Understanding the measurement of hunger and food insecurity in the elderly

The elderly are one of the population subgroups at greatest risk for hunger and food insecurity. To date, no accurate measures of this problem have been developed. What is needed are a thorough understanding of the phenomenon, and an assessment of how the elderly perceive and answer items commonly used to measure hunger and food insecurity in other subgroups. In-depth, open-ended interviews were conducted with forty-one low-income urban black and rural white residents of upstate New York. Results suggest a conceptual framework of food insecurity in the elderly with two significant differences from frameworks proposed for younger families: the major role of health problems and physical disabilities, and the impact of personal history on perceptions of food insecurity. In a telephone follow-up (approximately six months after the initial interviews) twenty-four respondents were asked commonly used food insecurity questionnaire items from six different sources. Results suggest that hunger and food insecurity among the elderly can be measured directly. The commonly used measures tested here will help categorize the stages of food insecurity. However, these direct measures might underestimate the prevalence of food insecurity because of a perceived reluctance to report problems with food.

Nutritional Consequences of Food Insecurity in a Rural New York State County

This study of women with children in a rural county of upstate New York examined the relationships of food insecurity and income with two nutritional consequences (adiposity and fruit and vegetables consumption), and assessed whether disordered eating patterns is a mediator for the effects of food insecurity and income on these nutritional consequences. Each of 193 respondents was interviewed twice in her home. Data were collected on household food stores, socioeconomic and demographic characteristics, methods of obtaining food, food program participation, household expenditures, food intake, the Radimer/Cornell hunger and food insecurity items, height, weight, frequency of fruit and vegetable consumption, and disordered eating patterns. Regression analysis was used to analyze the relationships of body mass index and an obesity classification with height, income, education, single parenthood, employment, food insecurity, disordered eating, and frequency of fruit and vegetable consumption. Regression analysis was also used to examine the relationships of disordered eating and frequency of fruit and vegetable consumption with the other variables. Lower income and unemployment were related to higher adiposity. The effects of income on adiposity were not mediated through disordered eating patterns or through fruit and vegetable consumption. Food insecurity was related to adiposity, and part of this effect of food insecurity was mediated through disordered eating. This mediating effect of disordered eating partially explained why those experiencing the least severe food insecurity were more likely to be overweight than those who were food secure, but those experiencing the most severe food insecurity were less likely to be overweight than those who were food secure. Food insecurity was related to lower fruit and vegetable consumption, but this did not translate into effects on adiposity.

Estimating the prevalence of hunger and food insecurity: The validity of questionnaire-based measures for the identification of households

This study had three objectives: (1) to assess the validity of questionnaire-based measures in identifying households experiencing hunger and food insecurity, (2) to examine the interrelationships of different questionnaire-based measures, and (3) to examine the construction of a continuous food insecurity scale intended to differentiate three levels of food insecurity within households. A 1993 survey of 193 randomly sampled rural households with women and children living at home provided data on demographics, risk factors for food insecurity, Radimer/Cornell, CCHIP, and NHANES III hunger and food insecurity items, coping strategies, fruit and vegetable consumption, disordered eating behaviors, height, weight, dietary recall, and household food-stores inventory. This information was used to develop a definitive criterion measure for hunger and food insecurity, against which the Radimer/Cornell and CCHIP questionnaire-based measures, the NHANES III item, and the continuous food insecurity scale were tested for their specificity and sensitivity in measuring levels of food insecurity.

Individual and Structural Environmental Influences on Utilization of IRON and Folic Acid Supplementation Among Pregnant Women in Harare, Zimbabwe

