A methodological proposal for assessing food insecurity from a multidimensional perspective

Cabral, Natália Louise de Araújo; Pequeno, Nila Patrícia Freire; Roncalli, Angelo Giuseppe; Marchioni, Dirce Maria Lobo; Lima, Severina Carla Vieira Cunha; Lyra, Clélia de Oliveira

doi:10.1590/1413-81232022277.11752021EN

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FREE THEMES • Ciênc. saúde coletiva 27 (7) • July 2022 • https://doi.org/10.1590/1413-81232022277.11752021EN copy

A methodological proposal for assessing food insecurity from a multidimensional perspective

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The aim of this study was to develop a methodological proposal for the assessment of food and nutritional insecurity (FNiS) in adults and older adults (Vigi-FNiS). The proposal was developed using data from the BRAZUCA Natal survey, a cross-sectional study with 411 people living in Natal in the state of Rio Grande do Norte, Brazil. The association between sociodemographic, health and nutrition variables and food insecurity (FI) was tested using Poisson multiple regression. Overall prevalence of FI was 42.1% (37.4%-46.9%) and was higher in women (47.5%), adults (48.2%) and black people (52.7%). The following variables were included in the Vigi-FNiS: people aged <18 years living in the household (A) (AdjPR=1.3; 1.1-1.6); family income (B) in quintiles (Q1: AdjPR=5, 4; 2.5-11.7; Q2: AdjPR=4.8; 2.2-10.5; Q3: AdjPR=3.8; 1.8-8.5; Q4 AdjPR=2.2; 1.0-5.1); inadequate treatment of drinking water (C) (AdjPR=1.3; 1.1-1.5); presence of chronic non-communicable diseases (D) (AdjPR=1.3; 1.1-1.7); not eating fruit for breakfast (E) (AdjPR=1.7; 1.3-2.5);eating meals on the couch or in bed (F) (AdjPR=1.3; 1.1-1.6); and skipping either lunch or dinner or dinner (G) (AdjPR=1.4; 1.2-1.7). A cutoff point for FNiS of 2.3 was adopted (Kappa=0.47; sensitivity=0.82; specificity=0.67; PPV=0.64; NPV=0.83).

Key words:
Public Health; Food and Nutrition Security; Food and Nutritional Surveillance; Questionnaire

Dimensions and indicators		n	Prevalence of FI	Crude PR	95%CI	p*
Access
People under 18 living in the household						<0.0001
	Yes	164	57.3	1.8	1.4-2.2
	No	247	32.0
Number of residents living in the household						<0.0001
	≥6	40	75.0	2.1	1.6-2.7
	4 to 5	130	43.8
	Up to 3	241	35.7
Family income						<0.0001
	Q1 (Up to R$ 1,091.80)	82	69.5	8.2	3.8-17.9
	Q2 (R$ 1,091.81 to R$ 2,000.00)	97	61.9	7.3	3.4-16.0
	Q3 (R$ 2,000.01 to R$ 3,000.00)	78	41.0	4.9	2.2-10.9
	Q4 (R$ 3,000.01 to R$ 6,000.00)	83	21.7	2.6	1.1-6.1
	Q5 (Over R$ 6.000.00)	71	8.5
Stability
Occupation						0.01
	Without a job	123	56.1	1.5	1.1-1.9
	Employed	132	38.6
	Retired	156	34.0
Education level						<0.001
	Illiterate	28	64.3	3.3	1.9-5.6
	1 to 4 years	118	51.7	2.7	1.6-4.3
	5 to 9 years	63	44.4	2.3	1.3-3.9
	10 to 11 years	125	40.8	2.1	1.3-3.5
	12 years or more	77	19.2
Biological utilization
Access to basic sanitation						0.01
	Inadequate	213	48.4	1.4	1.1-1.7
	Adequate	198	35.4
Frequency of water supply						0.001
	Inadequate	78	59.0	1.5	1.2-1.9
	Adequate	333	38.1
Treatment of drinking water						<0.0001
	Inadequate (not daily)	44	79.5	2.1	1.7-2.6
	Adequate (daily)	367	37.6
Nutritional status						0.05
	Inadequate (underweight + excess weight)	308	44.8	1.1	1.0-1.8
	Adequate (normal weight)	103	34.0
Adherence to dietary guidelines						<0.0001^†
	Low	55	58.2	1.8	1.3-2.4
	Moderate	165	47.9	1.5	1.1-1.9
	High	191	32.5
Chronic diseases						0.06
	At least one	291	45.0	1.3	1.0-1.7
	None	120	35.0

