Carmichael and colleagues (2007) examined data from a large, population-based case control study of primarily Hispanic women in California to determine associations between three levels of food security (food secure, food insecure without hunger, and food insecure with hunger) and risk for neural tube defects, orofacial cleft, and conotruncal heart defect. Their survey of 1,189 cases and 695 controls identified positive associations between food insecurity and anencephaly, cleft palate (modified by BMI), and tetralogy of Fallot (indicator of neural tube defect), suggesting that food insecurity is associated with increased risk for poor developmental outcomes.

Few studies have been conducted on the effects of food insecurity on breastfeeding. Zubieta and colleagues (2006) examined breastfeeding duration in infants from food secure and food insecure households using data from NHANES (1999-2000 and 2001-2002). They found that fewer infants were breastfed in the food insecure households, and among all infants that were breastfed, the duration was 38 days longer in the food secure than in the food insecure households.

Risk for Chronic Disease

Diabetes is a serious chronic disease that is particularly prevalent in low-income and minority populations (Beckles et al., 2011). African American and Latino adults are 1.7 to 1.8 times more likely to have diabetes than white adults (Schiller et al., 2012). In a two-city study of a community safety net clinic serving low-income, multiethnic individuals with type II diabetes, Seligman and colleagues (2011) found that nearly half were food insecure. Compared with food secure participants, those who were food insecure had higher levels of glycosylated hemoglobin (HbA1c), an important marker of glucose control. Further, about 30 percent of participants reported having a severe hypoglycemic event in the past year, and 9 percent reported four or more such events. The significance of these differences remained after adjusting for demographic and other risk factors. The relationship between food insecurity and lack of glycemic control was partially explained by difficulty following a prescribed diet and increased emotional distress related to diabetes. Consistent with these studies, Marjerrison and colleagues (2011), using a combination of telephone interviews and chart reviews for 183 Nova Scotian families with a child with type I diabetes, found that HbA1c levels were higher in children from food insecure households than in those from food secure households (9.5 ± 2.13 percent versus 8.96 ± 1.50 percent).

Seligman and colleagues (2010a) used NHANES (1999-2004) data to examine diet-related chronic diseases and prevalence of food insecurity in adult low-income (<200 percent of the poverty threshold) participants. They found that in adjusted models, food insecurity was associated with



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