Development and Validation of a Physical Food Security Tool for Older Adults.

BACKGROUND: Current measures of food insecurity focus on economic access to food, but not on the physical aspect of food insecurity that captures the inability to access food or prepare meals. This is particularly relevant among the older adult population who are at a high risk of functional impairments. OBJECTIVES: To develop a short-form physical food security (PFS) tool among older adults using statistical methods based on the Item Response Theory (Rasch) model. METHODS: Pooled data from adults aged ≥60 y of the NHANES (2013-2018) (n = 5892) were used. The PFS tool was derived from the physical limitation questions included in the physical functioning questionnaire of NHANES. Item severity parameters, fit and reliability statistics, and residual correlation between items were estimated using the Rasch model. The construct validity of the tool was assessed by examining associations with the Healthy Eating Index (HEI)-2015 scores, self-reported health, self-reported diet quality, and economic food insecurity, using weighted multivariable linear regression analysis, controlling for potential confounders. RESULTS: A 6-item scale was developed, which had adequate fit statistics and high reliability (0.62). It was categorized based on raw score severity into high, marginal, low, and very low PFS. Very low PFS was associated with respondent's self-reported poor health (OR = 23.8; 95% CI: 15.3, 36.9; P < 0.0001), self-reported poor diet (OR = 3.9; 95% CI: 2.8, 5.5; P < 0.0001), low and very low economic food security (OR = 6.08; 95% CI: 4.23, 8.76; P < 0.0001), and with lower mean HEI-2015 index score, in comparison to older adults with high PFS (54.5 compared with 57.5, P = 0.022). CONCLUSIONS: The proposed 6-item PFS scale captures a new dimension of food insecurity that can inform on how older adults experience food insecurity. The tool will require further testing and evaluation in larger and different contexts to demonstrate its external validity.

The imperative of arachidonic acid in early human development.

This review is about the role of arachidonic acid (ArA) in foetal and early growth and development. In 1975 and '76, we reported the preferential incorporation of ArA into the developing brain of rat pups, its conservation as a principal component in the brains of 32 mammalian species and the high proportion delivered by the human placenta for foetal nutrition, compared to its parent linoleic acid (LA). ArA is quantitatively the principal acyl component of membrane lipids from foetal red cells, mononuclear cells, astrocytes, endothelium, and placenta. Functionally, we present evidence that ArA, but not DHA, relaxes the foetal mesenteric arteries. The placenta biomagnifies ArA, doubling the proportion of the maternal level in cord blood. The proportions of ArA and its allies (di-homo-gamma-linolenic acid (DGLA), adrenic acid and ω6 docosapentaenoic acid) are similar or higher than the total of ω3 fatty acids in human milk, maintaining the abundant supply to the developing infant. Despite the evidence of the importance of ArA, the European Food Standard Agency, in 2014 rejected the joint FAO and WHO recommendation on the inclusion of ArA in infant formula, although they recommended DHA. The almost universal dominance of ArA in the membrane phosphoglycerides during human organogenesis and prenatal growth suggests that the importance of ArA and its allies in reproductive biology needs to be re-evaluated urgently.

Child-Reported Food Insecurity Is Negatively Associated with Household Food Security, Socioeconomic Status, Diet Diversity, and School Performance among Children Attending UN Relief and Works Agency for Palestine Refugees Schools in Lebanon.

BACKGROUND: Recent studies have shown that children are able to accurately describe their own experiences of food insecurity; however, few studies have quantified this experience. OBJECTIVES: We aimed to develop and validate a child food security scale to be used in Arabic-speaking countries. METHODS: As part of the Healthy Kitchens Healthy Children study on food security and nutrition in schools, 14 questions were administered to 5-15-y-old children (n = 1433) attending 4 UN Relief and Works Agency for Palestine refugees schools. We used statistical methods based on Item Response Theory to assess the internal validity of a proposed food security scale using these items. Further validation of the scale was conducted by examining associations with sociodemographic, economic, household food security, and diet diversity variables through logistic regression models adjusted for age, sex, and school of the children. RESULTS: A total of 1287 children (89.8%) provided complete responses to the questionnaire. Four items were dropped from the scale because of high infit statistics (>1.3) and high residual correlation with other items. The resulting 10-item scale had acceptable reliability (Cronbach α coefficient = 0.89). Children who reported food insecurity were more likely to be from food-insecure households (OR: 2.3; P < 0.001). Food-insecure children came from households with lower expenditures per capita (OR: 0.80; P = 0.007) and higher household crowding (OR: 1.70; P = 0.001), and had less educated mothers (OR: 0.89; P = 0.009), lower household diet diversity (OR: 0.85; P < 0.001), and lower household consumption of meat (OR: 0.89; P < 0.001) and fruit (OR: 0.95; P = 0.001). Child food insecurity was also associated with higher school absenteeism (OR: 1.64; P = 0.01) and lower academic grades in languages and science (P < 0.05). CONCLUSIONS: Child food security was accurately measured through a 10-item scale. This tool is appropriate to assess child food insecurity experience directly with children, and can be used in school-based interventions, where obtaining data from parents may be cumbersome.

Prevalence and Correlates of Food Insecurity among Palestinian Refugees in Lebanon: Data from a Household Survey.