Micronutrient deficiencies are prevalent among Zimbabweans with serious health and social implications. Due to alack of a national micronutrient food fortification policy, the Zimbabwe Ministry of Health and Child Careestablished a policy for the prevention of maternal micronutrient deficiencies, which centres on pregnant womenreceiving daily iron and folic acid (IFA) at theirfirst antenatal care visit and throughout pregnancy. Despite theseefforts, utilization of IFA supplementation in pregnancy in Zimbabwe is low. This study aimed to understand theexperiences and knowledge of IFA supplementation among pregnant women and healthcare workers in Harare,Zimbabwe, and the influence of health-service and social environments on utilization. Semi-structured in-depthinterviews were conducted in Shona and English, with pregnant women (n= 24) and healthcare workers (n=14)providing direct antenatal care services to pregnant women in two high-density community clinics. Data wereanalysed thematically using NVivo 10. Influences on utilization were at the individual and structural environmentallevels. Reasons for low utilization of IFA supplementation included forgetting to take IFA, side effects, misconcep-tions about IFA, limited access to nutrition information, delayed entry or non-uptake of antenatal care and socialnorms of pregnant women for IFA supplementation. Utilization was enhanced by knowledge of risks and benefitsof supplementation, fear of negative health complications with non-utilization, family support and healthcareworker recommendation for supplementation. Studyfindings can inform approaches to strengthen micronutrientsupplementation utilization to improve the micronutrient status of pregnant women to decrease maternal mortalityand improve overall maternal and child health in Zimbabwe

Household food security is associated with infant feeding practices in rural Bangladesh.

Although household food security (HHFS) has been shown to affect diet, nutrition, and health of adults and also learning in children, no study has examined associations with infant feeding practices (IFP). We studied 1343 infants born between May 2002 and December 2003 in the Maternal and Infant Nutrition Intervention in Matlab study to investigate the effect of HHFS on IFP in rural Bangladesh. We measured HHFS using a previously developed 11-item scale. Cumulative and current infant feeding scales were created from monthly infant feeding data for the age groups of 1-3, 1-6, 1-9, and 1-12 mo based on comparison to infant feeding recommendations. We used lagged, dynamic, and difference longitudinal regression models adjusting for various infant and maternal variables to examine the association between HHFS and changes in IFP, and Cox proportional hazards models to examine the influence of HHFS on the duration of breast-feeding and the time of introduction of complementary foods. Better HHFS status was associated with poor IFP during 3-6 mo but was associated with better IFP during 6-9 and 9-12 mo of age. Although better HHFS was not associated with the time of introduction of complementary foods, it was associated with the type of complementary foods given to the infants. Intervention programs to support proper IFP should target mothers in food-secure households when their babies are 3-6 mo old and also mothers in food-insecure households during the 2nd half of infancy. Our results provide strong evidence that HHFS influences IFP in rural Bangladesh

Functions of Social Networks in Maternal Food Choice for Children in Mexico

Food choice for children has important implications in establishing early-life dietary habits and preferences. Food choice for children has been studied as parent–child dyad dynamics, but little is known about the extended system of relationships in maternal food choice for children. The objective of this study was to understand the functions of mothers\u27 social networks in the food choices that mothers make for their children ages 1 to 5 years old in rural Mexico. In-depth interviews were conducted with 46 participants in three rural communities. The interviews inquired about participants\u27 child-feeding practices, personal and local beliefs about child feeding and the individuals with whom they had conversations about food and child feeding. All interviews were conducted in Spanish, audio-recorded, transcribed verbatim, verified for quality and analysed using the constant comparative method. Five interconnected networks emerged, consisting of household family, non-household family, community, children\u27s initial school and health and nutritional programme personnel. Each network had functions in food choice that ranged from shared food decision-making in the household family network to imparting formal dietary guidance in the health and nutritional programme personnel network. Across the networks, professionals, participants\u27 mothers and mothers-in-law, community senior women and other women with children emerged as prominent figures whom participants would turn to for child-feeding advice. These findings provide empirical evidence that social networks, as an organized system of interconnected relationships, have vital functions in establishing social norms for food choices made for children that can be leveraged to promote healthy food choices

Use of the new World Health Organization child growth standards to describe longitudinal growth of breastfed rural Bangladeshi infants and young children.

