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BMC Public Health
Published in: BMC Public Health 1/2020

Open Access 01-12-2020 | Research article

Is the modified household food security survey (HFSS) questionnaire a practical tool for screening food insecurity? Evidence from northwest of Iran

Authors: Helda Tutunchi, Mehrangiz Ebrahimi-Mameghani, Mohammad Asghari-Jafarabadi, Nazila Farrin, Sirous Tabrizi, Elnaz Vaghef-Mehrabany, Alireza Ostadrahimi

Published in: BMC Public Health | Issue 1/2020

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Abstract

Background

Adequate supplies of food and food security (FS) are the fundamental aspects of human societies, and considered one of the pivotal factors of individual and social health. The aim of the present study was to assess the applicability of the short questionnaire for screening food insecurity (FI) and to evaluate the prevalence of FI in northwest of Iran.

Methods

In this study, 550 subjects aged ≥16 years were studied. Three-day dietary records and a short questionnaire were applied to estimate the prevalence of FI in terms of hunger and hidden hunger. The sensitivity, specificity and accuracy of the short questionnaire were assessed. Moreover, the association between the results of the short questionnaire and the criteria that were theoretically related to FI were examined. Data were presented as mean (SD), median (min-max) for the numeric normal and non-normal variables, respectively, and frequency (percent) for categorical variables. The between-group comparisons of variables were done using independent samples t test. P values less than 0.05 were considered statistically significant.

Results

The prevalence of hunger and hidden hunger was 30.8 and 46.0%, respectively. Overall, 23.2% of the subjects were classified as “food secure”. The sensitivity, specificity and accuracy of the short questionnaire in determining hunger were 92.8% (95% CI: 87.3–95.9), 84.2% (95% CI: 79.3–89.3), and 87% (95% CI: 84–90.2), respectively. These values for hidden hunger were 21.6% (95% CI: 15.7–29.9), 92.3% (95% CI: 88.7–99.4), and 53.4% (95% CI: 47.9–59.8), respectively. Our study showed a statistically significant association between FI and socio-economic status. FI significantly enhanced the risk of underweight, while it markedly reduced the risk of overweight and obesity. The average frequency of monthly consumption of meat, dairy products, fruits, vegetables, and rice was significantly lower in food insecure group, while the median frequency of bread consumption was markedly higher in food insecure group. The participants of insecure group were less likely to consume fruits, vegetables, dairy products, rice and meat.

Conclusions

FI was frequent in North-west of Iran. The findings indicated that the short questionnaire was a simple, low-cost and practical tool for screening FI in terms of hunger.

