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This study investigated food intake patterns and contextual factors related to household food insecurity with hunger among a sample of 153 women in families seeking charitable food assistance in Toronto. Women in households characterized by food insecurity with severe or moderate hunger over the past 30 d (as assessed by the Food Security Module) reported lower intakes of vegetables and fruit, and meat and alternatives than those in households with no hunger evident. Women were more likely to report household food insecurity with hunger over the past 12 mo and 30 d if they also reported longstanding health problems or activity limitations, or if they were socially isolated. The circumstances that women identified as precipitating acute food shortages in their households included chronically inadequate incomes; the need to meet additional, unusual expenditures; and the need to pay for other services or accumulated debts. Women who reported delaying payments of bills, giving up services, selling or pawning possessions, or sending children elsewhere for a meal when threatened with acute food shortages were more likely to report household food insecurity with hunger. These findings suggest that expenditures on other goods and services were sometimes foregone to free up money for food, but the reverse was also true. Household food insecurity appears inextricably linked to financial insecurity. [ABSTRACT FROM AUTHOR]

A study of food insecurity and nutritional adequacy was conducted with a sample of 153 women in families receiving emergency food assistance in Toronto, Canada. Contemporaneous data on dietary intake and household food security over the past 30 d were available for 145 of the women. Analyses of these data revealed that women who reported hunger in their households during the past 30 d also reported systematically lower intakes of energy and a number of nutrients. The effect of household-level hunger on intake persisted even when other economic, socio-cultural, and behavioral influences on reported dietary intake were considered. Estimated prevalences of inadequacy in excess of 15% were noted for Vitamin A, folate, iron, and magnesium in this sample, suggesting that the low levels of intake associated with severe household food insecurity are in a range that could put women at risk of nutrient deficiencies. [ABSTRACT FROM AUTHOR]

