To systematically review the potential impact of reducing the set of Supplemental Nutrition Assistance Program (SNAP)-eligible foods (e.g. not allowing purchase of sugar-sweetened beverages with SNAP benefits) on expenditures for restricted foods.

The impact on food expenditures of a $US 1 reduction in available SNAP benefits can be used to estimate the impact of restrictions on SNAP-eligible foods. An electronic search of EconPapers, AgEcon Search, EconLit, WorldCat, ProQuest Dissertations and Theses, PubMed and NALDC, and a snowball search were conducted to obtain a sample of studies up to March 2015 that estimate the impacts of SNAP and other income on household food expenditures. The studies were classified according to study population, study design and whether they attempted to correct for major study design biases.

Estimates were extracted from fifty-nine published and unpublished studies.

US households.

Fifty-nine studies were found, yielding 123 estimates of the impact of SNAP benefits on food expenditures and 117 estimates of the difference in impacts between SNAP benefits and other income. Studies correcting for or mitigating study design biases had less estimate variation. Estimates indicate that expenditures on the restricted item would decrease by $US 1·6 to $US 4·8 if $US 10 of SNAP benefits would have otherwise been spent, with a median overall impact of $US 3.

The present literature suggests that restrictions on SNAP-eligible items may result in a small but potentially meaningful decrease in SNAP expenditures for restricted items. Further research is needed to evaluate whether this would translate into improvements in diet quality.

A randomized controlled trial was conducted to assess the effect of African leafy vegetable (ALV) consumption on Fe, Zn and vitamin A status in children.

Children were randomly allocated to receive either a 300 g cooked ALV dish and school meal starch (n 86) or the normal school meal (n 81) five times per week for three months. ALV in the dish consisted mainly of Amaranthus cruentus (at least 80 %) and the remainder of Cleome gynandra, Cucurbita maxima or Vigna unguiculata. Nutrient content and consumer acceptance of the ALV dish were also determined.

North West Province, South Africa.

Grade R to grade 4 children (6–12 years old) of two farm schools.

The ALV dish contributed 11·6–15·8 mg Fe and 1·4–3·7 mg Zn. At baseline, prevalence of deficiencies in the intervention group was 16·0 %, 16·3 %, 7·0 % and 75·6 %, respectively, for anaemia (Hb<11·5 g/dl), Fe (serum ferritin<15 µg/l), vitamin A (serum retinol<20 μg/dl) and Zn (serum Zn<65 μg/dl); and in the control group 10·5 %, 18·5 %, 2·5 % and 75·3 %, respectively. No significant estimated intervention effect was found.

This randomized controlled trial showed that ALV were unable to improve serum retinol, serum ferritin or Hb if there are only mild deficiencies present. Furthermore, despite the low Zn status in the study population, ALV consumption did not improve serum Zn concentrations either.

To determine macronutrients and micronutrients in foods served to and consumed by children at child-care centres in Oklahoma, USA and compare them with Dietary Reference Intakes (DRI).

Observed lunch nutrients compared with one-third of the age-based DRI (for 1–3 years-olds and 4–8-year-olds).

Oklahoma child-care centres (n 25), USA.

Children aged 3–5 years (n 415).

Regarding macronutrients, children were served 1782 (sd 686) kJ (426 (sd 164) kcal), 22·0 (sd 9·0) g protein, 51·5 (sd 20·4) g carbohydrate and 30·7 (sd 8·7) % total fat; they consumed 1305 (sd 669) kJ (312 (sd 160 kcal), 16·0 (sd 9·1) g protein, 37·6 (sd 18·5) g carbohydrate and 28·9 (sd 10·6) % total fat. For both age-based DRI: served energy (22–33 % of children), protein and carbohydrate exceeded; consumed energy (7–13 % of children) and protein exceeded, while carbohydrate was inadequate. Regarding micronutrients, for both age-based DRI: served Mg (65·9 (sd 24·7) mg), Zn (3·8 (sd 11·8) mg), vitamin A (249·9 (sd 228·3) μg) and folate (71·9 (sd 40·1) µg) exceeded; vitamin E (1·4 (sd 2·1) mg) was inadequate; served Fe (2·8 (sd 1·8) mg) exceeded only in 1–3-year-olds. Consumed folate (48·3 (sd 38·4) µg) met; Ca (259·4 (sd 146·2) mg) and Zn (2·3 (sd 3·0) mg) exceeded for 1–3-year-olds, but were inadequate for 4–8-year-olds. For both age-based DRI: consumed Fe (1·9 (sd 1·2) mg) and vitamin E (1·0 (sd 1·7) mg) were inadequate; Mg (47·2 (sd 21·8) mg) and vitamin A (155·0 (sd 126·5) µg) exceeded.

