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Child Food Insecurity and Iron Deficiency Anemia in Low-Income Infants and Toddlers in the United States

Objective: Examine the association between child-level food insecurity and iron status in young children utilizing community-based data from the Children's Sentinel Nutrition Assessment Program (C-SNAP). Methods: A cross-sectional sample of caregivers of children ≤36 months of age utilizing emergency department (ED) services were interviewed between 6/96–5/01. Caregiver interviews, which included questions on child-level food security, were linked to a primary clinic database containing hemoglobin, red blood cell distribution width, mean corpuscular volume, free erythrocyte protoporphyrin and lead values. Children a priori at-risk for anemia: birthweight ≤2500 g, with HIV/AIDS, sickle cell disease, or lead values ≥10.0 ug/dL, and children ≤6 months of age were excluded from the analysis. Only laboratory tests 365 days prior or 90 days after interview were examined. Iron status was classified in four mutually exclusive categories: 1) Iron Sufficient-No Anemia (ISNA), 2) Anemia (without iron deficiency), 3) Iron Deficient-No Anemia (IDNA), 4) Iron Deficient with Anemia (IDA). Results: 626 ED interviews linked to laboratory data met the inclusion criteria. Food insecure children were significantly more likely to have IDA compared to food secure children [Adjusted Odds Ratio = 2.4, 95% CI (1.1–5.2), p = 0.02]. There was no association between child food insecurity and anemia without iron deficiency or iron deficiency without anemia. Conclusion: These findings suggest an association between child level food insecurity and iron deficiency anemia, a clinically important health indicator with known negative cognitive, behavioral and health consequences. Cuts in spending on food assistance programs that address children's food insecurity may lead to adverse health consequences.

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The authors are indebted to Howard Bauchner, M.D. for his support and review of several drafts of this manuscript. We would also like to thank Timothy Heeren, Ph.D. and Mark Nord, Ph.D. for their comments on earlier drafts of this manuscript. This study was supported by grant P0053897 from the W. K. Kellogg Foundation (Battle Creek, MI) and grants from U.S. Department of Agriculture, Economic Research Service (Washington, DC), MAZON: A Jewish Response to Hunger (Los Angeles, CA), Project Bread: the Walk for Hunger, the Anthony Spinazzola Foundation, the Eos Foundation (Boston, MA), the Annie E. Casey Foundation, the Claneil Foundation (Philadelphia, PA), the David B. Gold Foundation, the Thomas A. Wilson Foundation, Minneapolis Foundation, the Sandpiper Fund, the Candle Foundation, the Beatrice Fox Auerbach donor advised fund of the Hartford Foundation for Public Giving (Hartford, CT) on the advice of Jean Schiro Zavela and Vance Zavela, the Daniel Pitino Foundation, and private donors Susan Schiro and Peter Manus and Anonymous donor.

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Correspondence to Anne Skalicky MPH.

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Skalicky, A., Meyers, A.F., Adams, W.G. et al. Child Food Insecurity and Iron Deficiency Anemia in Low-Income Infants and Toddlers in the United States. Matern Child Health J 10, 177 (2006).

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  • food insecurity
  • iron deficiency
  • food assistance
  • children