Special Issue "Nutrition among Vulnerable Populations"

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Epidemiology".

Deadline for manuscript submissions: closed (31 May 2020).

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Prof. Dr. Heather Eicher-Miller
E-Mail Website
Guest Editor
Department Nutrition Science, College of Health and Human Science, Purdue University, USA
Interests: Nutrition; Health Disparities; Food Security; Human Nutrition; Nutritional Education; Food Security Analysis; Nutritional Epidemiology; Nutrient Analysis; Community Nutrition; Food Consumption
Prof. Dr. Marie Kainoa Fialkowski Revilla
E-Mail Website
Guest Editor
Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources – University of Hawai‘i at Mānoa, USA
Interests: Nutrition and Health in Indigenous Populations; Nutritional Assessment; Nutrition Education for Underserved Populations

Special Issue Information

Dear Colleagues,

Food insecurity and low resources continue to be a burden influencing the health, well-being, growth, and development of millions of U.S. children and adults. Groups and individuals experiencing restrained access to food are our neighbors, individuals we may see each day, and individuals who we may not interact with or see because of their isolated situations. They include the elderly, those experiencing mental illness, veterans, certain race/ethnic groups, adolescents, young women with children, those living in rural areas, and those using food pantries, among others. Many of these groups, both hidden and visible, have rates of food insecurity above the national average that are resistant to national improvements in food security. Yet, attention to these subsets of the population is imperative to improve U.S. health and nutrition and to reduce rates of chronic disease.

Many groups face specific barriers to maintaining sufficient food, for example, rural populations may find it difficult to access federal food assistance or other resources such as food pantries and nutrition education because of distance or lack of consistent internet access separating them from these resources. Further, their remote locations may make it difficult to obtain the types of foods that they prefer.  Other specific barriers may include limited facilities and equipment for food preparation, access to culturally appropriate foods and preparation supplies, and foods that complement the foods that they already have. Tailored approaches to quantify access to food, the nutrition environment, dietary intake, and other barriers are necessary to build successful interventions and to quantify the needs in these populations.

Very little is known about the nutritional status and dietary intake in these low-resource and food insecure groups, and dietary barriers are not understood. Creating interventions that improve food security and improve dietary intake, however, are dependent on this information. We cannot improve what we do not understand.

In order to begin to fill this gap, the objective of this Special Issue on “Nutrition Among Vulnerable Populations” is to publish selected papers quantifying dietary intake, nutritional status, access to food and food insecurity, barriers to healthful foods and food security, and environmental influences experienced by vulnerable groups with a high prevalence of food insecurity.

Prof. Heather Eicher-Miller
Prof. Marie Kainoa Fialkowski Revilla
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Food insecurity
  • Chronic disease
  • Nutrition environment
  • Dietary intake

Published Papers (11 papers)

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Editorial

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Editorial
Nutrition among Vulnerable U.S. Populations
Nutrients 2020, 12(10), 3150; https://doi.org/10.3390/nu12103150 - 15 Oct 2020
Viewed by 639
Abstract
Food insecurity and low resources continue to be a burden influencing the health, well-being, growth and development of millions of U [...] Full article
(This article belongs to the Special Issue Nutrition among Vulnerable Populations)
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Research