Lunch at child-care centres was twice the age-based DRI for consumed protein, while energy and carbohydrate were inadequate. Areas of improvement for micronutrients pertain to Fe and vitamin E for all children; Ca, Zn, vitamin E and folate for older pre-schoolers. Adequate nutrients are essential for development and the study reveals where public health nutrition experts, policy makers and care providers should focus to improve the nutrient density of foods.

To assess the association between physical intimate partner violence and household food security within households with schoolchildren.

Cross-sectional study.

Salvador, Bahia, north-eastern Brazil.

The study was conducted in 1019 households with students. Violence between couples was evaluated using the Portuguese version of the revised Conflict Tactics Scales (CTS2), previously adapted and validated for use in Brazil. The Brazilian Food Insecurity Scale (BFIS) was used to identify food insecurity. We also obtained socio-economic information for each participant. We used multivariate Poisson regression to assess the associations of interest.

According to the results of the BFIS, 62·5 % of the households were found to experience food insecurity, including 19·5 % moderate food insecurity and 6·5 % severe food insecurity. The prevalence of minor physical violence was 9·6 % (95 % CI 7·8, 11·4 %) and of severe physical violence was 4·7 % (95 % CI 3·4, 6·0 %) among the couples. In the final multivariate model, it was found that couples reporting minor (prevalence ratio=1·23; 95 % CI 1·12, 1·35) and severe (prevalence ratio=1·16; 95 % CI 1·00, 1·34) physical violence were more likely to be experiencing household food insecurity, compared with those not reporting physical violence.

Physical intimate partner violence was associated with food insecurity of households. The present study brings new data to the subject of the role of violence in the context of food insecurity.

To assess the compatibility between reduction of diet-related greenhouse gas emissions (GHGE) and nutritional adequacy, acceptability and affordability dimensions of diet sustainability.

Dietary intake, nutritional composition, GHGE and prices were combined for 402 foods selected among those most consumed by participants of the Individual National Study on Food Consumption. Linear programming was used to model diets with stepwise GHGE reductions, minimized departure from observed diet and three scenarios of nutritional constraints: none (FREE), on macronutrients (MACRO) and for all nutrient recommendations (ADEQ). Nutritional quality was assessed using the mean adequacy ratio (MAR) and solid energy density (SED).

France.

Adults (n 1899).

In FREE and MACRO scenarios, imposing up to 30 % GHGE reduction did not affect the MAR, SED and food group pattern of the observed diet, but required substitutions within food groups; higher GHGE reductions decreased diet cost, but also nutritional quality, even with constraints on macronutrients. Imposing all nutritional recommendations (ADEQ) increased the fruits and vegetables quantity, reduced SED and slightly increased diet cost without additional modifications induced by the GHGE constraint up to 30 % reduction; higher GHGE reductions decreased diet cost but required non-trivial dietary shifts from the observed diet. Not all the nutritional recommendations could be met for GHGE reductions ≥70 %.

Moderate GHGE reductions (≤30 %) were compatible with nutritional adequacy and affordability without adding major food group shifts to those induced by nutritional recommendations. Higher GHGE reductions either impaired nutritional quality, even when macronutrient recommendations were imposed, or required non-trivial dietary shifts compromising acceptability to reach nutritional adequacy.

Finland is known for a sharp decrease in the intake of saturated fat and cardiovascular mortality. Since 2000, however, the consumption of butter-containing spreads – an important source of saturated fats – has increased. We examined social and health-related predictors of the increase among Finnish men and women.

An 11-year population follow-up.

A representative random sample of adult Finns, invited to a health survey in 2000.

Altogether 5414 persons aged 30–64 years at baseline in 2000 were re-invited in 2011. Of men 1529 (59 %) and of women 1853 (66 %) answered the questions on bread spreads at both time points. Respondents reported the use of bread spreads by choosing one of the following alternatives: no fat, soft margarine, butter–vegetable oil mixture and butter, which were later categorized into margarine/no spread and butter/butter–vegetable oil mixture (= butter). The predictors included gender, age, marital status, education, employment status, place of residence, health behaviours, BMI and health. Multinomial regression models were fitted.

