Joelle M. Schaefer Doctoral Candidate Department of Community Health & Epidemiology College of Medicine University of Saskatchewan

Transcription

1 Food Insecurity & Pregnancy: Considerations for Implementation of the Canadian Consensus on Female Nutrition: Adolescence, Reproduction, Menopause, and Beyond Joelle M. Schaefer Doctoral Candidate Department of Community Health & Epidemiology College of Medicine University of Saskatchewan

2 CFPC COI: Slide 1 Faculty/Presenter Disclosure Presenters: Joelle Schaefer Relationships with commercial interests: None

3 CFPC COI: Slide 2 Disclosure of Commercial Support Prevention Matters has received financial support from: Community Action Plan for Children in the form of an educational grant. This program has received in-kind support from the Saskatchewan Prevention Institute in the form of logistical support. Potential for conflict(s) of interest: No conflicts of interest

4 CFPC COI: Slide 3 Mitigating Potential Bias Does not apply

5 FOOD INSECURITY

6 Food Security Food security exists when all people, at all times, have access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life. (FAO, 1996)

7 Food Insecurity Lack of physical, social, economic access Lack of nutritious foods Insufficient amounts of food Lack of safe food Inability to acquire foods in socially acceptable ways Reliance on foods that are not preferred As household income decreases, the rate of food insecurity increases (Anderson, 1990; FAO, 1996; Tarasuk, Mitchell, & Dachner, 2016)

8 Food Insecurity & Nutrition People living in food insecure households identify an inability to consume healthy foods due to limited food choices and financial constraints (Runnels, Kristjansson, Calhoun, 2011) The Economics of Healthy Food Choice Simply put, fats and sweets cost less, whereas many healthier foods cost more. (Drewnowski, 2009)

9 Food Insecurity & Nutrition Lower overall nutritional quality of foods consumed Decreased consumption of: Vegetables and fruit Dairy products Meat and alternatives Fibre Overall energy intake Increased proportion of energy obtained through carbohydrates Increased energy density Energy dense foods have lots of calories per serving, including processed foods, and sweetened beverages Opposite to that is nutrient dense foods which have high levels of nutrients per servings (Tarasuk, 2001; Tarasuk & Beaton, 1999; Darmon & Drewnowski, 2008; Kirkpatrick & Tarasuk, 2008)

10 Food Insecurity & Health Source: PROOF: Food Insecurity and Policy Research

11 Food Insecurity & Health Individuals living with chronic illness in food insecure households connected unhealthy diets with difficulty managing their illness (Runnels, Kristjansson, Calhoun, 2011)

12 Self-Management of Diabetes among Adults affected by Food Insecurity Food insecurity negatively impacts management of diabetes Purchasing healthy foods necessary for management could not be afforded Erratic food supply meant management approaches such as meal planning and tracking serving sizes were unrealistic Meal planning was difficult when reliant on foods through food banks and community kitchens (also inappropriate foods via these sources) Participants worried about not having enough to eat and would reduce serving sizes (Chan, DeMelo, Gingras & Gucciardi, 2015)

13 Role of Healthcare Providers Healthcare providers who were genuinely caring, gentle and loving were important in enhancing resilience and agency in selfmanagement Advice to healthcare providers included: Provide alternatives to food choice advice Provide specific, low-cost ideas Provide recipes and creative ways to share food Listen to patients Be supportive, encouraging, positive and not judgemental (Chan, DeMelo, Gingras & Gucciardi, 2015)

14 Food Insecurity in Canadian Adults Receiving Diabetes Care Healthcare providers administered HFSSM survey among patients with diabetes attending counselling sessions Survey took 2-5 minutes to administer Clinicians said they would not have accurately predicted food insecurity without the tool Prevalence of food insecurity 15.0%, with 6.7% experiencing severe food insecurity (compared to 5.6% and 1.2% respectively in Alberta population) (Galeshoot, McIntyre, Fenton & Tyminski, 2012)

15 The unspoken premise [of health promotion] has been that adherence to healthy diets is essentially a matter of awareness, motivation, and making the right food choices. (Drewnowski & Darmon, 2005)