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Article
Supplemental Nutrition Assistance Program-Education Improves Food Security Independent of Food Assistance and Program Characteristics
Nutrients 2020, 12(9), 2636; https://doi.org/10.3390/nu12092636 - 29 Aug 2020
Cited by 2 | Viewed by 1331
Abstract
The purpose of this project was to determine whether consistent food assistance program participation or changes in participation over time mediated or moderated the effect of federal nutrition education through the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) on food security and determine the associations [...] Read more.
The purpose of this project was to determine whether consistent food assistance program participation or changes in participation over time mediated or moderated the effect of federal nutrition education through the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) on food security and determine the associations of SNAP-Ed program delivery characteristics with change in food security. This secondary analysis used data from a randomized controlled trial from September 2013 through April 2015. SNAP-Ed-eligible participants (n = 328; ≥18 years) in households with children were recruited from 39 counties in Indiana, USA. The dependent variable was one year change in household food security score measured using the United States Household Food Security Survey Module. Assessment of mediation used Barron-Kenny analysis and moderation used interactions of food assistance program use and changes over time with treatment group in general linear regression modeling. Program delivery characteristics were investigated using mixed linear regression modeling. Results showed that neither consistent participation nor changes in food assistance program participation over time mediated nor moderated the effect of SNAP-Ed on food security and neither were SNAP-Ed program delivery characteristics associated with change in food security over the one year study period. SNAP-Ed directly improved food security among SNAP-Ed-eligible Indiana households with children regardless of food assistance program participation and changes over time or varying program delivery characteristics. Full article
(This article belongs to the Special Issue Nutrition among Vulnerable Populations)
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Article
Prevalence and Predictors of Overweight and Obesity among Young Children in the Children’s Healthy Living Study on Guam
Nutrients 2020, 12(9), 2527; https://doi.org/10.3390/nu12092527 - 20 Aug 2020
Cited by 3 | Viewed by 1969
Abstract
This study is part of the Children’s Healthy Living program in U.S. Affiliated Pacific region. The objectives were to estimate overweight and obesity (OWOB) prevalence and identify possible related risk factors among ethnic groups in Guam. In 2013, 865 children (2–8 years) were [...] Read more.
This study is part of the Children’s Healthy Living program in U.S. Affiliated Pacific region. The objectives were to estimate overweight and obesity (OWOB) prevalence and identify possible related risk factors among ethnic groups in Guam. In 2013, 865 children (2–8 years) were recruited via community-based sampling from select communities in Guam. Children’s demographic and health behavior information; dietary intake; and anthropometric measurements were collected. Logistic regression, odds ratio, t-tests, and chi-square tests were used to determine differences and assess covariates of OWOB. The results indicate that 58% of children were living below the poverty level, 80% were receiving food assistance, and 51% experienced food insecurity. The majority of children surveyed did not meet recommendations for: sleep duration (59.6%), sedentary screen-time (83.11%), or fruit (58.7%) and vegetable (99.1%) intake, and consumed sugar sweetened beverages (SSB) (73.7%). OWOB affected 27.4% of children. Children affected by OWOB in this study were statistically more likely (p = 0.042) to suffer from sleep disturbances (p = 0.042) and consume marginally higher amounts (p value = 0.07) of SSB compared to children with healthy weight. Among Other Micronesians, children from families who considered themselves ‘integrated’ into the culture were 2.05 (CI 0.81–5.20) times more likely to be affected by OWOB. In conclusion, the OWOB prevalence among 2–8-year-olds in Guam was 27.4%; and compared with healthy weight children, children with OWOB were more likely to have educated caregivers and consume more SSBs. Results provide a basis for health promotion and obesity prevention guidance for children in Guam. Full article
(This article belongs to the Special Issue Nutrition among Vulnerable Populations)
Article
Caregiver’s Self-Confidence in Food Resource Management Is Associated with Lower Risk of Household Food Insecurity among SNAP-Ed-Eligible Head Start Families
Nutrients 2020, 12(8), 2304; https://doi.org/10.3390/nu12082304 - 31 Jul 2020
Cited by 3 | Viewed by 1437
Abstract
Food resource management (FRM) behaviors are key components within nutrition education programs designed to help food insecure households maximize their food dollars. However, little is known about the association between FRM self-confidence and financial practices with household food insecurity (HFI) among families with [...] Read more.
Food resource management (FRM) behaviors are key components within nutrition education programs designed to help food insecure households maximize their food dollars. However, little is known about the association between FRM self-confidence and financial practices with household food insecurity (HFI) among families with young children. Using a sample of SNAP-Ed-eligible Head Start families, this study examined associations between FRM self-confidence, FRM behaviors and financial practices by HFI. A needs assessment survey was conducted with caregivers of Head Start children (n = 365). HFI was measured using the US Household Food Security Survey Module. Chi-square and logistic regression analyses were conducted to examine if FRM self-confidence, FRM behaviors, and financial practices differed by HFI. Participants with high FRM self-confidence had lower odds of HFI (OR = 0.54, 95%CI: 0.33, 0.87), yet FRM behaviors, financial practices, and HFI were not related after adjusting for covariates. All FRM self-confidence questions significantly differed by HFI, whereas only one of six FRM behaviors and two of three financial practices differed by HFI (all p-values < 0.05). Promoting caregivers’ self-confidence in FRM skills within nutrition education programs may be explored as a potential strategy to assist low-income households to stretch their food dollars in an attempt to address HFI. Full article