Of the 2582 baseline margarine/no spread users, 24.6% shifted to butter. Only a few of the baseline sociodemographic or health-related determinants predicted the change. Finnish women were more likely to change to butter than men. Living with a spouse predicted the change among men.

The change from margarine to butter between 2000 and 2011 seemed not to be a matter of compliance with official nutrition recommendations. Further longitudinal studies on social, behavioural and motivational predictors of dietary changes are needed.

For more than 20 years, the FOODcents adult nutrition education programme has been delivered to Western Australians. The aim of the programme is to provide disadvantaged individuals with the knowledge, skills and motivation to buy healthy foods on a limited budget. The present study evaluated whether the FOODcents curriculum and the way it is delivered are effective in improving participants’ nutrition-related knowledge and behaviours.

Evaluation data were collected via in-session pre–post questionnaires and a post-course online questionnaire.

Western Australia.

Data were collected from participants attending just over one-half (54 %) of the FOODcents courses conducted over the two-year evaluation period. In total, 927 course participants provided usable data.

After exposure to the course, respondents demonstrated an improved ability to: (i) categorize foods according to the frequency with which they should be consumed and the proportion of the food budget that should be allocated to them; (ii) correctly interpret nutrition labels on food products; and (iii) appreciate the link between diet/obesity and a range of diseases. Improvements in the latter were especially pronounced among participants of low socio-economic status. In terms of behaviour change, significant improvements in fruit and vegetable consumption were reported, along with reductions in the consumption of fast food. Participants of low socio-economic status reported the greatest changes.

The results indicate that the FOODcents nutrition education programme improves participants’ nutrition-related knowledge and behaviours.

To examine the perspectives and practices of cooks responsible for carrying out healthy meal programmes in publicly funded foodservice, in order to better understand what they consider to be ‘good’ food and where nutrition and nutritional standards fit into this conceptualization.

A qualitative, exploratory study involving in-depth interviews that were conducted with cooks and their supervisors about their work practices and perspectives on providing healthy food for clients.

Participants were recruited from child-care, after-school, senior-centre and shelter settings that had participated in healthy menu training in New York City, USA.

Eighteen cooks and nine supervisors working in the aforementioned settings.

The views and practices of both cooks and supervisors about what constitutes ‘good’ food extend beyond a purely nutritional view of goodness to include the importance of addressing hunger and clients’ food preferences, among other factors. Cooks address these by interacting with clients and altering recipes and menus in a range of ways to maximize the likelihood of food consumption and enjoyment. These approaches are often, but not always, compatible with setting-specific nutritional guidelines that may be set at the national, state, local or organizational level.

Cooks play a key role in translating nutritional guidelines into what is served. In doing so, they engage in skilled labour and forms of care that increase the ability of public-sector foodservice to address food security and other goals, but these aspects of their work are not widely recognized.

We evaluated the effect of home fortification with multiple micronutrient powder (MNP) on anaemia and micronutrient status of young Amazonian children.

A pragmatic controlled trial was performed. A control group (CG) of children aged 11–14 months was recruited in the routine of primary health-care centres for assessing anaemia and micronutrient status. At the same time, an intervention group (IG) of infants aged 6–8 months was recruited in the same health centres to receive MNP daily in complementary feeding for 2 months. The IG children were assessed 4–6 months after enrolment (n 112) when they had reached the age of the CG participants (n 128) for comparisons.

Primary health centres in Rio Branco city, Brazilian Amazon.

A total of 240 children aged<2 years.

In the CG, the prevalence of anaemia (Hb<110 g/l), iron deficiency (ID; plasma ferritin <12 μg/l or soluble transferrin receptor >8·3 mg/l) and vitamin A deficiency (VAD; serum retinol <0·70 μmol/l) was 20·3 %, 72·4 % and 18·6 %, respectively. Among the IG participants (aged 11–14 months), the prevalence of anaemia, ID and VAD was 15·2 %, 25·2 % and 4·7 %, respectively. The IG had a lower likelihood of ID (prevalence ratio (95 % CI): 0·34 (0·24, 0·49)) and VAD (0·25 (0·09, 0·64)).

Home fortification of complementary feeding delivered through primary health care was effective in reducing iron and vitamin A deficiencies among young Amazonian children.

The present study compared foods and beverages provided to and consumed by children at child-care centres in New York City (NYC) with national nutrition recommendations.

The study used survey, observational and centre record data collected from child-care centres. Food and beverage intakes from two days of observation and amounts of energy and nutrients were estimated using the US National Cancer Institute’s Automated Self-Administered 24 h Recall system.

