Abstract
BACKGROUND: Food insecurity remains a significant public health concern in the United States, disproportionately affecting households with young children and posing risks to both nutritional status and developmental outcomes. OBJECTIVES: This study investigates how the duration and frequency of food insecurity affect diet quality and developmental outcomes in preschool children aged 2-5 y, using data from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infant and Toddler Feeding Practices Study-2. METHODS: Households were categorized by frequency of food insecurity: persistent (at all time points), frequent (at several), rare (at few), and never. Bivariate analyses examined the relationship between food insecurity frequency and both Healthy Eating Index (HEI)-2020 scores and Ages & Stages Questionnaires-3 responses. Multivariable linear and logistic regressions assessed associations between food insecurity and child outcomes, with statistical weights applied to represent the eligible WIC population. RESULTS: Among 981 participants, persistent food insecurity declined from 16.4% (aged 2-3 y) to 9.8% (aged 2-5 y), whereas households never experiencing food insecurity dropped from 62.9% to 55.8%. Children in persistently food insecure households had significantly lower HEI-2020 scores at age 3 (P = 0.014) compared with those in food-secure households. In addition, persistent food insecurity was linked with lower odds of typical developmental outcomes at ages 3.5 [odds ratio (OR): 0.49; confidence interval (CI): 0.30, 0.79] and 4.5 (OR: 0.35; CI: 0.16, 0.73) years. CONCLUSIONS: The findings indicate that persistent food insecurity is associated with poorer diet quality at age 3 y and negative developmental outcomes at ages 3.5 and 4.5 y. Future research should continue to explore the long-term impacts of food insecurity, considering a broader range of contextual factors to clarify mechanisms and identify effective intervention points.