Abstract
OBJECTIVES: To determine whether parent report of difficulty buying food was associated with child body mass index (BMI) z-score or with eating habits in young children.
METHODS: This was a cross-sectional study in primary care offices in Toronto, Ontario. Subjects were children aged 1–5 years and their caregivers, recruited through the TARGet Kids! Research Network from July 2008 to August 2011. Regression models were developed to test the association between parent report of difficulty buying food because of cost and the following outcomes: child BMI z-score, parent’s report of child’s intake of fruit and vegetables, fruit juice and sweetened beverages, and fast food. Confounders included child’s age, sex, birth weight, maternal BMI, education, ethnicity, immigration status, and neighbourhood income.
RESULTS: The study sample consisted of 3333 children. Data on difficulty buying food were available for 3099 children, and 431 of these (1 3.9%) were from households reporting difficulty buying food. There was no association with child BMI z-score (p = 0.86). Children from households reporting difficulty buying food (compared with never having difficulty buying food) had increased odds of consuming three or fewer servings of fruits and vegetables per day (odds ratio [OR]: 1.31, 95% confidence interval [CI]: 1.03–1.69), more than one serving of fruit juice/sweetened beverage per day (OR: 1.60, 95% CI: 1.28–2.00), and, among children 1–2 years old, one or more servings of fast food per week (OR: 2.91, 95% CI: 1.67–5.08).
CONCLUSION: Parental report of difficulty buying food is associated with less optimal eating habits in children but not with BMI z-score.
Key words: Child, obesity, diet, poverty, food supply
Résumé
OBJECTIFS: Déterminer si la difficulté indiquée par les parents d’acheter des aliments est associée à l’écart Z de l’indice de masse corporelle (IMC) ou aux habitudes alimentaires des jeunes enfants.
MÉTHODE: Il s’agissait d’une étude transversale menée dans des cabinets de soins primaires de Toronto (Ontario). Elle portait sur des enfants de 1 à 5 ans et leurs proches aidants, recrutés par le réseau de recherche TARGet Kids! entre juillet 2008 et août 2011. Des modèles de régression ont été mis au point pour tester l’association entre la difficulté indiquée par les parents d’acheter des aliments en raison de leur coût et les résultats suivants: l’écart Z de l’IMC des enfants, et la consommation de fruits et légumes, de jus de fruits, de boissons édulcorées et d’aliments de restauration rapide par les enfants selon les parents. Les facteurs confusionnels étaient l’âge, le sexe et le poids de naissance des enfants, l’IMC maternel, l’instruction, l’ethnicité, le statut d’immigration et le revenu selon le quartier.
RÉSULTATS: L’échantillon de l’étude comprenait 3 333 enfants, dont 431 (14,09 %) provenaient de ménages dont les parents disaient avoir de la difficulté à acheter des aliments. Aucune association n’a été observée avec l’écart Z de l’IMC des enfants (p = 0,86). Les enfants des ménages disant avoir de la difficulté à acheter des aliments (comparativement à ceux des ménages n’ayant jamais de difficulté à acheter des aliments) présentaient une probabilité accrue de consommer trois portions de fruits et légumes par jour ou moins (rapport de cotes [RC]: 1,31, intervalle de confiance de 95 % [IC]: 1,03–1,69), de consommer plus d’une portion de jus de fruit ou de boissons édulcorées par jour (RC: 1,60, IC de 95 %: 1,28–2,00) et, chez les enfants de 1 à 2 ans, de consommer une portion ou plus d’aliments de restauration rapide par semaine (RC: 2,91, IC de 95%: 1,67–5,08).
CONCLUSION: La difficulté indiquée par les parents d’acheter des aliments est associée à des habitudes alimentaires sous-optimales chez les enfants, mais pas avec l’écart Z de l’IMC.
Mots clés: enfant, obésité, régime alimentaire, pauvreté, approvisionnement en nourriture
Footnotes
Conflict of Interest: Parkin reports funding from Danone Institute of Canada (2002–2004, 2006–2009), Dairy Farmers of Ontario (2008–2010), and non-financial support from Mead Johnson Nutrition (2011–2017). Maguire and Parkin report funding from Dairy Farmers of Canada (2011–2013). These agencies had no role in the design, collection, analysis or interpretation of the results of this study or in the preparation, review or approval of the manuscript. The other authors have no conflict of interest to declare.