Trial registration

IR.TBZMED.REC.1397.400.
Appendix
Available only for authorised users
Literature
1.
Jones AD, Ngure FM, Pelto G, Young SL. What are we assessing when we measure food security? A compendium and review of current metrics. Adv Nutr. 2013;4(5):481–505.PubMedPubMedCentralCrossRef
2.
Weiler AM, Hergesheimer C, Brisbois B, Wittman H, Yassi A, Spiegel JM. Food sovereignty, food security and health equity: a meta-narrative mapping exercise. Health Policy Plan. 2015;30(8):1078–92.PubMedCrossRef
3.
Godfray HCJ, Garnett T. Food security and sustainable intensification. Philos Trans R Soc Lond Ser B Biol Sci. 369(1639):20120273.
4.
Leroy JL, Ruel M, Frongillo EA, Harris J, Ballard TJ. Measuring the food access dimension of food security: a critical review and mapping of indicators. Food Nutr Bull. 2015;36(2):167–95.PubMedCrossRef
5.
Quandt SA, Shoaf JI, Tapia J, Hernandez-Pelletier M, Clark HM, Arcury TA. Experiences of Latino immigrant families in North Carolina help explain elevated levels of food insecurity and hunger. J Nutr. 2006;136(10):2638–44.PubMedPubMedCentralCrossRef
6.
Frongillo EA, Nanama S. Development and validation of an experience-based measure of household food insecurity within and across seasons in northern Burkina Faso. J Nutr. 2006;136(5):1409s–19s.PubMedCrossRef
7.
Cook JT, Frank DA. Food security, poverty, and human development in the United States. Ann N Y Acad Sci. 2008;1136:193–209.PubMedCrossRef
8.
Zerafati Shoae N, Omidvar N, Ghazi-Tabatabaie M, Houshiar Rad A, Fallah H, Mehrabi Y. Is the adapted Radimer/Cornell questionnaire valid to measure food insecurity of urban households in Tehran, Iran? Public Health Nutr. 2007;10(8):855–61.PubMedCrossRef
9.
Ghassemi H, Harrison G, Mohammad K. An accelerated nutrition transition in Iran. Public Health Nutr. 2002;5(1a):149–55.PubMedCrossRef
10.
Vailas LI, Nitzke SA, Becker M, Gast J. Risk indicators for malnutrition are associated inversely with quality of life for participants in meal programs for older adults. J Am Diet Assoc. 1998;98(5):548–53.PubMedCrossRef
11.
Campbell CC. Food insecurity: a nutritional outcome or a predictor variable? J Nutr. 1991;121(3):408–15.PubMedCrossRef
12.
Jones AD. Food insecurity and mental health status: a global analysis of 149 countries. Am J Prev Med. 2017;53(2):264–73.PubMedCrossRef
13.
Webb P, Coates J, Frongillo EA, Rogers BL, Swindale A, Bilinsky P. Measuring household food insecurity: why it's so important and yet so difficult to do. J Nutr. 2006;136(5):1404s–8s.PubMedCrossRef
14.
Behzadifar M, Behzadifar M, Abdi S, Malekzadeh R, Arab Salmani M, Ghoreishinia G, et al. Prevalence of food insecurity in Iran: a systematic review and meta-analysis. Arch Iran Med. 2016;19(4):288–94.PubMed
15.
Mohamadpour M, Sharif ZM, Keysami MA. Food insecurity, health and nutritional status among sample of palm-plantation households in Malaysia. J Health Popul Nutr. 2012;30(3):291–302.PubMedPubMedCentralCrossRef
16.
Mello JA, Gans KM, Risica PM, Kirtania U, Strolla LO, Fournier L. How is food insecurity associated with dietary behaviors? An analysis with low-income, ethnically diverse participants in a nutrition intervention study. J Am Diet Assoc. 2010;110(12):1906–11.PubMedPubMedCentralCrossRef
17.
Willows ND, Veugelers P, Raine K, Kuhle S. Prevalence and sociodemographic risk factors related to household food security in aboriginal peoples in Canada. Public Health Nutr. 2009;12(8):1150–6.PubMedCrossRef
18.
Nagata JM, Fiorella KJ, Salmen CR, Hickey MD, Mattah B, Magerenge R, et al. Around the table: food insecurity, socioeconomic status, and instrumental social support among women living in a rural Kenyan Island community. Ecol Food Nutr. 2015;54(4):358–69.PubMedPubMedCentralCrossRef
19.
Gulliford MC, Mahabir D, Rocke B. Food insecurity, food choices, and body mass index in adults: nutrition transition in Trinidad and Tobago. Int J Epidemiol. 2003;32(4):508–16.PubMedCrossRef
20.
Blumberg SJ, Bialostosky K, Hamilton WL, Briefel RR. The effectiveness of a short form of the household food security scale. Am J Public Health. 1999;89(8):1231–4.PubMedPubMedCentralCrossRef
21.
Gulliford MC, Nunes C, Rocke B. The 18 household food security survey items provide valid food security classifications for adults and children in the Caribbean. BMC Public Health. 2006;6:26.PubMedPubMedCentralCrossRef
22.
Mohammadi F, Omidvar N, Houshiar-Rad A, Khoshfetrat MR, Abdollahi M, Mehrabi Y. Validity of an adapted household food insecurity access scale in urban households in Iran. Public Health Nutr. 2012;15(1):149–57.PubMedCrossRef
23.
Ostadrahimi A, Mahboob S, Tutunchi H, Dastgiri S. Prevalence and intensity of food insecurity (hunger and hidden hunger aspects) in AsadAbadi region of Tabriz. Yafteh. 2006;8(1):75–81.
24.
Frongillo EA Jr. Validation of measures of food insecurity and hunger. J Nutr. 1999;129(2S Suppl):506s–9s.PubMedCrossRef
25.
Kendall A, Olson CM, Frongillo EA Jr. Relationship of hunger and food insecurity to food availability and consumption. J Am Diet Assoc. 1996;96(10):1019–24.PubMedCrossRef
26.
Swindale A, Bilinsky P. Development of a universally applicable household food insecurity measurement tool: process, current status, and outstanding issues. J Nutr. 2006;136(5):1449s–52s.PubMedCrossRef
27.
Dastgiri S, Ostadrahimi AR, Tutunchi H, Mahboob SA. Validity of a short questionnaire (six-items) for food insecurity surveillance in Iran. Am J Epidemiol. 2006;163(Suppl 11):S47.CrossRef
