1. Associations of Food Insecurity with Dietary Intake in Children of Mexican Descent: Results of a Binational Study
Lisa Goldman Rosas, PhD MPH: University of California San Francisco (UCSF)
Kim Harley, PhD MPH: UCSF
Lia H.C. Fernald, PhD MBA: UCSF
Sylvia Guendelman, PhD LCSW: UCSF
Fabiola Mejia, MS: National Institute of Public Health (NIPH)
Lynnette Neufeld, PhD: NIPH
Brenda Eskenazi, PhD: UCSF
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Rosas L, et al. J Am Diet Assoc. 2009;109 (December).

2. Associations of Food Insecurity with Dietary Intake in Children of Mexican Descent: Results of a Binational Study
Research Question
Study overview
Is household food insecurity associated with dietary intake among 5-year-old children of Mexican descent?
Does this association differ by place of residence (California/Mexico)?
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Rosas L, et al. J Am Diet Assoc. 2009; 109 (December).

3. Background: Food insecurity
Associations of Food Insecurity with Dietary Intake in Children of Mexican Descent: Results of a Binational Study
Background: Food insecurity
Baseline data
Definition: Limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire foods in socially acceptable ways
US: Twice as prevalent among Mexican-Americans vs general population (19% vs. 11%)*
Mexico: Little research, 2 studies suggest high**:
40% in urban area
97% in rural area
* 2006 current Population Survey of US Households
** Ortiz-Hernandez, 2007 & Melgar-Quinonez, 2005
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Rosas L, et al. J Am Diet Assoc. 2009;109 (December).

4. BMI & Psychosocial measures
Associations of Food Insecurity with Dietary Intake in Children of Mexican Descent: Results of a Binational Study
Binational Study Design
BMI & Psychosocial measures
CHAMACOS:
Mexican mothers & 5-yr-old children
Proyecto Mariposa:
Mothers & 5-yr-old children
Migrant receiving community, Salinas, CA
Most commonly from the states of Guanajuato, Jalisco and Michoacán
Recruited in clinics
Migrant sending communities in Guanajuato, Jalisco, Michoacán
Participants in Oportunidades, federal social welfare program
Recruited in clinics
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Rosas L, et al. J Am Diet Assoc. 2009;109 (December).

5. Measures: Food Insecurity
Associations of Food Insecurity with Dietary Intake in Children of Mexican Descent: Results of a Binational Study
Measures: Food Insecurity
Correlation matrix
US Dept. of Agriculture Household Food Security Scale (Short form, Spanish) in both sites:
The food we bought just didn’t last, and we didn’t have money to get more
We couldn’t afford to eat balanced meals
Do adults ever cut the size of meals or skip meals because there is not enough food?
Were you ever hungry because you couldn’t afford enough food?
Households classified as:
Secure
Low food security
Very low food security
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Rosas L, et al. J Am Diet Assoc. 2009;109 (December).

6. Measures: Weight Status
Associations of Food Insecurity with Dietary Intake in Children of Mexican Descent: Results of a Binational Study
Measures: Weight Status
Correlation matrix
Identical anthropometric protocols in each site
Calculated Body Mass Index (BMI) (kg/m2)
Compared children’s BMI with sex-specific BMI-for-age percentiles (CDC 2000)*:
*According to current guidelines, these categories are now: normal weight, overweight and obese
<85th % normal weight
> 85th % & < 95th % at risk for overweight
> 95th % overweight
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Rosas L, et al. J Am Diet Assoc. 2009;109 (December).

7. Measures: Dietary intake
Associations of Food Insecurity with Dietary Intake in Children of Mexican Descent: Results of a Binational Study
Measures: Dietary intake
Figure
Children’s diet:
Different food frequency questionnaires (FFQ):
CA: Harvard Service FFQ for Hispanic children
Mexico: FFQ developed by Instituto Nacional de Salud Publica
Same structure and response options, different food items
Total energy
Nutrients:
Fat
Saturated fat
Carbohydrates
Protein
Food groups:
Vegetables
Fruit
Bread
Cereals, grains
Dairy
Meat
Sweetened beverages
Fast food
Sweets/snacks
Fiber
Cholesterol
Sodium
Vitamin A, E, C,
B6, B12
Folate
Calcium
Magnesium
Potassium
Iron
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Rosas L, et al. J Am Diet Assoc. 2009;109 (December).