TARGet Kids! Collaboration Co-Leads: Catherine S. Birken, Jonathon L. Maguire; Advisory Committee: Eddy Lau, Andreas Laupacis, Patricia C. Parkin, Michael Salter, Peter Szatmari, Shannon Weir; Science Review and Management Committees: Laura N. Anderson, Cornelia M. Borkhoff, David W.H. Dai, Christine Kowal, Dalah Mason; Site Investigators: Murtala Abdurrahman, Barbara Anderson, Kelly Anderson, Gordon Arbess, Jillian Baker, Tony Barozzino, Sylvie Bergeron, Dimple Bhagat, Nicholas Blanchette, Gary Bloch, Joey Bonifacio, Ashna Bowry, Anne Brown, Jennifer Bugera, Caroline Calpin, Douglas Campbell, Sohail Cheema, Elaine Cheng, Brian Chisamore, Evelyn Constantin, Erin Culbert, Karoon Danayan, Paul Das, Mary Beth Derocher, Anh Do, Michael Dorey, Kathleen Doukas, Anne Egger, Allison Farber, Amy Freedman, Sloane Freeman, Sharon Gazeley, Charlie Guiang, Dan Ha, Shuja Hafiz, Curtis Handford, Laura Hanson, Leah Harrington, Hailey Hatch, Teresa Hughes, Sheila Jacobson, Lukasz Jagiello, Gwen Jansz, Mona Jasuja, Paul Kadar, Tara Kiran, Lauren Kitney, Holly Knowles, Bruce Kwok, Sheila Lakhoo, Margarita Lam-Antoniades, Eddy Lau, Fok-Han Leung, Alan Li, Patricia Li, Jennifer Loo, Joanne Louis, Sarah Mahmoud, Jessica Malach, Roy Male, Vashti Mascoll, Aleks Meret, Rosemary Moodie, JuliaMorinis,Maya Nader, Katherine Nash, Sharon Naymark, James Owen, Jane Parry,Michael Peer, Kifi Pena, Marty Perlmutar, Navindra Persaud, Andrew Pinto, Michelle Porepa, Vikky Qi, Nasreen Ramji, Noor Ramji, Jesleen Rana, Danyaal Raza, Alana Rosenthal, Katherine Rouleau, Janet Saunderson, Rahul Saxena, Vanna Schiralli, Michael Sgro, Hafiz Shuja, Susan Shepherd, Barbara Smiltnieks, Cinntha Srikanthan, Carolyn Taylor, Suzanne Turner, Fatima Uddin, Meta van den Heuvel, Joanne Vaughan, Thea Weisdorf, Sheila Wijayasinghe, Peter Wong, Anne Wormsbecker, Ethel Ying, Elizabeth Young, Michael Zajdman; Research Team: Farnaz Bazeghi, Vincent Bouchard, Marivic Bustos, Charmaine Camacho, Dharma Dalwadi, Christine Koroshegyi, Tarandeep Malhi, Sharon Thadani, Julia Thompson, Laurie Thompson; Project Team: Mary Aglipay, Imaan Bayoumi, Sarah Carsley, Katherine Cost, Karen Eny, Theresa Kim, Laura Kinlin, Jessica Omand, Shelley Vanderhout, Leigh Vanderloo; Applied Health Research Centre: Christopher Allen, Bryan Boodhoo, Olivia Chan, Judith Hall, Peter Juni, Gerald Lebovic, Karen Pope, Kevin Thorpe; Mount Sinai Services Laboratory: Rita Kandel.
