Household Food Security and

Infant Adiposity
Sara E. Benjamin-Neelon, PhD, JD, MPH, RD,a Carter Allen, BS,b Brian Neelon, PhDb

Food insecurity has been associated with obesity, but previous studies are
OBJECTIVES: abstract
inconsistent and few included infants. We examined associations between household food
security and infant adiposity and assessed the Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP)
as effect modifiers. We hypothesized that infants from food-insecure households would have
greater adiposity, with attenuation by WIC and SNAP.
METHODS:We repeatedly measured 666 infants from the southeastern United States in
2013–2017. We categorized households as high, marginal, low, or very low using the US
Household Food Security Survey Module. Outcomes were BMI z score, subscapular and triceps
skinfold-for-age z score, the sum of subscapular and triceps skinfolds, the ratio of subscapular
and triceps skinfolds, and BMI z score $1 (at risk for overweight). We used covariate-adjusted
repeated-measures linear and logistic regressions.
RESULTS:Of infants, 68.6% were Black and 60.5% had household incomes ,$20 000.
Interactions between food security and WIC and/or SNAP were not significant. Compared
with infants from high food security households, infants from very low food security
households had higher BMI z scores (0.18 U; 95% confidence interval [CI] 0.01 to 0.35),
higher subscapular skinfold-for-age z scores (0.31 U; 95% CI 0.04 to 0.59), a higher sum of
subscapular and triceps skinfolds (0.53 mm; 95% CI 0.002 to 1.07), and greater odds of being
at risk for overweight (odds ratio 1.55; 95% CI 1.14 to 2.10). Infants from low food security
households had greater odds of being at risk for overweight (odds ratio 1.72; 95% CI 1.17
to 2.10).
CONCLUSIONS:In larger and longer studies, researchers should examine food security and
adiposity in young children.

a
Department of Health, Behavior, and Society, Johns Hopkins University, Baltimore, Maryland; and bDivision of WHAT’S KNOWN ON THIS SUBJECT: Food insecurity in
Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South young children may be associated with obesity and
Carolina excess adiposity, but findings are inconsistent.
Dr Benjamin-Neelon conceptualized and designed the study and drafted the initial manuscript; Mr However, in a single previous study of low-income
Allen conducted the analyses; Dr Neelon supervised data analysis; and all authors reviewed and infants, authors found no association between food
revised the manuscript, approved the final manuscript as submitted, and agree to be accountable insecurity and obesity.
for all aspects of the work.
WHAT THIS STUDY ADDS: Infants from very low food
DOI: https://doi.org/10.1542/peds.2019-3725 security households, compared with infants from high
Accepted for publication Jun 10, 2020 food security households, had higher odds of being at
Address correspondence to Sara E. Benjamin-Neelon, PhD, JD, MPH, RD, Department of Health, risk for overweight and had greater adiposity over the
Behavior and Society, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205. course of infancy.
E-mail: sara.neelon@jhu.edu
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2020 by the American Academy of Pediatrics To cite: Benjamin-Neelon SE, Allen C, Neelon B. Household
Food Security and Infant Adiposity. Pediatrics. 2020;
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to 146(3):e20193725
this article to disclose.

