Health Implications of Early Childhood Hunger

1. Health Implications of Early Childhood Hunger

2. Health implications of Hunger • Greater incidence of infections • Increased school absences • Fatigue/Headaches • Growth • Specific Nutrient Deficiencies • Lead Overburdening • Early Childhood Caries

3. Behavioral/ Developmental Implications of Hunger • Concentration Deficits • Impaired Test Performance • Behavioral Effects • Developmental Delays

4. The Impact of Hunger on Young Children is Different Than the Impact of Hunger on Adults.

5. Children’s Health • Perception of Child’s Health • Number of Lifetime Hospitalizations • Hospitalization at time of visit

6. National Data: TANF Sanctions and Children’s Health

7. WIC and Caregiver’s Report of Children’s Health(Unadjusted by covariates)Aug 1998 - Dec 2000; 2,718 families at six sites p = .01

8. Adjusted Odds Ratio WIC Participation and Child Health

9. Infants Who Receive WICAug 1998 - Dec 2000; 2,718 families at six sites Heavier, but not obese (covariate controls) Wt/age Z-score = .01 vs -.26, p = .001 At 5 months, mean difference = 223g Taller (covariate controls) Ht/age Z-score = -.01 vs -.26, p = .005 At 5 months, mean difference = 1.25 cm

10. # places lived in last yr.>3 places 1-2 places 95% CI p-valueOutcomes OR OR OR Hospitalization 1.51 1.00 (1.20, 1.90) <.001 Fair/Poor Child Health 1.86 1.00 (1.43, 2.41) <.001 Effect of Housing Instability on Child Health Aug 1998 - Dec 2000; 2,718 families at six sites

11. When We Think of Child Hunger…

12. Which of These Children Are Hungry?

13. <10 > 90 30-39 40-49 50-59 60-69 10-19 20-29 70-79 80-89 Weight for Height Percentilesby Hunger Status1994; Hunger Study at HCMC 25 20 15 Percent 10 5 0 Weight for Height Percentiles Hungry n = 171 At Risk n = 843 Not Hungry n = 1563

14. <10 > 90 30-39 40-49 50-59 60-69 10-19 20-29 70-79 80-89 Weight for Height Percentilesby Hunger Status1994; Hunger Study at HCMC 25 20 15 Percent 10 5 0 Weight for Height Percentiles Hungry n = 171 At Risk n = 843 Not Hungry n = 1563

15. Weight for Height Percentiles by Mother’s Race1994; Hunger Study at HCMC 70 60 50 40 * 30 Percent 20 10 0 < 10th Percentile > 90th Percentile Native American n = 197 White n = 672 • African American • n = 1415 * Native American Compared to White and African American p < 0.0001

16. 70 60 50 40 30 20 110 815 490 10 0 Upper and Lower Weight for Height Deciles by Hunger Status and Mother’s Race 12 > 90th Percentile < 10th Percentile 57 Percent 128 30 201 490 815 441 110 201 30 57 441 128 African American Native American Native American African American White White Hungry At Risk Not Hungry

17. Mean Growth Percentiles By Hunger Status1994 Study at HCMC Hungry (n=171) At Risk (n=842) Not Hungry (n=1559) 65 60 Growth Percentile 55 50 45 40 Weight for Weight for Age Height for Age Height

18. Everyone now knows that: Obesity is Increasing in Adults and Children

19. 1991 1995 2000 No Data <10% 10%-14% 15-19% 20% Obesity* Trends Among U.S. Adults BRFSS, 1991, 1995 and 2000 (*BMI 30, or ~ 30 lbs overweight for 5’4” person) Source: Mokdad A H, et al. JAMA1999;282:16, 2001;286:10.

20. Obesity in Children • Defining overweight or obesity in children is complicated by the normal processes of growth and development. • No risk-based criteria has been established as it is difficult to link weight status to chronic disease risk in children and youth.

21. Overweight Children  Overweight Adults ? Review of the literature suggests: • 1/3 of overweight preschool children; • 1/2 of overweight school-age children and; • 3/4 of overweight adolescents become overweight adults.

23. Etiology • DNA • Doughnut • Dormancy

24. The Problem Ancient Genes in a Modern Environment

25. High Calorie, High Fat Food Is: • Highly accessible • Inexpensive • Advertised heavily • Advertised deceptively • Delicious

26. Fast Food Accessibility • According to McDonald’s company historian John F. Love, “Working class families could finally afford to feed their kids restaurant food.” • The fast food industry employs the biggest group of low-wage workers in the U.S.

27. Toxic Environment and Children • >23,000 franchises in schools • 10,000 TV food ads • Soft drink contracts with schools

28. 25% of all vegetables eaten in the U.S. are French Fries Krebs-Smith, Cancer, 1998

29. Soft-drink Consumption • USDA data shows per capita soft-drink has increased by almost 500% over the past 50 years. • Half of all Americans and most adolescents (65% girls and 74% boys) consume soft-drinks daily.

