Association between food and nutrition insecurity with cardiometabolic risk factors in childhood and adolescence: a systematic review

Rocha, Naruna Pereira; Milagres, Luana Cupertino; Novaes, Juliana Farias de; Franceschini, Sylvia do Carmo Castro

doi:10.1016/j.rppede.2016.01.006

Brasil

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REVIEW ARTICLES • Rev. paul. pediatr. 34 (2) • Apr-Jun 2016 • https://doi.org/10.1016/j.rppede.2016.01.006 linkcopy

Association between food and nutrition insecurity with cardiometabolic risk factors in childhood and adolescence: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective: To address the association between food and nutrition insecurity and cardiometabolic risk factors in childhood and adolescence.

Data source: Articles were selected from the Medline, Lilacs and SciELO databases with no publication date limit, involving children and adolescents, using the descriptors: food and nutrition security, diabetes mellitus, hypertension, metabolic syndrome, stress and dyslipidemia. The terms were used in Portuguese, English and Spanish. The search was carried out systematically and independently by two reviewers.

Data synthesis: Exposure to food insecurity during childhood and adolescence ranged from 3.3% to 82% in the selected publications. Exposure to food insecurity was associated with stress, anxiety, greater chance of hospitalization, nutritional deficiencies, excess weight and inadequate diets with reduced intake of fruits and vegetables and increased consumption of refined carbohydrates and fats.

Conclusions: Food and nutrition insecurity was associated with the presence of cardiometabolic risk factors in the assessed publications. Childhood and adolescence constitute a period of life that is vulnerable to food insecurity consequences, making it extremely important to ensure the regular and permanent access to food. Because this is a complex association, some difficulties are found, such as the synergy between risk factors, the assessment of heterogeneous groups and extrapolation of data to other populations, in addition to the influence of environmental factors.

Keywords
Food and nutrition security; Diabetes mellitus; Hypertension; Metabolic syndrome; Stress and dyslipidemia

Author/year	Design	Sample	Age	Nutrition variables	Nutritional Status Classification	Tool to assess food and nutrition security
Weinreb et al., 2002¹³	Cross-sectional	408 preschoolers, children and adolescents	2.5-17 years	Do not assess	Do not perform	Community Childhood Hunger Identification Project and direct questions for children older than 9 years
Cook et al., 2004⁷	Cross-sectional with cohort.	11,539 children's caregivers	Children <36 months	Weight and height	Do not report	U.S. Household Food Security Scale (U.S. HFSS)
Molcho et al., 2006¹⁷	Cross-sectional	8424 schoolchildren	10-17 years	Do not assess	Do not report	Food and nutrition insecurity defined by two structured questions
Martin et al., 2007¹⁵	Cross-sectional	212 children and 200 parents or tutors	Children from 2 to 12 years	Weight and height	Curves of Centers for Disease Control and Prevention	USDA Food Security Module
Jiménez-Cruz et al., 2007¹⁶	Cross-sectional	Group in 2001: 1200 children. Group in 2003: 1452 children	Children from 6 to 11 years	BMI and waist circumference	Curves of Centers for Disease Control and Prevention	Community Childhood Hunger Identification Project, adapted for Mexican children
Gundersen et al., 2008⁶	Cross-sectional	841 children and adolescents	3-17 years	Weight and height, BMI, stress	Curves of Centers for Disease Control and Prevention	USDA Core Food Security Module (CFSM)
Chen et al., 2009¹⁸	Longitudinal	764,526 children	Children born between 1997 and 1999	Low birth weight reported	Not reported	Food and nutrition insecurity assessed by data on low birth weight, economic status, maternal nutritional status and family income
Kirkpatrick et al., 2010¹⁰	Longitudinal	5809 children and 3333 adolescents	1st group: 10-15 years and 2nd group: 16-21 years	Do not assess	Do not perform	Food and nutrition insecurity assessed by questions asked to the most experienced person
Marjerrison et al., 2011²⁰	Cross-sectional	183 families with children and adolescents	<18 yearsMean: 11.8±3.99 years	BMI and A1c hemoglobin	Do not report	Household Food Security Survey Canadian Community Health Survey Module
Sharkey et al., 2012¹⁴	Cross-sectional	50 mothers and 50 children	6-11 years	Weight, height and BMI	Curves of Centers for Disease Control and Prevention	Tool developed by Connell et al.,²⁴ (2004)^a a The instrument developed by Connell et al. (2004)24 has nine questions directed to the child.

