Dietary intake, household food insecurity, and their associations with anthropometric status and sociodemographic factors amongst young New Zealand children : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Science, Massey University, Auckland, New Zealand
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2024-04-08
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Massey University
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Abstract
Background: Household food insecurity is a serious public health concern that may impact young children's dietary intake. In New Zealand (NZ), there are limited studies on young children’s dietary intake. However, comprehensive dietary data is crucial to ensure that young NZ children obtain adequate energy and nutrient intakes to support their optimal growth and development. Certain sociodemographic groups are disproportionately affected by household food insecurity, which may have been reflected by the high proportion of obesity in NZ compared to other high-income countries and poor dietary consumption indicative of suboptimal nutrition.
Aim: Therefore, this thesis aims to describe the energy and nutrient intakes, food group consumption, and household food security status of young NZ children, their relationship, and associated correlates such as anthropometric status, ethnicity, socioeconomic status, sex, age, caregiver characteristics, and household size and structure.
Methods: Two 24-hour food recalls from 289 children aged 1-3 years participating in the Young Foods NZ (YFNZ) study were analysed to obtain energy, nutrient, and food group intake data. YFNZ is an observational cross-sectional study of children living in Auckland, Wellington, and Dunedin, NZ. Household food security status was measured using the NZ food security scale, a NZ-specific and validated questionnaire. NZ Index of Deprivation was utilised as a proxy measure of socioeconomic status. Anthropometric status was measured using the Body Mass Index (BMI) z-score. Data on other sociodemographic characteristics such as ethnicity, sex, age, caregiver characteristics, household size and structure were collected through online and interviewer-assisted questionnaires.
Results: Overall, most nutrient intake recommendations were met except for fibre, iron, calcium, and vitamin C, with a proportion of inadequacy at 54.0%, 15.2%, 3.8%, and 4.8% respectively. Additionally, high protein and saturated fat intakes were observed. Māori, Pacific, Asian, and children living in areas of high deprivation were more at risk of lower fibre intakes than their counterparts, whilst children living in areas of high deprivation had a higher fat intake than those living in low-deprived neighbourhoods.
Grains and pasta (n=276 participants), fruits (n=266), and biscuits, crackers, cakes, and desserts (n=242) were most commonly consumed. Formulae (i.e., infant and follow-on formula mixes) and mixed dishes primarily contributed to the intake of energy and most nutrients. Children who were more likely to consume dairy products and dairy-alternative products were children with healthy weight compared to those who were overweight (p=0.036), NZ European compared to Māori, Asian and Pacific children (p=0.005), and children living in areas of low deprivation compared to those who live in highly deprived areas (p=0.014). Food insecure children were more likely to consume pies and pasties (p=0.013), potatoes, kūmara and taro (p=0.040), and beverages (i.e., all fluids except for milk and water) (p=0.011) but less likely to consume biscuits, crackers, cakes and desserts (p=0.001), vegetables (p=0.005), and nuts and seeds (p=0.004). Energy-dense and nutrient-poor foods such as sausages and processed meats; sugar, confectionery, sweet spreads; and pies and pasties were the primary contributors to Pacific children's energy intake and those living in areas of higher deprivation and food insecure households.
Over a third of young children experienced food insecurity in the past year. Being overweight, Māori or Pacific, living in areas of high deprivation; having a caregiver who was younger, not in paid employment, or had low educational attainment; living with at least two other children in the household, and living in a sole parent household were associated with household food insecurity. Compared to food-secure children, moderately food-insecure children had higher fat and saturated fat intakes, consuming 3.0 (0.2, 5.8) g/day more fat, and 2.0 (0.6, 3.5) g/day more saturated fat (p<0.05). Moderately and severely food insecure children had lower fibre intake, consuming 1.6 (2.8, 0.3) g/day and 2.6 (4.0, 1.2) g/day less fibre, respectively, compared to food secure children. Severely food-insecure children had three times the prevalence of inadequate calcium intakes and over three times the prevalence of inadequate vitamin C intakes compared to food-secure children.
Conclusion: Young NZ children consume a diet that is mostly adequate in terms of most nutrients with the exception of fibre, iron, calcium, and vitamin C. High intakes of nutrients of concern (i.e., saturated fat and protein) were detected and reported to be commonly sourced from low-cost, energy-dense, and nutrient-poor foods. The consumption of these foods mirrors the high prevalence of household food insecurity and obesity amongst young NZ children. Other sociodemographic factors closely related to poverty or low income were associated with food insecurity. Therefore, targeted policies and programmes are imperative, particularly for the most vulnerable groups, to ensure young children's optimal growth and development and attain more equitable health outcomes in NZ.
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Food security, Cost and standard of living, Infants, Children, Nutrition, Requirements, Social conditions, New Zealand