Association of food insecurity with dietary intakes and nutritional biomarkers among US children, National Health and Nutrition Examination Survey (NHANES) 2011-2016

Abstract

Background: Food insecurity is associated with poorer nutrient intakes from food sources and lower dietary supplement use. However, its association with total usual nutrient intakes, inclusive of dietary supplements, and biomarkers of nutritional status among US children remains unknown.

Objective: The objective was to assess total usual nutrient intakes, Healthy Eating Index-2015 (HEI-2015) scores, and nutritional biomarkers by food security status, sex, and age among US children.

Methods: Cross-sectional data from 9147 children aged 1-18 y from the 2011-2016 NHANES were analyzed. Usual energy and total nutrient intakes and HEI-2015 scores were estimated using the National Cancer Institute method from 24-h dietary recalls.

Results: Overall diet quality was poor, and intakes of sodium, added sugars, and saturated fat were higher than recommended limits, regardless of food security status. Food-insecure girls and boys were at higher risk of inadequate intakes for vitamin D and magnesium, and girls also had higher risk for inadequate calcium intakes compared with their food-secure counterparts, when total intakes were examined. Choline intakes of food-insecure children were less likely to meet the adequate intake than those of their food-secure peers. No differences by food security status were noted for folate, vitamin C, iron, zinc, potassium, and sodium intakes. Food-insecure adolescent girls aged 14-18 y were at higher risk of micronutrient inadequacies than any other subgroup, with 92.8% (SE: 3.6%) at risk of inadequate intakes for vitamin D. No differences in biomarkers for vitamin D, folate, iron, and zinc were observed by food security status. The prevalence of iron deficiency was 12.7% in food-secure and 12.0% in food-insecure adolescent girls.

Conclusions: Food insecurity was associated with compromised intake of some micronutrients, especially among adolescent girls. These results highlight a need for targeted interventions to improve children's overall diet quality, including the reduction of specific nutrient inadequacies, especially among food-insecure children. This study was registered at clinicaltrials.gov as NCT03400436.

Keywords: Healthy Eating Index; NHANES; children; food security; iron deficiency; total usual nutrient intake.

FIGURE 1

Estimated percentage of nutrient biomarker concentrations below the at-risk cutoffs among US children by sex and food security status, NHANES 2011–2016. Values are percentage ± SE. Serum 25(OH)D data were only available in the 2011–2014 NHANES and were adjusted for season (winter and summer). Serum zinc data were limited to the one-third subsample and the cutoffs for assessing the risk of zinc deficiency were as follows: children <10 y (65 μg/dL, morning/nonfasting; 57 μg/dL, afternoon), females aged 10 y and older (70 μg/dL, morning/fasting; 66 μg/dL, morning/fasting; 59 μg/dL, afternoon), and males aged 10 y and older (74 μg/dL, morning/fasting; 70 μg/dL, morning/fasting; 61 μg/dL, afternoon). Serum ferritin and soluble transferrin data were only available for specific sex and age groups in the 2015–2016 NHANES. Iron deficiency based on total body iron was determined as <0 mg/kg. No significant differences between the food-secure and the food-insecure by sex, based on t-test, P < 0.05. 25(OH)D, 25-hydroxyvitamin D.