Article Text

Children who had experienced family food insufficiency were more likely to be overweight at 4.5 years of age
  1. Christine Kurtz Landy, RN, PhD
  1. McMaster University, Hamilton, Ontario, Canada

    Statistics from

 Q What is the relation between family food insufficiency and overweight in preschool children?


    Embedded ImageDesign:

    population based cohort study (part of the Longitudinal Study of Child Development in Quebec [LSCDQ]).

    Embedded ImageSetting:

    Quebec, Canada.

    Embedded ImageParticipants:

    1549 of a random sample of 2103 preschool children from the LSCDQ were included in the nutrition study.

    Embedded ImageRisk factors:

    family food insufficiency (based on mother’s response of “regularly or every month,” “>1/month,” “only during certain months,” or “occasionally but not regularly” to the following question: Have you or a member of your family not eaten adequately because the family had run out of food or money to buy food?), income insufficiency, socioeconomic status, annual gross income, and family type (1 or 2 parents); number of working parents and number of obese or overweight parents (body mass index [BMI] ⩾25); mother’s age, BMI, education, immigrant status, smoking during pregnancy, psychological distress, self perceived health status, and frequency of breastfeeding; and child’s birth weight and sex.

    Embedded ImageOutcomes:

    obesity (Cole’s criteria) or overweight (mean BMI ⩾95th percentile on US Centers for Disease Control sex and age specific growth charts).


    At 4.5 years of age, 6.3% of children had lived with family food insufficiency between birth and 18 months and/or between 3.5 and 4.5 years of age. Among children from food insufficient families, those who had low birth weight (LBW), obese or overweight parents, mothers who smoked during pregnancy (table), family income insufficiency, or mothers with less than a high school education were more likely to be obese or overweight at 4.5 years of age than children from food sufficient families. Children with LBW who had family food insufficiency were more likely to be overweight than children with normal or high birth weights and family food sufficiency or insufficiency (adjusted odds ratio 28, 95% CI 6 to 125).

    Risk factors for obesity or overweight in children 4.5 years of age


    Children who had experienced family food insufficiency were more likely to be overweight at 4.5 years of age.


    The study by Dubois et al showed that family food insufficiency was associated with a higher risk of obesity or overweight in children. The findings contribute to the body of conflicting studies on family food insufficiency and obesity or overweight in children. The use of different measures of food insufficiency may explain the conflicting results.1 Dubois et al used a simple “yes/no” question to ascertain whether families were food sufficient or insufficient, whereas degrees of food insufficiency may be important for understanding the relation between food insufficiency and obesity. Limitations of the study included the small sample of children from food insufficient families and reliance on self reports.

    Dubois et al discuss aspects of food quantity and quality to explain their findings. Other factors associated with overweight in children, such as low activity levels and excessive television watching, were not considered.2 Dubois et al suggest that the Barker hypothesis, which associates LBW (small for gestational age) with chronic disease later in life,3 may explain the interaction of LBW and family food insufficiency with higher odds of being overweight at 4.5 years. The study included infants born prematurely (not small for gestational age) and infants born small for gestational age (except for adjustment at 1.5 and 4.5 y) in the LBW category. Combination of the 2 groups and the theoretical explanation of the results are problematic because the underlying causes of LBW and long term prognoses are different.4,5

    For now, community and primary care nurses should continue to ensure that families have adequate resources for meeting their daily needs, a strategy that will decrease health problems in early childhood and later life. Researchers should continue to explore the link between family food insufficiency and overweight or obesity in children.


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    • For correspondence: Dr L Dubois, University of Ottawa, Ottawa, Ontario, Canada. ldubois{at}

    • Sources of funding: in part, Canadian Institute of Health Information, Population Health Initiative, and Canadian Institute of Health Research.

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