BACKGROUND: Although the National Center for Health Statistics (NCHS) reference has been widely used, in 2006 the World Health Organization (WHO) released new standards for assessing growth of infants and children worldwide. OBJECTIVE: To assess and compare the growth of breastfed rural Bangladeshi infants and young children based on the new WHO child growth standards and the NCHS reference. METHODS: We followed 1343 children in the Maternal and Infant Nutrition Intervention in Matlab (MINIMat) study from birth to 24 months of age. Weights and lengths of the children were measured monthly during infancy and quarterly in the second year of life. Anthropometric indices were calculated using both WHO standards and the NCHS reference. The growth pattern and estimates of undernutrition based on the WHO standards and the NCHS reference were compared. RESULTS: The mean birthweight was 2697 +/- 401 g, with 30% weighing <2500 g. The growth pattern of the MINIMat children more closely tracked the WHO standards than it did the NCHS reference. The rates of stunting based on the WHO standards were higher than the rates based on the NCHS reference throughout the first 24 months. The rates of underweight and wasting based on the WHO standards were significantly different from those based on the NCHS reference. CONCLUSIONS: This comparison confirms that use of the NCHS reference misidentifies undernutrition and the timing of growth faltering in infants and young children, which was a key rationale for constructing the new WHO standards. The new WHO child growth standards provide a benchmark for assessing the growth of breastfed infants and children

Household food security is associated with growth of infants and young children in rural Bangladesh.

OBJECTIVE: Despite a strong relationship between household food security and the health and nutritional status of adults and older children, the association of household food security with the growth of infants and young children has not been adequately studied, particularly in developing countries. We examined the association between household food security and subsequent growth of infants and young children in rural Bangladesh. DESIGN: We followed 1343 children from birth to 24 months of age who were born in the Maternal and Infant Nutrition Intervention in Matlab (MINIMat) study in rural Bangladesh. A food security scale was created from data collected on household food security from the mothers during pregnancy. Data on weight and length were collected monthly in the first year and quarterly in the second year of life. Anthropometric indices were calculated relative to the 2006 WHO child growth standards. Growth trajectories were modelled using multilevel models for change controlling for possible confounders. RESULTS: Household food security was associated (P < 0.05) with greater subsequent weight and length gain in this cohort. Attained weight, length and anthropometric indices from birth to 24 months were higher (P < 0.001) among those who were in food-secure households. Proportions of underweight and stunting were significantly (P < 0.05) lower in food-secure households. CONCLUSIONS: These results suggest that household food security is a determinant of child growth in rural Bangladesh, and that it may be necessary to ensure food security of these poor rural households to prevent highly prevalent undernutrition in this population and in similar settings elsewhere in the world

Appropriate infant feeding practices result in better growth of infants and young children in rural Bangladesh.

BACKGROUND: The World Health Organization and the United Nations International Children's Emergency Fund recommend a global strategy for feeding infants and young children for proper nutrition and health. OBJECTIVE: We evaluated the effects of following current infant feeding recommendations on the growth of infants and young children in rural Bangladesh. DESIGN: The prospective cohort study involved 1343 infants with monthly measurements on infant feeding practices (IFPs) and anthropometry at 17 occasions from birth to 24 mo of age to assess the main outcomes of weight, length, anthropometric indexes, and undernutrition. We created infant feeding scales relative to the infant feeding recommendations and modeled growth trajectories with the use of multilevel models for change. RESULTS: Mean (+/-SD) birth weight was 2697 +/- 401 g; 30% weighed < 2500 g. Mean body weight at 12 and 24 mo was 7.9 +/- 1.1 kg and 9.7 +/- 1.3 kg, respectively. More appropriate IFPs were associated (P < 0.001) with greater gain in weight and length during infancy. Prior IFPs were also positively associated (P < 0.005) with subsequent growth in weight during infancy. Children who were in the 75th percentile of the infant feeding scales had greater (P < 0.05) attained weight and weight-for-age z scores and lower proportions of underweight compared with children who were in the 25th percentile of these scales. CONCLUSIONS: Our results provide strong evidence for the positive effects of following the current infant feeding recommendations on growth of infants and young children. Intervention programs should strive to improve conditions for enhancing current infant feeding recommendations, particularly in low-income countries