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Food Insecurity and the Nutrition Care Process: Practical Applications for Dietetics Practitioners

Published:December 06, 2017DOI:
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      Food insecurity, defined as a household condition involving the “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways,”
      • Bickel G.
      • Nord M.
      • Price C.
      • Hamilton W.
      • Cook J.
      Guide To Measuring Household Food Security, Revised 2000.
      affects one out of eight US households

      Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household Food Security in the United States in 2015. US Dept of Agriculture; 2016. Economic Research Report 215.

      and exists in every county across the nation.
      • Gunderson C.
      • Dewey A.
      • Crumbaugh A.S.
      • et al.
      Map the Meal Gap 2016.
      Nutrition and dietetics practitioners working in clinical as well as community settings will likely encounter clients affected by food insecurity during their career. The Nutrition Care Process (NCP) is a systematic problem-solving method to guide critical thinking and evidence-based decision making for addressing nutrition-related problems experienced by individuals, groups, and communities, including food insecurity.
      • Swan W.I.
      • Vivanti A.
      • Hakel-Smith N.A.
      • et al.
      Nutrition Care Process and Model update: Toward realizing people-centered care and outcomes management.
      Beginning with an overview of food insecurity, including its nutrition implications and screening options for at-risk populations, this article describes how nutrition and dietetics practitioners can use food insecurity-informed critical thinking skills during each step of the NCP. Two case examples of nutrition and dietetics practitioners implementing these considerations in their daily practice with individuals and communities are presented to illustrate these applications, followed by dietetics-oriented action items to support the delivery of food insecurity-informed nutrition care.
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        • Bickel G.
        • Nord M.
        • Price C.
        • Hamilton W.
        • Cook J.
        Guide To Measuring Household Food Security, Revised 2000.
        US Department of Agriculture, Food and Nutrition Service, Alexandria, VA2000
      1. Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household Food Security in the United States in 2015. US Dept of Agriculture; 2016. Economic Research Report 215.

        • Gunderson C.
        • Dewey A.
        • Crumbaugh A.S.
        • et al.
        Map the Meal Gap 2016.
        Feeding America, Chicago, IL2016
        • Swan W.I.
        • Vivanti A.
        • Hakel-Smith N.A.
        • et al.
        Nutrition Care Process and Model update: Toward realizing people-centered care and outcomes management.
        J Acad Nutr Diet. 2017; 117: 2003-2014
        • Hanson K.L.
        • Connor L.M.
        Food insecurity and dietary quality in US adults and children: A systematic review.
        Am J Clin Nutr. 2014; 100: 684-692
        • Tarasuk V.
        • Mitchell A.
        • McLaren L.
        • McIntyre L.
        Chronic physical and mental health conditions among adults may increase vulnerability to household food insecurity.
        J Nutr. 2013; 143: 1785-1793
        • Seligman H.K.
        • Davis T.C.
        • Schillinger D.
        • Wolf M.S.
        Food insecurity is associated with hypoglycemia and poor diabetes self-management in a low-income sample with diabetes.
        J Health Care Poor Underserved. 2010; 21: 1227-1233
        • Seligman H.K.
        • Schillinger D.
        Hunger and socioeconomic disparities in chronic disease.
        N Engl J Med. 2010; 363: 6-9
        • Dixon L.B.
        • Winkleby M.A.
        • Radimer K.L.
        Dietary intakes and serum nutrients differ between adults from food-insufficient and food-sufficient families: Third National Health and Nutrition Examination Survey, 1988-1994.
        J Nutr. 2001; 131: 1232-1246
        • Bhattacharya J.
        • Currie J.
        • Haider S.
        Poverty, food insecurity, and nutritional outcomes in children and adults.
        J Health Econ. 2004; 23: 839-862
        • Dinour L.M.
        • Bergen D.
        • Yeh M.-C.
        The food insecurity–obesity paradox: A review of the literature and the role food stamps may play.
        J Am Diet Assoc. 2007; 107: 1952-1961
        • Holben D.
        Position of the American Dietetic Association: Food insecurity in the United States.
        J Am Diet Assoc. 2010; 110: 1368-1377
        • Hernandez D.C.
        • Reesor L.
        • Murillo R.
        Gender disparities in the food insecurity-overweight and food insecurity-obesity paradox among low-income older adults.
        J Acad Nutr Diet. 2017; 117: 1087-1096
        • Parker E.D.
        • Widome R.
        • Nettleton J.A.
        • Pereira M.A.
        Food security and metabolic syndrome in US adults and adolescents: findings from the National Health and Nutrition Examination Survey, 1999–2006.
        Ann Epidemiol. 2010; 20: 364-370
        • Laraia B.A.
        Food insecurity and chronic disease.
        Adv Nutr. 2013; 4: 203-212
        • Seligman H.K.
        • Laraia B.A.
        • Kushel M.B.
        Food insecurity is associated with chronic disease among low-income NHANES participants.
        J Nutr. 2010; 140: 304-310
        • Seligman H.K.
        • Jacobs E.A.
        • López A.
        • Tschann J.
        • Fernandez A.
        Food insecurity and glycemic control among low-income patients with type 2 diabetes.
        Diabetes Care. 2012; 35: 233-238
        • Ke J.
        • Ford-Jones E.L.
        Food insecurity and hunger: A review of the effects on children’s health and behaviour.
        Paediatr Child Health. 2015; 20: 89-91
        • Cook J.T.
        • Black M.
        • Chilton M.
        • et al.
        Are food insecurity’s health impacts underestimated in the US population? Marginal food security also predicts adverse health outcomes in young US children and mothers.
        Adv Nutr. 2013; 4: 51-61
        • Murphy C.
        • de Cuba S.E.
        • Cook J.
        • Cooper R.
        • Weill J.D.
        Reading, Writing, and Hungry: The Consequences of Food Insecurity on Children, and on Our Nation’s Economic Success.
        Partnership for America's Economic Success, Washington, DC2008
        • Popkin S.J.
        • Scott M.M.
        • Galvez M.
        Impossible Choices: Teens and Food Insecurity in America.
        The Urban Institue and Feeding America, Washington, DC2016
        • Lacey K.
        • Pritchett E.
        Nutrition Care Process and Model: ADA adopts road map to quality care and outcomes management.
        J Am Diet Assoc. 2003; 103: 1061-1072
        • Gundersen C.
        Measuring the extent, depth, and severity of food insecurity: An application to American Indians in the USA.
        J Popul Econ. 2008; 21: 191-215
        • Coleman-Jensen A.
        • Nord M.
        Food insecurity among households with working-age adults with disabilities.
        US Department of Agriculture, Economic Research Service, Washington, DC2013
        • Council on Community Pediatrics, Committee on Nutrition
        Promoting food security for all children.
        Pediatrics. 2015; 136: e1431-e1438
      2. Pooler J, Levin M, Hoffman V, Karva F, Lewin-Zwerdling A. Implementing food security screening for older patients in primary care: A resource guide and toolkit. AARP Foundation & IMPAQ International; 2016. Accessed September 27, 2017.