Lebanon hosts the highest per capita refugee concentration worldwide. The Palestinian presence in Lebanon dates from 1948 and they remain a marginalized population. No information on their food security status has been reported previously. A survey of a representative sample of Palestinian refugee households in Lebanon (n = 2501) was conducted using a stratified two stage cluster sampling approach. We measured food insecurity using a modified USDA household food security module, locally validated. We collected data on household demographic, socioeconomic, health, housing, coping strategies and household intake of food groups and analysed these by food security status. About 41% (CI: 39-43) of households reported being food insecure and 20% (CI: 18-22) severely food insecure. Poor households were more likely to be severely food insecure (OR 1.41 (1.06-1.86)) while higher education of the head of household was significantly associated with protection against severe food insecurity (OR 0.66 (0.52-0.84)). Additionally, higher food expenditure and possession of food-related assets were significantly associated with food security (OR 0.93 (0.89-0.97) and OR 0.74 (0.59-0.92), respectively). After adjusting for confounders, households where at least one member suffered from an acute illness remained significantly more likely to be severely food insecure (OR 1.31(1.02-1.66)), as were households whose proxy respondent reported poor mental health (OR 2.64 (2.07-3.38)) and poor self-reported health (OR 1.62 (1.22-2.13). Severely food insecure households were more likely to eat cheaper foods when compared to non-severely food insecure households (p<0.001) and were more likely to rely on gifts (p<0.001) or welfare (p<0.001). They were also more likely to have exhausted all coping strategies, indicating significantly more frequently that they could not do anything (p = 0.0102). Food insecurity is a significant problem among Palestinian refugees in Lebanon and is likely to be exacerbated at this time when the Syrian crisis amplifies the problem.

Arab Adolescents: Health, Gender, and Social Context.

This article reviews the evidence about adolescent health in the Arab world, against the background of social, economic, and political change in the region, and with a particular focus on gender. For the literature review, searches were conducted for relevant articles, and data were drawn from national population- and school-based surveys and from the Global Burden of Disease project. In some parts of the Arab world, adolescents experience a greater burden of ill health due to overweight/obesity, transport injuries, cardiovascular and metabolic conditions, and mental health disorders than those in other regions of the world. Poor diets, insufficient physical activity, tobacco use, road traffic injuries, and exposure to violence are major risk factors. Young men have higher risks of unsafe driving and tobacco use and young women have greater ill-health due to depression. Several features of the social context that affect adolescent health are discussed, including changing life trajectories and gender roles, the mismatch between education and job opportunities, and armed conflict and interpersonal violence. Policy makers need to address risk factors behind noncommunicable disease among adolescents in the Arab region, including tobacco use, unhealthy diets, sedentary lifestyles, unsafe driving, and exposure to violence. More broadly, adolescents need economic opportunity, safe communities, and a chance to have a voice in their future.

Food insecurity among Iraqi refugees living in Lebanon, 10 years after the invasion of Iraq: data from a household survey.

Iraqi refugees in Lebanon are vulnerable to food insecurity because of their limited rights and fragile livelihoods. The objective of the present study was to assess household food insecurity among Iraqi refugees living in Lebanon, almost 10 years after the invasion of Iraq. A representative survey of 800 UN High Commissioner for Refugees-registered refugee households in Lebanon was conducted using multi-stage cluster random sampling. We measured food insecurity using a modified US Department of Agriculture household food security module. We collected data on household demographic, socio-economic, health, housing and dietary diversity status and analysed these factors by food security status. Hb level was measured in a subset of children below 5 years of age (n 85). Weighted data were used in univariate and multivariate analyses. Among the Iraqi refugee households surveyed (n 630), 20·1% (95% CI 17·3, 23·2) were found to be food secure, 35·5% (95% CI 32·0, 39·2) moderately food insecure and 44·4% (95% CI 40·8, 48·1) severely food insecure. Severe food insecurity was associated with the respondent's good self-reported health (OR 0·3, 95% CI 0·2, 0·5), length of stay as a refugee (OR 1·1, 95% CI 1·0, 1·2), very poor housing quality (OR 3·3, 95% CI 1·6, 6·5) and the number of children in the household (OR 1·2, 95% CI 1·0, 1·4), and resulted in poor dietary diversity (P< 0·0001). Anaemia was found in 41% (95% CI 30·6, 51·9) of children below 5 years of age, but was not associated with food insecurity. High food insecurity, low diet quality and high prevalence of anaemia in Iraqi refugees living in Lebanon call for urgent programmes to address the food and health situation of this population with restricted rights.

Development and validation of an Arab family food security scale.

The objective of this article was to describe 1) the validation of 2 similar but not identical food security modules used to collect data from 2 vulnerable populations, southern Lebanon residents (n = 815) and Palestinian refugees in Lebanon (n = 2501), and 2) the development and validation of an Arab Family Food Security Scale (AFFSS). The surveys used a cluster-randomized sampling design. The 2 food security subscales underwent face and construct validity. In addition, both of these tools and the AFFSS underwent psychometric assessment for internal validity by using statistical methods based on Item Response Theory. The food security questions tested by focus groups were understood and accepted in all regions of Lebanon. The food security subscales and the AFFSS had acceptable levels of internal consistency. The psychometric assessment confirmed that the 7 items of the AFFSS had good internal validity and reasonable reliability with item in-fits from 0.73 to 1.16. Food insecurity was identified among 42% of southern Lebanese and 62% of Palestinian refugee households. The determinants and consequences of food security measured in this study provide additional support for the validity of the modules. Using multivariate logistic regression, the higher the mean monthly income per household member and the higher the educational attainment of the head of household, the lower the risk of food insecurity [ORs (95% CIs): 0.99 (0.98, 0.99) and 0.66 (0.54, 0.80), respectively]. There was a strong significant association between food insecurity and lower food expenditure and lower intake of all food categories except for legumes, which was significantly associated in the opposite direction (P < 0.001). The odds of borrowing money and accepting gifts/donations were significantly higher among moderately and severely food-insecure households (P < 0.000). The AFFSS has been validated within Lebanon and can potentially be extended to other Arab-speaking populations.