Background: "Diet cost" refers to a methodological approach developed by Drewnowski et al. to estimate individual daily diet costs, where cost vectors are derived by matching prices from food supply data to the food sources of reported intakes from dietary assessment tools. The dietary assessment method and food price collection approach have been found to vary diet cost estimates. There is a need to better understand how food supply prices might be better standardized and attached to price individuals' diets., Objectives: To conduct a scoping review to examine Drewnowski's diet cost method, with a focus on a detailed description and charting of cost estimation measures and methods used to price individuals' consumed diets., Methods: Five databases were searched from the inception of each database to March 2023. Included articles comprised analyses of individual-level dietary assessment data matched to food prices to assign estimates of individual daily diet costs., Results: A total of 55 articles were included, published between 1999 and 2022 from 17 countries. In all studies, cost estimates were intended to be representative of price exposures among individual respondents' dietary assessment data. All studies derived cost estimates from separately collected food prices. A total of 34 (62%) of included articles collected food prices from retail (supermarket) audits. A minority of studies (19, 35%) reported the number of food prices used to cost diets, and those varied widely, ranging from 57 to nearly 4600 distinct foods priced per study., Conclusions: In the absence of a standardized approach to study the relationship between diet costs and dietary adequacy, this scoping review has described methodological concepts and parameters used to price individuals' consumed diets. Our review shows that despite common arithmetic to calculate cost vectors, there is substantial variation in the methods used to select and attach prices from the food supply to self-reported dietary intake assessments., Competing Interests: Conflict of interest GL report financial support by Canadian Institutes of Health Research. CLM report financial support by Canadian Institutes of Health Research and Canada Research Chairs Program. MH reports financial support was provided by Canada Research Chairs Program. All other authors report no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Different food price sources and dietary assessment tools may impact the estimation of diet costs and hamper our understanding of the relationship between diet costs and dietary intakes., Objectives: We aimed to investigate the effect of 3 diet cost derivation methods, with increasing numbers of food prices and geographic specificity, holding consistent the dietary assessment tool, on the estimation of diet costs overall and by food group., Methods: We matched 24-h dietary recall data from the 2015 Canadian Community Health Survey-Nutrition (CCHS-N) to food price data from 3 Canadian Consumer Price Index (CPI) food price lists; national short list, national long list, and provincial long list. We compared the daily ($/day) and energy-adjusted ($/2000 kcal) diet costs overall and by food groups for the overall population (4+), children (4-18), and adults (19+)., Results: The proportion of dietary intakes (grams) that were covered by CPI prices significantly increased from the national short list to the national long list but did not significantly differ from the national long list to the provincial long list. The national short list resulted in the highest daily and energy-adjusted diet costs overall. No difference in diet costs was noted between the national and provincial long lists. Diet costs for 4 food groups-additions, sweets, fruits, and vegetables, which were poorly covered by the national short list-significantly differed using the national and provincial long lists. All 3 diet cost methods were significantly correlated with energy intakes; however, a strong/very strong correlation was detected for children, and a weak/moderate correlation for adults., Conclusions: The choice of food price data may introduce bias in the diet cost estimate, as well as limiting our understanding of how individuals allocate their diet costs. Refinement of diet cost estimation methodology and measures can strengthen future studies of how consumers allocate their purchases to their diets., Competing Interests: Conflict of interest The authors report no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Food insecurity, inadequate access to food due to financial constraints, is a major public health issue in the United States and Canada, where the same 18-item questionnaire is used to monitor food insecurity. Researchers often assume that findings on food insecurity from the 2 countries are comparable with each other, but there are between-country differences in how food insecurity status is determined., Objectives: We aimed to compare the distribution of household food insecurity in the Canadian population applying the US and Canadian classification schemes. We also examined the extent to which associations between food insecurity and adults' health differ under the 2 schemes., Methods: We used the population-representative Canadian Community Health Survey 2005-2017 linked to administrative health records. Food insecurity was measured by the Household Food Security Survey Module. Adults 18 y and older with valid food insecurity status were included from all jurisdictions except Quebec (n = 403,200). We cross-tabulated food insecurity status classified by the US and Canadian schemes. We also fitted logistic regressions on self-reported and objective health measures adjusting for confounders., Results: Applying the Canadian classification scheme, 7.7% of households were food insecure; the number fell to 6.0% with the US scheme. Associations between food insecurity status and health measures were mostly similar across classification schemes, although the associations between food insecurity and self-reported health were slightly larger if the US scheme was applied. Marginal food security/insecurity was associated with worse health measures irrespective of the classification scheme. United States-Canada discordance in classification of marginal food security/insecurity had a limited effect on health prediction., Conclusions: United States-Canada differences in classification affected the apparent distribution of household food insecurity but not the associations between food insecurity and measures of adult health. Marginal food security/insecurity should be set apart from the food-secure group for trend monitoring and health research., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Background: Household food insecurity has been associated with pregnancy complications and poorer birth outcomes in the United States and with maternal mental disorders in the United Kingdom, but there has been little investigation of the effects of food insecurity during this life stage in Canada., Objectives: Our objective was to examine the relationship between the food insecurity status of women during pregnancy and maternal and birth outcomes and health in infancy in Canada., Methods: We drew on data from 1998 women in Ontario, Canada, whose food insecurity was assessed using the Household Food Security Survey Module on the Canadian Community Health Survey, cycles 2005 to 2011-2012. These records were linked to multiple health administrative databases to identify indications of adverse health outcomes during pregnancy, at birth, and during children's first year of life. We included women who gave birth between 9 months prior and 6 months after their interview date, and for whom infant outcome data were available. Multivariable Poisson regression models were used to compare outcomes by maternal food security status, expressed as adjusted relative risks (aRR) with 95% CIs., Results: While pregnant, 5.6% of women were marginally food insecure and 10.0% were moderately or severely food insecure. Food insecurity was unrelated to pregnancy complications and adverse birth outcomes, but 26.8% of women with moderate or severe food insecurity had treatment for postpartum mental disorders in the 6-month postpartum period, compared to 13.9% of food-secure women (aRR, 1.86; 95% CI, 1.40-2.46). Children born to food-insecure mothers were at elevated risk of being treated in an emergency department in the first year of life (aRR, 1.18; 95% CI, 1.01-1.38)., Conclusions: Maternal food insecurity during pregnancy in Ontario, Canada, is associated with postpartum mental disorders and a greater likelihood of infants being treated in an emergency department., (Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.)

