Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA.
Pediatric Hematology & Oncology, Morgan Stanley Children's Hospital of NewYork-Presbyterian, New York, New York, USA.
Pediatr Blood Cancer. 2022 May;69(5):e29463. doi: 10.1002/pbc.29463. Epub 2021 Nov 22.
Food insecurity and housing instability, both social determinants of health (SDoH), disproportionately affect economically unstable, under-resourced US communities in which children with sickle cell disease (SCD) live. Association between these SDoH markers and dietary quality among children with SCD is unknown.
We assessed a cross-sectional sample of dyadic parent-child patients and young adult patients up to age 21 from one pediatric SCD center. Food insecurity, housing instability, and dietary quality were measured using validated US instruments and a food frequency questionnaire. Better dietary quality was defined using US dietary guidelines. Multivariate regression assessed for associations among dietary quality and food insecurity with or without (±) housing instability and housing instability alone.
Of 100 enrolled participants, 53% were Black and 43% Hispanic; mean age 10.6 ± 5.6 years. Overall, 70% reported less than or equal to one economic instability: 40% housing instability alone and 30% both food insecurity and housing instability. Eighty percent received more than or equal to one federal food assistance benefit. Compared to no economic instability, food insecurity ± housing instability was significantly associated with higher intake of higher dairy and pizza, while housing instability alone was significantly associated with higher dairy intake. Food insecurity ± housing instability was significantly associated with lower intake of whole grains compared to housing instability alone.
Our sample reported high frequencies of both food insecurity and housing instability; having more than or equal to one SDoH was associated with elements of poorer diet quality. Screening families of children with SCD for food insecurity and housing instability may identify those with potential nutrition-related social needs.
食品不安全和住房不稳定都是健康的社会决定因素（SDoH），它们不成比例地影响到美国经济不稳定、资源匮乏的社区，这些社区中患有镰状细胞病（SCD）的儿童生活于此。这些 SDoH 标志物与 SCD 儿童饮食质量之间的关联尚不清楚。
我们评估了一家儿科 SCD 中心的 100 名配对的父母-儿童患者和年轻成年患者的横断面样本。使用经过验证的美国工具和食物频率问卷评估了食品不安全、住房不稳定和饮食质量。使用美国膳食指南定义了更好的饮食质量。多元回归评估了饮食质量与食品不安全之间的关联，以及有或没有（±）住房不稳定和仅住房不稳定的关联。
在 100 名入组参与者中，53%是黑人，43%是西班牙裔；平均年龄为 10.6±5.6 岁。总体而言，70%的人报告经济不稳定程度为≤1：40%仅住房不稳定，30%同时存在食品不安全和住房不稳定。80%的人获得了≥1 项联邦食品援助福利。与无经济不稳定相比，食品不安全±住房不稳定与更高的乳制品和比萨摄入量显著相关，而仅住房不稳定与更高的乳制品摄入量显著相关。与仅住房不稳定相比，食品不安全±住房不稳定与全谷物摄入量较低显著相关。
我们的样本报告了食品不安全和住房不稳定的高频率；有≥1 种 SDoH 与较差的饮食质量元素显著相关。对 SCD 儿童的家庭进行食品不安全和住房不稳定筛查，可能会发现有潜在营养相关社会需求的家庭。
