Extreme Food Insecurity and Malnutrition in Haiti: Findings from a Population-Based Cohort in Port-au-Prince, Haiti

Abstract

Haiti is one of the most food-insecure (FIS) nations in the world, with increasing rates of overweight and obesity. This study aimed to characterize FIS among households in urban Haiti and assess the relationship between FIS and body mass index (BMI) using enrollment data from the Haiti Cardiovascular Disease Cohort Study. FIS was characterized as no/low, moderate/high, and extreme based on the Household Food Security Scale. Multinomial logistic generalized estimating equations were used to evaluate the association between FIS categories and BMI, with obesity defined as BMI ≥ 30 kg/m2. Among 2972 participants, the prevalence of moderate/high FIS was 40.1% and extreme FIS was 43.7%. Those with extreme FIS had higher median age (41 vs. 38 years) and were less educated (secondary education: 11.6% vs. 20.3%) compared to those with no/low FIS. Although all FIS categories had high obesity prevalence, those with extreme FIS compared to no/low FIS (15.3% vs. 21.6%) had the lowest prevalence. Multivariable models showed an inverse relationship between FIS and obesity: moderate/high FIS (OR: 0.77, 95% CI: 0.56, 1.08) and extreme FIS (OR: 0.58, 95% CI: 0.42, 0.81) versus no/low FIS were associated with lower adjusted odds of obesity. We found high prevalence of extreme FIS in urban Haiti in a transitioning nutrition setting. The inverse relationship between extreme FIS and obesity needs to be further studied to reduce both FIS and obesity in this population.

Spectrum of prevalent cardiovascular diseases in urban Port-au-Prince, Haiti: a population-based cross-sectional study

“…Food insecurity was measured at the household level using an adapted version of the six-item short form of the Household Food Security Scale. 13 …”

An Empirical Assessment of the Welfare Impacts of the Rising Global Price of Food: The Case of Haiti

“…One potential policy recommendation is to strengthen domestic agricultural production and food security in Haiti. At present, Haiti is regarded as a highly underdeveloped (Yu et al 2019, Dupuy 2019, Hashimoto et al 2020) and food insecure (Richardson et al 2022, Kianersi et al 2021, Rasul et al 2022) nation within the Caribbean region. Agriculture is the primary economic sector in Haiti, employing about two-thirds of the population.…”

“…Haiti is a small island nation situated in the Caribbean which is vulnerable to increasing global food prices (Mazzeo 2009, Himmelgreen and Romero-Daza 2009, Compton et al 2010. Haiti is regarded as one of the most food-insecure nations in the world (Rasul et al 2022). In 2016, it was estimated that around 30% of households were food-insecure (World Food Programme 2016), however, current estimates in 2022 indicates that around 43% of the population experience acute food-insecurity (FAO 2022b).…”

Risk factors for household food insecurity in the Eastern Caribbean Health Outcomes Research Network cohort study

“…Measuring food insecurity through household food insecurity (HFI) experience-based measurement scales continues to be the method of choice to assess food insecurity globally, compared to other methods like household expenditure surveys or dietary intake assessments (3). In adults worldwide, HFI has been associated with chronic diseases such as diabetes (4)(5)(6), hypertension (7) and overweight (8). In women and adults in low-income households, there is robust evidence of an association between HFI and malnutrition globally (8)(9)(10)(11)(12)(13).…”

“…In the Caribbean region, the prevalence of moderate or severe food insecurity was 71.3 percent in 2020, the highest of all subregions in Latin America when measured using the Food Insecurity Experience Scale (19). In this region, HFI has been associated with HIV/AIDS in Haitian adults (20,21), HIV in adults in the Dominican Republic (22), and malnutrition in adults from both the Dominican Republic and Haiti (6,22). HFI is associated with lower household income, physical disability, and having an underweight body mass index among adults in Trinidad & Tobago (23,24).…”