Household Food Insecurity, Hair Cortisol, and Adiposity Among Tsimane' Hunter-Forager-Horticulturalists in Bolivia.

OBJECTIVES: This study examined how household food insecurity (HFI) and chronic stress relate to adiposity among Tsimane' hunter-forager-horticulturalists in remote Bolivia with limited access to energy-dense processed foods that promote weight gain among industrialized populations. METHODS: Retrospective cross-sectional data on HFI (via the Household Food Insecurity Access Scale [HFIAS]), hair cortisol concentration (HCC), adiposity (BMI, body fat percentage [%BF]), and sociodemographics were collected from 171 men, 164 women, and 167 children. Linear mixed-effects models tested linear, quadratic, joint, and interactive relationships between adiposity measures and both the HFIAS score and HCC. RESULTS: Among children, each 3-point HFIAS score increase was associated with a 0.44-point higher %BF (SE = 0.22, P = 0.04). However, each 20% increase in HCC was associated with a -0.29-point difference in %BF (SE = 0.12, P = 0.01). Among men, a slight curvilinear relationship emerged between HFIAS and BMI. HFIAS and HCC were unrelated to adiposity measures among women. HCC did not modify relationships between HFIAS and adiposity in any subgroup. CONCLUSIONS: These findings from a remote, small-scale population suggest that positive associations between HFI and adiposity are not isolated to contexts of industrialized food environments and heavy reliance on processed foods. However, these dynamics and the role of stress appear to differ by sex and age group.

Prevalence, Determinants, and Effects of Food Insecurity among Middle Eastern and North African Migrants and Refugees in High-Income Countries: A Systematic Review.

Issues related to poverty and income inequality in high-income countries have led to food insecurity among some population groups, such as migrants and refugees. While there are some studies on the experience of some migrant groups (and other subpopulations), little is known about food security among Middle Eastern and African migrants and refugees. This systematic review identified the prevalence of food insecurity and its effects among Middle Eastern and North African (MENA) migrants and refugees in high-income countries. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in this systematic review. Four databases, namely MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), and PubMed were searched. Three studies met the inclusion criteria, all of which were conducted in USA: two among Sudanese migrant families, and one among Somali refugee women. The rates of reported food insecurity ranged from 40% to 71% and were significantly higher than for the general population. Food insecurity was associated with acculturation and socio-economic factors. Food insecurity adversely impacts the health of MENA migrants and refugees, creating economic implications for individuals, families, the broader community in which they now live, and for governments.

Association Between Living in Food Deserts and Cardiovascular Risk.

BACKGROUND: Food deserts (FD), neighborhoods defined as low-income areas with low access to healthy food, are a public health concern. We evaluated the impact of living in FD on cardiovascular risk factors and subclinical cardiovascular disease (CVD) with the hypothesis that people living in FD will have an unfavorable CVD risk profile. We further assessed whether the impact of FD on these measures is driven by area income, individual household income, or area access to healthy food. METHODS AND RESULTS: We studied 1421 subjects residing in the Atlanta metropolitan area who participated in the META-Health study (Morehouse and Emory Team up to Eliminate Health Disparities; n=712) and the Predictive Health study (n=709). Participants' zip codes were entered into the United States Food Access Research Atlas for FD status. Demographic data, metabolic profiles, hs-CRP (high-sensitivity C-reactive protein) levels, oxidative stress markers (glutathione and cystine), and arterial stiffness were evaluated. Mean age was 49.4 years, 38.5% male and 36.6% black. Compared with those not living in FD, subjects living in FD (n=187, 13.2%) had a higher prevalence of hypertension and smoking, higher body mass index, fasting glucose, and 10-year risk for CVD. They also had higher hs-CRP (P=0.014), higher central augmentation index (P=0.015), and lower glutathione level (P=0.003), indicative of increased oxidative stress. Area income and individual income, rather than food access, were associated with CVD risk measures. In a multivariate analysis that included food access, area income and individual income, both low-income area and low individual household income, were independent predictors of a higher 10-year risk for CVD. Only low individual income was an independent predictor of higher hs-CRP and augmentation index. CONCLUSIONS: Although living in FD is associated with a higher burden of cardiovascular risk factors and preclinical indices of CVD, these associations are mainly driven by area income and individual income rather than access to healthy food.

