Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas, USA.
Department of Sociology and Population Research Center, The University of Texas at Austin, Austin, Texas, USA.
BMJ Open. 2019 Feb 22;8(11):e021683. doi: 10.1136/bmjopen-2018-021683.
Food insecurity is positively associated with asthma, the most common chronic childhood disease, yet directionality is unclear. The objective was to determine the association between exposure to food insecurity in early childhood and the odds of asthma later in childhood.
Data from four waves of the Early Childhood Longitudinal Study-Kindergarten (ECLS-K) cohort, a prospective, dual-frame, multistage probability cluster sampling study of school-aged US children were entered in multivariate logistic regression models, adjusted for covariates. Exposures to food insecurity were based on parental responses to the validated USDA 18-item module at each wave.
Public and private primary and secondary schools between 1998 and 2007.
At its inception (1999), the ECLS-K had 20 578 kindergarteners; by the spring of eighth grade (2007), the cohort dropped to 9725 due to attrition. Children missing an exposure, outcome or confounding variable were excluded, final n=6731.
Child's diagnosis of asthma by a healthcare professional as reported by the parent.
Household food insecurity (vs food security) in the year before kindergarten and in second grade had a higher odds of asthma by 18% (95% CI 1.17 to 1.20) and 55% (95% CI 1.51 to 1.55). After removing asthmatics before third grade from the model, food insecurity in second grade was associated with higher odds of asthma at fifth or eighth grades (OR 1.55; 95% CI 1.53 to 1.58), whereas food insecurity in the year before kindergarten had a lower odds at fifth or eighth grades.
Food insecurity in the year before kindergarten and in second grade were associated with a higher odds of asthma in third grade. Food insecurity in second grade retained the signal for increased odds of asthma after third and through eighth grades. Additional research is needed to explore childhood windows of vulnerability to asthma.
食品不安全与哮喘呈正相关，哮喘是最常见的儿童慢性疾病，但两者之间的因果关系尚不清楚。本研究旨在确定儿童早期经历食品不安全暴露与儿童后期哮喘发病风险之间的关系。
本研究数据来自学前纵向研究-幼儿园（ECLS-K）队列的四个波次，这是一项针对美国学龄儿童的前瞻性、双框架、多阶段概率聚类抽样研究。多变量逻辑回归模型将校正协变量后的暴露数据纳入其中，暴露数据基于每个波次父母对经过验证的美国农业部 18 项模块的回答。
1998 年至 2007 年期间的公立和私立小学和中学。
ECLS-K 研究在 1999 年开始时共有 20578 名幼儿园儿童；到 2007 年春季八年级时，由于人员流失，该队列减少到 9725 名儿童。排除了缺失暴露、结局或混杂变量的儿童，最终纳入 6731 名儿童。
父母报告的儿童由医疗保健专业人员诊断的哮喘。
幼儿园前一年和二年级家庭食物不安全（与食物安全相比）与哮喘的风险比分别为 18%（95%CI 1.17 至 1.20）和 55%（95%CI 1.51 至 1.55）。在从模型中去除三年级前患有哮喘的儿童后，二年级食物不安全与五年级或八年级哮喘的高风险相关（OR 1.55；95%CI 1.53 至 1.58），而幼儿园前一年的食物不安全与五年级或八年级的哮喘风险较低相关。
幼儿园前一年和二年级的食物不安全与三年级哮喘的高风险相关。二年级的食物不安全在三年级后和八年级期间仍与哮喘发病风险增加相关。需要进一步研究以探索儿童哮喘易感性的窗口期。
