Global Health
Household Food Insecurity and child anthropometry, cognition and behavioral outcomes: Insights from the MAASTHI Birth Cohort in India Giridhara Rathnaiah Babu* Giridhara Rathnaiah Babu Babu Babu Babu Babu Professor of Population Medicine, College of Medicine, QU Health, Qatar University
Background: Globally, 2.4 billion people are facing moderate or severe food insecurity, which is a critical social determinant of child health. However, its impact in urban India remains understudied. We examined longitudinal associations between household food insecurity (measured by FAO’s FIES) and child health outcomes in a birth cohort in urban Bengaluru, India. We hypothesized that higher food insecurity would be associated with poorer growth and psychosocial outcomes in early childhood.
Material and Methods: We analyzed data from 985 mother–child dyads (child age: 6.6 ± 1.1 years) in the Maternal Antecedents of Adiposity and Studying the Trans-generational role of Hyperglycaemia and Insulin (MAASTHI) cohort. Household food insecurity in 2023 was measured using the FIES, with moderate and severe insecurity classified according to FAO thresholds. Child outcomes assessed at the 2024–25 follow-up included anthropometry (weight-for-age z-score [WAZ]) and behavioral difficulties (internalizing and externalizing subscales of the Strengths and Difficulties Questionnaire). We used multivariable linear regression adjusting for maternal and paternal education and occupation, household socioeconomic status, family size, marital status, maternal social support, and the child’s school type.
Results: Moderate and severe food insecurity prevalence was 20.5% and 3.6%, respectively. After adjustment, a higher FIES score was significantly associated with lower WAZ (β = –0.28 per unit; 95% confidence interval [CI]: –0.54, –0.01; p = 0.03). Higher food insecurity was also associated with greater behavioral difficulties: internalizing score (β = 0.042; 95% CI: 0.012–0.073; p = 0.007) and externalizing score (β = 0.030; 95% CI: 0.001–0.060; p = 0.046).
Conclusion: In this urban cohort, food insecurity was common and prospectively linked to undernutrition and adverse behavioral outcomes. Urban households experienced high levels of food insecurity. The association between higher FIES scores and lower weight-for-age underscores the need for targeted urban interventions to address undernutrition. Additionally, the significant associations with adverse behavioural outcomes highlight the impact of food insecurity on children’s mental well-being beyond physical growth.