Recent reports have asserted that, because of energy underreporting, dietary self-report data suffer from measurement error so great that findings that rely on them are of no value. This commentary considers the amassed evidence that shows that self-report dietary intake data can successfully be used to inform dietary guidance and public health policy. Topics discussed include what is known and what can be done about the measurement error inherent in data collected by using self-report dietary assessment instruments and the extent and magnitude of underreporting energy compared with other nutrients and food groups. Also discussed is the overall impact of energy underreporting on dietary surveillance and nutritional epidemiology. In conclusion, 7 specific recommendations for collecting, analyzing, and interpreting self-report dietary data are provided: (1) continue to collect self-report dietary intake data because they contain valuable, rich, and critical information about foods and beverages consumed by populations that can be used to inform nutrition policy and assess diet-disease associations; (2) do not use self-reported energy intake as a measure of true energy intake; (3) do use self-reported energy intake for energy adjustment of other self-reported dietary constituents to improve risk estimation in studies of diet-health associations; (4) acknowledge the limitations of self-report dietary data and analyze and interpret them appropriately; (5) design studies and conduct analyses that allow adjustment for measurement error; (6) design new epidemiologic studies to collect dietary data from both short-term (recalls or food records) and long-term (food-frequency questionnaires) instruments on the entire study population to allow for maximizing the strengths of each instrument; and (7) continue to develop, evaluate, and further expand methods of dietary assessment, including dietary biomarkers and methods using new technologies., (© 2015 American Society for Nutrition.)

Background: The most recent statistics indicate that the prevalence of food insecurity in the United States is double that in Canada, but the extent to which the nutrition implications of this problem differ between the countries is not known., Objective: This study was undertaken to compare adequacy of nutrient intakes in relation to household food insecurity among youth and adults in Canada and the United States., Methods: Data from comparable nationally representative surveys, the 2004 Canadian Community Health Survey and the 2003-2006 NHANES, were used to estimate prevalences of inadequate intakes of vitamins A and C, folate, calcium, magnesium, and zinc among youth and adults in food-secure and food-insecure households. Potential differences in the composition of the populations between the 2 countries were addressed by using standardization, and analyses also accounted for participation in food and nutrition assistance programs in the United States., Results: Larger gaps in the prevalences of inadequate intakes between those in food-secure and food-insecure households were observed in Canada than in the United States for calcium and magnesium. For calcium, the prevalences of inadequate intakes among those in food-secure and food-insecure households in Canada were 50% and 66%, respectively, compared with 50% and 51%, respectively, in the United States. For magnesium, the prevalences of inadequate intakes in Canada were 39% and 60% among those in food-secure and food-insecure households, respectively, compared with 60% and 61%, respectively, in the United States. These findings were largely unchanged after we accounted for participation in food and nutrition assistance programs in the United States., Conclusions: This study suggests that household food insecurity is a stronger marker of nutritional vulnerability in Canada than in the United States. The results highlight the need for research to elucidate the effects of domestic policies affecting factors such as food prices and fortification on the nutritional manifestations of food insecurity., (© 2015 American Society for Nutrition.)

Analyses of cross-sectional population survey data in Canada and the United States have indicated that household food insecurity is associated with poorer self-rated health and multiple chronic conditions. The causal inference has been that household food insecurity contributes to poorer health, but there has been little consideration of how adults' health status may relate to households' vulnerability to food insecurity. Our objectives were to examine how the presence of an adult with one or more chronic physical or mental health conditions affects the odds of a household being food insecure and how the chronic ill-health of an adult within a food-insecure household affects the severity of that household's food insecurity. Using household- and respondent-level data available for 77,053 adults aged 18-64 y from the 2007-2008 Canadian Community Health Survey, we applied logistic regression analyses, controlling for household sociodemographic characteristics, to examine the association between health and household food insecurity. Most chronic conditions increased the odds of household food insecurity independent of household sociodemographic characteristics. Compared with adults with no chronic condition, the odds of household food insecurity were 1.43 (95% CI: 1.28, 1.59), 1.86 (95% CI: 1.62, 2.14), and 3.44 (95% CI: 3.02, 3.93) for adults with 1, 2, and 3 or more chronic conditions, respectively. Among food-insecure households, adults with multiple chronic conditions had higher odds of severe household food insecurity than adults with no chronic condition. The chronic ill-health of adults may render their households more vulnerable to food insecurity. This has important practice implications for health professionals who can identify and assist those at risk, but it also suggests that appropriate chronic disease management may reduce the prevalence and severity of food insecurity.