Working with a fractional object: enactments of appetite in interdisciplinary work in anthropology and biomedicine.

This paper explores the productive tensions occurring in an interdisciplinary research project on weight loss after obesity surgery. The study was a bio-medical/anthropological collaboration investigating to what extent eating patterns, the subjective experience of hunger and physiological mechanisms are involved in appetite regulation that might determine good or poor response to the surgery. Linking biomedical and anthropological categories and definitions of central concepts about the body turned out to be a major challenge in the collaborative analysis. Notably, the conception of what constitutes 'appetite' was a key concern, as each discipline has its particular definition and operationalization of the term. In response, a material-semiotic approach was chosen which allowed for a reconceptualization of appetite as a 'fractional object', engaged in multiple relations and enacted differently in each instance. This perspective produced creative contrasts and offered alternative explorations of both scientific knowledge production and anthropological practices. The paper thereby explores the interfaces between anthropology and medical science by attending to the challenges and opportunities that result from destabilising an assumed fixed and well-defined concept associated with the body.

See food diet? Cultural differences in estimating fullness and intake as a function of plate size.

Previous research has suggested that manipulations of plate size can have a direct impact on perception of food intake, measured by estimated fullness and intake. The present study, involving 570 individuals across Canada, China, Korea, and New Zealand, is the first empirical study to investigate cultural influences on perception of food portion as a function of plate size. The respondents viewed photographs of ten culturally diverse dishes presented on large (27 cm) and small (23 cm) plates, and then rated their estimated usual intake and expected fullness after consuming the dish, using 100-point visual analog scales. The data were analysed with a mixed-model ANCOVA controlling for individual BMI, liking and familiarity of the presented food. The results showed clear cultural differences: (1) manipulations of the plate size had no effect on the expected fullness or the estimated intake of the Chinese and Korean respondents, as opposed to significant effects in Canadians and New Zealanders (p < 0.05); (2) Canadian (88.91 ± 0.42) and New Zealanders (90.37 ± 0.41) reported significantly higher estimated intake ratings than Chinese (80.80 ± 0.38) or Korean (81.69 ± 0.44; p < 0.05), notwithstanding the estimated fullness ratings from the Western respondents were comparable or even higher than those from the Asian respondents. Overall, these findings, from a cultural perspective, support the notion that estimation of fullness and intake are learned through dining experiences, and highlight the importance of considering eating environments and contexts when assessing individual behaviours relating to food intake.

The influence of ethnicity and glucose tolerance status on subjective hunger sensations and prospective food intake in overweight and obese Asian and European Australians.

AIMS: To examine the influence of ethnicity and glucose tolerance status on subjective sensations and food intake in overweight/obese Asian and European Australians. METHODS: 18 Asians and 26 Europids were classified as normal glucose tolerance (NGT) and impaired glucose tolerance (IGT) based on serial measures of finger-prick glucose following an oral glucose tolerance test (OGTT). Subjective sensations of hunger and satiety were measured before and every 15min after the OGTT using a visual analogue scale (VAS). Food intake was measured covertly from consumption of a buffet style lunch and from self-maintained 24h food records. All serial measurements were converted into total area under the curve (TAUC) and comparisons adjusted for age, fat and fat-free mass. RESULTS: There was a significant difference interaction between ethnicity (ETH) and glucose tolerance (GTT) for subjective fullness, desire for food and prospective food intake. IGT Asians had significantly greater sensations of fullness, but lesser prospective food and desire to eat, as compared to other groups. However there were no differences in calorie and macronutrient intake at buffet lunch or over 24-h. CONCLUSION: Interactions between ethnicity and glucose tolerance status in subjective sensations did not transcribe to differences in prospective food intake.

Dietary Diversity and Vegetable and Fruit Consumption of Households in a Resource-Poor Peri-Urban South Africa Community Differ by Food Security Status.