Meal and snack time at 108 child-care centres in low-income communities in NYC.

Children aged 3–4 years old in classrooms selected by the directors of the participating child-care centres.

Foods and beverages provided to and consumed by children (n 630) met >50 % of the Dietary Reference Intake (DRI) for most nutrients. Intakes of fibre and vitamins D and E were <30 % of the DRI. Foods and beverages provided >50 % of the recommended average daily intake amounts for total grains, fruits and fruit juices, and dairy, but <50 % of the recommended amounts for whole grains, protein foods and vegetables. Intake of oils was below the allowance for energy levels, but foods and beverages with solid fats and added sugars exceeded the limits by 68 %.

Providing more whole grains, vegetables and low-fat dairy and fewer foods with solid fats and added sugars may improve children’s diet quality when at child-care centres. Centre staff may need training, resources and strategies in order to meet the nutrition recommendations.

To summarize the recommendations on folate intake and folic acid supplementation and fortification in the periconceptional period, aimed at prevention of neural tube defects (NTD), provided by official health organizations in different countries worldwide and WHO.

Information on recommendations for folate and folic acid intake in the periconceptional period was gathered from the websites of official national health organizations of several countries worldwide and from the WHO website.

WHO, selected developed countries and emerging economies, totalling thirty-six countries worldwide (some European, BRICS, G8, Asian Tiger/Asian Dragon and Australia).

Recommendations differ between countries, although the majority (69·4 %) recommend a healthy diet plus a folic acid supplement of 400 µg/d from preconception (4–12 weeks) until the end of the first trimester of pregnancy (8–12 weeks). The same recommendation is issued by the WHO. Dosages for women at high risk of NTD are up to 4–5 mg/d (for 41·7 % of studied countries). The recommended intake for folate is in the range of 300–400 µg/d for women of childbearing age and 500–600 µg/d for pregnant women in different countries and WHO. Five countries emphasize the importance of a healthy diet rendering supplementation needless. By contrast, five others advise a healthy diet and supplementation plus mandatory fortification. Only one mentions the importance of ensuring an adequate folate status and refers to checking with a health-care provider on the need for supplements.

Different recommendations regarding folate and folic acid, seeking NTD prevention, are available worldwide; however, most countries and WHO focus on a healthy diet and folic acid supplementation of 400 µg/d periconceptionally.

It has been observed that diet quality and food choices vary depending on socio-economic status (SES), especially when measured through income and educational level. Although the reasons behind these differences are multiple, diet cost is a critical determinant in those groups that spend a higher proportion of their budget on food. Reference budgets are priced baskets containing the minimum goods and services necessary for well-described types of families to have an adequate social participation. In the current paper we describe the development and content of the Spanish Healthy Food Basket (SHFB).

National dietary guidelines were translated into monthly food baskets. Next, these baskets were validated in terms of acceptability and feasibility through focus group discussions, and finally they were priced.

The focus group discussions and the pricing were performed in Barcelona, Spain.

Twenty adults aged 30–50 years from different SES backgrounds and their children aged 2–22 years participated in three discussion groups.

The SHFB complies with the dietary recommendations for the Spanish population. The monthly cost of this basket ranges from 131·63 € to 573·80 € depending on the type of family.

The SHFB does not have the purpose of prescribing what people should eat, but of estimating a minimum budget threshold below which healthy eating is not possible for well-described types of families. Thus, the SHFB is an educative guide on how to plan a healthy food budget and orient policies designed to guarantee food access and reduce SES inequalities.

To compare an improved corn–soya blend (CSB+) with a ready-to-use supplementary food (RUSF) to test the hypothesis that satisfactory recovery rate will be achieved with CSB+ or RUSF when these foods provide 50 % of the child’s energy requirement, the 50 % remaining coming from usual diet.

A comparative efficacy trial study was conducted with moderately wasted children, using a controlled randomized design, with parallel assignment for RUSF or CSB+. Every child received a daily ration of 167 kJ (40 kcal)/kg body weight during 56 d with a follow-up performed every 14 d. Every caregiver received nutrition counselling at enrolment and at each follow-up visit.

Health districts of Mvog-Beti and Evodoula in the Centre region of Cameroon.

Eight hundred and thirty-three children aged 6–59 months were screened and eighty-one malnourished children (weight-for-height Z-score between −3 and −2) aged 25–59 months were selected.

