TSpace Research Repository tspace.library.utoronto.ca Total Breastfeeding Duration and Household Food Insecurity in Healthy Urban Children Peter D. Wong, Patricia C. Parkin, Rosemary G. Moodie, David W.H. Dai, Jonathan L. Maguire, Catherine S. Birken, Cornelia M. Borkhoff on behalf of the TARGet Kids! Collaboration. Version Post-print/Accepted Manuscript Citation (published version) Wong, P. D., Parkin, P. C., Moodie, R. G., Dai, D. W., Maguire, J. L., Birken, C. S., ... & TARGet Kids! Collaboration. (2019). Total Breastfeeding Duration and Household Food Insecurity in Healthy Urban Children. Academic pediatrics. 19(8), 884-890. https://doi.org/10.1016/j.acap.2019.02.009 Copyright/License This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit Creative Commons NC BY ND 4.0 License. How to cite TSpace items Always cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the author manuscript from TSpace because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page. This article was made openly accessible by U of T Faculty. Please tell us how this access benefits you. Your story matters.
27
Embed
Total Breastfeeding Duration and Household Food Insecurity in … · 2019-11-20 · Total Breastfeeding Duration and Household Food Insecurity in Healthy Urban Children . Peter D.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
TSpace Research Repository tspace.library.utoronto.ca
Total Breastfeeding Duration and Household Food Insecurity in Healthy Urban Children
Peter D. Wong, Patricia C. Parkin, Rosemary G. Moodie, David W.H. Dai, Jonathan L. Maguire, Catherine S. Birken, Cornelia M.
Borkhoff on behalf of the TARGet Kids! Collaboration.
Version Post-print/Accepted Manuscript
Citation (published version)
Wong, P. D., Parkin, P. C., Moodie, R. G., Dai, D. W., Maguire, J. L., Birken, C. S., ... & TARGet Kids! Collaboration. (2019). Total Breastfeeding Duration and Household Food Insecurity in Healthy Urban Children. Academic pediatrics. 19(8), 884-890. https://doi.org/10.1016/j.acap.2019.02.009
Copyright/License This work is licensed under the Creative Commons
Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit Creative Commons NC BY ND 4.0 License.
How to cite TSpace items
Always cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the author manuscript from TSpace
because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page.
This article was made openly accessible by U of T Faculty. Please tell us how this access benefits you. Your story matters.
TOTAL BREASTFEEDING DURATION AND HOUSEHOLD FOOD INSECURITY IN HEALTHY URBAN CHILDREN
Peter D. Wonga,d,f, Patricia C. Parkina,b,c,d,f, Rosemary G. Moodiea,e, David W.H. Daih, Jonathan L. Maguirea,b,c,d,g,h, Catherine S. Birkena,b,c,d,f, Cornelia M. Borkhoff c,d,f
on behalf of the TARGet Kids! Collaboration. Affiliations: aDepartment of Paediatrics, Faculty of Medicine and bJoannah & Brian Lawson Centre for Child Nutrition and cInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; dDivision of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT) and eDivision of Neonatology and fSick Kids Research Institute Hospital for Sick Children, Toronto, Ontario, Canada; gDepartment of Paediatrics and hLi Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada Corresponding author: Peter Wong, 722-115 Humber College Blvd., Toronto, Ontario, Canada M9V 0A9. email: [email protected] telephone: 417-743-6063 fax: 416-743-0101 Running title: Breastfeeding duration and household food insecurity Disclosure Statement: This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects/patients were approved by the SickKids Research Ethics Board. Written informed consent was obtained from all subjects/patients. Authorship: Peter Wong wrote the first draft of the manuscript. In addition, there was no honorarium, grant, or other form of payment given to anyone to produce the manuscript. Listed authors have made significant contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, and (3) final approval of the version submitted. Funding: This work was supported by the Physician’s Services Inc. Foundation to support TARGet Kids! was provided by multiple sources including the Canadian Institutes for Health Research (CIHR), Institute of Human Development, Child and Youth Health and Institute of Nutrition, Metabolism and Diabetes, as well as, St. Michael's Hospital Foundation. The Paediatric Outcomes Research Team is supported by a grant from The Hospital for Sick Children Foundation. Funding agencies had no role in the design, collection, analyses or interpretation of the results of this study or in the preparation, review or approval of the manuscript. Financial Disclosure: Authors have indicated they have no financial relationships relevant to this article to disclose.
