Children and youth who experience hunger appear more likely to have health problems, and repeated episodes of hunger may be particularly toxic, according to a report in the August issue ofArchives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Food insecurity—a lack of adequate access to food for financial reasons—affected approximately 15 percent of American households in 2008, according to background information in the article. This marks an increase from 11 percent in 2007 and the highest prevalence since monitoring began in 1995. Child hunger is an extreme manifestation of food insecurity, defined as a period of time when children experience being hungry because their family has run out of food or the money to buy food.

Sharon I. Kirkpatrick, Ph.D., M.H.Sc., R.D., now of the National Cancer Institute, Bethesda, Md., and then of the University of Calgary, Alberta, Canada, and colleagues analyzed data from a Canadian survey of 5,809 children age 10 to 15 years and 3,333 youth age 16 to 21 years over a 10-year period, from 1994 to 2004-2005. During this time, 3.3 percent of children and 3.9 percent of youth had ever experienced hunger and 1.1 percent of children and 1.4 percent of youth were hungry at two or more time points.

Overall, more than one in 10 children (13.5 percent) and one in four youth (28.6 percent) reported poor health in the final round of the survey. Rates of poor health were higher among those who were hungry at any time than among those who had never experienced hunger (32.9 percent vs. 12.8 percent for children and 47.3 percent vs. 27.9 percent for youth). The association between hunger and poor health among children persisted after adjustment for baseline health and for other household markers of disadvantage, including low income and lack of home ownership.

Although one episode of hunger was not associated with chronic conditions or with asthma, youth who were hungry more than once during the survey were more likely to have asthma or any chronic illness than those who had never been hungry.

"The mechanism by which childhood hunger negatively affects health is not well understood. Food insecurity has been associated with emotional and psychological stress among children, which could exert a negative effect on general health and contribute to heightened risk of chronic diseases," the authors write. "While abnormal body weight may also negatively influence health and increase vulnerability to a range of chronic conditions, the existing research has not confirmed an association between food insecurity and body weight among children."

"The findings of this study add to the literature showing that hunger is a serious risk factor for long-term poor health among children and youth, pointing to the relevance of severe food insecurity as an identifiable marker of vulnerability," the authors conclude. "Clinicians should familiarize themselves with risk factors for household food insecurity, which are largely related to economic disadvantage, and take steps to ensure that potentially vulnerable families receive available support. The findings also reinforce the need for advocacy for policy interventions to eliminate problems of poverty and food insecurity, which pose an unacceptable but remediable risk to children."

(Arch Pediatr Adolesc Med. 2010;164[8]:754-762. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: The study was supported by the Alberta Heritage Foundation for Medical Research and the Canadian Institutes of Health Research. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Policy Solutions Needed to Solve Hunger Issues

"The prevalence of food insecurity among all households with children was 21 percent in 2008; 37 percent of female-headed households with children were food insecure," write Patrick H. Casey, M.D., of Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, and colleagues of Children's HealthWatch in an accompanying editorial. "While data are not yet available for 2009, joblessness and cuts in family support programs may have increased food insecurity even further."

"The article by Kirkpatrick et al in this month's Archives represents an important advance in the literature that evaluates the association of household food insecurity and child health status," they write. "This longitudinal study moves us farther along the pathway of association toward causality between food insecurity, hunger and poor child health."

"This unacceptably high prevalence of food insecurity in households with children in the United States underscores the need to implement preventive and therapeutic policy measures that would have a positive effect on both health and economic dimensions," the authors continue. "Policy solutions to such problems are entirely feasible, simply by strengthening and expanding systems already in place."