(This article belongs to the Special Issue Nutrition among Vulnerable Populations)
Article
Food Security and Diet Quality in Native Hawaiian, Pacific Islander, and Filipino Infants 3 to 12 Months of Age
Nutrients 2020, 12(7), 2120; https://doi.org/10.3390/nu12072120 - 17 Jul 2020
Cited by 1 | Viewed by 881
Abstract
Food insecurity and other nutritional risks in infancy pose a lifelong risk to wellbeing; however, their effect on diet quality in Native Hawaiian, Pacific Islander, and Filipino (NHPIF) infants in Hawai‘i is unknown. In this cross-sectional analysis, the association between various indicators of [...] Read more.
Food insecurity and other nutritional risks in infancy pose a lifelong risk to wellbeing; however, their effect on diet quality in Native Hawaiian, Pacific Islander, and Filipino (NHPIF) infants in Hawai‘i is unknown. In this cross-sectional analysis, the association between various indicators of food security and NHPIF infant diet quality were investigated in 70 NHPIF infants aged 3–12 months residing on O‘ahu, Hawai‘i. The dietary assessments of the infants were collected using a mobile food recordTM. Foods consumed across four days were categorized into seven food groups. Indicators for food security were examined through an adapted infant food security index and other indicators. Data were analyzed using chi-square tests, independent sample t-tests, multinomial logistic regression, and linear regression models. In models adjusting for age and sex, infants defined as food insecure by the adapted index were found to consume foods from more food groups and consume flesh foods on a greater proportion of days. Of the indicators examined, the adapted index was shown to be the best indicator for food group consumption. Further work is needed on a more representative sample of NHPIF infants to determine the impact that food security has on nutritional status and other indicators of health. Full article
(This article belongs to the Special Issue Nutrition among Vulnerable Populations)
Article
Associations between Subjective and Objective Measures of the Community Food Environment and Executive Function in Early Childhood
Nutrients 2020, 12(7), 1944; https://doi.org/10.3390/nu12071944 - 30 Jun 2020
Cited by 2 | Viewed by 906
Abstract
The present study utilized a cross-sectional design to assess whether two indicators of the community food environment, parent perceptions of the community food environment (i.e., as assessed by parent reports of access to, availability, and affordability of foods) and limited food access (via [...] Read more.
The present study utilized a cross-sectional design to assess whether two indicators of the community food environment, parent perceptions of the community food environment (i.e., as assessed by parent reports of access to, availability, and affordability of foods) and limited food access (via census data), were related to executive function in preschool children. Children were recruited during the 2014–2015 academic year from Head Start and community-based preschools (N = 102) and children’s executive function ability was tested using the Head–Toes–Knees–Shoulders task. Multiple linear regression analysis was used, as well as adjusted standard errors to account for clustering at the classroom level. Parent reports of their food environment were significantly related to children’s executive function, such that children living in higher quality community food environments had better executive function. In contrast, limited food access using census data was not significantly related to executive function. The results suggest that parent reports of the community food environment in early childhood may contribute to young children’s cognitive outcomes more so than being in a limited food access area, as these data may not represent individual behaviors or capture the variability of the accessibility and affordability of healthy foods. Policy makers should consider correlations between the food environment and early executive functioning when developing new community health/wellness legislation. Full article
(This article belongs to the Special Issue Nutrition among Vulnerable Populations)
Article
Food Insecurity and COVID-19: Disparities in Early Effects for US Adults
Nutrients 2020, 12(6), 1648; https://doi.org/10.3390/nu12061648 - 02 Jun 2020
Cited by 104 | Viewed by 10703
Abstract
The COVID-19 pandemic has dramatically increased food insecurity in the United States (US). The objective of this study was to understand the early effects of the COVID-19 pandemic among low-income adults in the US as social distancing measures began to be implemented. On [...] Read more.
The COVID-19 pandemic has dramatically increased food insecurity in the United States (US). The objective of this study was to understand the early effects of the COVID-19 pandemic among low-income adults in the US as social distancing measures began to be implemented. On 19–24 March 2020 we fielded a national, web-based survey (53% response rate) among adults with <250% of the federal poverty line in the US (N = 1478). Measures included household food security status and COVID-19-related basic needs challenges. Overall, 36% of low-income adults in the US were food secure, 20% had marginal food security, and 44% were food insecure. Less than one in five (18.8%) of adults with very low food security reported being able to comply with public health recommendations to purchase two weeks of food at a time. For every basic needs challenge, food-insecure adults were significantly more likely to report facing that challenge, with a clear gradient effect based on severity of food security. The short-term effects of the COVID-19 pandemic are magnifying existing disparities and disproportionately affecting low-income, food-insecure households that already struggle to meet basic needs. A robust, comprehensive policy response is needed to mitigate food insecurity as the pandemic progresses. Full article
(This article belongs to the Special Issue Nutrition among Vulnerable Populations)
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Article
Household Food Insecurity and the Association with Cumulative Biological Risk among Lower-Income Adults: Results from the National Health and Nutrition Examination Surveys 2007–2010
Nutrients 2020, 12(5), 1517; https://doi.org/10.3390/nu12051517 - 23 May 2020
Cited by 6 | Viewed by 1355
Abstract
Household food insecurity has been associated with adverse health outcomes; however, the mechanisms underlying these associations are not well-defined. Using data from 5005 adults from the 2007–2010 National Health and Nutrition Examination Surveys (NHANES), we examined associations between household food insecurity and cumulative [...] Read more.
Household food insecurity has been associated with adverse health outcomes; however, the mechanisms underlying these associations are not well-defined. Using data from 5005 adults from the 2007–2010 National Health and Nutrition Examination Surveys (NHANES), we examined associations between household food insecurity and cumulative biological risk, a measure of the body’s physiological response to chronic stress. Household food security was assessed using the 18-item Household Food Security Survey Module. Marginal food security refers to 1–2 positive responses, and food insecurity refers to ≥3 positive responses. The cumulative biological risk scores were calculated based on the distributions of ten biomarkers from the cardiovascular, metabolic, and immune systems. Elevated biological risk was defined as a risk score of ≥3. Multivariable regression models were used to examine associations between food security and cumulative biological risk scores, adjusting for sociodemographic characteristics. After multivariable adjustment, food insecurity was associated with a 0.14-unit higher cumulative biological risk score (95% CI 0.05–0.22, p-trend = 0.003) and higher odds of elevated biological risk (OR 1.20, 95% CI 1.05–1.37, p-trend = 0.003). These associations differed by gender. Among women, food insecurity was associated with 0.30-unit higher cumulative biological risk score (95% CI 0.14–0.45, p-trend = 0.0004) and higher odds of elevated biological risk (OR 1.61, 95% CI 1.29–2.00, p-trend < 0.0001). These associations were not observed in men. Women experiencing food insecurity demonstrated elevated levels of biological risk. These findings support the hypothesis that food insecurity may be associated with women’s chronic health outcomes through the pathway of chronic stress. Further research is needed to understand why these associations were not observed in men. Full article
(This article belongs to the Special Issue Nutrition among Vulnerable Populations)
Article
Frequently Consumed Foods and Energy Contributions among Food Secure and Insecure U.S. Children and Adolescents
Nutrients 2020, 12(2), 304; https://doi.org/10.3390/nu12020304 - 23 Jan 2020
Cited by 2 | Viewed by 1488
Abstract
Food insecurity is associated with nutritional risk in children. This study identified and compared the most frequently consumed foods, beverages, and food groups and their contributions to energy intake among U.S. children and adolescents (6–11, 12–17 years) by food security status. Dietary intake [...] Read more.
Food insecurity is associated with nutritional risk in children. This study identified and compared the most frequently consumed foods, beverages, and food groups and their contributions to energy intake among U.S. children and adolescents (6–11, 12–17 years) by food security status. Dietary intake from the day-1, 24-h dietary recall, and household child food security status were analyzed in the 2007–2014 National Health and Nutrition Examination Survey (n = 8123). Foods and beverages were classified into food categories, ranked, and compared by weighted proportional frequency and energy contribution for food security groups by age. Significant differences between household child food security groups were determined using the Rao-Scott modified chi-square statistic. The weighted proportional frequency of beverages (including diet, sweetened, juice, coffee, and tea) and their energy was significantly higher among food insecure compared with food secure while the reverse was true for water frequency among 12–17 years. Beverage and mixed dish frequency were higher among food insecure compared with food secure 6–11 years while the reverse was true for frequency and energy from snacks. Frequency-differentiated intake patterns for beverages and snacks by food security across age groups may inform dietary recommendations, population-specific dietary assessment tools, interventions, and policy for food insecure children. Full article
(This article belongs to the Special Issue Nutrition among Vulnerable Populations)
Article
Total Usual Micronutrient Intakes Compared to the Dietary Reference Intakes among U.S. Adults by Food Security Status
Nutrients 2020, 12(1), 38; https://doi.org/10.3390/nu12010038 - 22 Dec 2019
Cited by 13 | Viewed by 1764
Abstract
This study examined total usual micronutrient intakes from foods, beverages, and dietary supplements (DS) compared to the Dietary Reference Intakes among U.S. adults (≥19 years) by sex and food security status using NHANES 2011–2014 data (n = 9954). DS data were collected [...] Read more.
This study examined total usual micronutrient intakes from foods, beverages, and dietary supplements (DS) compared to the Dietary Reference Intakes among U.S. adults (≥19 years) by sex and food security status using NHANES 2011–2014 data (n = 9954). DS data were collected via an in-home interview; the NCI method was used to estimate distributions of total usual intakes from two 24 h recalls for food and beverages, after which DS were added. Food security status was categorized using the USDA Household Food Security Survey Module. Adults living in food insecure households had a higher prevalence of risk of inadequacy among both men and women for magnesium, potassium, vitamins A, B6, B12, C, D, E, and K; similar findings were apparent for phosphorous, selenium, and zinc in men alone. Meanwhile, no differences in the prevalence of risk for inadequacy were observed for calcium, iron (examined in men only), choline, or folate by food security status. Some DS users, especially food secure adults, had total usual intakes that exceeded the Tolerable Upper Intake Level (UL) for folic acid, vitamin D, calcium, and iron. In conclusion, while DS can be helpful in meeting nutrient requirements for adults for some micronutrients, potential excess may also be of concern for certain micronutrients among supplement users. In general, food insecure adults have higher risk for micronutrient inadequacy than food secure adults. Full article
(This article belongs to the Special Issue Nutrition among Vulnerable Populations)
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Review