Conflict of Interest: PDW reports that he is an international lactation consultant certified by the International Board of Lactation Consultant Examiners. PCP reports receiving a grant from Hospital for Sick Children Foundation during the conduct of the study. PCP reports receiving the following grants unrelated to this study: a grant from Canadian Institutes of Health Research (FRN # 115059) for an ongoing investigator-initiated trial of iron deficiency in young children, for which Mead Johnson Nutrition provides non-financial support (Fer-In-Sol® liquid iron supplement) (2011-2017); and peer-reviewed grants for completed investigator-initiated studies from Danone Institute of Canada (2002-2004 and 2006-2009), Dairy Farmers of Canada (2011-2013). JLM received an unrestricted research grant for a completed investigator-initiated study from the Dairy Farmers of Canada (2011-2012). CMB reports previously receiving a grant for a completed investigator-initiated study from the SickKids Centre for Health Active Kids (CHAK) (2015-2016) involving the development and validation of a risk stratification tool to identify young asymptomatic children at risk for iron deficiency. These agencies had no role in the design, collection, analyses or interpretation of the results of this study or in the preparation, review or approval of the manuscript. RGM, DWHD, CSB report no conflicts of interest. Word counts: Abstract 250 words, main text 2956 words Abbreviations: NutriSTEP® Nutrition Screening for Every Preschooler TARGet Kids! The Applied Research Group for Kids US United States
3
ABSTRACT
Background and Objective: Health care policy positions breastfeeding as an important part of
the solution to household food insecurity. The relationship between breastfeeding duration
(exposure variable) and household food insecurity (outcome variable) has critical gaps in
knowledge to support this hypothesis. Our objective was to examine this relationship.
Methods: A cross-sectional study was conducted of healthy urban children (n=3838), aged 0-3
years recruited from the TARGet Kids! practice-based research network, Toronto, Canada
(2008-16). Total breastfeeding duration was collected from parent-reported questionnaires.
Household food insecurity was measured using 1-item and 2-item food insecurity screens.
Multivariable regression analysis was performed adjusting for pre-specified covariates.
Results: The median total breastfeeding duration was 10.5 months (Interquartile Range 6.0,
14.0) and 14.7% of households were food insecure. After adjusting for child characteristics (age
and sex), maternal characteristics (age, ethnicity, education, employment) and family
characteristics (number of children, single parent family, neighborhood equity score) there was
no significant association between total breastfeeding duration and household food insecurity
(OR 0.99; 95% CI 0.98-1.01). While low-income families had an increased odds of being
household food insecure (P≤0.001), we found no significant association between total
breastfeeding duration and household food insecurity at varying income levels.
Conclusions: We found no association between breastfeeding duration and household food
insecurity, regardless of family income. Although breastfeeding is associated with improved
child health outcomes and considered to be part of the solution to household food insecurity,
interventions focused on social determinants may provide more promising targets for the
36. McIntyre L, Glanville NT, Raine KD, et al. Do low-income lone mothers compromise their
nutrition to feed their children? CMAJ. 2003;168(6):686-91.
23
Abbreviations: SD, standard deviation. a Numbers may not add to the total due to missing values
b Other includes mixed ethnicity and Indigenous. Note. Neighbourhood equity score is a composite measure of neighbourhood well-being across a broad range of thematic domains based on a social determinants of health model. Theoretical scores range from 0-100; 0 have worst outcomes and 100 have best outcomes.