Cross-sectional studies have established a relationship between poverty and food insecurity, but little is known about the acute changes within households that lead to changes in food insecurity. This study examined how changes in income, employment status, and receipt of welfare related to change in severity of food insecurity during 1 y among low-income families. In 2005-2007, 501 families living in market and subsidized rental housing were recruited through door-to-door sampling in high-poverty neighborhoods in Toronto. One year later, families were re-interviewed. The final longitudinal analytic sample included 331 families. Within-household change in income, employment, and welfare receipt were examined in relation to change in severity of food insecurity. Severity was denoted by the aggregate raw score on the Household Food Security Survey Module (HFSSM). Analyses were stratified by housing subsidy status owing to differences in characteristics between households. Food insecurity was a persistent problem among families; 68% were food insecure at both interviews. Severity was dynamic, however, as 73.4% answered more or fewer questions affirmatively on the HFFSM between baseline and follow-up. Among market-rent families, a $2000 gain in income during the year and gain of full-time employment were associated with a 0.29 and 1.33 decrease in raw score, respectively (P < 0.01). This study suggests that improvements in income and employment are related to improvements in families' experiences of food insecurity, highlighting the potential for income- and employment-based policy interventions to affect the severity of household food insecurity for low-income families.

Health Canada has proposed new fortification policies that will allow manufacturers to add vitamins and minerals to a wide variety of foods at their discretion and increase nutrient additions to breakfast cereals. Our objective was to examine the potential impact of these policies on nutrient inadequacies and excesses in the Canadian population. Using dietary intake data from the Canadian Community Health Survey, Cycle 2.2 (2004), usual intake distributions from food were estimated for vitamins A and C, folate, niacin, calcium, and magnesium for all age/sex groups. The prevalence of individuals with inadequate nutrient intake and the proportion of individuals with intakes above the tolerable upper intake level (UL) were assessed where possible, assuming full implementation of the proposed policies. To approximate a "mature market" scenario, consumption patterns of fortified foods in the United States were estimated and applied to Canadian intake data. Full implementation resulted in marked reductions in inadequate intakes of vitamin A, vitamin C, magnesium, and folate, and improvements in calcium intakes for some age/sex groups. However, it caused intakes of folate, niacin, vitamin A, and calcium to rise above the UL, particularly among younger age groups. Although increased food fortification may reduce the apparent prevalence of inadequate intakes for some nutrients, there is no evidence of inadequacies for niacin or several other nutrients slated for addition. Our modeling suggests that Health Canada's proposed policies are misaligned with the nutritional needs of the population, because they are not rooted in an assessment of current nutrient intake patterns.

Household food insecurity constrains food selection, but whether the dietary compromises associated with this problem heighten the risk of nutrient inadequacies is unclear. The objectives of this study were to examine the relationship between household food security status and adults' and children's dietary intakes and to estimate the prevalence of nutrient inadequacies among adults and children, differentiating by household food security status. We analyzed 24-h recall and household food security data for persons aged 1-70 y from the 2004 Canadian Community Health Survey (cycle 2.2). The relationship between adults' and children's nutrient and food intakes and household food security status was assessed using regression analysis. Estimates of the prevalence of inadequate nutrient intakes by food security status and age/sex group were calculated using probability assessment methods. Poorer dietary intakes were observed among adolescents and adults in food-insecure households and many of the differences by food security status persisted after accounting for potential confounders in multivariate analyses. Higher estimated prevalences of nutrient inadequacy were apparent among adolescents and adults in food-insecure households, with the differences most marked for protein, vitamin A, thiamin, riboflavin, vitamin B-6, folate, vitamin B-12, magnesium, phosphorus, and zinc. Among children, few differences in dietary intakes by household food security status were apparent and there was little indication of nutrient inadequacy. This study indicates that for adults and, to some degree, adolescents, food insecurity is associated with inadequate nutrient intakes. These findings highlight the need for concerted public policy responses to ameliorate household food insecurity.