Sociodemographic, living standard measure, consumption of vegetables and fruit, and dietary diversity in relation to household food security were assessed. Using a hunger score, households were categorized as food secure (n = 125) or food insecure (n = 273). Food secure respondents had a higher mean dietary diversity score (3.98; 95%CI [3.79, 4.18] versus 3.65; 95% [CI 3.53, 3.77]), were more likely to eat vitamin A-rich foods (OR 1.15; 95% CI [1.05, 1.26]), a more varied diet (DDS ≥ 4, OR 1.90; 95% CI [1.19, 3.13]), and vegetables daily (OR 3.37; 95% CI [2.00, 5.76]). Cost limited daily vegetable/fruit consumption in food insecure households. Respondents with ≥ 8 years of schooling were more likely (OR 2.07; 95% CI [1.22, 3.53]) and households receiving social grants were less likely (OR 0.37; 95% CI [0.19, 0.72]) to be food secure. Results highlight the association between dietary diversity and household food security.

Looking for cues - infant communication of hunger and satiation during milk feeding.

It is known that duration of breastfeeding and responsive feeding are associated with decreased risk of obesity. It is however, not clear whether breastfed infants signal more to mothers to facilitate responsive feeding, compared to formula fed, nor what communication cues are important during the feeding interaction. The present study aimed to explore feeding cues in milk-fed infants and to examine if such cues vary by mode of feeding. Twenty-seven mothers and infants were filmed while breastfeeding or formula feeding. Infants' age ranged from 3 to 22 weeks. Feeding cues were identified using a validated list of communication cues (NCAST). The frequency of each cue during the beginning, middle, and end of the meal was recorded. There were 22 feeding cues identified during the feeds, with significantly more frequent disengagement cues expressed than engagement cues. Significantly more frequent feeding cues were observed at the beginning than at the end of the meal showing that cue frequency changes with satiation. Breastfeeding infants exhibited more engagement and disengagement cues than formula fed infants. Supporting mothers to identify engagement and disengagement cues during a milk feed may promote more responsive feeding-strategies that can be acquired by mothers using different modes of feeding.

Household Food Insecurity Is Associated with Adverse Mental Health Indicators and Lower Quality of Life among Koreans: Results from the Korea National Health and Nutrition Examination Survey 2012-2013.

Food insecurity is an ongoing public health issue and contributes to mental health status. We investigated whether food insecurity is associated with inadequate nutrient intake and whether it affects mental health indicators (perceived stress/experience of depressive symptom/suicidal ideation) and quality of life (QOL) among Koreans (n = 5862, 20-64 years) using data from the Korea National Health and Nutritional Examination Survey (2012-2013). Household food security status was categorized as "food-secure household", "food-insecure household without hunger", and "food-insecure household with hunger". Data on food insecurity, sociodemographic factors, nutrient intake, mental health indicators, and QOL were used. A logistic regression model was conducted to determine odds ratios (ORs) for psychological health. A greater proportion of food-insecure participants were nutritionally deficient compared with expectations of the 2015 Korean Dietary Reference Intakes. These deficiencies were generally higher in both "food-insecure household" groups. Both "food-insecure household" groups, particularly the "food-insecure household with hunger" group showed significantly adverse mental health status (ORs: 1.52-3.83) and lower QOL (ORs: 1.49-3.92) than did the "food-secure household" group before and after adjusting for sex, age, education, household income, smoking/alcohol consumption, physical activity, marital status, and receiving food assistance. In conclusion, food insecurity may be significantly associated with adverse mental health indicators and decreased QOL in young/middle-aged Koreans.

Antiretroviral Therapy and Nutrition in Southern Africa: Citizenship and the Grammar of Hunger.

How might we understand and respond to the new forms of hunger that arise with the massive rollout of antiretroviral therapy (ART) for HIV in southern Africa? Rather than 'merely' a technical problem of measurement, medicine or infrastructure, I suggest that a philosophical question arises concerning the relationship between the experience of hunger, the utterances that communicate that experience, and the bodily regimes of well-being and ill-being indexed by such utterances. Taking the gut as a particular kind of mediator of experience, I draw on ethnographic fieldwork conducted in KwaZulu-Natal, South Africa to open up a set of questions on acknowledgment and avoidance. The central question concerns the divergent concepts of 'grammar' that confront the relationship between hunger and ART.

