Abstract
PURPOSE: This study investigated the relationships between socioeconomic status (SES), housing conditions, BMI z-score, food availability and consumption, food insecurity, and health-related quality of life (HRQoL) in schoolchildren aged 5 to 10 years living in rural riverine communities. METHODS: This school-based cross-sectional study included 128 parent-child dyads living in rural riverside in the city of Coari, Amazonas, Brazil. SES, housing conditions, household food availability, consumption of ultra-processed foods and food insecurity data were gathered from children's parents. Children's nutritional status (BMI z-scores), diet quality and HRQoL [Kiddo-KINDL] were also assessed. Direct and indirect relationships between variables were examined through structural equation modelling. RESULTS: Food insecurity was directly linked to poorer HRQoL. Worse socioeconomic status, lower availability of food at household, and poorer child's diet quality were directly linked to food insecurity. Greater household food availability, higher children's BMI z-score, and worse diet quality were directly linked to higher socioeconomic status. Availability of food at home was directly associated with higher consumption of ultra-processed foods, which, in turn, was directly associated with poorer diet quality. Food insecurity mediated the indirect associations of socioeconomic status, availability of food at household, consumption of ultra-processed foods, and diet quality with HRQoL. CONCLUSION: The present findings elucidate the complex pathways between socioeconomic inequalities, food access and availability, diet quality, and children's quality of life.