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PEDIATRICS Volume 146, number 3, September 2020:e20193725 ARTICLE
Preventing food insecurity in young
children in the United States is an
important public health goal because
there are both immediate and long-
term adverse health consequences.1
Household food security is defined by
the US Department of Agriculture as
all members having readily available,
nutritionally adequate, and safe foods
at all times.2 An estimated 12% of
households were food insecure in the
United States in 2017.3 That same
year, nearly 3 million or ∼8% of
households included children who
experienced food insecurity.3 In
a recent report by the US Department
of Agriculture, it was estimated that
nationally, 7.1% of food-insecure
households had children aged 6 years
and younger who experienced food
insecurity in 2018.3 In another study
of caregivers with children aged
5 years and younger in 4 US cities,
household food insecurity ranged
from ∼10% to 15% in 2018.4 Little is
known, however, about the prevalence
of food insecurity among infants. In
one previous study of 144 infants in
Ohio, authors found that 31% lived in
food-insecure households.5 In a study
of ∼20 000 infants participating in
a federal food assistance program in
Massachusetts, authors found that
20% to 25% lived in households that
were food insecure.6,7
Infants may be especially vulnerable
to food insecurity because infancy is
a time of rapid growth. Food insecurity
during infancy has been associated
with overall poor health,8 but few
studies have assessed associations
between food insecurity and obesity or
excess adiposity in young children. In
a recent large cross-sectional study of
low-income infants from 5 US cities,
authors found no association between
food insecurity and obesity, defined as
weight-for-age .90th percentile by
using World Health Organization
(WHO) reference data.9 There is,
however, some evidence that food
insecurity in preschool- and school-
aged children may be associated with
obesity and excess adiposity.6,10–15 The
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2 BENJAMIN-NEELON et al
results of these studies, however, have
been mixed. In one study, authors
observed an association with
overweight among girls only.13 On the
other hand, the authors of some studies
observed no association,16–20 mixed
associations with obesity was noted in
one study,9 and the authors of another
study found that food insecurity had
a protective effect against having
overweight.21 Additionally, the authors
of 2 previous systematic reviews found
mixed evidence of an association
between food security and weight
status in children,22,23 further adding to
the lack of clarity surrounding food
insecurity and obesity or excess
adiposity in early childhood. Food
insecurity may be associated with
lower diet quality,24–26 which, in turn,
may increase risk of obesity. In young
children, caregiver feeding behaviors
may also play a role.10,24–29
Moreover, the ability of federal food
assistance programs to influence the
association between food insecurity
and obesity or excess adiposity remains
unclear. Programs such as the Special
Supplemental Nutrition Program for
Women, Infants, and Children (WIC)
and the Supplemental Nutrition
Assistance Program (SNAP) play a role
in alleviating food insecurity and
associated health risks in young
children.30–34 In 2 previous studies,
authors found a protective effect of
WIC on childhood overweight and the
BMI z score,31,35 but in another study, it
was suggested that participation may
be associated with greater obesity.36
This association may, however, depend
on food security status. Kohn et al35
found that participation in WIC and
SNAP was associated with higher
weight in food-secure but not food-
insecure youth. In a large study of
children younger than 3 years, authors
found that SNAP participation was
marginally (approached but did not
reach significance) associated with
lower odds of being at risk for
obesity.34 Similarly, but in school-aged
children, Jones et al37 found that girls
had a reduced risk of overweight if they
participated in the Food Stamp
program (now SNAP) and the National
School Lunch and Breakfast program.
However, in the study by Nguyen
et al,38 household food security was not
associated with BMI percentile in
school-aged children whose families
participated in SNAP. The majority of
these studies included few or no
infants and were limited by their cross-
sectional design. Therefore, our
purpose for this study was to examine
associations between household food
security and infant adiposity.
Secondarily, we evaluated whether
participation in WIC and SNAP
modified this potential relation. We
hypothesized that infants from food-
insecure households would have
greater adiposity than those from food-
secure households and that WIC and
SNAP participation would attenuate
this association.
METHODS
Study Design and Population
Participants were from the Nurture
Study, a birth cohort of 666 racially
diverse women and their infants
residing in the southeastern United
States.39 Between 2013 and 2017, we
enrolled pregnant women,
reconsented them after delivery, and
conducted home visits when infants
were 3, 6, 9, and 12 months. Women
completed questionnaires via
telephone in months 1, 2, 4, 5, 7, 8,
10, and 11. The goal of the Nurture
Study was to assess feeding, physical
activity, sleep, and stress and
associations with weight gain in
infancy, exploring the role of food
security.
