Abstract
BACKGROUND: In 2023, food insecurity (FI) impacted households with children under 5 years old (< 5 y), where FI reached 37.5%. Establishing the link between feeding practices and FI in household surveys is essential to understanding children's dietary habits. However, this association has not yet been examined in Brazil using nationally representative data. This study aims to describe the prevalence of FI by sociodemographic variables and to estimate its association with feeding practices in Brazilian children < 5 y. METHODOLOGY: This study analysed data from the Brazilian National Survey on Child Nutrition (ENANI-2019), a household-based population evaluating 14,558 children < 5 y. FI was assessed using the Brazilian Food Insecurity Scale. Feeding practices were defined using national and international indicators/recommendations for each age group, using a structured questionnaire about food intake the day before the interview (< 6 months: early introduction of complementary feeding; 6-23 months: minimum dietary diversity (MDD), egg and/or flesh foods, and zero consumption of vegetables or fruits; 24-59 months: beans, vegetables, fruit, sweetened beverage and ultra-processed food consumption). Logistic regression was performed to estimate the association between FI and feeding practices, with p-values adjusted for multiple testing using the Benjamini-Hochberg method. RESULTS: FI was not associated with the early introduction of complementary feeding. Children aged 6-23 months experiencing severe FI had a 60% lower chance of meeting MDD (OR = 0.40 [95% CI: 0.21; 0.77]) and were 2.48 times more likely to consume zero vegetables or fruit (OR = 2.48 [95% CI: 1.31;4.69]) compared to those in food-secure households. Children aged 24-59 months living in severe FI had a 53% lower chance of consuming vegetables than their food-secure counterparts (OR = 0.47 [95% CI: 0.30;0.73]). CONCLUSIONS: We found socioeconomic disparities across FI levels, with poorer feeding practices in food-insecure households, except among children under 6 months. Severe FI was associated to reduced fruit and vegetable intake and lower dietary diversity. Addressing FI requires policies that ensure food quantity and quality, prioritising low-income and underserved families. Future research should explore structural determinants and assess targeted interventions to improve child nutrition in the context of FI.