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Household food access and child malnutrition: results from the eight-country MAL-ED study.

Psaki S, Bhutta ZA, Ahmed T, Ahmed S, Bessong P, Islam M, John S, Kosek M, Lima A, Nesamvuni C, Shrestha P, Svensen E, McGrath M, Richard S, Seidman J, Caulfield L, Miller M, Checkley W, for MALED Network Investigato - Popul Health Metr (2012)

Bottom Line: In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in height-for-age Z score (95% CI 0.05 to 0.34 SD; p = 0.008).A likelihood ratio test for heterogeneity revealed that this relationship was consistent across countries (p = 0.17).Such a measure could be used to direct interventions by identifying children at risk of illness and death related to malnutrition.

View Article: PubMed Central - HTML - PubMed

Affiliation: Fogarty International Center, National Institutes of Health, Bethesda, USA. wcheckl1@jhmi.edu.

ABSTRACT

Background: Stunting results from decreased food intake, poor diet quality, and a high burden of early childhood infections, and contributes to significant morbidity and mortality worldwide. Although food insecurity is an important determinant of child nutrition, including stunting, development of universal measures has been challenging due to cumbersome nutritional questionnaires and concerns about lack of comparability across populations. We investigate the relationship between household food access, one component of food security, and indicators of nutritional status in early childhood across eight country sites.

Methods: We administered a socioeconomic survey to 800 households in research sites in eight countries, including a recently validated nine-item food access insecurity questionnaire, and obtained anthropometric measurements from children aged 24 to 60 months. We used multivariable regression models to assess the relationship between household food access insecurity and anthropometry in children, and we assessed the invariance of that relationship across country sites.

Results: Average age of study children was 41 months. Mean food access insecurity score (range: 0-27) was 5.8, and varied from 2.4 in Nepal to 8.3 in Pakistan. Across sites, the prevalence of stunting (42%) was much higher than the prevalence of wasting (6%). In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in height-for-age Z score (95% CI 0.05 to 0.34 SD; p = 0.008). A likelihood ratio test for heterogeneity revealed that this relationship was consistent across countries (p = 0.17).

Conclusions: Our study provides evidence of the validity of using a simple household food access insecurity score to investigate the etiology of childhood growth faltering across diverse geographic settings. Such a measure could be used to direct interventions by identifying children at risk of illness and death related to malnutrition.

No MeSH data available.


Related in: MedlinePlus

Relationship between food access insecurity score and height-for-age (HAZ); 2009–10. We fitted a smoothing spline to study the relationship between food access insecurity score and HAZ using a generalized additive model. The figure shows the fitted smoothing spline and corresponding 95% confidence intervals.
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Figure 4: Relationship between food access insecurity score and height-for-age (HAZ); 2009–10. We fitted a smoothing spline to study the relationship between food access insecurity score and HAZ using a generalized additive model. The figure shows the fitted smoothing spline and corresponding 95% confidence intervals.

Mentions: In exploratory analyses, the relationship between food access insecurity and HAZ was approximately linear (Figure 4). Food access insecurity score was statistically significantly associated with HAZ (p = 0.008), but not with WHZ (Table 3). In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in HAZ score (95% CI 0.05 to 0.34), controlling for water source, maternal education and people per room. Sensitivity analyses indicated that the use of individual indicators of SES and the use of a linear combination of indicators using principal components analysis produce similar results with respect to our research question (results not presented). We chose to include individual SES indicators in our model for ease of interpretation. A likelihood ratio test comparing nested models with and without interactions terms indicated that the relationship between food access insecurity score and HAZ did not vary significantly across countries (p = 0.17). Moreover, none of the individual interaction terms between food insecurity and site achieved statistical significance at the 0.05 level (See Additional file 1 and Additional file 2).


Household food access and child malnutrition: results from the eight-country MAL-ED study.

Psaki S, Bhutta ZA, Ahmed T, Ahmed S, Bessong P, Islam M, John S, Kosek M, Lima A, Nesamvuni C, Shrestha P, Svensen E, McGrath M, Richard S, Seidman J, Caulfield L, Miller M, Checkley W, for MALED Network Investigato - Popul Health Metr (2012)

Relationship between food access insecurity score and height-for-age (HAZ); 2009–10. We fitted a smoothing spline to study the relationship between food access insecurity score and HAZ using a generalized additive model. The figure shows the fitted smoothing spline and corresponding 95% confidence intervals.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3584951&req=5

Figure 4: Relationship between food access insecurity score and height-for-age (HAZ); 2009–10. We fitted a smoothing spline to study the relationship between food access insecurity score and HAZ using a generalized additive model. The figure shows the fitted smoothing spline and corresponding 95% confidence intervals.
Mentions: In exploratory analyses, the relationship between food access insecurity and HAZ was approximately linear (Figure 4). Food access insecurity score was statistically significantly associated with HAZ (p = 0.008), but not with WHZ (Table 3). In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in HAZ score (95% CI 0.05 to 0.34), controlling for water source, maternal education and people per room. Sensitivity analyses indicated that the use of individual indicators of SES and the use of a linear combination of indicators using principal components analysis produce similar results with respect to our research question (results not presented). We chose to include individual SES indicators in our model for ease of interpretation. A likelihood ratio test comparing nested models with and without interactions terms indicated that the relationship between food access insecurity score and HAZ did not vary significantly across countries (p = 0.17). Moreover, none of the individual interaction terms between food insecurity and site achieved statistical significance at the 0.05 level (See Additional file 1 and Additional file 2).

Bottom Line: In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in height-for-age Z score (95% CI 0.05 to 0.34 SD; p = 0.008).A likelihood ratio test for heterogeneity revealed that this relationship was consistent across countries (p = 0.17).Such a measure could be used to direct interventions by identifying children at risk of illness and death related to malnutrition.

View Article: PubMed Central - HTML - PubMed

Affiliation: Fogarty International Center, National Institutes of Health, Bethesda, USA. wcheckl1@jhmi.edu.

ABSTRACT

Background: Stunting results from decreased food intake, poor diet quality, and a high burden of early childhood infections, and contributes to significant morbidity and mortality worldwide. Although food insecurity is an important determinant of child nutrition, including stunting, development of universal measures has been challenging due to cumbersome nutritional questionnaires and concerns about lack of comparability across populations. We investigate the relationship between household food access, one component of food security, and indicators of nutritional status in early childhood across eight country sites.

Methods: We administered a socioeconomic survey to 800 households in research sites in eight countries, including a recently validated nine-item food access insecurity questionnaire, and obtained anthropometric measurements from children aged 24 to 60 months. We used multivariable regression models to assess the relationship between household food access insecurity and anthropometry in children, and we assessed the invariance of that relationship across country sites.

Results: Average age of study children was 41 months. Mean food access insecurity score (range: 0-27) was 5.8, and varied from 2.4 in Nepal to 8.3 in Pakistan. Across sites, the prevalence of stunting (42%) was much higher than the prevalence of wasting (6%). In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in height-for-age Z score (95% CI 0.05 to 0.34 SD; p = 0.008). A likelihood ratio test for heterogeneity revealed that this relationship was consistent across countries (p = 0.17).

Conclusions: Our study provides evidence of the validity of using a simple household food access insecurity score to investigate the etiology of childhood growth faltering across diverse geographic settings. Such a measure could be used to direct interventions by identifying children at risk of illness and death related to malnutrition.

No MeSH data available.


Related in: MedlinePlus