We recruited women from a private
prenatal clinic and the local county
health department prenatal clinic. To
participate, women were required to
be between 20 and 36 weeks into
their pregnancy, be pregnant with
a singleton with no known congenital
abnormalities, be at least 18 years
old, speak and read English, intend to
keep their infants, and plan to stay
within the area for 1 year. At the
reconsent at birth, we excluded
infants born before 28 weeks’
gestation, infants with congenital
abnormalities that could affect
development, infants in the hospital
for $3 weeks, and infants not able to
take food by mouth at discharge.
Women provided written informed
consent for their participation and
that of their infants. The Duke
University Medical Center
Institutional Review Board approved
this study.
Exposure: Household Food Security
Our primary exposure was household
food security status, measured when
infants were 3, 6, 9, and 12 months.
We used the 18-item US Household
Food Security Survey Module.40 We
asked mothers to consider the past
30 days rather than the previous
12 months when responding to each
question because we were interested
in assessing household food security
status over a shorter and often
dynamic life stage. We categorized
response scores of 0 as high, 1 to 2 as
marginal, 3 to 7 as low, and 8 to 18 as
very low food security, consistent
with the US Department of
Agriculture classifications for
households with $1 child present.40
Outcomes: Infant Adiposity
We measured infant length using
a ShorrBoard Portable Length Board
to the nearest one-eighth inch and
infant weight using a Seca Infant
Scale to the nearest 0.1 lb. We
calculated infant BMI z scores using
WHO age- and sex-specific reference
data.41 We classified infants as at risk
for overweight if their BMI z scores
were $1, per WHO cut points.42,43
We measured subscapular and
triceps skinfold thicknesses to the
nearest 0.2 mm at each home visit
using Holtain Tanner/Whitehouse
Skinfold Calipers.
We used the sum of subscapular and
triceps skinfolds (SS 1 TR) thickness
as a proxy for overall fatness, and the
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PEDIATRICS Volume 146, number 3, September 2020
ratio of subscapular and triceps
skinfolds (SS/TR) as a proxy for
central fatness. This approach is
consistent with that of previous
studies.44,45 We also calculated
subscapular and triceps skinfold-for-
age z scores using WHO growth
standards.41 We measured in
triplicate, taking an average of the
three, using standard techniques.46
Other Measures
Maternal variables included race
(Black, white, other or .1 race), age,
education (high school graduate or
less, some college or more),
prepregnancy BMI, and number of
children in the household. Infant
variables included race (Black, white,
other or .1 race), sex, and birth weight
for gestational age z score. At each
home visit, we assessed participation in
WIC and SNAP. We also measured
breastfeeding monthly and calculated
total months of any breastfeeding.
Analysis
Of the 666 women who enrolled their
infants, 535 (80.3%) completed the 3-
month home visit, 497 (74.6%)
completed the 6-month home visit,
457 (68.6%) completed the 9-month
home visit, and 468 (70.3%)
completed the 12-month home visit.
We examined covariate-adjusted
associations between household food
security and infant adiposity at 3, 6, 9,
and 12 months. We fit repeated-
measures linear and logistic
regression models with an
unstructured error covariance
(linear) or an unstructured working
covariance (logistic) to account for
the correlation among repeated
measures within infants. We treated
food security as a time-varying
exposure because families may
experience food insecurity differently
over time. We evaluated 4 categories
of food security, including high,
marginal, low, and very low, with high
security as the reference. We treated
time (ie, each home visit) as
a categorical variable to allow for
a nonlinear time trend. We omitted
an interaction between time and food
security after testing for and failing to
detect a significant difference of food
security effect over time. To examine
effect modification, we tested a 2-way
interaction between food security and
WIC or SNAP separately.
The final model included covariates
we identified a priori as potential
confounders on the basis of existing
literature,6,13,20,25,38,47–49 including
maternal race, age, education, and
prepregnancy BMI; number of
children in the household; and infant
race, sex, birth weight for gestational
age z score, and breastfeeding.