Author/year	Result association	Ethnicities	Prevalence of FNiS	Limitations
Weinreb et al., 2002¹³	Preschoolers: food and nutrition insecurity and worse health status (OR: 2.8), life events (OR: 8.5), family size (OR: 3.2), low birth weight (OR: 1.42). Schoolchildren: food and nutrition insecurity and low birth weight (OR: 1.35), health status (OR: 3.4), life events (OR: 8.8)	Yes	Preschoolers: 59.2% of food and nutrition insecurity	Yes
			Schoolchildren: 66%
Cook et al., 2004⁷	Food and nutrition insecurity and health status reported as "Fair/poor" (OR=1.90; CI: 1.66-2.18). Food and nutrition insecurity and hospitalizations since birth (OR=1.31; CI: 1.16-1.48). There was no association between food and nutrition insecurity and growth risk variables (OR=1.09; CI: 0.94-1.25)	Yes	21.4% of households with food and nutrition insecurity	Yes
Molcho et al., 2006¹⁷	Food and nutrition insecurity and lower consumption of fruits (OR: 0.66; 95%CI: 0.45-0.87), vegetables (OR: 0.68; CI: 0.49-0.87), whole-grain bread (OR: 0.66; CI: 0.42-0.90), higher consumption of potato chips among girls and boys (OR: 1.62; CI: 1.39-1.85 and OR: 1.33; CI: 1.05-1.61 respectively). Food and nutrition insecurity and mental, somatic symptoms (OR: 2.42; CI: 2.06-2.78) and emotional symptoms (CI: 1.47; CI: 1.47-1.23)	No	Low social classes: 15.3%	Yes
			Middle class: 15.9%
			High social classes: 14.8%
Martin et al., 2007¹⁵	There was no association between excess weight and food and nutrition insecurity (OR: 1.41; CI: 0.67-2.99). Insufficient income and obesity (OR: 0.4; CI: 0.18-0.92). Risk of overweight and food and nutrition insecurity (OR: 1.34; CI: 0.53-3.36)	Yes	51.4% of households in food and nutrition insecurity	Yes
Jiménez-Cruz et al., 2007¹⁶	Higher food and nutrition insecurity in children of parents of Native ethnicity (68%; p<0.001)	Yes	46% in 2001 group	No
	Higher food and nutrition insecurity in children younger than 9 years (71%; p <0.001)		58% in the 2003 group
	Children without abdominal obesity and higher prevalence of food and nutrition insecurity (78%, p <0.001)
Gundersen et al., 2008⁶	Stress and food and nutrition insecurity at family level (OR: 0.05; CI: -0.27 to 0.37), food and nutrition insecurity and cumulative stress (OR: 0.02; CI: -0.01 to 0.005)	Yes	44.5% of households with food and nutrition insecurity	Yes
Chen et al., 2009¹⁸	Food and nutrition insecurity and diabetes mellitus (OR: 1.87), inherited metabolic disorders (OR: 1.94), iron-deficiency anemia (OR: 2.68) and poorly defined symptoms related to nutrition, metabolism and development (OR: 2.02)	No	Food and nutrition insecurity value is not shown, the study associates income to food and nutrition insecurity	Yes
Kirkpatrick et al., 2010¹⁰	Food and nutrition insecurity and higher chances of having worse health status (OR=1.91; CI: 1.33-2.74)	No	10-15 years: 3.3%	Yes
	Food and nutrition insecurity was not associated to diagnosed chronic health conditions ( OR =1.22; CI: 0.75-1.99)		16-21 years: 3.9%
Marjerrison et al., 2011²⁰	Food and nutrition insecurity and higher rate of hospitalization (OR, 3.66; CI: 1.54-8.66). Mean concentration of A1c hemoglobin was higher in children with food and nutrition insecurity	No	21.9% of food and nutrition insecurity	Yes
Sharkey et al., 2012¹⁴	Food and nutrition insecurity higher total consumption of energy, calcium, calories from added sugars (β=4.8. Standard error=2.2. p=0.032; β=4.4. Standard error=1.9. p=0.028 and β=8.4. Standard error=2.0. p<0.001)	No	82% of children with food and nutrition insecurity	Yes
	Body mass index was not associated with food and nutrition insecurity status ^a a Data not shown.

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The instrument developed by Connell et al. (2004)²⁴ has nine questions directed to the child.