615 - Food Insecurity Risk During Infancy and Weight Through Age 6 Years

Publication Number: 3596.615

Felice Le-Scherban, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States; Jeffrey Moore, Drexel University, Philadelphia, PA, United States; Kelly A. Courts, Drexel University College of Medicine, Philadelphia, PA, United States; Matthew jannetti, Drexel University, Dornsife School of Public Health, Urban Health Collaborative, Philadelphia, PA, United States; Stephanie Mayne, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Janani Ramachandran, Childrens Hospital of Philadelphia, Houston, TX, United States; Alexander G. Fiks, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Hans B. Kersten, St. Christopher's Hospital for Children, Philadelphia, PA, United States

Background: Both insufficient and rapid growth in infancy and early childhood put children at risk for future obesity and poor health. Food insecurity-inadequate access to enough food for every person in a household to live an active, healthy life-threatens this critical early childhood growth and can put children at risk for poor short- and long-term health, even when experienced at low levels. However, longitudinal evidence on longer-term impacts on growth of food insecurity during infancy is limited.

Objective: Assess whether food insecurity at age 0-6 months predicts height-adjusted weight through age 6 years, as well as subpopulation and temporal variation in the association.

Design/Methods: Using 2010-2024 electronic health record data from primary care patients at two pediatric health systems in the Philadelphia, PA, metro area (n=29,899 children; n=409,757 visits), we examined associations of household food insecurity risk at age 0-6 months with weight-for-age z-score (WAZ) through age 6 years. Food insecurity risk was measured using the 2-item Hunger Vital Sign(TM) screener. We used covariate-adjusted linear random intercept models, stratified by age group ( < 2 years, 2-6 years). We used interaction terms and stratification to test effect modification by sociodemographics, time period (pre- vs. post-onset of COVID pandemic), and health system.

Results: The sample was diverse in race and ethnicity (44% Black non-Latino, 28% white non-Latino, 13% Latino, 15% other race/ethnicity) and insurance status (64% public, 33% private, 3% other/multiple). Four percent had a positive food insecurity screen at age 0-6 months. Overall, positive food insecurity screen at age 0-6 months was associated with slightly higher WAZ later in childhood (adjusted difference = 0.05 [95% CI 0.02-0.08] for age < 2 years, 0.11 [0.08-0.15] for age 2-6 years). However, associations varied by subpopulation (Figure 1). In particular, there were larger differences in WAZ associated with positive infancy food insecurity screen among White non-Latino and Asian non-Latino children than among Black non-Latino and Latino children.

Conclusion(s): Household food insecurity risk in infancy was associated with higher height-adjusted weight through age 6. However, variation in estimates between subpopulations suggests multiple factors that may contribute to or mitigate future health risk associated with food insecurity. Identifying interventions to bolster mitigating factors may complement efforts to reduce food insecurity at this critical life stage to protect children's healthy growth.

Figure 1. Positive food insecurity screen at age 0-6 months was associated with higher weight-for-age z-score through age 2 and at age 2-6 years.
From random-intercept linear regression models stratified by age group and adjusted for age, sex, birthweight, race/ethnicity, insurance type, and height-for-age z-score.