Household food insecurity, dietary intake, and weight status among children in Madrid, Spain: A cross-sectional study

Background Household food insecurity (HFI) is increasingly prevalent and disproportionately affects households with children, who may be particularly vulnerable to adverse diet-related outcomes. However, evidence on the association between HFI and these outcomes in Mediterranean settings is scarce. This study assessed the association between HFI, dietary intake, and weight status in a socioeconomically diverse sample of children aged 3–12 years living in Madrid, Spain. Methods We analyzed data from a citywide cross-sectional survey conducted in Madrid in 2017 (n = 5,144), including objective anthropometric measurements (height and weight) of children aged 3–12 years, and parent-reported information on HFI and children’s intake of fruits, vegetables, and sugar-sweetened beverages (SSBs). We fitted Poisson regression models with robust standard errors to estimate prevalence ratios (PRs) for overweight and obesity, and multinomial logistic regression models to estimate odds ratios (ORs) for dietary intake outcomes, with corresponding 95% confidence intervals (CIs). Results Overall, 18.1% of children experienced HFI. After adjustment for age, sex, and family affluence, HFI was associated with a higher prevalence of overweight (PR  =  1.17; 95% CI: 1.04, 1.31), but not obesity (PR  =  1.20; 95% CI: 0.97, 1.48). Experiencing HFI was also associated with higher odds of never consuming fruits (OR= 1.81; 95% CI:1.25, 2.64) or vegetables (OR= 3.23; 95% CI: 2.03, 5.13), and of consuming SSB daily (OR = 1.67; 95% CI: 1.01,2.76). Moreover, we found stronger associations among girls; however, we only observed evidence of interaction by sex for fruit consumption. Conclusions HFI was associated with a less frequent consumption of fruits and vegetables, a more frequent intake of SSBs, and a higher prevalence of overweight. Our findings underscore the need for policies and interventions addressing HFI and supporting access to healthy foods, particularly among socioeconomically disadvantaged households with children.