How Does Food Insecurity Affect Nutrient Intakes?
Pulitzer Prize winner Frank McCourt writes about the extreme food insecurity that he experienced growing up in the United States and Ireland in the 1930s and 1940s:
"...everything was precious. I remember a loaf of bread that was precious because it was so little. My mother would bring home what they called a Vienna loaf. I remember one particular loaf of bread when we were so hungry. I can still taste it. So poverty does make things precious. It turns everything into jewelry."
Food insecurity changes food choices and how we think about food. Outside of frank undernourishment (shown on the FAO’s World Hunger Map), a spectrum of food insecurity exists as a result of the uneven distribution of income and resources within countries. Even occasional incidents of food insecurity throughout the year can have an influence on types of food selected, and therefore the nutrient content of the diet. Lee and co-workers recently looked at the effect that food insecurity has on nutrient intakes and food groups selected. They used data from the Korean National Health and Nutrition Examination Survey (KNHANES) to group participants into food insecurity categories. 15,603 adult participants were asked about whether they had had been able to consume the types and quantities of foods that they wanted over the previous year. Three categories were formed: a food secure group, a mildly food insecure group that could not always purchase the types of foods that were wanted, and a severely food insecure group that sometimes or often did not have enough to eat. Nutrient intakes and food consumption patterns for each food insecurity category were determined.
It seems that elderly women in single-person households with a low educational level were most at risk of food insecurity. Household income also was the lowest for the most food insecure group. People that were severely food insecure were more likely to exhibit poorer health behaviors such as skipping breakfast, and not engaging in regular exercise, plus they had a poorer subjective health status and less sleep than the food secure and mildly food insecure groups.
Intakes of all nutrients except carbohydrates were lower in the food insecure groups, and especially so in the severely food insecure group. This included total energy, fat, protein, calcium, iron, and vitamins A, B1, B2, B3, and C. It seems that intakes of grains increased for the food insecure, however intakes of the other food groups (protein foods, vegetables, fruit, dairy, and oils) all decreased. This probably reflects the less expensive cereal staple foods being used to make up for shortfalls in other food groups. While cereals can be nutritious, rice has a fairly low protein content for a cereal (7g per 100g, compared to 13g per 100g for wheat and oats), and also contains relatively little riboflavin and folate. White rice also loses considerable vitamin B1, B5 and B6 compared to brown rice. Like most cereals, the vitamin C and B12 content of rice is non-existent. The lower protein, fruit and vegetable intakes mean that the shortfalls of white rice as a staple food are not compensated for. In all cases, the mildly food insecure group had food and nutrient intakes that were intermediate between the food secure and severely food insecure groups.
Food insecurity changes not only total energy consumption but also protein, fat and micronutrient intakes. Studies in other populations show similar trends (for example, see Leung and colleagues using US data). This is usually due to decreased dietary diversity and a greater reliance on cereal staples that are inexpensive and have a long shelf life but can lack certain nutrients. Frank McCourt’s Vienna loaf is an example of this: the precious loaf of bread stilled his hunger but did not provide vitamins A, C and B12. Even mild food insecurity affects food choices and can place individuals at greater risk of poor nutrient intakes. The severely food insecure remain at greatest risk of malnutrition.
Lee SE, Song YJ, Kim Y, Choe J, Paik HY. Household food insufficiency is associated with dietary intake in Korean adults. Public Health Nutr. 2015 Aug 24:1-10. [Epub ahead of print] doi:10.1017/S1368980015002438
Frank McCourt Interview. Pulitzer Prize for Biography. June 19, 1999. Washington, D.C. http://www.achievement.org/autodoc/page/mcc1int-1
Leung CW, Epel ES, Ritchie LD, Crawford PB, Laraia BA. Food insecurity is inversely associated with diet quality of lower-income adults. J Acad Nutr Diet. 2014 Dec;114(12):1943-53.e2. doi: 10.1016/j.jand.2014.06.353. Epub 2014 Aug 1. http://www.ncbi.nlm.nih.gov/pubmed/25091796