David H. Holben, Christopher A. Taylor. Food Insecurity and Its Association With Central Obesity and Other Markers of Metabolic Syndrome Among Persons Aged 12 to 18 Years in the United States. J Am Osteopath Assoc 2015;115(9):536–543. doi: 10.7556/jaoa.2015.111.
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Context: Food insecurity is a preventable health threat and may precipitate central obesity and metabolic syndrome in children and adolescents in the United States.
Objective: To examine (1) health by household food security status; and (2) differences and prevalence of central obesity among persons aged 12 to 18 years in the United States.
Methods: The National Health and Nutrition Examination Survey was administered to a cross-sectional sample of persons aged 12 to 18 years in 1999 to 2006. Controlling for age, race/ethnicity, and sex differences in mean obesity and chronic disease factors across levels of food insecurity (analysis of covariance [Bonferroni post hoc] and ORs [logistic regression analyses]) were examined, as were differences in the rates of risk factors (χ2 statistics).
Results: A total of 7435 participants were analyzed. Those from marginally food secure (n=751) and low–food secure (n=1206) (population size estimate, 26,714,182) households were significantly more likely than their high–food secure counterparts (n=4831) to be overweight (P=.036) (OR, 1.44), and those from marginally food secure households were 1.3-times more likely to be obese (P=.036). Nearly 25% of respondents from marginally food secure, low–food secure, and very low–food secure (n=647) households reported central obesity (P=.002), which was 1.4 to 1.5 times more likely than those from high–food secure households. Participants from high–food secure households had significantly higher mean high-density lipoprotein values (P=.019). Risk factors indicative of metabolic syndrome were present in 3.1%.
Conclusion: Household food insecurity was associated with an increased likelihood of being overweight and having central obesity. Limitations included the use of cross-sectional data and some self-reported data and the inability to control for all moderating variables in obesity and overall health status.
a Data are given as mean (95% CI) unless otherwise indicated. Nonoverlapping CIs represent significant differences (P<.05).
b Percent of age- and sex-specific threshold criteria for the waist circumference risk factor.
Abbreviations: BMI, body mass index; LDL, low-density lipoprotein; HDL, high-density lipoprotein.
a High food security serves as the reference group to which the other groups are compared for likelihood to present with the risk factor.
b Overweight was defined as greater than or equal to 85th percentile and obesity was defined as greater than 95th body mass index–for-age percentile.
Abbreviation: HDL, high-density lipoprotein.
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