However, because we were interested
in fat distribution after controlling for
overall body size, we further adjusted
for BMI z score in our analyses with
SS/TR.44,45 We fit the final
multivariable models to both available-
case and multiply imputed data sets.
For multiple imputation, we generated
1000 imputed data sets and combined
parameter estimates and SEs using
standard imputation formulas.50 We
used an F test to assess the interaction
between WIC and food security and
SNAP and food security and combined
results across multiply imputed data
sets using the approach described by
Grund et al.51 Results were nearly
identical between imputed and
nonimputed models. Therefore, we
present results from imputed models
in terms of parameter estimates, 95%
confidence intervals (CIs), and 2-sided
P values. We conducted these analyses
using SAS version 9.4 (SAS Institute,
Inc, Cary, NC), with a significance level
of a = .05.
RESULTS
Of infants, 68.6% were Black and
14.9% were white (Table 1).
Households had a mean (SD) of 3.7
(1.6) children. Just over half (55.4%)
had household incomes #$20 000
per year. Among infants from food-
secure households (high and marginal
food security) the percentage of
infants at risk for overweight
3
decreased from 46.8% at 3 months to TABLE 1 Demographic Characteristics of Participants in the Nurture Study, 2013–2017 (N = 666)
33.1% at 12 months, whereas among Value
infants from food-insecure Infant characteristics
households (low and very low food Birth length, cm, mean (SD) 49.7 (2.6)
security), the percentage increased Birth wt, g, mean (SD) 3209.7 (512.5)
Birth wt for gestational age z score, mean (SD) 0.1 (1.0)
from 53.2% to 66.9%. Household Any breastfeeding duration, min, mean (SD) 4.1 (4.3)
food security status also changed BMI z score, mean (SD)
over the course of infancy (Table 2). At 3 mo 0.2 (0.9)
At 6 mo 0.3 (1.0)
Of households, 66.4% remained in the
At 9 mo 0.6 (1.0)
high or marginal food security At 12 mo 0.7 (1.0)
category and 8.8% remained in the At risk for overweight (BMI z score $1), No. (%)
low or very low food security At 3 mo 94 (14.1)
At 6 mo 110 (16.5)
category across assessments; the At 9 mo 129 (19.4)
remainder changed categories over At 12 mo 154 (23.1)
time (eg, moved from marginal to Wt gain from birth to 12 mo, kg, mean (SD) 6.6 (1.2)
Female sex, No. (%) 326 (48.9)
low). When we tested for effect Race, No. (%)
modification, we found no evidence of Black 457 (68.6)
interactions between food security White 100 (14.9)
and WIC or SNAP (P = .691 for WIC Other race or .1 race 99 (14.9)
Ethnicity, Latinx or Hispanic, No. (%) 59 (8.9)
and P = .22 for SNAP). Therefore, we Age, mean (SD), mo
fit a main effect model only and At 3-mo assessment 3.4 (0.5)
adjusted for WIC and SNAP in all At 6-mo assessment 6.3 (0.5)
At 9-mo assessment 9.5 (0.5)
analyses. At 12-mo assessment 12.5 (0.8)
Maternal characteristics
After adjustment for potential Age, y. mean (SD) 27.3 (5.8)
confounders, infants from very low Prepregnancy BMI, mean (SD) 29.9 (9.2)
food security households had higher Parity assessed in pregnancy, No. (%)
0 236 (35.4)
BMI z scores (0.18 U; 95% CI 0.01 to 1 190 (28.5)
0.35; P = .04), higher subscapular 2 216 (32.4)
skinfold-for-age z scores (0.31 U; Marital status, No. (%)
Married or living with partner 395 (59.3)
95% CI 0.04 to 0.59; P = .03), higher
Never married, divorced, separated, or other 271 (40.7)
SS 1 TR (0.53 mm; 95% CI 0.002 to Race, No. (%)
1.07; P = .046), and greater odds of Black 476 (71.4)
being at risk for overweight (odds White 128 (19.2)
Other race or .1 race 62 (9.3)
ratio 1.55; 95% CI 1.14 to 2.10; P = Ethnicity, Hispanic, No. (%) 43 (6.5)