28.
Hoseinikhorrami S, Dastgiri S, Bakhtari F, Tutunchi H. Epidemiology of food insecurity in the north west of Iran. Res J Biol Sci. 2007;2(4):472–5.
29.
Gulliford MC, Mahabir D, Rocke B. Reliability and validity of a short form household food security scale in a Caribbean community. BMC Public Health. 2004;4:22.PubMedPubMedCentralCrossRef
30.
Coates J, Frongillo EA, Rogers BL, Webb P, Wilde PE, Houser R. Commonalities in the experience of household food insecurity across cultures: what are measures missing? J Nutr. 2006;136(5):1438s–48s.PubMedCrossRef
31.
Tutunchi H, Asghari Jafarabadi M, Hoojeghani S, Tabrizi S, Farrin N, Ostadrahimi A. General and abdominal obesity is related to socioeconomic status and food choices: a cross-sectional study. Nutr Food Sci. 2019;50:61–73.CrossRef
32.
Esfahani FH, Asghari G, Mirmiran P, Azizi F. Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran lipid and glucose study. J Epidemiol. 2010;20(2):150–8.PubMedCrossRef
33.
Ghassemi H. Food and nutrition security in Iran: studies of planning and implementation models. Final Report of Research Poroject. Tehran: National Nutrition and Food Technology Research Institute; 1998. (in Farsi).
34.
Dastgiri S, Tutunchi H, Ostadrahimi A, Mahboob S. Sensitivity and specificity of a short questionnaire for food insecurity surveillance in Iran. Food Nutr Bull. 2007;28(1):55–8.PubMedCrossRef
35.
Tarasuk VS, Beaton GH. Women’s dietary intakes in the context of household food insecurity. J Nutr. 1999;129(3):672–9.PubMedCrossRef
36.
Agbadi P, Urke HB, Mittelmark MB. Household food security and adequacy of child diet in the food insecure region north in Ghana. PLoS One. 2017;12(5):e0177377.PubMedPubMedCentralCrossRef
37.
Singh A, Singh A, Ram F. Household food insecurity and nutritional status of children and women in Nepal. Food Nutr Bull. 2014;35(1):3–11.PubMedCrossRef
38.
Rezazadeh A, Omidvar N, Eini-Zinab H, Ghazi-Tabatabaie M, Majdzadeh R, Ghavamzadeh S, et al. Food insecurity, socio-economic factors and weight status in two Iranian ethnic groups. Ethn Health. 2016;21(3):233–50.PubMedCrossRef
39.
Belachew T, Lindstrom D, Gebremariam A, Jira C, Hattori MK, Lachat C, et al. Predictors of chronic food insecurity among adolescents in Southwest Ethiopia: a longitudinal study. BMC Public Health. 2012;12:604.PubMedPubMedCentralCrossRef
40.
Carter MA, Dubois L, Tremblay MS, Taljaard M. Local social environmental factors are associated with household food insecurity in a longitudinal study of children. BMC Public Health. 2012;12(1):1038.PubMedPubMedCentralCrossRef
41.
Harris-Fry H, Azad K, Kuddus A, Shaha S, Nahar B, Hossen M, et al. Socio-economic determinants of household food security and women's dietary diversity in rural Bangladesh: a cross-sectional study. J Health Popul Nutr. 2015;33:2.PubMedPubMedCentralCrossRef
42.
Kendall A, Olson CM, Frongillo EA Jr. Validation of the Radimer/Cornell measures of hunger and food insecurity. J Nutr. 1995;125(11):2793–801.PubMed
43.
Tabrizi JS, Nikniaz L, Sadeghi-Bazargani H, Farahbakhsh M, Nikniaz Z. Socio-demographic determinants of household food insecurity among Iranian: a population-based study from northwest of Iran. Iran J Public Health. 2018;47(6):893–900.PubMedPubMedCentral
44.
Lohman BJ, Neppl TK, Lee Y, Diggs ON, Russell D. The association between household food insecurity and body mass index: a prospective growth curve analysis. J Pediatr. 2018;202:115–20.PubMedCrossRef
45.
Yang TC, Sahota P, Pickett KE, Bryant M. Association of food security status with overweight and dietary intake: exploration of white British and Pakistani-origin families in the born in Bradford cohort. Nutr J. 2018;17(1):48.PubMedPubMedCentralCrossRef
46.
Power M, Uphoff EP, Stewart-Knox B, Small N, Doherty B, Pickett KE. Food insecurity and socio-demographic characteristics in two UK ethnic groups: an analysis of women in the born in Bradford cohort. J Public Health (Oxf). 2018;40(1):32–40.CrossRef
47.
Hwalla N, Al Dhaheri AS, Radwan H, Alfawaz HA, Fouda MA, Al-Daghri NM, et al. The Prevalence of Micronutrient Deficiencies and Inadequacies in the Middle East and Approaches to Interventions. Nutrients. 2017;9(3).
48.
Pouraram H, Djazayery A, Mohammad K, Parsaeian M, Abdollahi Z, Dorosty Motlagh A, et al. Second National Integrated Micronutrient Survey in Iran: study design and preliminary findings. Arch Iran Med. 2018;21(4):137–44.PubMed
49.
Raskind IG, Haardörfer R, Berg CJ. Food insecurity, psychosocial health and academic performance among college and university students in Georgia. USA Public Health Nutr. 2019;22(3):476–85.PubMedCrossRef
50.
Sarlio-Lahteenkorva S, Lahelma E. Food insecurity is associated with past and present economic disadvantage and body mass index. J Nutr. 2001;131(11):2880–4.PubMedCrossRef
51.
Kaiser LL, Townsend MS, Melgar-Quinonez HR, Fujii ML, Crawford PB. Choice of instrument influences relations between food insecurity and obesity in Latino women. Am J Clin Nutr. 2004;80(5):1372–8.PubMedCrossRef
52.
Townsend MS, Peerson J, Love B, Achterberg C, Murphy SP. Food insecurity is positively related to overweight in women. J Nutr. 2001;131(6):1738–45.PubMedCrossRef
53.
Cheung HC, Shen A, Oo S, Tilahun H, Cohen MJ, Berkowitz SA. Food insecurity and body mass index: a longitudinal mixed methods study, Chelsea, Massachusetts, 2009-2013. