Health, nutrition, and food insecurity

Food insecurity is a public health problem in Canada, affecting both adults and children. Whenever possible, it is important to consider age and sex groups separately since nutritional requirements and critical health outcomes vary across the lifecycle, which has implications for the evaluation and design of policies and programs.

Nutrition and food insecurity
In 2004, Canada conducted the first national nutrition survey in more than 30 years, and it allowed us to examine the relationship between household food insecurity and nutrient intake. This work demonstrated that in Canada household food insecurity is associated with diets that are inadequate to support good health in adults and adolescents. While research reveals some differences in food intake patterns among children living in food-insecure households, these do not appear to be related to higher rates of nutrient inadequacy.

Health and food insecurity among adults
To date, research in Canada examining health and food insecurity among adults has been cross-sectional, meaning that findings represent a single point in time or a snapshot. Since these studies do not follow individuals over time, these types of studies do not allow us to draw conclusions about causality. Food insecurity could be both an outcome and cause of poor health, or another factor (e.g. poverty) could be a cause of both.

Studies have shown that adults in food insecure households have poorer self-rated health, poorer mental and physical health, poorer oral health, greater stress, and are more likely to suffer from chronic conditions such as diabetes, hypertension and mood and anxiety disorders. Food insecurity also makes it difficult to manage existing chronic conditions such as diabetes and HIV. For example, food insecure individuals with HIV – an infection that is associated with increased energy and protein needs – are critically constrained in their ability to control the quality and quantity of food they consume.

Health and food insecurity among children
The most important piece of work we have examining the long-term effects household food insecurity on children’s health in Canada is a longitudinal (over a period of 10 years) study of national population data. This study provides causal evidence that children and youth who experienced hunger were more likely to have poorer health, and children who faced hunger repeatedly were more likely than others to have developed several chronic health conditions, including asthma. There have also been a few smaller, regional Canadian studies of children that have described negative health consequences of household food insecurity on children.

Food insecurity and obesity
Obesity is a major public health concern today, but the relationship between obesity and poverty-related measures including food insecurity is unclear. In Canada, household food insecurity is not associated with body weight among men, and while food insecure women are more likely to be obese, it does not necessarily follow that food insecurity caused these women to become obese.

The current measure of food insecurity captures experiences in the past 12 months and these maybe episodic or chronic, while the development of obesity typically happens over a much longer period of time.  It is possible that factors that lead to both obesity and food insecurity underlie the cross-sectional associations observed in some studies. A recent nutrition study of Canadian youth found that boys, but not girls, from food insecure households had a higher prevalence of obesity than their food secure counterparts. In the US, where there has been more research on childhood obesity, a recent study indicates that food-insecure children are no more likely to be obese than their food-secure counterparts. More research on the relationship between household food insecurity and body weight in Canada is required to clarify assumptions of an obesity-poverty link.

The following articles present research on health, nutrition, and food insecurity:

Food insecurity status and mortality among adults in Ontario, Canada
Gundersen C, Tarasuk V, Cheng J, de Oliveira C, Kurdyak P.
PLOS ONE 2018; 13(8): e0202642.
[Free Full Text]

The relationship between household food insecurity and breastfeeding in Canada
Orr S, Dachner N, Frank L, Tarasuk V.
Canadian Medical Association Journal 2018; 190(11): E312-319.

The relation between food insecurity and mental health care service utilization in Ontario
Tarasuk V, Cheng J, Gundersen C, de Oliveira C, Kurdyak P.
Canadian Journal of Psychiatry 2018; 63(8): 557-569.

The household food insecurity gradient and potential reductions in adverse population mental health outcomes in Canadian adults
Jessiman-Perreault G, McIntyre L.
SSM-Population Health 2017; 3: 464-472.
[Free Full Text]

The pervasive effect of youth self-report of hunger on depression over 6 years of follow up
McIntyre L, Wu X, Kwok C, Patten SB.
Social Psychiatry and Psychiatric Epidemiology 2017; 52(5): 537–547

Food insecurity in HIV-Hepatitis C virus co-infected individuals in Canada: The importance of co-morbidities
Cox J, Hamelin AM, McLinden T, Moodie EE, Anema A, Rollet-Kurhajec KC, et al.
AIDS and Behavior 2016; 1-11.
[Free Full Text]

Association between household food insecurity and annual health care costs
Tarasuk V, Cheng J, de Oliveira C, Dachner N, Gundersen C, Kurdyak P.
Canadian Medical Association Journal 2015; 187(14): E429-E436.
[Free Full Text]

Household food insecurity is a stronger marker of adequacy of nutrient intakes among Canadian compared to American youth and adults
Kirkpatrick SI, Dodd KW, Parsons R, Ng C, Garriguet D, Tarasuk V.
Journal of Nutrition 2015; 145(7): 1596-1603.

Association of moderate and severe food insecurity with suicidal ideation in adults: national survey data from three Canadian provinces
Davison KM, Marshall-Fabien GL, Tecson A.
Social Psychiatry and Psychiatric Epidemiology 2015; 50(6): 963-972.

Relationship between food insecurity and mortality among HIV-positive injection drug users receiving antiretroviral therapy in British Columbia, Canada
Anema A, Chan K, Chen Y, Weiser S, Montaner JS, Hogg RS.
PLoS One 2013; 8(5): e61277.
[Full Free Text]

Chronic physical and mental health conditions among adults may increase vulnerability to household food insecurity
Tarasuk V, Mitchell A, McLaren L, McIntyre L.
Journal of Nutrition 2013; 143(11): 1785-93.
[Full free text]

Food insecurity and children’s mental health: A prospective birth cohort study
Melchior M, Chastang J-F, Falissard B, Galéra C, Tremblay RE, Côté SM, Boivin M.
PLOS ONE 2012; 7(12): e52615.
[Free Full Text]

Depression and suicide ideation in late adolescence and early adulthood are an outcome of child hunger
McIntyre L, Williams JV, Lavorato DH, Patten S.
Journal of Affective Disorders 2012; 150(1): 123-129.

Food insufficiency is associated with psychiatric morbidity in a nationally representative study of mental illness among food insecure Canadians
Muldoon KA, Duff PK, Fielden S, Anema A.
Social Psychiatry and Psychiatric Epidemiology 2013; 48(5): 795-803.

Household income, food insecurity and nutrition in Canadian youth
Mark S, Lambert M, O’Loughlin J, Gray-Donald K.
Canadian Journal of Public Health 2012; 103(2): 94-9.
[Free Full Text]

Food insecurity in Canadian adults: Receiving diabetes care
Galesloot S, McIntyre L, Fenton T, Tyminski S.
Canadian Journal of Dietetic Practice and Research 2012; 73(3): 141.

The relationship between childhood obesity and food insecurity: A nonparametric analysis
Kuku O, Garasky S, Gundersen C.
Applied Economics 2012; 44(21): 2667-2677.

Affordability of a nutritious diet for income assistance recipients in Nova Scotia (2002-2010)
Williams P, Watt CG, Amero M, Anderson BJ, Blum I, Green-LaPierre R, Johnson CP, Reimer DE.
Canadian Journal of Public Health 2012; 103(3): 183.

Is food insecurity related to overweight and obesity in children and adolescents? A summary of studies, 1995-2009
Eisenmann JC, Gundersen C, Lohman BJ, Garasky S, Stewart SD.
Obesity Reviews 2011; 12(501): e73-e83.
[Free Full Text]

Child hunger and long-term adverse consequences for health
Kirkpatrick SI, McIntyre L, Potestio ML.
Archives of Pediatrics & Adolescent Medicine 2010; 164(8): 754-762.
[Free Full Text]

Prevalence and associations of food insecurity in children with diabetes mellitus
Marjerrison S, Cummings E, Glanville NT, Kirk S, Ledwell M.
Journal of Pediatrics 2010; 158(4): 607-611.

Nutrition inequities in Canada
Tarasuk V,  Fitzpatrick S,  Ward, H.
Applied Physiology, Nutrition & Metabolism 2010: 35(2): 172-179.

Food insecurity and HIV/AIDS: Current knowledge, gaps, and research priorities
Anema A, Vogenthaler N, Frongillo EA, Kadiyala S, Weiser SD.
Current HIV/AIDS Reports 2009; 6(4): 224-231.
[Full Free Text]

Exploration of the relationship between household food insecurity and diabetes in Canada
Gucciardi E, Vogt JA, Demelo M, Stewart DE.
Diabetes Care 2009; 32: 2218–2224.
[Free Full Text]

Food insecurity is not associated with childhood obesity as assessed using multiple measures of obesity.
Gundersen C, Garasky S, Lohman B.
Journal of Nutrition 2009; 139: 1173-1178.
[Free Full Text]

Food insufficiency in currently or formerly homeless persons is associated with poorer health
Hamelin AM, Hamel D.
Canadian Journal of Urban Research 2009; 18(2): 1-24.

Food insecurity and dietary intake of immigrant food bank users
Rush TJ, Ng V, Irwin JD, Stitt LW, He M.
Canadian Journal of Dietetic Practice and Research 2007; 68(2): 73-78.

Food security, maternal stressors, and overweight among low-income U.S. children: Results from NHANES 1999-2002
Gundersen C,  Lohman B, Garasky  S, Stewart S,  Eisenmann J.
Pediatrics 2008; 122: e529–e540.
[Free Full Text]

Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents
Kirkpatrick S, Tarasuk V.
Journal of Nutrition 2008; 138: 604–612.
[Free Full Text]

Improving the nutritional status of food insecure women: First, let them eat what they like
McIntyre L, Tarasuk V, Li YJ.
Public Health Nutrition 2007; 10(11): 1288-1298.
[Free Full Text]

The dynamics of food insecurity and overall health: Evidence from the Canadian National Population Health Survey
McLeod L, Veall M.
Applied Economics 2006; 38: 2131–2146.

Predictors and outcomes of household food insecurity among inner city families with preschool children in Vancouver
Broughton MA, Janssen PS, Hertzman C, Innis SM, Frankish CJ.
Canadian Journal of Public Health 2006; 97(3): 214-216.
[Free Full Text]

‘Managing’ homeless youth in Toronto: Mismanaging food access and nutritional well-being
Gaetz S,  Dachner N, Kirkpatrick S, Tarasuk V.
Canadian Review of Social Policy 2006; 58: 43-61.

Food insecurity and hunger are prevalent among HIV-positive individuals in British Columbia, Canada
Normen L, Chan K, Braitstein P, Anema A, Bondy G, Montaner JSG, Hogg RS.
Journal of Nutrition 2005; 135: 820-825.
[Free Full Text]

Determinants of healthy eating in Aboriginal peoples in Canada
Willows N.
Canadian Journal of Public Health 2005; 96(S3): S32-S36.
[Free Full Text]

Homeless youth in Toronto are nutritionally vulnerable
Tarasuk V, Dachner N, Li J.
Journal of Nutrition 2005; 135: 1926-1933.
[Free Full Text]

Household food insufficiency is associated with poorer health
Vozoris N, Tarasuk V.
Journal of Nutrition 2003; 133: 120-126.
[Free Full Text]

Do low-income lone mothers compromise their nutrition to feed their children?
McIntyre L, GlanvilleNT, Raine KD, Dayle JB, AndersonB, Battaglia N.
Canadian Medical Association Journal 2003; 168(6): 686-691.
[Free Full Text]

Characterization of household food insecurity in Quebec: Food and feelings
Hamelin AM, Beaudry M, Habicht JP.
Social Science & Medicine 2002; 54(1): 119-132.

Household food insecurity with hunger is associated with women’s food intakes, health, and household circumstances
Tarasuk VS.
Journal of Nutrition 2001; 131: 2670-2676.
[Free Full Text]