Abstract
Objective: The contribution of nutrition to health inequalities is poorly understood, particularly with regard to children. The objective of this study was to examine the influence of income and the conjoint influence of low income and food insecurity on several dietary indicators in a representative sample of Canadian youth.
Methods: We used data from the Canadian Community Health Survey (CCHS) Cycle 2.2, a nationally representative population-based sample, to examine the diets of 8,938 youth aged 9–18 years. A single 24-hour recall was used to collect dietary information. Interviews were conducted in person, and anthropometric measurements were available for 71% of the sample. Estimates of variance were calculated using bootvar with weights specific to the CCHS. Generalized linear models were used to examine the associations between both low income and low-income food insecurity and anthropometric measures, food and nutrient intakes.
Results: Youth from low-income households had lower height percentiles than youth from higher-income households. Low-income girls (but not low-income boys) had a higher prevalence of BMI ≥85th percentile than their higher-income counterparts. Among low-income food-insecure households, there was a higher prevalence of BMI ≥85th percentile in boys than among the food-secure low-income boys. Calcium and vitamin D intakes were lower among boys and girls living in low-income households. Similarly, milk consumption was lower in low-income boys. Low-income food-insecure girls had lower milk intakes and higher intake of sweetened beverages.
Conclusions: We found some evidence of nutritional deprivation among Canadian youth from disadvantaged households. Longer-term indicators of nutritional status such as lower height and greater weight among disadvantaged households were consistent with these findings.
Keywords: Children, adolescent, diet, household income, food insecurity
Résumé
Objectif: Le faible statut socioéconomique est associé à une moins bonne santé à tous les âges au Canada. Le rôle de la nutrition dans les inégalités en santé est mal compris, surtout chez les enfants. Nous avons cherché à examiner l’influence du revenu et l’influence conjointe du faible revenu et de l’insécurité alimentaire sur plusieurs indicateurs alimentaires au sein d’un échantillon représentatif de jeunes Canadiens.
Méthode: Nous avons utilisé les données du cycle 2.2 de l’Enquête sur la santé dans les collectivités canadiennes (ESCC), un échantillon représentatif de la population du pays, pour examiner le régime alimentaire de 8 938 jeunes de 9 à 18 ans. L’information sur le régime a été recueillie à l’aide d’une feuille de rappel des aliments ingérés pendant les 24 dernières heures. Les entretiens ont eu lieu en personne, et des mesures anthropométriques ont pu être prises sur 71 % de l’échantillon. Les estimations de la variance ont été calculées à l’aide du programme Bootvar avec des pondérations propres à l’ESCC. Des modèles linéaires généralisés ont servi à examiner les associations entre le faible revenu, et l’insécurité alimentaire combinée au faible revenu, et les mesures anthropométriques, les aliments ingérés et les apports en nutriments.
Résultats: Les jeunes des ménages à faible revenu se situaient dans des centiles de taille inférieurs à ceux des jeunes de ménages à revenu élevé. Les filles des ménages à faible revenu (mais pas les garçons) présentaient une plus forte prévalence d’IMC ≥85e centile que les filles des ménages à revenu élevé. Dans les ménages à faible revenu souffrant d’insécurité alimentaire, il y avait une plus forte prévalence d’IMC ≥85e centile chez les garçons que dans les ménages à faible revenu sans insécurité alimentaire. Les apports en calcium et en vitamine D étaient plus faibles chez les garçons et les filles vivant au sein de ménages à faible revenu. De même, la consommation de lait était inférieure chez les garçons des ménages à faible revenu. Les filles des ménages à faible revenu vivant une insécurité alimentaire consommaient proportionnellement moins de lait et plus de boissons édulcorées.
Conclusion: Dans un échantillon représentatif, nous avons trouvé des indices de défavorisation nutritionnelle chez les jeunes Canadiens vivant dans des ménages défavorisés. Les indicateurs à plus long terme de l’état nutritionnel, comme la taille inférieure et le poids supérieur dans les ménages défavorisés, étaient conformes à ces constatations.
Mots clés: enfant, adolescent, régime alimentaire, revenu du ménage, insécurité, alimentaire
Footnotes
Acknowledgement: This study was funded by the Canadian Institutes of Health Research.
Conflict of Interest: None to declare.
