Abstract
BACKGROUND: Maternal and early childhood nutrition is foundational in setting the course for lifetime metabolic and disease outcomes. Food security influences the achievement of optimal diets; however, little is known about how traditional food intake may influence this dynamic for Aboriginal and Torres Strait Islander people living in remote communities. This study describes diets and food security status of Aboriginal and Torres Strait Islander pregnant and breastfeeding women and children 6 months to 5 years in remote communities in Australia, and explores interactions between diet quality, food security and traditional food consumption. METHODS: Baseline data from a trial testing a discount on healthy foods and drinks were used. Participants from eight communities (four each in coastal Cape York, Queensland and desert Central Australia, Northern Territory) participated in June-September 2021. A validated food frequency questionnaire was used to assess usual intake and calculate a diet quality score. A modified version of the United States Department of Agriculture 18-item Household Food Security Scale Module measured food security status. A model was fitted to explore the interactions between diet quality, food security and traditional food consumption. RESULTS: Complete dietary data were available for 471 participants from 294 households. Average reported food group intakes of children were similar to recommended patterns, however except for adequate meat intakes those of women were not; mean diet quality scores were 23% higher in children than women (p < 0.001). Long-duration breastfeeding was described (36% of > 2-4 years breastfed). High rates of household food insecurity were reported (76%), although rates were lower in Cape York (p < 0.001). Reported traditional food intake was higher in Cape York than in Central Australia (p < 0.001). For diet quality, a significant three-way interaction between food security status, traditional food frequency and adult/child status was demonstrated (p = 0.005). CONCLUSIONS: Remote community families carry out practices that protect and support the diet quality of children despite conditions that challenge food security and optimal diets. The role of traditional food consumption in reducing the impact of food insecurity on diet quality provides further evidence for Aboriginal and Torres Strait Islander food systems to be at the centre of comprehensive efforts to address food insecurity. TRIAL REGISTRATION: This work is part of a trial that has been registered with Australian New Zealand Clinical Trials Registry: ACTRN12621000640808. Trial registration date: 28/05/2021.