References
- 1.Food and Agriculture Organization. An Introduction to the Basic Concepts of Food Security. New York, NY: Food and Agriculture Organization; 2008. [Google Scholar]
- 2.Government of Canada. The Household Food Security Survey Module (HFSSM). Ottawa, ON: Health Canada; 2012. [Google Scholar]
- 3.United States Department of Agriculture. U.S. Household Food Security Survey Module. Washington, DC: USDA Economic Research Service; 2012. [Google Scholar]
- 4.Health Canada. Household Food Insecurity in Canada. Ottawa, ON: Statistics Canada; 2013. [Google Scholar]
- 5.Tarasuk V, Mitchell A, Dachner N. Household Food Insecurity in Canada, 2014. Toronto, ON: Research to Identify Policy Options to Reduce food Insecurity (PROOF); 2016. [Google Scholar]
- 6.Grutzmacher S, Gross S. Household food security and fruit and vegetable intake among low-income fourth-graders. J Nutr Educ Behav. 2011;43:455–63. doi: 10.1016/j.jneb.2010.10.004. [DOI] [PubMed] [Google Scholar]
- 7.Cunningham TJ, Barradas DT, Rosenberg KD, May AL, Kroelinger CD, Ahluwalia IB. Is maternal food security a predictor of food and drink intake among toddlers in Oregon? Matern Child Health J. 2012;16(Suppl2):339–46. doi: 10.1007/s10995-012-1094-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Rose D, Bodor JN. Household food insecurity and overweight status in young school children: Results from the Early Childhood Longitudinal Study. Pediatrics. 2006;117:464–73. doi: 10.1542/peds.2005-0582. [DOI] [PubMed] [Google Scholar]
- 9.Kakinami L, Gauvin L, Seguin L, Lambert M, Nikiema B, Paradis G. Persistent and occasional poverty and children’s food consumption: Evidence from a longitudinal Quebec birth cohort. J Epidemiol Commun Health. 2014;68:987–92. doi: 10.1136/jech-2014-203951. [DOI] [PubMed] [Google Scholar]
- 10.Gross RS, Mendelsohn AL, Fierman AH, Racine AD, Messito MJ. Food insecurity and obesogenic maternal infant feeding styles and practices in low-income families. Pediatrics. 2012;130:254–61. doi: 10.1542/peds.2011-3588. [DOI] [PubMed] [Google Scholar]
- 11.Eisenmann JC, Gundersen C, Lohman BJ, Garasky S, Stewart SD. Is food insecurity related to overweight and obesity in children and adolescents? A summary of studies, 1995–2009. Obes Rev. 2011;12:e73–e83. doi: 10.1111/j.1467-789X.2010.00820.x. [DOI] [PubMed] [Google Scholar]
- 12.Kirkpatrick SI, Dodd KW, Parsons R, Ng C, Garriguet D, Tarasuk V. Household food insecurity is a stronger marker of adequacy of nutrient intakes among Canadian compared to American youth and adults. J Nutr. 2015;145:1596–603. doi: 10.3945/jn.114.208579. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Black JL, Billette JM. Do Canadians meet Canada’s Food Guide’s recommendations for fruits and vegetables? Appl Physiol Nutr Metab. 2013;38:234–42. doi: 10.1139/apnm-2012-0166. [DOI] [PubMed] [Google Scholar]
- 14.Randall Simpson J, Keller H. Nutrition Screening Tool for Every Preschooler (NutriSTEP): Validation and test-retest reliability of a parent-administered questionnaire assessing nutrition risk of preschoolers. Eur J Clin Nutr. 2008;62:770–80. doi: 10.1038/sj.ejcn.1602780. [DOI] [PubMed] [Google Scholar]
- 15.Morinis J, Maguire J, Khovratovich M, McCrindle BW, Parkin PC, Birken CS. Paediatric obesity research in early childhood and the primary care setting: The TARGet Kids! research network. Int J Environ Res Public Health. 2012;9:1343–54. doi: 10.3390/ijerph9041343. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.National Center for Health Statistics. Anthropometry and Physical Activity Monitor Procedures Manual. Atlanta, GA: US Department of Health and Human Services; 2005. [Google Scholar]
