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J Nutr. 2015 Aug;145(8):1924-33. doi: 10.3945/jn.115.210229. Epub 2015 Jun 17.

Cross-Sectional and Longitudinal Associations between Household Food Security and Child Anthropometry at Ages 5 and 8 Years in Ethiopia, India, Peru, and Vietnam.

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Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, CT;
Department of Global Health, Boston University, Boston, MA;
Department of Health Science, Brigham Young University, Provo, UT;
School of Public Health, University of California at Berkeley, Berkeley, CA;
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA;
Department of Economics, Addis Ababa University, Addis Ababa, Ethiopia;
Nutrition Research Institute, Lima, Peru; and.
Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, PA.



Poor childhood nutritional status has lifetime effects and food insecurity is associated with dietary practices that can impair nutritional status.


We assessed concurrent and subsequent associations between food insecurity and height-for-age z scores (HAZs) and body mass index-for-age z scores (BMI-Zs); evaluated associations with transitory and chronic food insecurity; and tested whether dietary diversity mediates associations between food insecurity and nutritional status.


We used data from the Young Lives younger cohort composed of children in Ethiopia (n = 1757), India (n = 1825), Peru (n = 1844), and Vietnam (n = 1828) recruited in 2002 (round 1) at ∼1 y old, with subsequent data collection at 5 y in 2006 (round 2) and 8 y in 2009 (round 3).


Children from food-insecure households had significantly lower HAZs in all countries at 5 y (Ethiopia, -0.33; India, -0.53; Peru, -0.31; and Vietnam, -0.68 HAZ; all P < 0.001), although results were attenuated after controlling for potential confounders (Ethiopia, -0.21; India, -0.32; Peru, -0.14; and Vietnam, -0.27 HAZ; P < 0.01). Age 5 y food insecurity predicted the age 8 y HAZ, but did not add predictive power beyond HAZ at age 5 y in Ethiopia, India, or Peru. Age 5 y food insecurity predicted the age 8 y BMI-Z even after controlling for the 5 y BMI-Z, although associations were not significant after the inclusion of additional confounding variables (Ethiopia, P = 0.12; India, P = 0.29; Peru, P = 0.16; and Vietnam, P = 0.51). Chronically food-insecure households had significantly lower HAZs than households that were consistently food-secure, although BMI-Zs did not differ by chronic food-insecurity status. Dietary diversity mediated 18.8-30.5% of the association between food security and anthropometry in Vietnam, but mediated to a lesser degree (8.4-19.3%) in other countries.


In 4 countries, food insecurity at 5 y of age was associated with both HAZ and BMI-Z at age 8 y, although the association was attenuated after adjusting for other household factors and anthropometry at age 5 y, and remained significant only for the HAZ in Vietnam.


child growth; dietary diversity; household food security; longitudinal cohort study; weight gain

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