Food insecurity is adversely associated with the physical and mental health of adults and children, and the mechanism that underlies this association has been assumed to be dietary intake of lower quality in food insecure than food secure individuals. A thorough understanding of observed associations between food insecurity and dietary quality is needed to test this assumption and may highlight pathways through which to improve the health of food-insecure adults and children. We systematically reviewed all evidence of associations between food insecurity and dietary quality and contrasted associations observed in adults and those for children. Evidence came from studies that appeared in indexed, peer-reviewed journals and 1) sampled US residents, 2) separately sampled children and adults, 3) contained a measure of food insecurity or food insufficiency, and 4) included at least one measure of dietary quality. In adults, 170 associations between food insecurity and dietary quality were tested, and 50 associations (29%) suggested an adverse association. Food-insecure adults consumed fewer vegetables, fruit, and dairy products than did food secure adults and had lower intake of vitamins A and B-6, calcium, magnesium, and zinc. In children, 130 associations were tested, and 21 associations (16%) showed an adverse association. There was substantial evidence of only lower fruit consumption in food-insecure compared with food-secure children. Reporting and publication biases may have contributed to an overestimation of the association between food insecurity and dietary quality. Food insecurity is adversely associated with dietary quality in adults, particularly intakes of nutrient-rich vegetables, fruit, and dairy that promote good health. However, food insecurity was less-consistently associated with lower dietary quality in children. The idea that parents effectively shield their children from compromised dietary quality because of food shortages is supported by the evidence.

Prior research shows that food insecurity is associated with being overweight in women, with few and ambiguous results in men. Little is known about the characteristics and roles of individuals who are most likely to be both food insecure and overweight or obese. This study analyzed associations between food insecurity and body weight, and whether gender and marital status are involved in that relationship. Using multiple regression models, we examined food insecurity, marriage, and body weight among 4338 men and 4172 women aged ≥ 20 y in the 1999–2002 NHANES. Married men were more likely to be overweight than men in all other marital-status categories except for those living with partners. Divorced men were more likely than never-married men to live in a household with very low food security. Compared with fully food-secure men, marginally food-secure men were heavier, whereas men with low food security were lighter. Compared with fully food-secure women, marginally food-secure women also showed a tendency to be overweight (P = 0.05), whereas women with low food security were more likely to be obese. When considering the interaction between food insecurity and marital status, food insecurity was related to a greater likelihood of obesity among married women, those living with partners, and widows, when compared with never-married women. Sensitivity analyses suggest this effect was concentrated among marginally food-secure women. These findings indicate that food insecurity relates differently to body weight for men and women, and that partnering plays a strong part in this relationship for women.

Childhood obesity persists in the United States and is associated with serious health problems. Higher rates of obesity among children from disadvantaged households may be, in part, attributable to disparities in access to healthy foods such as fruits and vegetables. Community supported agriculture can improve access to and consumption of fresh produce, but the upfront payment structure, logistical barriers, and unfamiliarity with produce items may inhibit participation by low-income families. The aim of this project is to assess the impact of subsidized, or “cost-offset,” community supported agriculture participation coupled with tailored nutrition education for low-income families with children. The Farm Fresh Foods for Healthy Kids community-based, randomized intervention trial will build on formative and longitudinal research to examine the impact of cost-offset community supported agriculture on diet and other health behaviors as well as the economic impacts on local economies. The intervention will involve reduced-price community supported agriculture shares which can be paid for on a weekly basis, nine skill-based and seasonally-tailored healthy eating classes, and the provision of basic kitchen tools. Low income families with at least one child aged 2–12 years will be recruited to join existing community supported agriculture programs in New York, North Carolina, Vermont, and Washington. In each program, families will be randomized 1:1 to intervention or delayed intervention groups. Data will be collected at baseline, and in the fall and spring for 3 years. The primary outcomes are children’s intake of fruits and vegetables and foods high in sugar and/or (solid) fat, as well as diet quality; secondary outcomes include physical, behavioral, psychosocial, and environmental variables. Cost-effectiveness and economic impact at the farm and community levels also will be assessed. This integrated project will provide important information and contribute to the evidence base regarding the use of local agricultural interventions to improve children’s dietary behaviors and weight maintenance. Findings also will inform the development of a toolkit for farmers and education modules related to local food system innovations for undergraduate and graduate students. ClinicalTrials.gov NCT02770196 . Registered 5 April 2016.

This paper examines fruit and vegetable intake (FVI) in low-income households that participated in a cost-offset (CO), or 50% subsidized, community-supported agriculture (CSA) program. CSA customers paid farms upfront for a share of the harvest, and received produce weekly throughout the growing season. A cohort of adults and children 2–12 y in a summer CO-CSA were surveyed online twice: August 2015 (n = 41) and February 2016 (n = 23). FVI was measured by the National Cancer Institute’s (NCI) Fruit and Vegetable Screener (FVS) and an inventory of locally grown fruits and vegetables. FVI relative to United States (US) recommendations and averages, and across seasons, were tested with non-parametric tests and paired t-tests (p < 0.05). Both adults and children in the CO-CSA had higher FVI than the US averages, and more often met recommendations for vegetables. Some summer fruits and vegetables were more often eaten when locally in-season. The CO-CSA model warrants further examination as an avenue for improving vegetable consumption among adults and children in low-income households. However, causality between CO-CSA participation and FVI cannot be inferred, as CO-CSA participants may be positive deviants with respect to FVI. A multi-state randomized controlled trial is currently underway to evaluate impacts of CO-CSAs on FVI and related outcomes.

The accuracy of national statistics on children's food insecurity depends on the reliability of interview responses by adults. In this study of 395 adolescents ages 15 to 17 in National Health and Nutrition Examination Survey data, adolescents’ self-reported food insecurity was more common than, and only weakly associated with, adult proxy reports of those adolescents’ food insecurity. Adolescents’ dietary quality as measured by the Healthy Eating Index was best when both reports indicated food security, worst when both indicated food insecurity, and intermediate with no systematic difference between the 2 groups when reports disagreed, leaving unanswered the question of which report is more reliable.

Prior research has shown positive associations between participation in school meals and some dietary measures, but the evidence is equivocal. Few pr