30. “For each additional serving of sugar-sweetened drink consumed, both body mass index and frequency of obesity increased…” “Consumption of sugar-sweetened drinks is associated with obesity in children” Ludwig et al., Lancet, 2001

31. Minnesota Decreases Physical Education Requirements

32. Children With Daily Physical Education American Academy of Pediatrics

33. Data is lacking about the physical activity levels of children Difficult to measure, especially in young children Lack comparative data Assume physical activity has changed because of the changes in weight status Largest number of recommendations focus on schools and phy ed class time Need to give attention to physically active lifestyle, community environment and adult role models. Physical Activity

34. Physical Activity • Lack of safe play areas • Not a priority for families experiencing hunger • Housing issues • Television is cheaper than other forms of entertainment

35. The prevalence of obesity is lowest among children watching 1 or fewer hours of TV a day and highest among those watching 4 or more hours of TV a day. Crespo, etal, Arch Pediatr Adolesc Med 2001;155:360-365 Television

36. Besharov’s Theory of Obesity • “Federal feeding programs still operate under their nearly half century old objective of increasing food consumption. Few experts are willing to say that federal feeding programs are making the poor fat, although the evidence points in that direction.”

37. Association or Causation • Hunger and overweight share common risk factors • Both are complex, multi-etiological frameworks

38. “Not Too Rich or Too Thin” • “One in 4 adults below the poverty level is obese, compared with 1 in 6 in households with an income of $67,000 or more.” • “For minorities, poverty has an even heavier effects: obesity strikes 1 in 3 poor African Americans.” Time June 7, 2004

39. High Calorie Foods are Cheaper?

40. Does Hunger Cause Obesity? • Higher fat foods may be eaten to increase satiety when there is not enough money to buy food. • Obesity may be an adaptation to intermittent periods of hunger. W.H. Dietz. PEDIATRICS. May, 1995

41. Hunger and Beverage Use1994; HCMC Hungry (n=171) At Risk (n=842) Not Hungry (n=1559) 80 70 60 50 40 Percent 30 20 10 0 Pop* Kool-Aid** Juice *Chi Square analysis compared with hungry group p<0.001 **test for linear association p<0.001

42. Malnutrition Leaves Obesity Time Bomb • UN Food and Agriculture Study released in 2004 suggests that reducing malnutrition in pregnant women could prevent their children from becoming fat later in life and ease the impending worldwide crisis in obesity. • Growing evidence suggests hunger during pregnancy sets up babies to get the most out of the limited nutrition while they are in the womb by laying down fat and programs them to expect famine in the outside world

43. Malnutrition Leaves Obesity Time Bomb (continued) • When they grow up in an environment abundant in food and lacking in exercise—which is increasingly the case as developing nations urbanize—their bodies are not as well adapted as those who were well-nourished as a fetus. • Researchers have drawn parallels between low birth weight and later development of problems such as heart disease, obesity, diabetes, high cholesterol and hypertension.

44. Three Year Follow-up of Growth in Young Children Previously Identified by Hunger Status1994 to 1997; 3 Year Follow-up Study at HCMC * * p = 0.001 hungry compared with not hungry

45. Conclusion: Hunger and Obesity • Risk factors for hunger are similar to risk factors for obesity: Genetics, Race and poverty are powerful covariates. • Coping mechanisms differ in families experiencing hunger. High fat, high calorie foods increase satiety. • Hunger may flatten the normal curve of growth, with more children being underweight and more children being overweight • Hungry children can be overweight, underweight or normal weight. • Politics on both sides tend to forget the multi-causal framework for obesity

46. Anemia and Lead • Hungry children were more likely to have anemia. • There is a significant linear trend in anemia by growth category in hungry children. Hungry children with growth delays were more likely to have anemia. • A significant linear trend in elevated lead levels by growth category also was present in hungry children. Hungry children with growth delays were more likely to have elevated lead levels.

47. Developmental Delays • Developmental delays were significantly associated with delayed growth and with obesity for hungry children. No association was found between development delays and growth in the not hungry children.

48. Multiple Hit Theory • Anemia • Lead • Poor nutrient intake (Pop, Kool-aid) Interacting factors which magnify effects

49. Dental Caries • The most prevalent chronic disease of childhood is dental caries. • Nationally, although dental services are included in government insurance programs, 80% of children enrolled in public insurance programs haven’t seen a dentist in the last year.

50. Hunger and Early Childhood Caries Co-exist • 70% of all dental caries are found in 20% of US children. • This 20% is predominantly comprised of low-income, minority, and/or immigrant families. • Approximately 18% of children from both hungry and not hungry households had received restorative dental surgery requiring three years after being interviewed for the 1994 study.