8. Socio-demographic characteristics
Associations of Food Insecurity with Dietary Intake in Children of Mexican Descent: Results of a Binational Study
Socio-demographic characteristics
Figure
Characteristic
California
(CHAMACOS)
Mexico
(Proyecto Mariposa)
Female
53%
Breastmilk only at least 6 months
12%
32%
Mother overweight/obese
87%
75%
Mother elementary school or less
50%
69%
Mother work
46%
28%
Mother years in the US
5-10
56%
11-15
16+
18%
Family member currently in US
44%
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Rosas L, et al. J Am Diet Assoc. 2009;109 (December).

9. Data analysis: Food insecurity & dietary intake
Associations of Food Insecurity with Dietary Intake in Children of Mexican Descent: Results of a Binational Study
Data analysis: Food insecurity & dietary intake
Figure
Children with implausible total energy values excluded
Diet variables transformed to approximate a normal distribution
Test for differences in diet by food security status:
Unadjusted & adjusted ANOVA
Multiple comparisons
Separate models for CA & Mexico because of significant interaction
Test for trend in diet by food security status
All analyses conducted using STATA 10.0
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Rosas L, et al. J Am Diet Assoc. 2009;109 (December).

10. Household Food Insecurity
Associations of Food Insecurity with Dietary Intake in Children of Mexican Descent: Results of a Binational Study
Household Food Insecurity
Figure
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Rosas L, et al. J Am Diet Assoc. 2009;109 (December).

11. Food security status & macronutrients: California (n=301)
Associations of Food Insecurity with Dietary Intake in Children of Mexican Descent: Results of a Binational Study
Food security status & macronutrients: California (n=301)
Figure
Daily nutrient intake
(Median)
Secure
Low food security
Very low food security
ANOVA
Adjusted ANOVA
Energy (kcal)
1897.3
2114.2
2042.4 *
Fat (g)
61.0
68.2
71.5
Saturated Fat (g)
23.3
26.3
27.6
Carbohydrate (g)
275.8
309.2
291.7
Protein (g)
66.9
73.0
Adjusted for SESa, maternal education, receiving food assistance and mother currently working in farmwork
Test for trend significant for all above nutrients
* Significant p<0.05 a. SES = socio-economic status
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Rosas L, et al. J Am Diet Assoc. 2009; 109 (December).

12. Food security status & macronutrients: Mexico (n=301)
Associations of Food Insecurity with Dietary Intake in Children of Mexican Descent: Results of a Binational Study
Food security status & macronutrients: Mexico (n=301)
Figure
Daily nutrient intake
(Median)
Secure
Low food security
Very low food security
ANOVA
Adjusted ANOVA
Energy (kcal)
1631.7
1521.9
1356.6 *
Fat (g)
45.5
41.5
39.3
Saturated Fat (g)
12.2
11.1
9.8
Carbohydrate (g)
277.3
244.2
219.6
Protein (g)
44.4
42.7
39.2
Adjusted for SESa and maternal education
Test for trend significant for all above nutrients
* Significant p<0.05
a. SES = socio-economic status
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Rosas L, et al. J Am Diet Assoc. 2009;109 (December).

13. Food Security & food groups: California & Mexico
Associations of Food Insecurity with Dietary Intake in Children of Mexican Descent: Results of a Binational Study
Food Security & food groups: California & Mexico
Conclusions
Adj. ANOVA <
ANOVA <
California
Mexico
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Rosas L, et al. J Am Diet Assoc. 2009;109 (December).

14. Conclusion Conclusions Association of Food insecurity with: California
Associations of Food Insecurity with Dietary Intake in Children of Mexican Descent: Results of a Binational Study
Conclusion
Conclusions
Association of Food insecurity with:
California
(CHAMACOS)
Mexico
(Proyecto Mariposa)
Dietary intake
 energy, fat*, sweets & snacks*
 energy, carbohydrates*, dairy*, meat, fruit
*Significant in adjusted analysis
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Rosas L, et al. J Am Diet Assoc. 2009;109 (December).

15. Thank you to our funders:
Associations of Food Insecurity with Dietary Intake in Children of Mexican Descent: Results of a Binational Study
Thank you to our funders:
Conclusions
W.K. Kellogg Health Scholars
National Institute of Environmental Health Sciences (PO1 ES009605)
Environmental Protection Agency (RD )
UC-Mexus & Health Initiative of the Americas (PIMSA)
Center for Latino Policy Research, UC Berkeley
UC-Mexus Dissertation Grant
Institute for the Study of Social Change, UC Berkeley
Tinker Fellowship, Center for Latino Policy Studies, UC Berkeley
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION
Rosas L, et al. J Am Diet Assoc. 2009;109 (December).