Of children treated with CSB+ and RUSF, 73 % (95 % CI 59 %, 87 %) and 85 % (95 % CI 73 %, 97 %), respectively, recovered from moderate acute malnutrition, with no significant difference between groups. The mean duration of treatment required to achieve recovery was 44 d in the RUSF group and 51 d in the CSB+ group (log-rank test, P=0·0048).

There was no significant difference in recovery rate between the groups. Both CSB+ and RUSF were relatively successful for the treatment of moderate acute malnutrition in children. Despite the relatively low ration size provided, the recovery rates observed for both groups were comparable to or higher than those reported in previous studies, a probable effect of nutrition education.

To describe why and how capacity-building systems for scaling up nutrition programmes should be constructed in low- and middle-income countries (LMIC).

Position paper with task force recommendations based on literature review and joint experience of global nutrition programmes, public health nutrition (PHN) workforce size, organization, and pre-service and in-service training.

The review is global but the recommendations are made for LMIC scaling up multisectoral nutrition programmes.

The multitude of PHN workers, be they in the health, agriculture, education, social welfare, or water and sanitation sector, as well as the community workers who ensure outreach and coverage of nutrition-specific and -sensitive interventions.

Overnutrition and undernutrition problems affect at least half of the global population, especially those in LMIC. Programme guidance exists for undernutrition and overnutrition, and priority for scaling up multisectoral programmes for tackling undernutrition in LMIC is growing. Guidance on how to organize and scale up such programmes is scarce however, and estimates of existing PHN workforce numbers – although poor – suggest they are also inadequate. Pre-service nutrition training for a PHN workforce is mostly clinical and/or food science oriented and in-service nutrition training is largely restricted to infant and young child nutrition.

Unless increased priority and funding is given to building capacity for scaling up nutrition programmes in LMIC, maternal and child undernutrition rates are likely to remain high and nutrition-related non-communicable diseases to escalate. A hybrid distance learning model for PHN workforce managers’ in-service training is urgently needed in LMIC.

The present study examined the association between unemployment and household food insecurity during the 2007–2009 economic recession in the USA.

Longitudinal survey of the Survey of Income and Program Participation (SIPP; 2008–2011). Food insecurity was measured by five questions excerpted from an eighteen-item Food Security Scale. Unemployment was measured by a dichotomous indicator, the number of job losses and the total duration of all episodes in the observation period.

As nationally representative data, the SIPP interviewed respondents in multiple waves with a time interval of four months.

The study created two analytic samples including working-age household heads employed at the beginning of the observation period. The size of the two samples was 14 417 and 13 080.

Unemployment was positively associated with food insecurity (OR=1·55; 95 % CI 1·32, 1·83; P<0·001). Similar results were obtained when the analysis controlled for food insecurity status measured before unemployment (OR=1·54; 95 % CI 1·27, 1·88; P<0·001). For households with the same duration of unemployment, one more episode of unemployment increased the odds of food insecurity by 8 % (OR=1·08; 95 % CI 1·00, 1·18; P<0·001).

More in-depth understanding of the relationship between unemployment and food insecurity is useful to better identify and serve the at-risk population. Connecting unemployment assistance closely to nutrition assistance could lower the prevalence of food insecurity among unemployed households. Public policy should better account for both episodes and duration of unemployment to reduce food insecurity.

Safety of home fortificants in children is uncertain in areas where infections are common. We tested the hypothesis that provision of lipid-based nutrient supplements (LNS) containing Fe does not increase infectious morbidity in children.

Randomized controlled trial. Infants were randomised to receive 10, 20 or 40 g LNS/d; or no supplement until age 18 months. All LNS contained 6 mg Fe/d. Morbidity outcomes (serious adverse events, non-scheduled visits and guardian-reported morbidity episodes) were compared between control and intervention groups using a non-inferiority margin of 20 %.

Namwera and Mangochi catchment areas in rural Malawi.

Infants aged 6 months (n 1932).

The enrolled 1932 infants contributed 1306 child-years of follow-up. Baseline characteristics were similar across groups. Compared with the control group, the relative risk (95 % CI) of serious adverse events was 0·71 (0·48, 1·07), 0·67 (0·48, 0·95) and 0·91 (0·66, 1·25) in 10, 20 and 40 g LNS/d groups, respectively. The incidence rate ratio (95 % CI) of non-scheduled visits due to malaria was 1·10 (0·88, 1·37), 1·08 (0·89, 1·31) and 1·21 (1·00, 1·46), and of guardian-reported morbidity episodes was 1·04 (0·96, 1·11), 1·03 (0·97, 1·10) and 1·04 (0·97, 1·10), in the respective LNS groups.