        • Gundersen C.
        • Engelhard E.E.
        • Crumbaugh A.S.
        • Seligman H.K.
        Brief assessment of food insecurity accurately identifies high-risk US adults.
        Public Health Nutr. 2017; 20: 1367-1371
      3. Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. Accessed November 27, 2017.

        • Kirkpatrick S.I.
        • Tarasuk V.
        Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents.
        J Nutr. 2008; 138: 604-612
        • Muirhead V.
        • Quinonez C.
        • Figueiredo R.
        • Locker D.
        Oral health disparities and food insecurity in working poor Canadians.
        Community Dent Oral Epidemiol. 2009; 37: 294-304
        • Cutler-Triggs C.
        • Fryer G.E.
        • Miyoshi T.J.
        • Weitzman M.
        Increased rates and severity of child and adult food insecurity in households with adult smokers.
        Arch Pediatr Adolesc Med. 2008; 162: 1056-1062
        • Anema A.
        • Weiser S.D.
        • Fernandes K.A.
        • et al.
        High prevalence of food insecurity among HIV-infected individuals receiving HAART in a resource-rich setting.
        AIDS Care. 2011; 23: 221-230
        • Hanson K.L.
        • Olson C.M.
        Chronic health conditions and depressive symptoms strongly predict persistent food insecurity among rural low-income families.
        J Health Care Poor Underserved. 2012; 23: 1174-1188
        • Leung C.W.
        • Epel E.S.
        • Ritchie L.D.
        • Crawford P.B.
        • Laraia B.A.
        Food insecurity is inversely associated with diet quality of lower-income adults.
        J Acad Nutr Diet. 2014; 114: 1943-1953.e1942
        • White J.V.
        • Guenter P.
        • Jensen G.
        • Malone A.
        • Schofield M.
        Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition.
        J Parenter Enteral Nutr. 2012; 36: 275-283
        • Satter E.
        Hierarchy of food needs.
        J Nutr Educ Behav. 2007; 39: S187-S188
      4. Tulsa CARES. Our story. Accessed February 1, 2017.

      5. NCP Step 1: Nutrition Assessment. In: Bates T, Rising C, eds. Public Health/Community Nutrition Nutrition Care Process (NCP) Toolkit. Chicago, IL: Academy of Nutrition and Dietetics; 2012.

      6. Just Say Yes to Fruits & Vegetables. About. 2017; Accessed August 12, 2017.

        • Weinfield N.S.
        • Mills G.
        • Borger C.
        • et al.
        Hunger in America 2014: National Report Prepared for Feeding America.
        Westat, and Washington, DC: Urban Institute, Rockville, MD2014 ( Accessed September 27, 2017)
        • Boeing H.
        • Bechthold A.
        • Bub A.
        • et al.
        Critical review: Vegetables and fruit in the prevention of chronic diseases.
        Eur J Nutr. 2012; 51: 637-663
        • Carter P.
        • Gray L.J.
        • Troughton J.
        • Khunti K.
        • Davies M.J.
        Fruit and vegetable intake and incidence of type 2 diabetes mellitus: Systematic review and meta-analysis.
        BMJ (Clinical research ed). 2010; 341
        • Glasgow R.E.
        • Vogt T.M.
        • Boles S.M.
        Evaluating the public health impact of health promotion interventions: The RE-AIM framework.
        Am J Public Health. 1999; 89: 1322-1327