Food insecurity screening and local food access: Contributions to nutritional outcomes among children and adults with cystic fibrosis in the United States

Bailey, Julianna; Baker, Elizabeth; Schechter, Michael S.; Robinson, Keith J.; Powers, Kate E.; Dasenbrook, Elliot; Hossain, Monir; Durham, Dixie; Brown, Georgia; Clemm, Cristen; Reno, Kim; Oates, Gabriela R.

doi:10.1016/j.jcf.2023.08.006

Cited by 5 publications

(3 citation statements)

References 48 publications

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“…Among cystic fibrosis patients, both food access and food insecurity independently had a significant impact on nutritional outcomes. 3 In patients with metabolic dysfunction-associated steatotic liver disease, food insecurity was associated with a higher incidence of fibrosis, mortality, and healthcare utilization. 4 Despite a wealth of literature on nutrition, lifestyle, and socio-economic determinants suggesting a plausible association, direct evidence linking geospatial food access to AP outcomes and dietary patterns are lacking.…”

Section: Discussionmentioning

confidence: 99%

“…Existing evidence suggests that food insecurity may play a role in digestive health, and has been previously investigated in patients with liver diseases and cystic fibrosis. 3,4 Food insecurity overlaps with low food access, which refers to geographical and infrastructural aspects of food availability, such as the distance to the nearest food source. Access to nutritious food is an important social determinant of health and has an impact on health disparities and outcomes across diverse populations.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Geospatial Food Access on Acute Pancreatitis Outcomes

Chhoda,

Noriega,

Kahan

et al. 2024

Preprint

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BACKGROUND AND AIM: Food access is an important social determinant of health and refers to geographical and infrastructural aspects of food availability. Using publicly available data on food access from the United States Department of Agriculture (USDA), geospatial analyses can identify regions with variable food access, which may impact acute pancreatitis (AP), an acute inflammatory condition characterized by unpredictable outcomes and substantial mortality. This study aimed to investigate the association of clinical outcomes in patients with AP with geospatial food access. METHODS: We examined AP-related hospitalizations at a tertiary center from January 2008 to December 2018. The physical addresses were geocoded through ArcGIS Pro2.7.0 (ESRI, Redlands, CA). USDA Food Access Research Atlas defined low food access as urban areas with 33% or more of the population residing over one mile from the nearest food source. Regression analyses enabled assessment of the association between AP outcomes and food access. RESULTS: The study included 772 unique patients with AP residing in Massachusetts with 931 AP-related hospitalizations. One hundred and ninety-eight (25.6%) patients resided in census tracts with normal urban food access and 574 (74.4%) patients resided in tracts with low food access. AP severity per revised Atlanta classification [OR: 1.88 (95%CI: 1.21-2.92); p=0.005], and 30-day AP-related readmission [OR: 1.78(95%CI: 1.11-2.86); p=0.02] had significant association with food access, despite adjustment for demographics, healthcare behaviors, and comorbidities (Charlson Comorbidity Index). However, food access lacked significant association with AP-related mortality (p=0.40) and length of stay (LOS: p=0.99). CONCLUSION: Low food access had a significant association with 30-day AP-related readmissions and AP severity. However, mortality and LOS lacked significant association with food access. The association between nutrition, lifestyle, and AP outcomes warrants further prospective investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of Geospatial Food Access on Acute Pancreatitis Outcomes

Chhoda,

Noriega,

Kahan

et al. 2024

Preprint

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“…Nutritional outcomes for pwCF are also closely linked to socioeconomic status. Food insecurity and food access have been shown to be predictors of nutritional status among pwCF 42 . and therefore need to be considered and actively addressed across all levels of CF clinical care.…”

Section: Considerations For the Cf Care Teammentioning

confidence: 99%

Nutrition and behavioral health in cystic fibrosis: Eating and body image

Lyons,

Muther,

Sabharwal

2024

Pediatric Pulmonology

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People with CF (pwCF) are at high risk for malnutrition, making nutritional management a critical aspect of CF care. Over the past several decades, optimal nutritional status for pwCF has been defined by body mass index (BMI) based on evidence linking suboptimal BMI to decreased lung function and life expectancy, although more recent changes in CF care may also bring changes to how nutritional health is defined. The historical focus on weight, BMI, and nutrition as key parts of multidisciplinary CF care starting at an early age places pwCF at increased risk for body image concerns and disordered eating. The landscape of CF care is evolving with the approval of highly effective modulator therapies (HEMT) and resulting improvements in growth; however, issues related to body image and eating remain important to consider, especially as past difficulties gaining weight may shift to discomfort with one's weight gain and/or physical appearance. This review aims to describe how body image concerns and disordered eating occur in pwCF across the lifespan; to discuss evidence‐based approaches to addressing these concerns; and to identify future directions for research and clinical practice in assessing and treating eating disorders and body image concerns in this population.

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“I eat chocolate milk for dinner because we just have nothing in our fridge”: The invisible burden and dire consequences of food insecurity for people with cystic fibrosis in the United States

Niranjan,

Brown,

Bailey

et al. 2024

Pediatric Pulmonology

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BackgroundOne‐third of people with cystic fibrosis (pwCF) are food insecure, with profound negative implications for their health. This qualitative study explored lived experiences with food insecurity among pwCF or their caregivers and summarized their perspectives on food insecurity screening in the cystic fibrosis (CF) programs where they receive care.MethodsSemi‐structured qualitative interviews were conducted with two groups: (1) adults with CF and (2) parents or caregivers of children with CF. PwCF or their caregivers with previously documented food insecurity were referred for participation by pediatric and adult CF programs across the United States. Interviews were recorded and transcribed, and data were coded and analyzed by two independent coders using a content‐analysis approach with a constant comparative method to generate themes.ResultsA total of 26 participants from 22 CF programs were interviewed. The sample included 17 adults with CF and nine parents of children with CF. Participants were predominantly White (88%) and female (92%). Five overarching themes emerged: (1) food insecurity among CF patients and their families is onerous, (2) financial constraints imposed by the CF disease contribute to food insecurity, (3) federal and state programs provide limited food assistance, and other support is minimal, (4) shame and stigma engulf conversations around food insecurity with CF care teams, and (5) food insecurity screening in clinical settings is critical.ConclusionsFood insecurity among pwCF is invisible, but its consequences are dire. Assistance is limited, screening is inconsistent, and stigma is widespread. There is an urgent need to normalize food insecurity screening, standardize the screening process, and expand food assistance programs for pwCF.

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Food insecurity screening and local food access: Contributions to nutritional outcomes among children and adults with cystic fibrosis in the United States

Cited by 5 publications

References 48 publications

Impact of Geospatial Food Access on Acute Pancreatitis Outcomes

Impact of Geospatial Food Access on Acute Pancreatitis Outcomes

Nutrition and behavioral health in cystic fibrosis: Eating and body image

“I eat chocolate milk for dinner because we just have nothing in our fridge”: The invisible burden and dire consequences of food insecurity for people with cystic fibrosis in the United States

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