297 - Associations Between Food Insecurity, Social Vulnerability, and Growth Outcomes in Children with Food Allergies

Publication Number: 2287.297

Kelly Staples, Childrens Hospital of Philadelphia, Haddonfield, NJ, United States; Amy Dean, CHOP, Phila, PA, United States; Terri Brown-Whitehorn, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Alexandra Navard-Keck, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Food insecurity is common among families managing pediatric food allergies, compounding challenges in accessing nutritionally adequate, allergen-free foods. Limited data exists on how food insecurity and resource utilization, such as Women, Infants, and Children (WIC) participation, relate to nutritional outcomes and social vulnerability in this population.

Objective: To assess associations between food insecurity risk, WIC use, social vulnerability, and nutritional outcomes among pediatric patients with food allergies.

Design/Methods: This descriptive analysis included patients aged 0-19 years evaluated in a food allergy clinic and seen by an allergy-registered dietitian. Families completed the standardized Hunger Vital Signs (HVS) questionnaire to assess food insecurity; positive screens indicated any level of food insecurity. Social Vulnerability Index (SVI) was assigned by patient zip code. Descriptive analyses, including chi-square test and odds ratios (OR) were performed.

Results: Participant demographics including WIC and SVI data are summarized in Table 1. Significant associations (p < 0.05) were observed between WIC usage and high SVI (OR 4.17, graph 1), positive HVS screening and elevated weight-for-length Z-scores (OR 4.46, graph 2), and WIC usage and elevated Z-scores (OR 8.00, graph 2). Allergen data was also collected (table 1).

Conclusion(s): Patients identified as at risk for food insecurity through a positive HVS screen, WIC participation, or high SVI, demonstrated higher odds of being overweight, aligning with prior literature linking food insecurity to imbalanced nutrition and excess weight. While WIC participation was associated with higher SVI, findings suggest that current WIC offerings may not adequately address the nutritional needs of children with food allergies due to few allergen-free options. Recent efforts have expanded screening for food insecurity in patients with food allergies, and an allergen-friendly food pantry was established in clinic. Using the Model for Improvement framework to address nutritional risk, we aim to expand dietitian access for food allergy patients at risk for food insecurity, with 80% of interested families completing a visit within 3 months by December 2026. Enhancing dietician access is critical for these families, as prior studies highlight food insecurity as an important indication for dietician referral. Further research is warranted to evaluate the adequacy and perceived helpfulness of WIC resources for food allergy populations.

Table 1
Participant demographics including self-reported age, sex, race, ethnicity, and Women, Infants, and Children (WIC) usage. Assigned Social Vulnerability Index (SVI) and collected Hunger Vital Signs (HVS) data included. Allergen data of the top three allergens in each subgroup included. Values are presented as counts (percentages) with associated n value. The asterisks (**) indicates a statistically significant association between self-reporting as Hispanic or Latino ethnicity and having a high SVI as determined by chi-square testing (p < 0.001).

Graph 1
Association between Women, Infants, and Children (WIC) program participation and Social Vulnerability Index (SVI). The asterisk (*) indicates a statistically significant association (P < 0.05), with higher SVI observed among WIC participants.

Graph 2
Scatter plots comparing weight-for-length Z-scores across three subgroups: (A) Women, Infants, and Children (WIC) participation, (B) Social Vulnerability Index (SVI), and (C) Hunger Vital Signs (HVS) screening. Mean Z-scores were 0.003 for non-WIC and 0.7 for WIC, 0.07 for low SVI and 0.38 for high SVI, and -0.003 for negative HVS screening and 0.6 for positive HVS screening, respectively. Asterisks denote statistically significant differences between groups (*P < 0.05; **P < 0.001).