Prevalence and correlates of hunger among primary and secondary school children in Malawi: results from the 2009 Global School-based Health Survey.

BACKGROUND: Education is important in improving economies and creating literate, self-reliant and healthy societies. However, hunger is a barrier to basic education in Malawi. Hunger is also associated with a number of health risk behaviours, such as bullying, suicide ideation and unhygienic behaviours that may jeopardize the future of children. There are, however, limited data on the prevalence and associated factors of hunger among school children in Malawi. METHODS: The study used data from the Malawi Global School-Based Health Survey conducted in 2009 to estimate the prevalence of self-reported hunger within the last 30 days among primary and secondary school age group. It also assessed the association between self-reported hunger and some selected list of independent variables using frequency distribution, chi-squared test and logistic regression. RESULTS: A total of 2359 students were available for analysis. The overall self-reported prevalence of hunger within the last 30 days was 12.5% (18.9% (172) in the rural and 8.3% (115) in urban areas; and 11.9%(123) for male and 12.5(148) for female children). In the final analysis, geographical location, eating fruits, having been bullied, suicide ideation, and washing hands with soap were significantly associated with hunger. CONCLUSION: Hunger in both primary and secondary school children in Malawi is a major social problem. The design of school feeding programmes aimed to reduce hunger should incorporate the factors identified as associated with hunger.

Effects of a free school breakfast programme on children's attendance, academic achievement and short-term hunger: results from a stepped-wedge, cluster randomised controlled trial.

BACKGROUND: Free school breakfast programmes (SBPs) exist in a number of high-income countries, but their effects on educational outcomes have rarely been evaluated in randomised controlled trials. METHODS: A 1-year stepped-wedge, cluster randomised controlled trial was undertaken in 14 New Zealand schools in low socioeconomic resource areas. Participants were 424 children, mean age 9±2 years, 53% female. The intervention was a free daily SBP. The primary outcome was children's school attendance. Secondary outcomes were academic achievement, self-reported grades, sense of belonging at school, behaviour, short-term hunger, breakfast habits and food security. RESULTS: There was no statistically significant effect of the breakfast programme on children's school attendance. The odds of children achieving an attendance rate <95% was 0.76 (95% CI 0.56 to 1.02) during the intervention phase and 0.93 (95% CI 0.67 to 1.31) during the control phase, giving an OR of 0.81 (95% CI 0.59 to 1.11), p=0.19. There was a significant decrease in children's self-reported short-term hunger during the intervention phase compared with the control phase, demonstrated by an increase of 8.6 units on the Freddy satiety scale (95% CI 3.4 to 13.7, p=0.001). There were no effects of the intervention on any other outcome. CONCLUSIONS: A free SBP did not have a significant effect on children's school attendance or academic achievement but had significant positive effects on children's short-term satiety ratings. More frequent programme attendance may be required to influence school attendance and academic achievement. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR)-ACTRN12609000854235.

On hunger and child mortality in India.

Despite accelerated growth there is pervasive hunger, child undernutrition and mortality in India. Our analysis focuses on their determinants. Raising living standards alone will not reduce hunger and undernutrition. Reduction of rural/urban disparities, income inequality, consumer price stabilization, and mothers' literacy all have roles of varying importance in different nutrition indicators. Somewhat surprisingly, public distribution system (PDS) do not have a significant effect on any of them. Generally, child undernutrition and mortality rise with poverty. Our analysis confirms that media exposure triggers public action, and helps avert child undernutrition and mortality. Drastic reduction of economic inequality is in fact key to averting child mortality, conditional upon a drastic reordering of social and economic arrangements.

The association between housing instability, food insecurity, and diabetes self-efficacy in low-income adults.

