The Association Between Food Security and Anemia among Children and Adolescents in the Supplemental Nutrition Assistance Program NHANES (2013-2014) Open Access

Huerta, Jennifer (Summer 2019)

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Background: Public health experts estimate that 20% of American children will have anemia at some point in their childhood. Anemia is defined as having a hemoglobin concentration (Hgb) less than the 5th percentile for age. Iron deficiency is the most common cause of anemia and often is a result of a poor diet. Although there is a recommended amount of daily iron consumption for children, food insecure children are at a greater risk of not meeting the recommended iron intake. Studies show that iron deficiency anemia is a clinically important health indicator for cognitive and health consequences and therefore food assistance programs that address children’s food insecurity should be studied.

Methods: Data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) was used to assess the relationship between child food security and anemia. Multivariable logistic regression analysis was used to obtain odds ratios (ORs) with 95% confidence intervals (CI) and model imputation was used to impute missing values and generate parameter estimates.

Results: The odds of having anemia were 30% (CI [95] 0.94, 1.02) higher for females when compared to males. The odds of having anemia were twice as high for those who are black when compared to those who are white (CI [95] 1.72, 2.72). The odds of anemia among those who have low food security is 21% (CI [95] 0.88, 1.67) higher when compared to the odds of anemia among those who are completely food secure, holding all other variables constant. Although not significant, the odds of having anemia are less likely for those with marginal food security 0.26 (CI [95] 0.50, 1.10) when compared to those who are completely food secure. Also, not significant are the odds of anemia among those who have not received SNAP benefits in the past 12 months. The odds of having anemia are 26% (CI [95] 0.92, 1.35) higher when compared to the odds of anemia among those who received SNAP benefits in the past 12 months, holding all other variables constant.

Discussion: In conclusion, our study suggests that there is a slight insignificant association between CFS and the odds of developing anemia among children and adolescents age (0-18) in the U.S. Carefully designed prospective studies with longitudinal follow-up are needed to verify that CFS is linked to anemia in order to demonstrate potential benefits of SNAP participation on CFS.

Table of Contents

1     Manuscript 10

2     Introduction. 1

3     Review of Literature. 2

3.1      Anemia in Children. 2

3.2      Anemia and Food Insecurity. 3

3.3      Supplemental Nutrition Assistance Program and Food Security. 4

4     Methods. 5

4.1      Study Design. 5

4.2      Setting, Study Size and Target Population. 6

4.3      Variables. 7

4.4      Data Sources. 9

4.5      Bias. 10

4.6      Statistical Methods. 10

4.7      IRB Review.. 14

5     Results. 14

5.1      Key Findings & Summary of Results. 14

6     Discussion. 16

6.1      Background and Summary of Results. 16

6.2      Limitations. 19

6.3      Generalizability and Conclusion. 20

7     References. 22

8     Tables and Figures. 26

9     Appendices. 33

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