Department of Nutrition Science,Purdue University,West Lafayette,IN 47907,USA.
Nutr Res Rev. 2018 Jun;31(1):98-113. doi: 10.1017/S0954422417000245. Epub 2018 Jan 10.
Approximately 6·5 million US children live in food-insecure households, meaning that they have restrained access to the types and amounts of foods they usually eat. The nutrient demands of growth and general sub-par dietary intake of US children by age highlight the importance and difficulty of attaining recommended amounts of critical dietary components to promote health and prevent disease. Evaluation of the evidence for a relationship of food insecurity with key dietary outcomes for the specific stages of child growth at 1-5 years, 6-11 years and 12-19 years has not been previously documented. Bradford Hill criteria of strength, consistency and dose-response were applied to aid evaluation. A comprehensive search of original research on US children using food-security assessment measures indexed to January 2017 was completed and identified sixteen studies that evaluated the relationship of food insecurity with key dietary outcomes. Evidence for a strong, consistent and dose-response relationship of food insecurity with lower vegetable intake compared with food security was determined among children aged 1-5 years and strong and consistent evidence of higher added sugar intake among food-insecure children aged 6-11 years compared with food-secure children was apparent. Adolescent-focused evidence was sparse but revealed adolescence as the paediatric age stage where food insecurity has the most potential for negative impact on child dietary intake. A discussion of future research opportunities includes strengthening the evidence through longitudinal study designs, inclusion of additional nutrients of concern, and stronger mitigation of bias and error.
大约有 650 万美国儿童生活在食物无保障的家庭中，这意味着他们在食物种类和数量上受到限制，无法满足日常所需。美国儿童在成长过程中营养需求较高，整体饮食摄入水平较差，这突出了获取推荐量的关键饮食成分的重要性和难度，这些成分有助于促进健康和预防疾病。此前尚未有文献评估食物无保障状况与 1-5 岁、6-11 岁和 12-19 岁儿童生长特定阶段的关键饮食结果之间的关系。本文应用了布拉德福·希尔（Bradford Hill）的因果关系强度、一致性和剂量反应标准，以帮助评估。全面检索了 2017 年 1 月之前使用食物保障评估措施的美国儿童原始研究，共确定了 16 项评估食物无保障与关键饮食结果之间关系的研究。研究结果表明，1-5 岁儿童中，食物无保障与蔬菜摄入量较低之间存在较强、一致且呈剂量反应关系，而 6-11 岁儿童中，食物无保障与添加糖摄入量较高之间存在较强且一致的关系。青少年相关证据较为缺乏，但揭示了青春期是食物无保障对儿童饮食摄入产生负面影响最大的儿童期阶段。未来研究机会的讨论包括通过纵向研究设计、纳入更多关注的营养素以及更有力地减轻偏差和错误，来加强证据。