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Review
Fruit and Vegetable Incentive Programs for Supplemental Nutrition Assistance Program (SNAP) Participants: A Scoping Review of Program Structure
Nutrients 2020, 12(6), 1676; https://doi.org/10.3390/nu12061676 - 04 Jun 2020
Cited by 6 | Viewed by 1836
Abstract
The low intake of fruits/vegetables (FV) by Supplemental Nutrition Assistance Program (SNAP) participants is a persistent public health challenge. Fruit and vegetable incentive programs use inducements to encourage FV purchases. The purpose of this scoping review is to identify structural factors in FV [...] Read more.
The low intake of fruits/vegetables (FV) by Supplemental Nutrition Assistance Program (SNAP) participants is a persistent public health challenge. Fruit and vegetable incentive programs use inducements to encourage FV purchases. The purpose of this scoping review is to identify structural factors in FV incentive programs that may impact program effectiveness, including (i.) differences in recruitment/eligibility, (ii.) incentive delivery and timing, (iii.) incentive value, (iv.) eligible foods, and (v.) retail venue. Additionally, the FV incentive program impact on FV purchase and/or consumption is summarized. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, a search of four bibliographic databases resulted in the identification of 45 publications for consideration; 19 of which met the pre-determined inclusion criteria for full-length publications employing a quasi-experimental design and focused on verified, current SNAP participants. The data capturing study objective, study design, sample size, incentive program structure characteristics (participant eligibility and recruitment, delivery and timing of incentive, foods eligible for incentive redemption, type of retail venue), and study outcomes related to FV purchases/consumption were entered in a standardized chart. Eleven of the 19 studies had enrollment processes to receive the incentive, and most studies (17/19) provided the incentive in the form of a token, coupon, or voucher. The value of the incentives varied, but was usually offered as a match. Incentives were typically redeemable only for FV, although three studies required an FV purchase to trigger the delivery of an incentive for any SNAP-eligible food. Finally, most studies (16/19) were conducted at farmers’ markets. Eighteen of the 19 studies reported a positive impact on participant purchase and/or consumption of FV. Overall, this scoping review provides insights intended to inform the design, implementation, and evaluation of future FV incentive programs targeting SNAP participants; and demonstrates the potential effectiveness of FV incentive programs for increasing FV purchase and consumption among vulnerable populations. Full article
(This article belongs to the Special Issue Nutrition among Vulnerable Populations)
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