title: Food insecurity, vitamin D insufficiency and respiratory infections among Inuit children.
abstract: BACKGROUND
  Food insecurity, vitamin D deficiency and lower respiratory tract infections are highly prevalent conditions among Inuit children. However, the relationship between these conditions has not been examined in this population.
  
  
  OBJECTIVE
  The objective of this study was to examine the relationship between food insecurity and severe respiratory infections before age 2 years and health centre visits for a respiratory problem in the past year. We also explored the relationship between serum vitamin D status and respiratory outcomes in this population.
  
  
  METHODS
  We included children aged 3-5 years who participated in a cross-sectional survey of the health of preschool Inuit children in Nunavut, Canada, from 2007 to 2008 (n=388). Parental reports of severe respiratory infections in the first 2 years of life and health care visits in the past 12 months were assessed through a questionnaire. Child and adult food security were assessed separately and serum 25-hydroxyvitamin D3 levels were measured in a subgroup of participants (n=279). Multivariate logistic regression was performed to assess the association between food security, vitamin D and each of the 2 respiratory outcomes.
  
  
  RESULTS
  Child and adult food insecurity measures were not significantly associated with adverse respiratory outcomes. Household crowding [odds ratio (OR)=1.51, 95% confidence interval (CI) 1.09-2.09, p=0.01 for the child food security model] and higher birth weight (OR=1.21, 95% CI: 1.02-1.43, p=0.03) were associated with reported severe chest infections before age 2 years while increasing age was associated with decreased odds of reported health care visits for a respiratory problem (OR=0.66, 95% CI: 0.48-0.91, p=0.02). Neither vitamin D insufficiency nor deficiency was associated with these respiratory outcomes.
  
  
  CONCLUSIONS
  Using a large cross-sectional survey of Inuit children, we found that household crowding, but not food security or vitamin D levels, was associated with adverse respiratory outcomes. Further studies are warranted to examine the impact of decreasing household crowding on the respiratory health of these children.
authors.affiliation: Division of Pediatric Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Health Center, Montréal, Quebec, Canada; sze.man.tse@umontreal.ca.
authors.forename: Sze Man
authors.initials: SM
authors.lastname: Tse
authors.affiliation: School of Dietetics and Human Nutrition, McGill University, Montreal, Quebec, Canada.
authors.forename: Hope
authors.initials: H
authors.lastname: Weiler
authors.affiliation: Division of Pediatric Respirology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Quebec, Canada.
authors.forename: Tom
authors.initials: T
authors.lastname: Kovesi
mesh_terms: D002170:Canada / Q000453:epidemiology; D000067576:Child Health; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007223:Infant; D004930:Inuit / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D020957:Nunavut / Q000453:epidemiology; D009752:Nutritional Status; D011203:Poverty; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D018570:Risk Assessment; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014808:Vitamin D Deficiency / Q000175:diagnosis / Q000453:epidemiology*
keywords: Inuit; bronchiolitis; crowding; food security; lower respiratory tract infections; vitamin D