Cumulative Household Food Insecurity Is Associated with Adverse Eating Behaviors Among Youth Exposed to Gestational Diabetes in Utero.

BACKGROUND/OBJECTIVES: Food insecurity has been associated with adverse eating patterns, which increase the risk for overweight and obesity. However, most studies measure food insecurity and eating behaviors cross-sectionally, not assessing whether experiencing food insecurity over time influences eating behaviors. Therefore, this study assessed the relationship between cumulative food insecurity and food approach and food avoidance eating behaviors and evaluated the effect of breastfeeding intensity and duration on this relationship. METHODS: The Study of Women, Infant Feeding and Type 2 Diabetes after Gestational Diabetes Pregnancy (SWIFT) is a prospective longitudinal cohort of 1033 mothers diagnosed with gestational diabetes and their youth. Breastfeeding intensity and duration were assessed at research visits and through mailed monthly surveys from birth to one year postpartum. The SWIFT study in Youth (SWIFT-Y) was a cohort of 701 SWIFT offspring that consented to participate in a research visit 11-16 years postpartum. Youth's BMI was measured at 11-16 years old through a research visit or their electronic health record. At each of the four research visits (6-9 weeks, one year, two years, and 11-16 years postpartum), participants were categorized as being food secure (0) or food insecure (1). Scores across the four visits were summed (range 0-4), reflecting the number of assessments one was classified as food insecure. The Child Eating Behavior Questionnaire was used to measure the prevalence of eight eating behaviors in the youth, with higher scores indicating that the behaviors were more apparent. According to the measure, the behaviors were categorized into two groups: food approach and food avoidance. Food approach consists of youth's food responsiveness, emotional overeating, enjoyment of food, and desire to drink, and has been positively associated with a child's BMI. Food avoidance includes the youth's satiety responsiveness, slowness in eating, emotional undereating, and food fussiness, and is negatively associated with BMI. Linear regressions assessed whether cumulative food insecurity was associated with eating patterns, and exploratory analysis analyzed whether this relationship differed by breastfeeding duration (<six months, ≥six months) and intensity (exclusive, not exclusive), controlling for the child's BMI and sociodemographic characteristics. RESULTS: In this complete-case secondary analysis (n = 321), each additional experience of food insecurity was associated with a higher food approach score (B = 0.30, 95% CI [0.04, 0.57], p = 0.03), but not food avoidance (B = -0.03, 95% CI [-0.21, 0.15], p = 0.74). These results varied by breastfeeding duration (B = -0.74, p = 0.001), as the relationship remained significant among those who were breastfed for <six months (B = 0.73, p < 0.001) but was attenuated among those who were breastfed for ≥six months (B = -0.26, p = 0.18). CONCLUSIONS: Experiencing food insecurity more during childhood is associated with adverse eating patterns at 11-16 years old. However, breastfeeding for ≥six months influenced this relationship, suggesting that early-life feeding may impact the effect of food insecurity on one's eating behaviors later in life.