Provision of 10 and 20 g LNS/d containing 6 mg Fe/d did not increase morbidity in the children. Provision of 40 g LNS/d did not affect guardian-reported illness episodes but may have increased malaria-related non-scheduled visits.

To identify the association of household food insecurity (HFI) with anthropometric status, the risk of vitamin A deficiency and anaemia, morbidities such as cough and fever, and hospitalizations for diarrhoea and pneumonia in children under 5 years old.

Cross-sectional study using data from the 2006 Brazilian Demographic and Health Survey. HFI was measured with the Brazilian Food Insecurity Measurement Scale (EBIA). Vitamin A deficiency and anaemia were assessed in blood samples. Child morbidities were reported by the child’s mother and included cough, fever, and hospitalizations for diarrhoea and pneumonia. Regression results were expressed as unadjusted and adjusted OR and corresponding 95 % CI for severe food insecurity, with statistical significance set at P<0·05.

Nationally representative survey.

Children (n 4064) under 5 years old.

There was no association between HFI and vitamin A deficiency, pneumonia, wasting or overweight. The prevalence of cough, fever, hospitalization for diarrhoea and stunting were associated with degree of HFI severity. There was a significant association of morbidities and stunting with severe food insecurity (v. food secure). After controlling for confounders, the association between severe food insecurity (v. food secure/rest of food insecurity categories) and the prevalence of common morbidities remained strong, showing that severely food-insecure children had a greater likelihood of experiencing cough (adjusted OR=1·79) and of being hospitalized for diarrhoea (adjusted OR=2·55).

Severe HFI was associated with cough and severe diarrhoea among Brazilian children.

To measure the effect of organic food conversion projects on the percentage of organic food used in Danish public kitchens participating in the Danish Organic Action Plan 2020.

The current longitudinal study was based on measurements of organic food percentages in Danish public kitchens before and after kitchen employees participated in conversion projects.

Public kitchens participating in the nine organic food conversion projects under the Danish Organic Action Plan 2020, initiated during autumn 2012 and spring 2013 and completed in summer 2015.

A total of 622 public kitchens.

The average (median) increase in organic food percentage from baseline to follow-up was 24 percentage points (P<0·001) during an overall median follow-up period of 1·5 years. When analysing data according to public kitchen type, the increase remained significant for seven out of eight kitchens. Furthermore, the proportion of public kitchens eligible for the Organic Cuisine Label in either silver (60–90 % organic food procurement) or gold (90–100 % organic food procurement) level doubled from 31 % to 62 %, respectively, during the conversion period. Conversion project curriculum mostly included elements of ‘theory’, ‘menu planning’, ‘network’ and ‘Organic Cuisine Label method’ to ensure successful implementation.

The study reports significant increases in the level of organic food procurement among public kitchens participating in the Danish Organic Action Plan 2020. Recommendations for future organic conversion projects include adding key curriculum components to the project’s educational content and measuring changes in organic food percentage to increase the chances of successful implementation.

To examine the relationship between food insecurity and coping strategies (actions taken to manage economic stress) hypothesized to worsen glucose control in patients with diabetes.

Using a cross-sectional telephone survey and clinical data, we compared food-insecure and food-secure individuals in their use of coping strategies. Using logistic regression models, we then examined the association between poor glucose control (glycated Hb, HbA1c≥8·0 %), food insecurity and coping strategies.

An urban medical centre, between June and December 2013.

Four hundred and seven adults likely to be low income (receiving Medicaid or uninsured and/or residing in a zip code with >30 % of the population below the federal poverty level) with type 2 diabetes.

Of respondents, 40·5 % were food insecure. A significantly higher percentage of the food-insecure group reported use of most examined coping strategies, including foregone medical care, participation in the Supplemental Nutrition Assistance Program (SNAP)) and use of emergency food programmes. Food insecurity was associated with poor glucose control (OR=2·23; 95 % CI 1·22, 4·10); coping strategies that were more common among the food insecure were not associated with poor glucose control. Among the food insecure, receipt of SNAP was associated with lower risk of poor glucose control (OR=0·27; 95 % CI 0·09, 0·80).

While food insecurity was associated with poor glucose control, most examined coping strategies did not explain this relationship. However, receipt of SNAP among food-insecure individuals was associated with better diabetes control, suggesting that such programmes may play a role in improving health.