16 Food Insecurity & Pregnancy Women of childbearing age living in food insecure households have been found to have nutrient inadequacies, including key nutrients for a healthy pregnancy (Ivers & Cullen, 2011) Food insecurity has been found to be associated with poor pregnancy outcomes, including non-normal birth weight, pregravid obesity, and gestational diabetes mellitus (Nunnery & Dharod, 2015; Laraia, Siega-Riz & Gundersen, 2010)

17 Food Insecurity & Pregnancy Reasons why food insecurity has particular importance for women during pregnancy: Nutrient demands are higher Effort required for food preparation may be more difficult Women may be obliged to leave the workforce, especially in later pregnancy, leading to financial strain (Laraia, Siega-Riz, Gundersen & Dole, 2006; Ivers & Cullen)

18 Women & Food Insecurity Women have been found to protect children from food insecurity by compromising their own food consumption and going without (McIntyre et al., 2003; Olson, 2005) Nutrition and health professionals involved in health promotion programs and dietary counseling with foodinsecure mothers need to be aware of the trade-offs between their own and their children s health that these women make. (Olson, 2005)

19 CANADIAN CONSENSUS ON FEMALE NUTRITION: ADOLESCENCE, REPRODUCTION, MENOPAUSE, AND BEYOND

20 Canadian Consensus on Female Nutrition: Adolescence, Reproduction, Menopause, and Beyond Objective: To provide Canadian health care professionals with the basic knowledge and tools to provide nutrition guidance to women throughout their lifecycle

21 An Educational Intervention A visit with a health care professional, whether routine or for a specific medical concern, provides an opportunity to initiate a dialogue about nutrition, screen for the basic elements of a healthy diet, and offer specific advice to improve dietary choices or nutrition-related health behaviours... (pg. 512)

22 An Educational Intervention Discussing behaviour change strategies as appropriate, such as reducing screen time and the frequency of eating at fast food restaurants or increasing the frequency of family meals and importance of reading food labels, in a short clinic visit can help facilitate change in unhealthy eating patterns and provide a basis for ongoing discussion. (pg. 512)

23 General Female Nutrition

24 General Female Nutrition: Social Determinants of Health and the Food Environment

25 Nutrition & Pregnancy Pre-conceptual Nutrition Healthy body weight Nutrients of concern (folic acid) Nutrition in Pregnancy Increased energy intake Nutrient-rich diet (iodine, omega-3 fatty acids, iron, choline, folate) Consumption of fish each week Healthy weight gain Postpartum Nutrition & Lactation Healthy body weight Consumption of fish each week Nutrients of concern (thiamin, riboflavin, vitamin B6, vitamin B12, choline, Vitamin A, vitamin D, selenium, iodine)

26 Nutrition in Pregnancy

27 Canadian Consensus on Female Nutrition: Food Insecure Women Approximately 12.5% of households in Canada are food insecure, and among those whose major source of income is social assistance, 68% are food insecure.39 Most recent reports suggest that food insecurity is most prevalent in Canada s North (e.g., 45% in Nunavut) and the Maritimes. Low socioeconomic status is frequency associated with poorer diet quality (40); healthy food choices such as fresh fruit and vegetables are often more expensive than energy-dense, processed foods (41). The health care provider will need to work with women and be sufficiently engaged in their community to make the appropriate referrals necessary for their patients to access social assistance, housing, and employment supports. (pg.516)

28 The Reality of Food Insecurity

29 Encouraging people in low-income, food-insecure households to eat healthier diets if they have little or no financial, geographical, or cultural access to low-cost nutritious food is fatuous DISCUSSION (Runnels, Kristjansson, Calhoun, 2011

30 References 1. O Connor DL, Blake J, Bell R, Bowen A, Callum J, Fenton S, et al. Canadian Consensus on Female Nutrition: Adolescence, Reproduction, Menopause, and Beyond. J Obstet Gynaecol Canada. 2016;38(6): e Gregson J, Foerster SB, Orr R, Jones L, Benedict J, Clarke B, et al. System, environmental, and policy changes: using the social-ecological model as a framework for evaluating nutrition education and social marketing programs with low-income audiences. J Nutr Educ. 2001;33 Suppl 1:S Drewnowski A, Darmon N. The economics of obesity: dietary energy density and energy cost. TL Am J Clin Nutr Clin Nutr [Internet]. 2005;82(Suppl):265S 273S. Available from: /Users/grahamjeffries/Documents/literature/Am J Clin Nutr 2005 Drewnowski A.pdf%5Cnhttp:// 4. Drewnowski A, Darmon N. Food Choices and Diet Costs : an Economic Analysis. J Nutr. 2005;135: Food and Agriculture Organization of the United Nations. Rome Declaration on World Food Security and World Summit Plan of Action [Internet] [cited 2016 Jun 28]. Available from: 6. Anderson SA. Core indicators of nutritional state for difficult-to-sample populations. J Nutr. 1990;120 Suppl: Tarasuk V, Mitchell A, Dachner N. Household Food Insecurity in Canada 2014 [Internet] Available from:

31 References 8. Drewnowski A. Obesity, diets, and social inequalities. Nutr Rev. 2009;67(SUPPL. 1). 9. Galesloot S, McIntyre L, Fenton T, Tyminski S. Food insecurity in Canadian adults: Receiving diabetes care. Can J Diet Pract Res. 2012;73(3). 10. Ivers LC, Cullen K a. Food insecurity : special considerations for women. Am J Clin Nutr. 2011;94: Runnels VE, Kristjansson E, Calhoun M. An Investigation of Adults Everyday Experiences and Effects of Food Insecurity in an Urban Area in Canada. Can J Community Ment Heal [Internet]. 2011;30(1): Available from: Galesloot S, McIntyre L, Fenton T, Tyminski S. Food insecurity in Canadian adults: Receiving diabetes care. Can J Diet Pract Res. 2012;73(3). 13. Laraia B a., Siega-Riz AM, Gundersen C. Household Food Insecurity Is Associated with Self-Reported Pregravid Weight Status, Gestational Weight Gain, and Pregnancy Complications. J Am Diet Assoc [Internet]. Elsevier Inc.; 2010;110(5): Available from: Laraia B a, Siega-Riz AM, Gundersen C, Dole N. Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women. J Nutr. 2006;136(1): Nunnery D & Dharod J. (2015). Prenatal food insecurity: how is it related to pregnancy and birth outcomes among low-income women. The FASEB Journal, vol 29(Suppl 1).

32 References 16. McIntyre L, Glanville NT, Raine KD, Dayle JB, Anderson B, Battaglia N. Do low-income lone mothers compromise their nutrition to feed their children? Cmaj. 2003;168(6): Olson CM. Food Insecurity in Women. Top Clin Nutr [Internet]. 2005;20(4): Available from: Kirkpatrick SI, Tarasuk V. Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents. J Nutr. 2008;138(3): Chan J, DeMelo M, Gingras J, Gucciardi E. Challenges of Diabetes Self-Management in Adults Affected by Food Insecurity in a Large Urban Centre of Ontario, Canada. Int J Endocrinol. 2015; Che J, Chen J. Food insecurity in Canadian households. 12(4). Available from:

33 ADDITIONAL INFORMATION ON FOOD INSECURITY IN CANADA

34 Prevalence of Food Insecurity 11.8% of Canadian households experienced food insecurity in 2014 (Tarasuk, Mitchell, & Dachner, 2016) 1.3 million households, or 3.2 million individuals, including almost 1 million children Source: Tarasuk, Mitchell, & Dachner, 2016

35 Income and Food Insecurity Source: Tarasuk, Mitchell, & Dachner, 2016

36 Who Experiences Food Insecurity in Canada? Over-represented groups include: Families with children (15.6%) Single-parent families, headed by women (33.5%) Single-parent families, headed by men (14.7%) Aboriginal households (25.7%) Black households (29.4%) Financial social assistance (60.9%) Renting a household (24.5%) Recent Immigrant, <5 years in Canada (15.2%)

37 Severity of Food Insecurity Source: Tarasuk, Mitchell, & Dachner, 2016 Marginal: Worry about or an income-related barrier to adequate, secure food access Moderate: Compromise in quality and/or quantity of food consumed due to a lack of money for food Severe: Disrupted eating patterns and reduced food intake

38 Income Adequacy & Food Insecurity: Social Assistance Source: Tarasuk, Mitchell, & Dachner, 2016

39 Income Adequacy & Food Insecurity: Source of Income Source: Tarasuk, Mitchell, & Dachner, 2016