References
- 1.James PD, Wilkins R, Detsky AS, Tugwell P, Manuel DG. Avoidable mortality by neighbourhood income in Canada: 25 years after the establishment of universal health insurance. J Epidemiol Community Health. 2007;61(4):287–96. doi: 10.1136/jech.2006.047092. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Williams DR, Collins C. US socioeconomic and racial differences in health: Patterns and explanations. Annu Rev Sociol. 1995;21(1):349–86. doi: 10.1146/annurev.so.21.080195.002025. [DOI] [Google Scholar]
- 3.Shah CP, Kahan M, Krauser J. The health of children of low-income families. CMAJ. 1987;137(6):485–90. [PMC free article] [PubMed] [Google Scholar]
- 4.Lynch JW, Kaplan GA, Salonen JT. Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. Soc Sci Med. 1997;44(6):809–19. doi: 10.1016/S0277-9536(96)00191-8. [DOI] [PubMed] [Google Scholar]
- 5.Vozoris NT, Tarasuk VS. Household food insufficiency is associated with poorer health. J Nutr. 2003;133(1):120–26. doi: 10.1093/jn/133.1.120. [DOI] [PubMed] [Google Scholar]
- 6.Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al. Body-mass index and cause-specific mortality in 900 000 adults: Collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–96. doi: 10.1016/S0140-6736(09)60318-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Alamian A, Paradis G. Clustering of chronic disease behavioral risk factors in Canadian children and adolescents. Prev Med. 2009;48(5):493–99. doi: 10.1016/j.ypmed.2009.02.015. [DOI] [PubMed] [Google Scholar]
- 8.Darmon N, Drewnowski A. Does social class predict diet quality? Am J Clin Nutr. 2008;87(5):1107–17. doi: 10.1093/ajcn/87.5.1107. [DOI] [PubMed] [Google Scholar]
- 9.Kirkpatrick SI, Tarasuk V. Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents. J Nutr. 2008;138(3):604–12. doi: 10.1093/jn/138.3.604. [DOI] [PubMed] [Google Scholar]
- 10.Kendall A, Olson CM, Frongillo EA., Jr. Validation of the Radimer/Cornell measures of hunger and food insecurity. J Nutr. 1995;125(11):2793–801. doi: 10.1093/jn/125.11.2793. [DOI] [PubMed] [Google Scholar]
- 11.Starkey LJ, Kuhnlein HV, Gray-Donald K. Food bank users: Sociodemograph-ic and nutritional characteristics. CMAJ. 1998;158(9):1143–49. [PMC free article] [PubMed] [Google Scholar]
- 12.Mark S, Gray-Donald K, Delvin EE, O’Loughlin J, Paradis G, Levy E, Lambert M. Low vitamin D status in a representative sample of youth from Quebec, Canada. Clin Chem. 2008;54(8):1283–89. doi: 10.1373/clinchem.2008.104158. [DOI] [PubMed] [Google Scholar]
- 13.Roth DE, Martz P, Yeo R, Prosser C, Bell M, Jones AB. Are national vitamin D guidelines sufficient to maintain adequate blood levels in children? Can J Public Health. 2005;96(6):443–49. doi: 10.1007/BF03405185. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Langlois K, Greene-Finestone L, Little J, Hidiroglou N, Whiting S. Vitamin D status of Canadians as measured in the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 2010;21(1):46–55. [PubMed] [Google Scholar]
- 15.Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: A systematic review. Am J Clin Nutr. 2006;84(2):274–88. doi: 10.1093/ajcn/84.2.274. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Van Duyn MA, Pivonka E. Overview of the health benefits of fruit and vegetable consumption for the dietetics professional: Selected literature. J Am Diet Assoc. 2000;100(12):1511–21. doi: 10.1016/S0002-8223(00)00420-X. [DOI] [PubMed] [Google Scholar]
- 17.Health Canada. Eating Well with Canada’s Food Guide. Ottawa, ON: Health Canada; 2007. [Google Scholar]
- 18.Institute of Medicine FoodNutrition Board; Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients) Washington, DC: National Academy Press; 2005. [Google Scholar]
- 19.Canadian Fitness and Lifestyle Research Institute. 2009. Available at: http://www.cflri.ca/eng/index.php (Accessed August 2009).
