title: Child food insecurity and iron deficiency anemia in low-income infants and toddlers in the United States.
abstract: OBJECTIVE
  Examine the association between child-level food insecurity and iron status in young children utilizing community-based data from the Children's Sentinel Nutrition Assessment Program (C-SNAP).
  
  
  METHODS
  A cross-sectional sample of caregivers of children < or =36 months of age utilizing emergency department (ED) services were interviewed between 6/96-5/01. Caregiver interviews, which included questions on child-level food security, were linked to a primary clinic database containing hemoglobin, red blood cell distribution width, mean corpuscular volume, free erythrocyte protoporphyrin and lead values. Children a priori at-risk for anemia: birthweight < or =2500 g, with HIV/AIDS, sickle cell disease, or lead values > or =10.0 ug/dL, and children < or =6 months of age were excluded from the analysis. Only laboratory tests 365 days prior or 90 days after interview were examined. Iron status was classified in four mutually exclusive categories: 1) Iron Sufficient-No Anemia (ISNA), 2) Anemia (without iron deficiency), 3) Iron Deficient-No Anemia (IDNA), 4) Iron Deficient with Anemia (IDA).
  
  
  RESULTS
  626 ED interviews linked to laboratory data met the inclusion criteria. Food insecure children were significantly more likely to have IDA compared to food secure children [Adjusted Odds Ratio = 2.4, 95% CI (1.1-5.2), p = 0.02]. There was no association between child food insecurity and anemia without iron deficiency or iron deficiency without anemia.
  
  
  CONCLUSIONS
  These findings suggest an association between child level food insecurity and iron deficiency anemia, a clinically important health indicator with known negative cognitive, behavioral and health consequences. Cuts in spending on food assistance programs that address children's food insecurity may lead to adverse health consequences.
authors.affiliation: Boston University School of Public Health, Massachusetts 02118, USA. skalicky@bu.edu
authors.forename: Anne
authors.initials: A
authors.lastname: Skalicky
authors.forename: Alan F
authors.initials: AF
authors.lastname: Meyers
authors.forename: William G
authors.initials: WG
authors.lastname: Adams
authors.forename: Zhaoyan
authors.initials: Z
authors.lastname: Yang
authors.forename: John T
authors.initials: JT
authors.lastname: Cook
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Frank
mesh_terms: D000385:Aid to Families with Dependent Children; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis / Q000453:epidemiology*; D001900:Boston / Q000453:epidemiology; D017028:Caregivers; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005523:Food Supply / Q000191:economics / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D006815:Hunger / Q000502:physiology; D007223:Infant; D007228:Infant Nutrition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D007407:Interviews as Topic; D044342:Malnutrition / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D011203:Poverty; D018571:Sentinel Surveillance; D012959:Socioeconomic Factors; D014481:United States