Food insecurity and maternal–child nutritional status in Mexico: cross-sectional analysis of the National Health and Nutrition Survey 2012

OBJECTIVE To examine the association between household food insecurity (HFI) and risk of childhood stunting and to determine whether this association is modified by maternal-child overweight/obesity. DESIGN Observational cross-sectional study. SETTING Data come from the Mexican National Health and Nutrition Survey (ENSANUT 2012 by its initials in Spanish), representative of rural and urban areas. PARTICIPANTS Our study sample included 5087 mother-preschool child pairs and 7181 mother-schoolchild pairs. MAIN OUTCOME MEASURES Differences in the prevalence (95% CI) of each HFI category by socioeconomic characteristics and maternal-child nutritional status were estimated. A logistic regression model was conducted for stunting and overweight among preschool children and for stunting and overweight/obesity among schoolchildren, adjusting for pertinent covariates. HFI was measured according to the Latin American and Caribbean Food Security Scale (ELCSA by its initials in Spanish). Weight and recumbent lenght or height measures were obtained from children. Overweight and obesity in women were determined according to the WHO Growth Reference Charts. The following covariates were included: sex of the child. urbanicity (urban/rural), region of residence and maternal education. Benefiting from food assistance programmes and socioeconomic status index were also included. Results were expressed as adjusted ORs. RESULTS Stunting proved more prevalent in preschool children with moderate or severe HFI (16.2% and 16.8%, respectively) (p=0.036 and p=0.007, respectively) than in their counterparts with mild or no HFI (13.2% and 10.7%, respectively). Furthermore, the interaction between HFI and maternal obesity had a significant impact on stunting in preschool children (p<0.05). Severe HFI increased risk of stunting in children with non-obese mothers but not in those with obese mothers. CONCLUSION We have discovered a new relationship between HFI and maternal obesity on the one hand and risk of childhood stunting on the other hand. This may reflect a shared mechanism involving dual forms of malnutrition.