Dimensions and indicators		n	Prevalence of FI	p*	Crude PR	Adjusted PR	p^†
Access
People under 18 living in the household
	Yes	164	57.3	<0.001	1.8 (1.4-2.2)	1.3 (1.1-1.6)	0.01
	No	247	32.0
Family income
	Q1 (Up to R$ 1,091.80)	82	69.5	<0.001	8.2 (3.8-17.9)	5.4 (2.5-11.7)	<0.0001
	Q2 (R$ 1,091.81 to R$ 2,000.00)	97	61.9		7.3 (3.4-16.0)	4.8 (2.2-10.5)
	Q3 (R$ 2,000.01 to R$ 3,000.00)	78	41.0		4.9 (2.2-10.9)	3.8 (1.8-8.5)
	Q4 (R$ 3,000.01 to R$ 6,000.00)	83	21.7		2.6 (1.1-6.1)	2.2 (1.0-5.1)
	Q5 (Over R$ 6,000.00)	71	8.5
Biological utilization
Treatment of drinking water
	Inadequate	44	79.5	<0.001	2.1 (1.7-2.6)	1.4	0.01
	Adequate	367	37.6
Presence of chronic disease
	At least one	291	45.0	0.06	1.3 (1.0-1.7)	1.3	0.02
	None	120	35.0
Eat fruit for breakfast
	Never/rarely	282	52.5	<0.001	2.7 (1.9-3.9)	1.7 (1.3-2.5)	0.001
	Almost always/always	129	19.4
Eat meals on the couch or in bed
	Almost always/always	133	57.9	<0.001	1.7 (1.3-2.1)	1.3 (1.1-1.6)	0.01
	Never/rarely	278	34.5
Skip either lunch or dinner
	Almost always/always	87	63.2	<0.001	1.7 (1.4-2.2)	1.4 (1.2-1.7)	0.001
	Never/ Rarely	324	36.4

Access	Score
A. Are there any residents aged under 18 living in your home?
Yes=0.3
No=0
B. What is your total family income, including the income of all people living in the household?
Up to R$ 1,091.80= 1.7
Between R$ 1,091.81 and R$ 2,000.00= 1.6
Between R$ 2,000.01 and R$ 3,000.00= 1.4
Between R$ 3,000.00 and R$ 6,000.00= 0.8
Over R$ 6,000.00= 0
Biological utilization
C. Is your household drinking water treated?
No (untreated)=0.2
Yes (mineral, treated or boiled)=0
D. Do you have one of the following conditions: hypertension, diabetes, arthritis, stroke, depression, cancer, cardiovascular diseases, chronic lung diseases, chronic kidney disease?
Yes=0.3
No=0
E. Do you eat fruit at breakfast?
No (rarely/never)=0.6
Yes (almost always/always)=0
F. Do you eat your meals on the couch or in bed?
Yes (almost always/always)=0.3
No (rarely/never)=0
G. Do you skip either lunch or dinner?
Yes (almost always/always)=0.3
No (rarely/never=0
Total score

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[1] Collaborations

NLA Cabral contributed to study conception and design, data analysis and interpretation, writing and critically revising the article, and approving the final version to be published. NPF Pequeno contributed to critically revising the article and approving the final version to be published. AGRC Oliveira contributed to critically revising the article and approving the final version to be published. DML Marchioni contributed to critically revising the article and approving the final version to be published. SCVC Lima contributed to critically revising the article and approving the final version to be published. CO Lyra contributed to study conception and design, writing and critically revising the article, and approving the final version to be published.