title: Food Price Spikes Are Associated with Increased Malnutrition among Children in Andhra Pradesh, India.
abstract: BACKGROUND
  Global food prices have risen sharply since 2007. The impact of food price spikes on the risk of malnutrition in children is not well understood.
  
  
  OBJECTIVE
  We investigated the associations between food price spikes and childhood malnutrition in Andhra Pradesh, one of India's largest states, with >85 million people. Because wasting (thinness) indicates in most cases a recent and severe process of weight loss that is often associated with acute food shortage, we tested the hypothesis that the escalating prices of rice, legumes, eggs, and other staples of Indian diets significantly increased the risk of wasting (weight-for-height z scores) in children.
  
  
  METHODS
  We studied periods before (2006) and directly after (2009) India's food price spikes with the use of the Young Lives longitudinal cohort of 1918 children in Andhra Pradesh linked to food price data from the National Sample Survey Office. Two-stage least squares instrumental variable models assessed the relation of food price changes to food consumption and wasting prevalence (weight-for-height z scores).
  
  
  RESULTS
  Before the 2007 food price spike, wasting prevalence fell from 19.4% in 2002 to 18.8% in 2006. Coinciding with India's escalating food prices, wasting increased significantly to 28.0% in 2009. These increases were concentrated among low- (χ(2): 21.6, P < 0.001) and middle- (χ(2): 25.9, P < 0.001) income groups, but not among high-income groups (χ(2): 3.08, P = 0.079). Each 10.0 rupee ($0.170) increase in the price of rice/kg was associated with a drop in child-level rice consumption of 73.0 g/d (β: -7.30; 95% CI: -10.5, -3.90). Correspondingly, lower rice consumption was significantly associated with lower weight-for-height z scores (i.e., wasting) by 0.005 (95% CI: 0.001, 0.008), as seen with most other food categories.
  
  
  CONCLUSIONS
  Rising food prices were associated with an increased risk of malnutrition among children in India. Policies to help ensure the affordability of food in the context of economic growth are likely critical for promoting children's nutrition.
authors.affiliation: Department of Sociology, University of Oxford, Oxford, United Kingdom; Public Health Foundation of India, New Delhi, India; and sukumar.vellakkal@phfi.org.
authors.forename: Sukumar
authors.identifier: http://orcid.org/0000-0003-2635-1944
authors.initials: S
authors.lastname: Vellakkal
authors.affiliation: Department of Sociology, University of Oxford, Oxford, United Kingdom;
authors.forename: Jasmine
authors.initials: J
authors.lastname: Fledderjohann
authors.affiliation: Department of Medicine, Stanford University, Stanford, CA;
authors.forename: Sanjay
authors.initials: S
authors.lastname: Basu
authors.affiliation: Public Health Foundation of India, New Delhi, India; and.
authors.forename: Sutapa
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Shah
authors.initials: S
authors.lastname: Ebrahim
authors.affiliation: Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Oona
authors.initials: O
authors.lastname: Campbell
authors.affiliation: Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Pat
authors.initials: P
authors.lastname: Doyle
authors.affiliation: Department of Sociology, University of Oxford, Oxford, United Kingdom; Public Health Foundation of India, New Delhi, India; and.
authors.forename: David
authors.initials: D
authors.lastname: Stuckler
mesh_terms: D002648:Child; D015362:Child Nutrition Disorders / Q000191:economics / Q000453:epidemiology*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005502:Food / Q000191:economics*; D005523:Food Supply / Q000191:economics*; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D013997:Time Factors; D015431:Weight Loss
keywords: India; child nutrition; food consumption; food price spikes; weight-for-height z scores