.005) compared with infants from Education, No. (%)
high food security households (Tables Less than high school 135 (20.3)
High school degree 184 (27.6)
3–5). Additionally, infants from low Some college 240 (36.0)
food security households had greater College or graduate degree 107 (16.1)
odds of being at risk for overweight Household characteristics, mean (SD)
No. adults 2.9 (1.2)
(odds ratio 1.72; 95% CI 1.17 to 2.10;
No. children 3.7 (1.6)
P = .005). We did not observe any Annual income, No. (%)
other significant associations. ,$20 000 403 (60.5)
$20 000–$39 999 133 (20.0)
$40 000–$70 000 65 (9.8)
.$70 000 49 (7.4)
DISCUSSION Missing 16 (2.4)
WIC participation, No. (%)
In this cohort of infants, we found At 3 mo 391 (58.7)
that infants from low and very low At 6 mo 357 (53.6)
food security households had greater At 9 mo 323 (48.8)
At 12 mo 318 (47.7)
odds of being at risk for overweight
SNAP participation, No. (%)
compared with infants from high food At 3 mo 352 (52.3)
security households. Moreover, we At 6 mo 324 (48.6)
found that infants from very low food At 9 mo 292 (43.8)
At 12 mo 289 (43.4)
security households had higher BMI z
scores, subscapular skinfold-for-age z

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4 BENJAMIN-NEELON et al
TABLE 2 Household Food Security Status of development risks (and not with behaviors. In a sample of 201
Nurture Study Infants at 3, 6, 9, and anthropometric changes within the predominately Hispanic mothers and
12 Months normal range) may explain the infants participating in WIC, Gross
Household No. (%) differences in our findings. The et al28 found that food insecurity was
Food Security 3 mo 6 mo 9 mo 12 mo authors recommended that not associated with breastfeeding or
High 348 358 341 348 subsequent studies investigate the adding cereal to the bottle. Moreover,
(65.3) (72.9) (74.8) (74.7) mechanisms linking food insecurity to in a sample of 8693 infants, Bronte-
Marginal 67 48 43 40 adverse health conditions. Thus, our Tinkew et al10 did not observe
(12.6) (9.8) (9.4) (8.6) study extends and complements the associations between household food
Low 74 50 33 37
previous work by Drennen et al.9 security and breastfeeding or early
(13.9) (10.1) (7.2) (7.9)
introduction of solid foods. However,
Very low 44 35 39 41 There are several potential
their results suggested that food
(8.3) (7.1) (8.6) (8.8) explanations for our finding that very
security influenced parenting style,
low food security was associated with
which, in turn, was associated with
greater adiposity during infancy. One
scores, and SS 1 TR, which is infant feeding behaviors. These
may relate to maternal feeding
a marker of overall adiposity. We did studies provide some evidence of
behaviors in the absence of an
not, however, observe these a food insecurity–obesity association,
adequate supply of healthy foods.
associations for infants from low or but additional research is needed to
Some previous studies suggest that
marginal food security households. help identify a relationship and
food insecurity may influence obesity
Furthermore, we did not observe any elucidate potential pathways.
and excess adiposity through
associations between household food
inappropriate infant feeding practices Notably in our study, we did not
security and triceps skinfold-for-age z
and less healthy diets.10,24–29 It is observe an interaction between WIC
scores or SS/TR, which may indicate
well established that healthier foods and food security or SNAP and food
that food security is less influential on
cost more than less healthy foods, security. Therefore, our findings
extremity versus trunk fat.