Food insecurity affects individuals' dietary intakes, but there have been few direct examinations of changes in individuals' intakes in the context of declining resources. This study examined changes in dietary intake over 30 d following the receipt of income in a sample of low-income, predominantly food-insecure women with children. Data on 182 women who received the bulk of their income in 1 monthly check were drawn from 2 Canadian studies. Equivalent 30-d measures of adult food security were constructed from participants' responses to items on the Radimer-Cornell questionnaire or the U.S. Household Food Security Survey Module. Intake data from multiple 24-h dietary recalls collected over 1 mo were merged. Mixed linear models were used to examine relationships between women's energy, nutrient, and food intakes and the depletion in household resources over 30 d, as indicated by days since the receipt of the household's major source of income. Women's intakes of energy, milk products, and vegetables decreased significantly as the time since they received income increased. When their food security status was considered, women who were food secure or marginally insecure showed no significant within-month patterns, but significant declines in energy, carbohydrate, vitamin B-6, and fruit and vegetable intake were observed for women with moderate or severe adult food insecurity. The food intakes of women in deprived circumstances are sensitive to the decline in household resources following the receipt of a monthly check.

Many women are advised to consume a folic acid-containing prenatal supplement for the duration of pregnancy and lactation. Whether this remains necessary after folic acid fortification of the food supply in North America has yet to be determined. Our objective was to assess the dietary folate intake of a sample of pregnant and lactating women at mandated and predicted folic acid-fortification levels and determine the prevalence of inadequate and excessive intakes. Weighed food records (for 3 d) were collected from predominantly university-educated women (32 +/- 4 y of age) at 36 wk of pregnancy (n = 61) and at 4 and 16 wk of lactation (n = 60). Dietary folate intakes during pregnancy and lactation, assuming fortification at mandated levels (140-150 micro g/100 g), were 562 +/- 106 and 498 +/- 99 micro g/d dietary folate equivalents (DFE), respectively. The prevalence of inadequacy for folate, or the proportion of individuals with usual folate intakes less than their nutrient requirement, was 36% for women during pregnancy (estimated average requirement of 520 micro g/d DFE), and 32% during lactation (estimated average requirement of 450 micro g/d DFE). Assuming fortification at twice the mandated level, mean dietary intakes during pregnancy and lactation were 786 +/- 132 and 716 +/- 150 micro g/d DFE, respectively, producing only a 3% prevalence of folate inadequacy. Grains contributed approximately 41% of total folate intake followed by fruits and vegetables (approximately 21%). To conclude, at mandated levels of fortification many pregnant and lactating women are unlikely to meet their folate requirements from dietary sources alone; however, the actual level of inadequacy cannot be determined until the level of folic acid in the food supply is known with greater precision.

This study was undertaken to characterize nutritional vulnerability among a sample of homeless youth in downtown Toronto. Interviews were conducted with 261 homeless youth (149 male, 112 female), recruited from drop-in centers and outdoor locations. Information about current living circumstances, nutrition and health-related behaviors, and 24-h dietary intake recalls were collected, and height, weight, triceps skinfold thickness, and mid-upper arm circumference were measured. A second 24-h dietary intake recall was conducted with 195 youth. Youth's energy intakes approximated the requirements for a very sedentary lifestyle; 7% were underweight and 22% were overweight or obese. Over half of the youth had inadequate intakes of folate, vitamin A, vitamin C, magnesium, and zinc; in addition, more than half of females had inadequate vitamin B-12 and iron intakes. Most youth got food from more than one source in the course of a day: 74% of males and 75% of females purchased food; 48% of males and 51% of females obtained food from charitable meal programs; 47% of males and 75% of females received food from strangers or acquaintances; and 10% of males and 6% of females stole food or took it from the garbage. Compared to a sample of 114 domiciled youth from the 1997-1998 Ontario Food Survey, males had lower energy and nutrient intakes and females had lower intakes of most nutrients.

The purpose of this paper is to examine key issues in the interpretation of nutritional epidemiologic study results when the focus is on major chronic degenerative diseases of multifactorial etiology. The estimation of disease risk associated with a particular dietary factor is influenced by the presence of other risk factors within the study population, complicating the interpretation of relative risk and odds ratio estimates in this context. Identifying the precise role(s) that dietary factors play in the onset or progression of chronic diseases is further complicated by the intercorrelation of dietary components and by the correlation of dietary patterns with other behavioral and environmental factors which may also impart or exacerbate risk of disease. Issues of study design and measurement make it difficult to identify relationships in nutritional epidemiology, but also thwart the rejection of hypotheses regarding diet-disease relationships when studies fail to yield significant associations. In drawing causal inferences from epidemiologic findings, it is important to examine evidence from a variety of sources and to look for congruence between epidemiologic, clinical and laboratory research findings.