Cross-Sectional and Longitudinal Associations between Household Food Security and Child Anthropometry at Ages 5 and 8 Years in Ethiopia, India, Peru, and Vietnam

Abstract

Background: Poor childhood nutritional status has lifetime effects and food insecurity is associated with dietary practices that can impair nutritional status.

Objectives: We assessed concurrent and subsequent associations between food insecurity and height-for-age z scores (HAZs) and body mass index-for-age z scores (BMI-Zs); evaluated associations with transitory and chronic food insecurity; and tested whether dietary diversity mediates associations between food insecurity and nutritional status.

Methods: We used data from the Young Lives younger cohort composed of children in Ethiopia (n = 1757), India (n = 1825), Peru (n = 1844), and Vietnam (n = 1828) recruited in 2002 (round 1) at ∼1 y old, with subsequent data collection at 5 y in 2006 (round 2) and 8 y in 2009 (round 3).

Results: Children from food-insecure households had significantly lower HAZs in all countries at 5 y (Ethiopia, -0.33; India, -0.53; Peru, -0.31; and Vietnam, -0.68 HAZ; all P < 0.001), although results were attenuated after controlling for potential confounders (Ethiopia, -0.21; India, -0.32; Peru, -0.14; and Vietnam, -0.27 HAZ; P < 0.01). Age 5 y food insecurity predicted the age 8 y HAZ, but did not add predictive power beyond HAZ at age 5 y in Ethiopia, India, or Peru. Age 5 y food insecurity predicted the age 8 y BMI-Z even after controlling for the 5 y BMI-Z, although associations were not significant after the inclusion of additional confounding variables (Ethiopia, P = 0.12; India, P = 0.29; Peru, P = 0.16; and Vietnam, P = 0.51). Chronically food-insecure households had significantly lower HAZs than households that were consistently food-secure, although BMI-Zs did not differ by chronic food-insecurity status. Dietary diversity mediated 18.8-30.5% of the association between food security and anthropometry in Vietnam, but mediated to a lesser degree (8.4-19.3%) in other countries.

Conclusions: In 4 countries, food insecurity at 5 y of age was associated with both HAZ and BMI-Z at age 8 y, although the association was attenuated after adjusting for other household factors and anthropometry at age 5 y, and remained significant only for the HAZ in Vietnam.

Keywords: child growth; dietary diversity; household food security; longitudinal cohort study; weight gain.

FIGURE 1

Conceptual framework of household food security and child anthropometry. Boxes with dashed borders represent the independent variables that were tested in the models. Thick-bordered boxes are the dependent variables. Child characteristics were included in age- and sex-adjusted models. Household, community, and child characteristics were included in fully adjusted models. Double arrows represent the associations that were explored: food security and concurrent anthropometry (1); dietary diversity as a mediator of concurrent anthropometry (1a); and food security and future anthropometry (2). ¹Paternal height also influences child anthropometry; however, paternal height was lacking for many children across the 4 countries and it was not included in this analysis. BMI-Z, body mass index–for age z score; HAZ, height-for-age z score.

FIGURE 2

Anthropometric measures at age 8 y in the Young Lives younger cohort, by persistence of food insecurity and country. Mean HAZ (A) and BMI-Z (B), adjusted for age and sex, by experience of food security at ages 5 y and 8 y. Values are means ± 95% CIs. Sample size: Ethiopia, n = 1757; India, n = 1825; Peru, n = 1844; and Vietnam, n = 1828. Bars within a country with different letters are significantly different, P < 0.05. BMI-Z, body mass index–for-age z score; HAZ, height-for-age z score.