contributing to socioeconomic suggest that the effect of food security
Alternatively, the effect of food
disparities in health outcomes.52–54 did not vary by WIC or SNAP
insecurity may need to accumulate
Studies in older children suggest participation, which was contrary to
throughout both infancy and
associations between food insecurity our hypothesis. Our hypothesis was
childhood before a consistent
and lower diet quality.24–26 In based on previous studies in which
association with skinfolds emerges.
a previous study of 278 mothers and authors found a protective effect of
children, Feinberg et al27 found that WIC and SNAP participation on
Our findings build on results from
a recent study of food insecurity and
food-insecure mothers were more childhood obesity.31,34,35 Conversely,
likely to give their preschool- and WIC and SNAP may be associated
obesity in the United States that
included a large number of infants.9
school-aged children high-energy with greater weight,36 but this may
supplements to compensate for food depend on children’s food security
The authors examined food security
and obesity and found no
shortages. However, no researchers status.35 Nonetheless, both WIC and
have examined food security and diet SNAP play an essential role in the
associations.9 However, the cross-
quality in infants.26 lives of food-insecure families in the
sectional design, the inclusion of low-
income children only, and the focus In other studies, authors have United States.30–33,55
on growth parameters associated examined associations between food This study has limitations. First, we
with subsequent health and insecurity and maternal feeding measured food security at the
household level rather than in infants.
TABLE 3 Adjusted Estimates and 95% CIs of Longitudinal Associations of Household Food Security Mothers responded to questions on
and Infant Adiposity: At Risk for Overweight and BMI z Score child food security for all children in
Household Food Security Infant Adiposity the household and not just the index
infant enrolled in the Nurture Study.
At Risk for Overweight (BMI z Score BMI z Score
$1) There is limited information on the
extent to which household food
Odds Ratio 95% CI P Estimate 95% CI P
insecurity reaches infants. Second, we
High Reference Reference Reference Reference Reference Reference
modeled food security in 4 categories
Marginal 1.07 0.78 to 1.49 .66 0.01 20.11 to 0.19 .57
Low 1.72 1.17 to 2.48 .005 0.09 20.10 to 0.27 .35 rather than dichotomizing households
Very low 1.55 1.14 to 2.10 .005 0.18 0.01 to 0.35 .04 as food secure or food
Adjusted for infant race, sex, birth weight for gestational age z score, and breastfeeding; maternal age, education, and insecure.5,6,9,13,23,56,57 There is,
prepregnancy BMI; and number of children in the household, WIC participation, and SNAP participation. however, some previous evidence of

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PEDIATRICS Volume 146, number 3, September 2020 5
TABLE 4 Adjusted Estimates and 95% CIs of Longitudinal Associations of Household Food Security substantially from 3 to 12 months but
and Infant Adiposity: Triceps Skinfold-for-Age z Score and Subscapular Skinfold-for-Age z more so among food-insecure infants.
Score
In previous studies, authors have
Household Food Security Infant Adiposity
observed similar inconsistent
Triceps Skinfold-for-Age z Score Subscapular Skinfold-for-Age z Score associations between exposure and
Estimate 95% CI P Estimate 95% CI P BMI or skinfold thickness. For
High Reference Reference Reference Reference Reference Reference example, Taveras et al62 found that
Marginal 0.08 20.22 to 0.38 .60 0.16 20.08 to 0.40 .20 infants who slept ,12 hours per day
Low 0.17 20.18 to 0.52 .34 0.07 20.24 to 0.38 .66 had higher BMI z scores and greater
Very low 0.23 20.09 to 0.55 .16 0.31 0.04 to 0.59 .03
SS 1 TR but not SS/TR. Similarly,
Adjusted for infant race, sex, birth weight for gestational age z score, and breastfeeding; maternal age, education, and Gillman et al63 observed associations
prepregnancy BMI; and number of children in the household, WIC participation, and SNAP participation.
