Food insecurity, food choices, and body mass index in adults: nutrition transition in Trinidad and Tobago.

BACKGROUND This study evaluated whether food insecurity and obesity were associated in a population sample in Trinidad. METHODS A sample was drawn of 15 clusters of households, in north central Trinidad. Resident adults were enumerated. A questionnaire was administered including the short form Household Food Security Scale (HFSS). Heights and weights were measured. Analyses were adjusted for age, sex, and ethnic group. RESULTS Data were analysed for 531/631 (84%) of eligible respondents including 241 men and 290 women with a mean age of 47 (range 24-89) years. Overall, 134 (25%) of subjects were classified as food insecure. Food insecurity was associated with lower household incomes and physical disability. Food insecure subjects were less likely to eat fruit (food insecure 40%, food secure 55%; adjusted odds ratio [OR] = 0.60, 95% CI: 0.36-0.99, P = 0.045) or green vegetables or salads (food insecure 28%, food secure 51%; adjusted OR = 0.46, 95% CI: 0.27-0.79, P = 0.005) on >/=5-6 days per week. Body mass index (BMI) was available for 467 (74%) subjects of whom 41 (9%) had BMI <20 kg/m(2), 157 (34%) had BMI 25-29 kg/m(2), and 120 (26%) had BMI >/=30 kg/m(2). Underweight (OR = 3.21, 95% CI: 1.17-8.81) was associated with food insecurity, but obesity was not (OR = 1.08, 95% CI: 0.55-2.12). CONCLUSIONS Food insecurity was frequent at all levels of BMI and was associated with lower consumption of fruit and vegetables. Food insecurity was associated with underweight but not with present obesity.

[1]  B. Popkin.  The nutrition transition and obesity in the developing world. , 2001, The Journal of nutrition.

[2]  E. Frongillo.  Validation of measures of food insecurity and hunger. , 1999, The Journal of nutrition.

[3]  H. Colhoun,et al.  Health Survey for England 1994 , 1994 .

[4]  H. Fraser,et al.  Distribution of anthropometric variables and the prevalence of obesity in populations of west African origin: the International Collaborative Study on Hypertension in Blacks (ICSHIB). , 1995, Obesity research.

[5]  M. Peña,et al.  Obesity and Poverty: A New Public Health Challenge , 2000 .

[6]  C. Olson,et al.  Food insufficiency exists in the United States: results from the third National Health and Nutrition Examination Survey (NHANES III). , 1998, American journal of public health.

[7]  B. Popkin,et al.  Independent effects of income and education on the risk of obesity in the Brazilian adult population. , 2001, The Journal of nutrition.

[8]  B. Popkin,et al.  An overview on the nutrition transition and its health implications: the Bellagio meeting , 2002, Public Health Nutrition.

[9]  V. Tarasuk.  Household food insecurity with hunger is associated with women's food intakes, health and household circumstances. , 2001, The Journal of nutrition.

[10]  E. Frongillo,et al.  Building Household Food-security Measurement Tools from the Ground Up , 2001 .

[11]  M. Andrews,et al.  Measuring food insecurity and hunger in the United States: development of a national benchmark measure and prevalence estimates. , 1999, The Journal of nutrition.

[12]  W. Dietz.  Does hunger cause obesity? , 1995, Pediatrics.

[13]  B. Rolls,et al.  Energy density of foods affects energy intake across multiple levels of fat content in lean and obese women. , 2001, The American journal of clinical nutrition.

[14]  C. Olson,et al.  Importance of Cognitive Testing for Survey Items: An Example From Food Security Questionnaires , 1999 .

[15]  C. Olson,et al.  Relationship of hunger and food insecurity to food availability and consumption. , 1996, Journal of the American Dietetic Association.

[16]  Markku Heliövaara,et al.  Associations of body mass index and obesity with physical activity, food choices, alcohol intake, and smoking in the 1982-1997 FINRISK Studies. , 2002, The American journal of clinical nutrition.

[17]  Thailand. Samnakngān Khana Kammakān Phatthanākān Sētthakit l Chāt.  1990 population and housing census , 1993 .

[18]  B. Popkin,et al.  Overweight and underweight coexist within households in Brazil, China and Russia. , 2000, The Journal of nutrition.

[19]  C. Olson.  Nutrition and health outcomes associated with food insecurity and hunger. , 1999, The Journal of nutrition.

[20]  Free school meals and children's social and nutritional status in Trinidad and Tobago , 2002, Public Health Nutrition.

[21]  C. Achterberg,et al.  Food insecurity is positively related to overweight in women. , 2001, The Journal of nutrition.

[22]  E. Lahelma,et al.  Food insecurity is associated with past and present economic disadvantage and body mass index. , 2001, The Journal of nutrition.

[23]  P. Casey,et al.  Children in food-insufficient, low-income families: prevalence, health, and nutrition status. , 2001, Archives of pediatrics & adolescent medicine.

[24]  Samuel H. Preston,et al.  The Epidemiological Transition: Policy and Planning Implications for Developing Countries , 1993 .

[25]  Madhavi Bajekal,et al.  Health Survey for England , 2004 .

[26]  B. Kirkwood,et al.  Obesity in women in an urban Trinidadian community. Prevalence and associated characteristics. , 1985, International journal of obesity.

[27]  C. Olson,et al.  Low family income and food insufficiency in relation to overweight in US children: is there a paradox? , 2001, Archives of pediatrics & adolescent medicine.

[28]  E. Frongillo,et al.  Household food insecurity was prevalent in Java during Indonesia's economic crisis. , 2001, The Journal of nutrition.

[29]  C. Olson,et al.  Nutritional Consequences of Food Insecurity in a Rural New York State County , 1997 .

[30]  H. Goldstein.  Multilevel Statistical Models , 2006 .

[31]  R. Gillum,et al.  Physical activity and stroke incidence in women and men. The NHANES I Epidemiologic Follow-up Study. , 1996, American journal of epidemiology.

[32]  H. S. Ferreira,et al.  Obesity and undernutrition in a very-low-income population in the city of Maceió, northeastern Brazil , 2001, British Journal of Nutrition.

[33]  A. Astrup,et al.  Obesity : Preventing and managing the global epidemic , 2000 .

[34]  Crispin Jenkinson,et al.  Development and Testing of the UK SF-12 , 1997 .

[35]  A. Stunkard,et al.  Socioeconomic status and obesity: a review of the literature. , 1989, Psychological bulletin.

[36]  E. Frongillo,et al.  Factors associated with food insecurity among U.S. elderly persons: importance of functional impairments. , 2001, The journals of gerontology. Series B, Psychological sciences and social sciences.

[37]  R. Briefel,et al.  The effectiveness of a short form of the Household Food Security Scale. , 1999, American journal of public health.

[38]  A. Kant.  Consumption of energy-dense, nutrient-poor foods by adult Americans: nutritional and health implications. The third National Health and Nutrition Examination Survey, 1988-1994. , 2000, The American journal of clinical nutrition.

[39]  S. Chinn,et al.  Overweight, obesity and skinfold thicknesses of children of African or Indian descent in Trinidad and Tobago. , 2001, International journal of epidemiology.

[40]  J. Derrickson,et al.  Interpretations of the "balanced meal" household food security indicator. , 2001, Journal of nutrition education.

[41]  S. Walker,et al.  Schoolchildren's diets and participation in school feeding programmes in Jamaica , 1998, Public Health Nutrition.

[42]  R. Jeffery,et al.  Temporal trends in energy intake in the United States: an ecologic perspective. , 2000, The American journal of clinical nutrition.