Table 1. Subject Characteristics
Level Overalla n 3838 Total breastfeeding duration, mo, median [IQR] 10.5 [6.0, 14.0] Age, mo, mean (SD) 23.2 (9.7) Child Sex, n (%) Female 1838 (47.9) Male 2000 (52.1) Maternal age, year, mean (SD) 34.8 (4.5) Maternal-self reported ethnicity, n (%) European 2341 (67.1) African 168 (4.8) Arab 69 (2.0)
East, South, Southeast Asian
611 (17.5)
Latin American 117 (3.4) Other b 185 (5.3) Maternal education, n (%) Primary school 36 (1.0) High school 280 (7.5) College 3431 (91.6) Number of children, mean (SD) 1.7 (0.8) Family self-reported income (Canadian $), n (%) 0-29,999 164 (5.5) 30,000-79,999 489 (16.4) 80,000-150,000 990 (33.2) Over 150,000 1342 (45.0) Neighbourhood equity score, mean (SD) 65.5 (14.4) Maternal employment, n (%) No employment 726 (20.2) Full time 1451 (40.3) Parental leave 932 (25.9) Part time 435 (12.1) Self-employed 53 (1.5) Single parent family, n (%) No 3568 (96.5) Yes 131 (3.5) Household food insecurity, n (%) No 3274 (85.3) Yes 564 (14.7)
24
Abbreviations: OR, Odds ratio; CI, confidence interval; ref, reference category a Other includes mixed ethnicity, and North American Indigenous.
Table 2. Association between total breastfeeding duration and household food insecurity
Characteristic Unadjusted Adjusted
OR (95% CI)
OR (95% CI) Total breastfeeding duration, mo 0.98 (0.97, 1.00) 0.99 (0.98, 1.01) Child age, mo 1.02 (1.00, 1.03) Sex Female 1.00 (ref) Male 1.56 (0.96, 1.40) Maternal age, year 0.94 (0.92, 0.96) Maternal-self reported ethnicity European 1.00 (ref) African 1.79 (1.20, 2.67) Arab 0.97 (0.48, 1.98) East, South, Southeast Asian 1.77 (1.38, 2.28) Latin American 1.41 (0.86, 2.31) Other a 1.58 (1.06, 2.36) Maternal education Public school 1.00 (ref) High school 0.93 (0.43, 2.04) College 0.46 (0.21, 0.99) Number of children, n 1.18 (1.05, 1.33) Maternal employment No Employment 1.00 (ref) Full time employed 0.62 (0.48, 0.80) Parental leave 0.57 (0.42, 0.77) Part time employed 0.87 (0.63, 1.20) Self-employed 1.02 (0.48, 2.14) Single parent family No 1.00 (ref) Yes 2.35 (1.52, 3.26) Neighbourhood Equity Score 1.00 (0.99, 1.01)
25
Table 3. Adjusted logistic regression models for association between total breastfeeding duration and household food insecurity (n=3838)
Adjusteda Adjusted with income
as covariateb Adjusted with interactionc
Variable OR (95% CI) p-value OR (95% CI) p-value OR (95% CI) p-value Total breastfeeding duration (per month)
0.991 (0.977, 1.005)
0.220 0.993 (0.979, 1.008)
0.377 0.988 (0.950, 1.028)
0.558
Family self-reported income Lowest income ($0 - $29,999)
__ __ 9.018 (5.410, 15.032)
<0.0001 9.216 (4.279, 19.849)
<0.0001
Lower middle income ($30,000 - $79,999)
__ __ 6.121 (4.402, 8.511)
<0.0001 5.079 (2.830, 9.114)
<0.0001
Higher middle income ($80,000 - $149,999)
__ __ 2.876 (2.052, 4.032)
<0.0001 2.980 (1.611, 5.511)
0.001
Highest income ($150,000 or more)
__ __ 1.00 1.00
Interaction Total breastfeeding duration * Less than $30,000
__ __ __ __ 1.019 (0.973, 1.067)
0.430
Total breastfeeding duration * $30,000 - $79,999
__ __ __ __ 0.997 (0.949, 1.047)
0.901
Total breastfeeding duration * $80,000 - $149,999
__ __ __ __ 0.996 (0.942, 1.054)
0.897
Total breastfeeding duration * $150,000 or more
__ __ __ __ 1.00
26
Abbreviations: CI, confidence interval. aAdjusted for child age, child sex, maternal age, maternal ethnicity, maternal education, maternal employment, number of children, single parent family, and Neighbourhood Equity Score. bAdjusted for all pre-specified covariates in primary model and family self-report income as a covariate. cAdjusted for all pre-specified covariates in primary model and family self-report income as a covariate, and interaction between total breastfeeding duration*family self-report income.