Cook John T, Frank Deborah A, Berkowitz Carol, Black Maureen M, Casey Patrick H, Cutts Diana B, Meyers Alan F, Zaldivar Nieves, Skalicky Anne, Levenson Suzette, Heeren Tim, Nord Mark
Boston University School of Medicine, Department of Pediatrics, MA, USA.
J Nutr. 2004 Jun;134(6):1432-8. doi: 10.1093/jn/134.6.##.
The U.S. Household Food Security Scale, developed with federal support for use in national surveys, is an effective research tool. This study uses these new measures to examine associations between food insecurity and health outcomes in young children. The purpose of this study was to determine whether household food insecurity is associated with adverse health outcomes in a sentinel population ages < or = 36 mo. We conducted a multisite retrospective cohort study with cross-sectional surveys at urban medical centers in 5 states and Washington DC, August 1998-December 2001. Caregivers of 11,539 children ages < or = 36 mo were interviewed at hospital clinics and emergency departments (ED) in central cities. Outcome measures included child's health status, hospitalization history, whether child was admitted to hospital on day of ED visit (for subsample interviewed in EDs), and a composite growth-risk variable. In this sample, 21.4% of households were food insecure (6.8% with hunger). In a logistic regression, after adjusting for confounders, food-insecure children had odds of "fair or poor" health nearly twice as great [adjusted odds ratio (AOR) = 1.90, 95% CI = 1.66-2.18], and odds of being hospitalized since birth almost a third larger (AOR = 1.31, 95% CI = 1.16-1.48) than food-secure children. A dose-response relation appeared between fair/poor health status and severity of food insecurity. Effect modification occurred between Food Stamps and food insecurity; Food Stamps attenuated (but did not eliminate) associations between food insecurity and fair/poor health. Food insecurity is associated with health problems for young, low-income children. Ensuring food security may reduce health problems, including the need for hospitalizations.
在美国联邦政府支持下开发用于全国性调查的美国家庭粮食安全量表,是一种有效的研究工具。本研究使用这些新指标来检验幼儿粮食不安全状况与健康结果之间的关联。本研究的目的是确定家庭粮食不安全状况是否与年龄小于或等于36个月的哨点人群的不良健康结果相关。我们于1998年8月至2001年12月在5个州的城市医疗中心和华盛顿特区进行了一项多地点回顾性队列研究,并开展了横断面调查。在中心城市的医院诊所和急诊科对11539名年龄小于或等于36个月儿童的照料者进行了访谈。结果指标包括儿童的健康状况、住院史、在急诊科就诊当天是否住院(针对在急诊科接受访谈的子样本)以及一个综合生长风险变量。在这个样本中,21.4%的家庭粮食不安全(6.8%的家庭存在饥饿)。在逻辑回归分析中,在对混杂因素进行调整后,粮食不安全家庭的儿童健康状况为“一般或较差”的几率几乎是粮食安全家庭儿童的两倍[调整后的优势比(AOR)=1.90,95%置信区间(CI)=1.66 - 2.18],自出生以来住院的几率比粮食安全家庭儿童高出近三分之一(AOR = 1.31,95% CI = 1.16 - 1.48)。健康状况一般/较差与粮食不安全严重程度之间呈现剂量反应关系。食品券与粮食不安全之间存在效应修正;食品券减弱了(但并未消除)粮食不安全与健康状况一般/较差之间的关联。粮食不安全与低收入幼儿的健康问题相关。确保粮食安全可能会减少健康问题,包括住院需求。