102 - Association of Young Children’s Weight Faltering with Food Insecurity

Poster Number: 102
Publication Number: 102.212

Ana Poblacion, Boston Medical Center, Boston, MA, United States; Stephanie Ettinger de Cuba, Boston University School of Medicine, Boston, MA, United States; Carolina Giudice, Boston Medical Center, Medford, MA, United States; Georgiana Esteves, Children's HealthWatch, New Haven, CT, United States; Ian K. Weijer, Children's HealthWatch, Allston, MA, United States; Maureen M. Black, University of Maryland School of Medicine, Baltimore, MD, United States; Diana B. Cutts, Hennepin Healthcare, Minneapolis, MN, United States; Felice Le-Scherban, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States; Megan T. Sandel, Boston University School of Medicine, Boston, MA, United States; Eduardo R. Ochoa, UAMS Pediatrics, Community Pediatrics, Little Rock, AR, United States; Antonella Zanobetti, Harvard University, Boston, MA, United States; Patricia Fabian, Boston University, Boston, MA, United States; Deborah Frank, Boston University School of Medicine, Brookline, MA, United States

Background: Children’s weight trajectory is a health indicator. However, family material hardships, like food insecurity may impede children’s healthy weight trajectories. Healthy to unhealthy weight shifts in early childhood may indicate current health problems likely to influence future chronic diseases.

Objective: We investigated whether food insecurity at the household or child level impacts young children’s weight trajectory.

Design/Methods: Longitudinal data (2009-2018) from families with children < 2 years interviewed twice in emergency departments in 4 US cities included sociodemographic characteristics, food insecurity (FI), public food assistance program participation, birthweight and length of gestation. Survey data linked with electronic health records was used to obtain weight of children over time. Children’s weight change was calculated by subtracting CDC’s weight-for-age z-scores between 2 visits and defined as ‘expected weight gain’ when change was within ± 1.34 SD, ‘rapid weight gain’ when change was ≥+1.34 SD, and ‘slow weight gain’ when change was ≤-1.34 SD, corresponding to a 2 major centile band change on growth charts. This change is one of the clinical definitions of weight faltering (formerly called “failure to thrive”). FI was defined using the 18-item US Household Food Security Survey Module (HFSSM). Households were classified as FI if reported 3+ conditions (HFSSM questions 1–18). In addition, households were classified as having FI among children if reported 2+ conditions (HFSSM questions 11–18).

Results: Of 1,756 children born at term, with birth weight >2500 grams, and with a healthy weight at first visit, by the second visit 88.5% (1,502 children) had expected weight gain, 4.4% (78 children) had rapid weight gain, and 10.0% (176 children) had slow weight gain. Average time between visits was 11 months, coinciding with the HFSSM 12-month recall period retrieved at 2nd interview. After adjustment, FI among children was associated with slow weight gain (aOR 2.11; 95%CI 1.01-4.41) but not associated with rapid weight gain (aOR 0.82; 95%CI 0.37-1.73). Associations with either slow or rapid weight gain were not significant when FI was identified at the household level.Conclusion(s): Our findings suggest that slow weight gain among young children may have been influenced by the lack of money to buy food, indicated by the association with FI at the child level. Thus, when a young child is seen for clinically meaningful weight faltering, nutrition intervention and connection with public food programs are both crucial steps towards recovery.