title: Cross-Sectional and Longitudinal Associations between Household Food Security and Child Anthropometry at Ages 5 and 8 Years in Ethiopia, India, Peru, and Vietnam.
abstract: BACKGROUND
  Poor childhood nutritional status has lifetime effects and food insecurity is associated with dietary practices that can impair nutritional status.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Epidemiology of Microbial Disease, Yale School of Public Health, New Haven, CT; debbie.humphries@yale.edu.
authors.forename: Debbie L
authors.initials: DL
authors.lastname: Humphries
authors.affiliation: Department of Global Health, Boston University, Boston, MA;
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Dearden
authors.affiliation: Department of Health Science, Brigham Young University, Provo, UT;
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Crookston
authors.affiliation: School of Public Health, University of California at Berkeley, Berkeley, CA;
authors.forename: Lia C
authors.initials: LC
authors.lastname: Fernald
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA;
authors.forename: Aryeh D
authors.initials: AD
authors.lastname: Stein
authors.affiliation: Department of Economics, Addis Ababa University, Addis Ababa, Ethiopia;
authors.forename: Tassew
authors.initials: T
authors.lastname: Woldehanna
authors.affiliation: Nutrition Research Institute, Lima, Peru; and.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Penny
authors.affiliation: Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jere R
authors.initials: JR
authors.lastname: Behrman
mesh_terms: D000886:Anthropometry; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005191:Family Characteristics; D005260:Female; D005523:Food Supply / Q000592:standards*; D006801:Humans; D007194:India; D008137:Longitudinal Studies; D008297:Male; D010568:Peru; D014744:Vietnam
keywords: child growth; dietary diversity; household food security; longitudinal cohort study; weight gain