1.00
1.00

0.98 (0.83, 1.15)
0.94 (0.77, 1.14)
1.00 (0.82, 1.22)
1.10 (0.88, 1.38)

Underweight
<13 months
13–24 months
25–36 months
37–48 months

A Age
1.00
1.06 (0.94, 1.21)
0.72 (0.61, 0.85)
0.51 (0.41, 0.64)

ref.
p=0.36
p<0.001
p<0.001

B. Food Secure (ref.) vs. Food Insecure
1.00
1.00
1.00
1.00

0.87 (0.72, 1.07)
1.04 (0.84, 1.30)
1.32 (0.97, 1.79)
0.92 (0.59, 1.45)

Poor/fair Health
<13 months
13–24 months
25–36 months
37–48 months

A. Age
1.00
1.48 (1.31, 1.67)
1.72 (1.51, 1.96)
1.82 (1.57, 2.11)

ref.
p <0.001
p<0.001
p<0.001

B. Food Secure (ref.) vs. Food Insecure
1.00
1.00
1.00
1.00

1.50 (1.25, 1.80)
1.53 (1.27, 1.86)
1.55 (1.25, 1.94)
1.49 (1.14, 1.94)

Developmental Risk
<13 months
13–24 months
25–36 months
37–48 months

A. Age
1.00
2.28 (2.02, 2.58)
3.25 (2.87, 3.69)
3.61 (3.14, 4.15)

ref.
p<0.001
p<0.001
p<0.001

B. Food Secure (ref.) vs. Food Insecure
1.00
1.00
1.00
1.00

1.16 (0.93, 1.45)
1.34 (1.14, 1.58)
1.30 (1.08, 1.55)
1.44 (1.16, 1.79)