Limited data exist on whether structural factors associated with poverty such as inadequate housing and food insecurity affect diabetes care. In a sample of low-income participants with diabetes (N=711), we sought to determine if housing instability was associated with lower diabetes self-efficacy, and whether this relationship was mediated by food insecurity. We ordered housing from most to least stable. We observed a linear decrease in diabetes self-efficacy as housing instability increased (p<.01). After adjusting for age, sex, race/ethnicity, and alcohol or substance use, adults lacking a usual place to stay had lower self-efficacy than those who owned their own home (ß-coefficient -0.94, 95% CI -1.88, -0.01). Food insecurity mediated the association between housing instability and diabetes self-efficacy (ß-coefficient -0.64, 95% CI -1.57, 0.31). Our findings suggest that inadequate access to food lowers self-efficacy among adults with diabetes, and supports provision of food to unstably housed adults as part of diabetes care.

Rights to food with a human face in the global south.

This article seeks to dispel the popular myth surrounding the food crises which precipitated food riots in the global South in 2008. Arguing from a structural and historical perspective, the article suggests that global hunger is a deep-rooted crisis that is embedded in the social and structural variables associated within the nation-state that places a restraint on the self-regulating capacity of nation-states in the South. Internationalizing the food crisis, however, will do more harm to the south's agricultural transformation and rural development. The article argues for integrated rural development that will increase output growth through an institutional, technological, and marketing strategy.

Country of birth is associated with very low food security among Mexican American older adults living in colonias along the south Texas border with Mexico.

The availability of an adequate household food supply is critical for the older population. There is little work that has examined food security and the influence of nativity on food security among older Mexican Americans living along the Texas-Mexico border. Using data from 140 older women (age ≥ 50 y) who participated in the 2009 Colonia Household and Community Food Resource Assessment (C-HCFRA), we examined demographic characteristics, health characteristics, food access and mobility, federal and community food and nutrition assistance programs, quality of food environment, food security, eating behaviors, and alternative food sources. 77% of participants experienced food insecurity, with 68% experiencing very low food security. Very low food security was associated with being born in Mexico, adjusting for household income and food assistance program participation. This article provides compelling evidence for enhanced research efforts that will better understand coping strategies and the use of food and nutrition assistance programs for reducing hardship associated with very low food security among older U.S.- and Mexico-born Mexican American women.

Food security politics and the Millennium Development Goals.

This article reviews proposals regarding the recent food crisis in the context of a broader, threshold debate on the future of agriculture and food security. While the MDGs have focused on eradicating extreme poverty and hunger, the food crisis pushed the hungry over the one billion mark. There is thus a renewed focus on agricultural development, which pivots on the salience of industrial agriculture (as a supply source) in addressing food security. The World Bank's new 'agriculture for development' initiative seeks to improve small-farmer productivity with new inputs, and their incorporation into global markets via value-chains originating in industrial agriculture. An alternative claim, originating in 'food sovereignty' politics, demanding small-farmer rights to develop bio-regionally specific agro-ecological methods and provision for local, rather than global, markets, resonates in the IAASTD report, which implies agribusiness as usual ''is no longer an option'. The basic divide is over whether agriculture is a servant of economic growth, or should be developed as a foundational source of social and ecological sustainability. We review and compare these different paradigmatic approaches to food security, and their political and ecological implications.

From famine to food crisis: what history can teach us about local and global subsistence crises.

The number of famine prone regions in the world has been shrinking for centuries. It is currently mainly limited to sub-Saharan Africa. Yet the impact of endemic hunger has not declined and the early twenty-first century seems to be faced with a new threat: global subsistence crises. In this essay I question the concepts of famine and food crisis from different analytical angles: historical and contemporary famine research, food regime theory, and peasant studies. I will argue that only a more integrated historical framework of analysis can surpass dualistic interpretations grounded in Eurocentric modernization paradigms. This article successively debates historical and contemporary famine research, the contemporary food regime and the new global food crisis, the lessons from Europe's 'grand escape' from hunger, and the peasantry and 'depeasantization' as central analytical concepts. Dualistic histories of food and famine have been dominating developmentalist stories for too long. This essay shows how a blending of historical and contemporary famine research, food regime theory and new peasant studies can foster a more integrated perspective.