Childhood food insecurity and incident diabetes: A longitudinal cohort study of 34 042 children in Ontario, Canada

Abstract

Aim: To examine the association between childhood food insecurity and incident diabetes. Methods: Using health administrative databases linked to the Canadian Community Health Survey, we conducted a population-based cohort study of children aged <18 years from Ontario, Canada. Children without diabetes who had a household response to the Canadian Community Health Survey Household Food Security Survey Module were followed for a median of 9.5 years for incident diabetes. Multivariable Cox proportional hazards models were used to examine the association between childhood food insecurity and incident diabetes, adjusted sequentially for important clinical and socio-economic risk factors. Results: We included 34 042 children, of whom 5.3% lived in food-insecure households. There were 184 new cases of diabetes, diagnosed at a median age of 16 and 18.5 years in food-secure and food-insecure children, respectively. In unadjusted analysis, childhood food insecurity was associated with an increased risk of incident diabetes (hazard ratio 1.69, 95% CI 1.01 to 2.81). When adjusted for clinical and socioeconomic confounders, the relationship was no longer statistically significant (hazard ratio 1.55, 95% CI 0.91 to 2.66, adjusted for clinical confounders; hazard ratio 1.30, 95% CI 0.72 to 2.37, adjusted for clinical/socio-economic confounders). Our results remained robust in sensitivity analyses. Conclusions: Although food-insecure children are a medically and socially vulnerable population, they do not appear to be at increased risk of incident diabetes over a median of 9.5 years.

Holding steady

“…At the same time, up to 10% of households in the United Kingdom are affected by moderate or severe food insecurity, a risk factor for poor nutrition and obesity in children, and diabetes prevalence in adults. Reassuringly, food insecurity is not reported to be associated with incident diabetes in children, as reported in this issue, 10 with clinical and socio‐economic risks accounting for new onset diabetes. I was again very fortunate to be able to discuss this paper with the authors and the podcast is available to listen to at the link above.…”

Childhood food insecurity and incident asthma: A population-based cohort study of children in Ontario, Canada

“…Our child cohort was built using previously described methods [ 18 ]. In brief, we included children in three ways.…”

“…Given the small number of severely food insecure children in our cohort (n = 1079), we a-priori grouped both moderately and severely food insecure children into one “food insecure” category. A similar approach has been used in previous research studies on food insecurity, including our recently published report [ 18 , 19 ]. We defined unexposed children as those who were food secure as per the HFSSM.…”

“…The details of our time-to-event analysis have been reported previously [ 18 ]. In brief, we generated non-parametric Kaplan-Meier (KM) curves to compare the unadjusted incidence of asthma by exposure group.…”

Addressing consequences of school closure on oral health care of children during COVID-19

“…Studies have also shown that adults in families with food insecure households are more susceptible to heart disease, diabetes, hypertension, increased inflammation and obesity (29)(30)(31). Moreover, children in families experiencing food insecure are more prone to psychosocial, cognitive and behavioral problems as well as a reduction in the intake of important nutrients and developmental deficiencies (32)(33)(34)(35).…”