- 20.Office of Nutrition PolicyPromotion. Income-related household food security in Canada. Ottawa, ON: Health Canada; 2007. [Google Scholar]
- 21.CDC. 2000 CDC Growth Charts: United States. 2007. [Google Scholar]
- 22.Institute of Medicine FoodNutrition Board Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary Reference Intakes for Calcium and Vitamin D. 2010. Washington: IOM. [Google Scholar]
- 23.Bhattacharya J, Currie J, Haider S. Poverty, food insecurity, and nutritional outcomes in children and adults. J Health Econ. 2004;23(4):839–62. doi: 10.1016/j.jhealeco.2003.12.008. [DOI] [PubMed] [Google Scholar]
- 24.Casey PH, Szeto K, Lensing S, Bogle M, Weber J. Children in food-insufficient, low-income families: Prevalence, health, and nutrition status. Arch Pediatr Adolesc Med. 2001;155(4):508–14. doi: 10.1001/archpedi.155.4.508. [DOI] [PubMed] [Google Scholar]
- 25.Miech RA, Kumanyika SK, Stettler N, Link BG, Phelan JC, Chang VW. Trends in the association of poverty with overweight among US adolescents, 1971–2004. JAMA. 2006;295(20):2385–93. doi: 10.1001/jama.295.20.2385. [DOI] [PubMed] [Google Scholar]
- 26.Wang Y, Beydoun MA. The Obesity Epidemic in the United States—Gender, Age, Socioeconomic, Racial/Ethnic, and Geographic Characteristics: A Systematic Review and Meta-Regression Analysis. Epidemiol Rev. 2007;29(1):6–28. doi: 10.1093/epirev/mxm007. [DOI] [PubMed] [Google Scholar]
- 27.Weng FL, Shults J, Leonard MB, Stallings VA, Zemel B. Risk factors for low serum 25-hydroxyvitamin D concentrations in otherwise healthy children and adolescents. Am J Clin Nutr. 2007;86(1):150–58. doi: 10.1093/ajcn/86.1.150. [DOI] [PubMed] [Google Scholar]
- 28.O’Loughlin JL, Paradis G, Gray-Donald K, Renaud L. The impact of a community-based heart disease prevention program in a low-income, inner-city neighborhood. Am J Public Health. 1999;89(12):1819–26. doi: 10.2105/AJPH.89.12.1819. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Van Lenthe FJ, Boreham CA, Twisk JWR, Strain JJ, Savage JM, Smith GD. Socio-economic position and coronary heart disease risk factors in youth. Eur J Public Health. 2001;11:43–50. doi: 10.1093/eurpub/11.1.43. [DOI] [PubMed] [Google Scholar]
- 30.Silventoinen K. Determinants of variation in adult body height. J Biosoc Sci. 2003;35(02):263–85. doi: 10.1017/S0021932003002633. [DOI] [PubMed] [Google Scholar]
- 31.Cole TJ. The secular trend in human physical growth: A biological view. Econ Hum Biol. 2003;1(2):161–68. doi: 10.1016/S1570-677X(02)00033-3. [DOI] [PubMed] [Google Scholar]
- 32.Stunkard AJ, Sorensen TI. Obesity and socioeconomic status—a complex relation. N Engl J Med. 1993;329(14):1036–37. doi: 10.1056/NEJM199309303291411. [DOI] [PubMed] [Google Scholar]
- 33.Sobal J, Stunkard AJ. Socioeconomic status and obesity: A review of the literature. Psychol Bull. 1989;105(2):260–75. doi: 10.1037/0033-2909.105.2.260. [DOI] [PubMed] [Google Scholar]
- 34.Zhang Q, Wang Y. Socioeconomic inequality of obesity in the United States: Do gender, age, and ethnicity matter? Soc Sci Med. 2004;58(6):1171–80. doi: 10.1016/S0277-9536(03)00288-0. [DOI] [PubMed] [Google Scholar]
- 35.Dayle JB, McIntyre L, Raine-Travers KD. The dragnet of children’s feeding programs in Atlantic Canada. Soc Sci Med. 2000;51(12):1783–93. doi: 10.1016/S0277-9536(00)00110-6. [DOI] [PubMed] [Google Scholar]
- 36.Boivin JF, Roy E, Haley N, Galbaud du Fort G. The health of street youth: A Canadian perspective. Can J Public Health. 2005;96(6):432–37. doi: 10.1007/BF03405183. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Dachner N, Tarasuk V. Homeless “squeegee kids”: Food insecurity and daily survival. Soc Sci Med. 2002;54(7):1039–49. doi: 10.1016/S0277-9536(01)00079-X. [DOI] [PubMed] [Google Scholar]
- 38.Beaton GH, Milner J, Corey P, McGuire V, Cousins M, Stewart E, et al. Sources of variance in 24-hour dietary recall data: Implications for nutrition study design and interpretation. Am J Clin Nutr. 1979;32(12):2546–49. doi: 10.1093/ajcn/32.12.2546. [DOI] [PubMed] [Google Scholar]
- 39.Livingstone MB, Robson PJ. Measurement of dietary intake in children. Proc Nutr Soc. 2000;59(2):279–93. doi: 10.1017/S0029665100000318. [DOI] [PubMed] [Google Scholar]