Association of household food insecurity with diet quality in a nationally representative sample of United States toddlers: a cross-sectional study.

backgroundAlthough previous research has shown that food insecurity adversely affects diet quality in adults, this relationship is less consistently observed in children. However, studies in children have focused on those aged 2 y or older and the association of food insecurity with diet quality in children aged 12-23 mo is unclear.

objectivesThe objective was to determine the association of household food insecurity with diet quality, as indicated by Healthy Eating Index-Toddlers-2020 (HEI-Toddlers-2020), in United States children aged 12-23 mo.

methodsThe study used a cross-sectional design based on data from 2013-2014, 2015-2016, and 2017-March 2020 survey cycles of National Health and Nutrition Examination Survey. The primary sample included 708 children aged 12-23 mo with 1) complete data on food security, assessed via the United States Food Security Survey Module (USFSSM); 2) ≥1 d of reliable 24-h dietary recall data; and 3) reported energy intake from complementary foods/beverages (that is, foods and beverages other than human milk or infant formula). On the basis of responses to USFSSM, households were classified as food secure or food insecure. Proxies, typically parents, reported child's dietary intake. Diet quality was assessed using the HEI-Toddlers-2020. Linear regression analyses examined the association of household food security status with HEI-Toddlers-2020 total and component scores, adjusted for demographic characteristics.

resultsHousehold food insecurity was significantly associated with lower HEI-Toddlers-2020 total score (estimate = -3.78; standard error = 1.06; P = 0.0007), as well as lower component scores for whole fruits (estimate = -0.56; standard error = 0.18; P = 0.003), and whole grains (estimate = -0.85; standard error = 0.35; P = 0.02).

conclusionsThe association of household food insecurity with lower diet quality in this study suggests that toddlers may not be shielded from household food shortages. Although consumption of certain food groups, such as whole grains, was inadequate in the overall sample of United States toddlers, food insecurity could exacerbate suboptimal intake of whole grains. Interventions to improve diet quality of young children must account for household food insecurity.