between higher sugary beverage
consumption in pregnancy and higher
associations of marginal household between household food security and BMI z score and SS 1 TR, but not SS/
food security and adverse health infant adiposity and is an area for TR, among children in middle
outcomes in young children, further exploration. We did, however, childhood. Skinfold thickness may be
suggesting that marginal food control for breastfeeding, which is likely more closely associated with body fat
security should be examined an important factor related to diet. than BMI in infants.64 However, in
separately,58 which is why we another study,65 authors found that
modeled them separately. Finally, we did not use a more among infants, skinfold thicknesses
objective measure of infant adiposity. and BMI were relatively equivalent
Third, Nurture Study participants were A recent study suggests that in their ability to predict later body
not representative of the general bioelectrical impedance may be fat. Despite a more objective measure
population in the southeastern United a more appropriate measure of body of infant adiposity, this study includes
States; the demographic composition of composition in infants.61 This may both BMI and skinfolds, and both
our sample included a higher explain the inconsistent associations provide useful information about risk
representation of Black infants. we observed between household food of overweight and excess adiposity.
However, Black infants are security and infant adiposity. For
underrepresented in most US birth instance, very low household food CONCLUSIONS
cohorts,59 so this racially diverse cohort security was associated with higher
Food insecurity may be especially
makes a unique contribution. Fourth, as infant BMI z scores (both
problematic during infancy because
with most birth cohorts, we experienced dichotomized and continuous), but
the first year represents a dynamic
attrition. From birth to the 12-month low household food security was
time for growth and development. We
assessment, we retained 70% of the associated with higher BMI z scores as
found that food insecurity in infancy
sample. In a similar birth cohort from a dichotomized variable only.
was associated with obesity and
the same geographic area, 56% of Moreover, very low household food
excess adiposity, but larger and
women completed a 12-month follow- security was associated with greater
longer studies are needed to assess
up.60 To compensate for modest attrition, subscapular, but not triceps, skinfold
sustained associations.
we imputed data for this analysis. Fifth, thickness; low household food security
we did not assess the nutritional quality was associated with neither. Notably,
of infants’ diets. Diet quality, for example, however, the percentage of infants at
ABBREVIATIONS
may fall within the causal pathway risk for overweight increased
CI: confidence interval
TABLE 5 Adjusted Estimates and 95% CIs of Longitudinal Associations of Household Food Security SNAP: Supplemental Nutrition
and Infant Adiposity: SS 1 TR and SS/TR Assistance Program
SS 1 TR: sum of subscapular and
Household Food Security Infant Adiposity
triceps skinfolds
SS 1 TR SS/TRa
SS/TR: ratio of subscapular and
Estimate 95% CI P Estimate 95% CI P triceps skinfolds
High Reference Reference Reference Reference Reference Reference WHO: World Health Organization
Marginal 0.24 20.3 to 0.72 .32 0.01 20.02 to 0.40 .50 WIC: Special Supplemental
Low 0.23 20.34 to 0.80 .42 20.01 20.05 to 0.03 .55
Nutrition Program for
Very low 0.53 0.002 to 1.07 .046 0.01 20.02 to 0.04 .53
Women, Infants, and
Adjusted for infant race, sex, birth weight for gestational age z score, and breastfeeding; maternal age, education, and
prepregnancy BMI; and number of children in the household, WIC participation, and SNAP participation. Children
a Additionally adjusted for BMI z score.

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6 BENJAMIN-NEELON et al
FUNDING: Supported by a grant from the National Institutes of Health (grant R01DK094841). Funded by the National Institutes of Health (NIH).
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
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9
 Household Food Security and Infant Adiposity
Sara E. Benjamin-Neelon, Carter Allen and Brian Neelon
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 Household Food Security and Infant Adiposity
Sara E. Benjamin-Neelon, Carter Allen and Brian Neelon
Pediatrics originally published online August 28, 2020;

The online version of this article, along with updated information and services, is
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