A longitudinal study of food insecurity on obesity in preschool children.

BACKGROUND Obesity and its co-occurrence with household food insecurity among low-income families is a public health concern, particularly because both are associated with later adverse health consequences. OBJECTIVE Our aim was to examine the relationship between household food insecurity with and without hunger in infancy and later childhood with weight status at 2 to 5 years. DESIGN This longitudinal study uses household food-security status, weight, and height data collected at the first infancy and last child (2 to 5 years) Special Supplemental Nutrition Program for Women, Infants, and Children visits. Household food security was based on parent/caretaker responses to a four-question subscale of the 18-item Core Food Security Module. Obesity was defined as sex-specific body mass index for age ≥ 95th percentile. PARTICIPANTS/SETTING A diverse (58.6% non-white) low-income sample of 28,353 children participating in the Massachusetts Special Supplemental Nutrition Program for Women, Infants, and Children (2001-2006); 24.9% of infants and 23.1% of children lived in food-insecure households and 17.1% were obese at their last child visit. STATISTICAL ANALYSIS Multivariate logistic regression analyses assessed the association between household food-security status during the infant and child visits, and risk of preschool obesity, while controlling for child race/Hispanic ethnicity, sex, child and household size, maternal age, education, and prepregnancy weight. Interactions between these covariates and household food-security status were also examined. In cases of multiple comparisons, a Bonferroni correction was applied. RESULTS Persistent household food insecurity without hunger was associated with 22% greater odds of child obesity (odds ratio=1.22; 95% CI 1.06 to 1.41) compared with those persistently food secure (P<0.05). Maternal prepregnancy weight status modified this association with children of underweight (adjusted odds ratio=3.22; 95% CI 1.70 to 6.11; P=0.003) or overweight/obese (adjusted odds ratio=1.34; 95% CI 1.11 to 1.62; P=0.03) mothers experiencing greater odds of child obesity with persistent household food insecurity without hunger compared with those with persistent household food security. CONCLUSIONS These results suggest that persistent household food insecurity without hunger is prospectively related to child obesity, but that these associations depend on maternal weight status. Vulnerable groups should be targeted for early interventions to prevent overweight and obesity later in life.