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Title: Indirect effects of food insecurity on body mass index through feeding style and dietary quality among low-income Hispanic preschoolers

Author
item KAMDAR, NIPA - University Of Texas Health Science Center
item HUGHES, SHERYL - Children'S Nutrition Research Center (CNRC)
item CHAN, WENYAW - University Of Texas Health Science Center
item POWER, THOMAS - Washington State University
item MEININGER, JANET - University Of Texas Health Science Center

Submitted to: Journal of Nutrition Education and Behavior
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/26/2019
Publication Date: 4/8/2019
Citation: Kamdar, N., Hughes, S., Chan, W., Power, T.G., Meininger, J. 2019. Indirect effects of food insecurity on body mass index through feeding style and dietary quality among low-income Hispanic preschoolers. Journal of Nutrition Education and Behavior. https://doi.org/10.1016/j.jneb.2019.02.010.
DOI: https://doi.org/10.1016/j.jneb.2019.02.010

Interpretive Summary: Hispanic preschool aged children are at higher risk for obesity and food insecurity compared to non-Hispanic children. However, a direct link between obesity and food insecurity, lack of access to food due to restricted financial resources, remains unclear. It is possible that consumption of lower-cost but energy-dense foods is higher among individuals living in food insecure households. This may contribute to excess body mass over time. In addition, parents who are struggling with food insecurity may also engage in behaviors that contribute to childhood obesity. Research has shown that parental feeding behaviors could be affected by economic hardships. Thus, the current study examined if food insecurity affected long-term (18 months) child body mass index (BMI) via parental feeding demandingness and responsiveness and dietary quality. Specifically, the current study analyzed data previously collected (secondary data analysis) as part of an observational study. The data analysis included data collected at baseline (before any study procedures took place) and 18 months later from 137 self-identified Hispanic parent-preschooler dyads. Data analyzed included food insecurity (6-item Household Food Security Survey), child BMI (BMI z-score), child dietary quality (Healthy Eating Index), and parental feeding demandingness and responsiveness (Caregiver's Feeding Style Questionnaire). Overall, results did not identify and pathways between baseline food insecurity and child BMI at 18 months through either feeding demandingness/responsiveness or child dietary quality. Unexpectedly, results showed that food insecurity had a protective effect on children's dietary quality 18 months later. Further research into the long-term impact of early exposure to food insecurity on children and their parents is needed. In addition, further research is needed to distinguishing chronic from episodic food insecurity, especially in terms of the varying effects they may have on child outcomes.

Technical Abstract: To investigate whether food insecurity affects child body mass index (BMI) through parental feeding demandingness and/or responsiveness and dietary quality 18 months later among low-income Hispanic preschoolers. Secondary analysis of data at baseline and 18 months afterward. Houston, TX. Hispanic parent-preschooler dyads (n = 137). Food insecurity (6-item Household Food Security Survey), child BMI (BMI z-score), child dietary quality (Healthy Eating Index), and parental feeding demandingness and responsiveness (Caregiver's Feeding Style Questionnaire). Ordinary least-squares regression models and 95% bootstrapped confidence intervals (CIs) to estimate effects. Controlling for baseline child BMI, maternal acculturation, and maternal BMI, total indirect effects of food insecurity on child BMI through feeding demandingness, responsiveness, and subsequent child dietary quality were estimated to be 0.001 (95% bias-controlled bootstrap CI, -0.01 to 0.01). Confidence intervals for all indirect pathways straddled 0. As food insecurity worsened, child dietary quality 18 months after baseline improved (c = 1.06; 95% CI, 0.41-1.71). Food insecurity had no influence on child BMI through feeding demandingness/responsiveness and/or child dietary quality. Additional research is needed to examine why food insecurity had a protective effect on dietary quality 18 months later. This finding suggests the adoption of coping mechanisms.