- 17.Borkhoff CM, Bayoumi I, Nurse K, Chen Y, Maguire JL, Birken CS, et al. A single NutriSTEP™ question as a food insecurity screening tool. 2016. [Google Scholar]
- 18.Hager ER, Quigg AM, Black MM, Coleman SM, Heeren T, Rose-Jacobs R, et al. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics. 2010;126:e26–e32. doi: 10.1542/peds.2009-3146. [DOI] [PubMed] [Google Scholar]
- 19.Pietrobelli A, Faith MS, Allison DB, Gallagher D, Chiumello G, Heymsfield SB. Body mass index as a measure of adiposity among children and adolescents: A validation study. J Pediatr. 1998;132:204–10. doi: 10.1016/S0022-3476(98)70433-0. [DOI] [PubMed] [Google Scholar]
- 20.Mei Z, Grummer-Strawn LM, Pietrobelli A, Goulding A, Goran MI, Dietz WH. Validity of body mass index compared with other body-composition screening indexes for the assessment of body fatness in children and adolescents. Am J Clin Nutr. 2002;75:978–85. doi: 10.1093/ajcn/75.6.978. [DOI] [PubMed] [Google Scholar]
- 21.de Onis M, Garza C, Victora C. The WHO Multicenter Growth Reference Study: Strategy for developing a new international growth reference. Forum Nutr. 2003;56:238–40. [PubMed] [Google Scholar]
- 22.Health Canada. Eating Well with Canada’s Food Guide. Ottawa, ON: Health Canada; 2016. [Google Scholar]
- 23.Anderson SE, Ramsden M, Kaye G. Diet qualities: Healthy and unhealthy aspects of diet quality in preschool children. Am J Clin Nutr. 2016;103:1507–13. doi: 10.3945/ajcn.115.128454. [DOI] [PubMed] [Google Scholar]
- 24.Statistics Canada. Comparison of Ethnic Origins Disseminated in 2006, 2001 and 1996. Ottawa, ON: Statistics Canada. Available at: http://wwwl2.statcan.gc.ca/census-recensement/2006/ref/dict/app-ann003-eng.cfm (Accessed May 2014).
- 25.Fuller-Thomson E, Noack AM, George U. Health decline among recent immigrants to Canada: Findings from a nationally-representative longitudinal survey. Can J Public Health. 2011;102:273–80. doi: 10.1007/BF03404048. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Wilkins R. Automated Geographic Coding Based on the Statistics Canada Postal Code Conversion Files, Including Postal Codes Through 2009. Ottawa, ON: Statistics Canada; 2010. [Google Scholar]
- 27.Norman GR, Streiner DL. Biostatistics: The Bare Essentials. Hamilton, ON: B.C. Decker; 2008. [Google Scholar]
- 28.Little RJA, Rubin DB. Statistical Analysis with Missing Data. Hoboken, NJ: John Wiley and Sons; 2002. [Google Scholar]
- 29.Harreil FE. Regression Modeling Stategies With Applications to Linear Models, Logistic Regression, and Survival Analysis. New York, NY: Springer; 2001. [Google Scholar]
- 30.Team RDC. R: A Language and Environment for Statistical Computer. Vienna, Autria: R Development Core Team; 2009. [Google Scholar]
- 31.Dubois L, Farmer A, Girard M, Porcherie M. Family food insufficiency is related to overweight among preschoolers. Soc Sci Med (1982) 2006;63:1503–16. doi: 10.1016/j.socscimed.2006.04.002. [DOI] [PubMed] [Google Scholar]
- 32.Mclntyre L, Bartoo AC, Pow J, Potestio ML. Coping with child hunger in Canada: Have household strategies changed over a decade? Can J Public Health. 2012;103:e428–32. doi: 10.1007/BF03405632. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Drewnowski A. Obesity and the food environment: Dietary energy density and diet costs. Am J PrevMed. 2004;27:154–62. doi: 10.1016/j.amepre.2004.06.011. [DOI] [PubMed] [Google Scholar]
- 34.Dubois L, Girard M. Social inequalities in infant feeding during the first year of life. The Longitudinal Study of Child Development in Quebec (LSCDQ 1998-2002) Public Health Nutr. 2003;6:773–83. doi: 10.1079/PHN2003497. [DOI] [PubMed] [Google Scholar]