Background: To characterize the scenario of food insecurity in Portugal at a time of economic crisis recovery is of the utmost relevance. Objective: This study aimed to estimate the prevalence and to identify the determinants of food insecurity during economic crisis recovery in a population-based urban sample of middle- and older-aged Portuguese adults. Methods: A cross-sectional study including 604 participants of the EPIPorto cohort was conducted. Data on sociodemographic characteristics and on food security status were collected. Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Logistic regression models, crude and adjusted for sex, age, education, and household income perception, were performed. Results: The prevalence of food insecurity was 16.6%. Women (odds ratio [OR] = 1.96; 95% confidence interval [CI]: 1.09-3.54), those less educated (OR = 5.46; 95% CI: 2.84-10.46), and those who had the perception of an insufficient household income (OR = 10.39; 95% CI: 5.00-21.56) were more likely to belong to a food insecure household. Unmarried individuals (OR = 1.79; 95% CI: 1.05-3.06) and lower white-collar workers (OR = 2.22; 95% CI: 1.03-4.77) were also more prone to live within a food insecure household, regardless of sex, age, education, and household income perception. Conclusions: The obtained information is valuable for the development of intervention strategies to reduce food insecurity in middle- and older-aged adults, suggesting that women, unmarried, less educated individuals, less skilled workers, and lower income families should be targeted.

There is a lack of evidence regarding the association between the undernutrition risk at hospital admission with adverse clinical outcomes amongst pulmonology inpatients. The aim of this study was to quantify the association between undernutrition risk at hospital admission and time to discharge alive. A retrospective cohort study including patients consecutively admitted to a pulmonology unit was conducted. Undernutrition risk at hospital admission was identified using the Malnutrition Universal Screening Tool. Survival analyses (Kaplan-Meier curves and Cox regression) were carried out. The sample was composed of 683 patients. Patients who presented high undernutrition risk on hospital admission had a longer length of hospital stay (approximately 50% were discharged to home after 14 days of hospitalization). In the multivariable Cox regression, high undernutrition risk was shown to be independently associated with a lower probability of discharge alive over time (adjusted hazard ratio=0.70; 95% confidence interval: 0.55-0.90). Pulmonology inpatients with high undernutrition risk have a longer length of hospital stay and had a lower probability of being discharged to home. In particular, lung cancer patients had a lower probability of being discharged to home, which corroborates a worse prognosis for these patients.

Pulmonology patients are predisposed to be undernourished and a wide variability in the estimates of frequency of undernutrition risk and undernutrition is found in the literature. The aim of this systematic review and meta-analysis was to investigate the prevalence of undernutrition risk and undernutrition on hospital admission in pulmonology department inpatients. We also intend to take into account the different methodologies used to evaluate undernutrition risk and undernutrition in this population. Pubmed, ISI-Web of Science, and Scopus were searched until January 2015. The evidence regarding the prevalence of undernutrition risk and undernutrition was summarized. Twenty-two studies were included in the qualitative analysis and 21 in meta-analysis. The overall prevalence of undernutrition risk (32.73%; 95% confidence interval [CI], 31.29%-34.17%, I2 = 97.6%) was lower than undernutrition prevalence (36.95%; 95% CI, 34.80%-39.10%, I2 = 99.7%). The subtotal prevalence of undernutrition risk was similar using the Malnutrition Universal Screening Tool and Nutritional Risk Screening-2002. The studies using only anthropometric parameters for the assessment of undernutrition reported lower prevalence of undernutrition than the studies that used Subjective Global Assessment. Cross-sectional studies reported higher prevalence of undernutrition risk and undernutrition than cohort studies. Studies including larger samples reported a prevalence estimate similar to the overall prevalence for undernutrition risk and undernutrition. Studies conducted in non-pulmonology departments showed lower prevalence of undernutrition risk than those from pulmonology departments, contrary to the estimates for undernutrition prevalence. Undernutrition risk and undernutrition prevalence at hospital admission are high among pulmonology inpatients, but the heterogeneity between the studies illustrates the lack of standardized methods to assess nutritional status in this population. The assessment of undernutrition must always be preceded by nutritional screening, according to guidelines, which did not take place in some analyzed studies. Teaching Points • Undernutrition risk and undernutrition prevalence are high among pulmonology inpatients. • The heterogeneity between the analyzed studies reveals that there is no standard pattern in the choice of methods for nutritional status assessment in these patients. • Timely screening and identification of undernutrition is of the utmost relevance in earlier nutritional interventions and implementation of nutritional support. • The assessment of undernutrition must always be preceded by nutritional screening, in accordance with guidelines, which did not occur in some of the analyzed studies.

Evidence on the association between children’s food insecurity (FI) and dietary patterns (DPs) is scarce. This study assessed the association between children’s FI anda priorianda posteriori-defined DPs in a Portuguese population-based sample of children. A cross-sectional study including 2800 children from the 10-year-old follow-up of the Generation XXI birth cohort was performed. Data on food security status, assessed by the Self-administered Food Security Survey Module for children (SAFSSMC), dietary intake and socio-demographics were collected. A previously developed Healthy Eating Index (HEI) was adapted for this study. Using the HEI score and its food groups, linear and logistic regression models were performed. Using latent class analysis, fivea posteriori-defined DPs were identified. The DPs names considered an overall picture of the DP. Food security status as a categorical (food security/FI) and continuous variable (SAFSSMC raw score: higher scores representing higher FI) was used. Multinomial logistic regression models were used to assess the association between food security status and DPs. Children’s FI (9·4 %) was inversely associated with the HEI score (β=–0·695;95%CI:–1·154,–0·235), representing worse diet quality. A higher SAFSSMC raw score was associated with low fruit and vegetables (OR=1·089;95%CI:1·023,1·159) and seafood and eggs consumption (OR=1·073;95%CI:1·009,1·142) and high consumption of meat and meat products (OR=1·091;95%CI:1·026,1·160), salty snacks (OR=1·067;95%CI:1·003,1·136) and soft drinks (OR=1·097;95%CI:1·031,1·168). The SAFSSMC raw score was positively associated with ‘Low consumption’ (OR=1·119;95%CI:1·016,1·232), ‘Energy-dense foods’ (OR=1·155;95%CI:1·028,1·298) and ‘Snacking’ (OR=1·119;95%CI:1·006,1·245) DPs. FI was associated with worse dietary choices. Intervention strategies targeting food insecure children should be developed to promote healthy dietary habits.