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Association of Family Income and Risk of Food Insecurity With Iron Status in Young Children.
JAMA Netw Open. 2020 07 01; 3(7):e208603.JN

Abstract

Importance

Iron deficiency (ID) has the greatest prevalence in early childhood and has been associated with poor developmental outcomes. Previous research examining associations of income and food insecurity (FI) with ID is inconsistent.

Objective

To examine the association of family income and family risk of FI with iron status in healthy young children attending primary care.

Design, Setting, and Participants

This cross-sectional study included 1245 children aged 12 to 29 months who attended scheduled primary care supervision visits from 2008 to 2018 in Toronto, Canada, and the surrounding area.

Exposures

Family income and risk of FI were collected from parent-reported questionnaires. Children whose parents provided an affirmative response to the 1-item FI screen on the Nutrition Screening Tool for Every Toddler or at least 1 item on the 2-item Hunger Vital Sign FI screening tool were categorized as having family risk of FI.

Main Outcomes and Measures

Iron deficiency (serum ferritin level <12 ng/mL) and ID anemia (IDA; serum ferritin level <12 ng/mL and hemoglobin level <11.0 g/dL). All models were adjusted for age, sex, birth weight, body mass index z score, C-reactive protein level, maternal education, breastfeeding duration, bottle use, cow's milk intake, and formula feeding in the first year.

Results

Of 1245 children (595 [47.8%] girls; median [interquartile range] age, 18.1 [13.3-24.0] months), 131 (10.5%) were from households with a family income of less than CAD $40 000 ($29 534), 77 (6.2%) were from families at risk of FI, 185 (14.9%) had ID, and 58 (5.3%) had IDA. The odds of children with a family income of less than CAD $40 000 having ID and IDA were 3 times higher than those of children in the highest family income group (ID: odds ratio [OR], 3.08; 95% CI, 1.66-5.72; P < .001; IDA: OR, 3.28; 95% CI, 1.22-8.87; P = .02). Being in a family at risk of FI, compared with all other children, was not associated with ID or IDA (ID: OR, 0.43; 95% CI, 0.18-1.02; P = .06; IDA: OR, 0.16; 95% CI, 0.02-1.23; P = .08).

Conclusions and Relevance

In this study, low family income was associated with increased risk of ID and IDA in young children. Risk of FI was not a risk factor for ID or IDA. These findings suggest that targeting income security may be more effective than targeting access to food to reduce health inequities in the prevention of iron deficiency.

Authors+Show Affiliations

Department of Family Medicine, Queen's University, Kingston, Ontario, Canada. Centre for Studies in Primary Care, Queen's University, Kingston, Ontario, Canada.Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada. Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada.Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada. Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada.Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada. Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. The Applied Health Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada. St Michael's Hospital, Toronto, Ontario, Canada.Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario, Canada. Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Child Health Evaluative Sciences, Sick Kids Research Institute, Toronto, Ontario, Canada.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32729920

Citation

Bayoumi, Imaan, et al. "Association of Family Income and Risk of Food Insecurity With Iron Status in Young Children." JAMA Network Open, vol. 3, no. 7, 2020, pp. e208603.
Bayoumi I, Parkin PC, Birken CS, et al. Association of Family Income and Risk of Food Insecurity With Iron Status in Young Children. JAMA Netw Open. 2020;3(7):e208603.
Bayoumi, I., Parkin, P. C., Birken, C. S., Maguire, J. L., & Borkhoff, C. M. (2020). Association of Family Income and Risk of Food Insecurity With Iron Status in Young Children. JAMA Network Open, 3(7), e208603. https://doi.org/10.1001/jamanetworkopen.2020.8603
Bayoumi I, et al. Association of Family Income and Risk of Food Insecurity With Iron Status in Young Children. JAMA Netw Open. 2020 07 1;3(7):e208603. PubMed PMID: 32729920.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Family Income and Risk of Food Insecurity With Iron Status in Young Children. AU - Bayoumi,Imaan, AU - Parkin,Patricia C, AU - Birken,Catherine S, AU - Maguire,Jonathon L, AU - Borkhoff,Cornelia M, AU - ,, Y1 - 2020/07/01/ PY - 2020/7/31/entrez PY - 2020/7/31/pubmed PY - 2020/7/31/medline SP - e208603 EP - e208603 JF - JAMA network open JO - JAMA Netw Open VL - 3 IS - 7 N2 - Importance: Iron deficiency (ID) has the greatest prevalence in early childhood and has been associated with poor developmental outcomes. Previous research examining associations of income and food insecurity (FI) with ID is inconsistent. Objective: To examine the association of family income and family risk of FI with iron status in healthy young children attending primary care. Design, Setting, and Participants: This cross-sectional study included 1245 children aged 12 to 29 months who attended scheduled primary care supervision visits from 2008 to 2018 in Toronto, Canada, and the surrounding area. Exposures: Family income and risk of FI were collected from parent-reported questionnaires. Children whose parents provided an affirmative response to the 1-item FI screen on the Nutrition Screening Tool for Every Toddler or at least 1 item on the 2-item Hunger Vital Sign FI screening tool were categorized as having family risk of FI. Main Outcomes and Measures: Iron deficiency (serum ferritin level <12 ng/mL) and ID anemia (IDA; serum ferritin level <12 ng/mL and hemoglobin level <11.0 g/dL). All models were adjusted for age, sex, birth weight, body mass index z score, C-reactive protein level, maternal education, breastfeeding duration, bottle use, cow's milk intake, and formula feeding in the first year. Results: Of 1245 children (595 [47.8%] girls; median [interquartile range] age, 18.1 [13.3-24.0] months), 131 (10.5%) were from households with a family income of less than CAD $40 000 ($29 534), 77 (6.2%) were from families at risk of FI, 185 (14.9%) had ID, and 58 (5.3%) had IDA. The odds of children with a family income of less than CAD $40 000 having ID and IDA were 3 times higher than those of children in the highest family income group (ID: odds ratio [OR], 3.08; 95% CI, 1.66-5.72; P < .001; IDA: OR, 3.28; 95% CI, 1.22-8.87; P = .02). Being in a family at risk of FI, compared with all other children, was not associated with ID or IDA (ID: OR, 0.43; 95% CI, 0.18-1.02; P = .06; IDA: OR, 0.16; 95% CI, 0.02-1.23; P = .08). Conclusions and Relevance: In this study, low family income was associated with increased risk of ID and IDA in young children. Risk of FI was not a risk factor for ID or IDA. These findings suggest that targeting income security may be more effective than targeting access to food to reduce health inequities in the prevention of iron deficiency. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/32729920/Association_of_Family_Income_and_Risk_of_Food_Insecurity_With_Iron_Status_in_Young_Children_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.8603 DB - PRIME DP - Unbound Medicine ER -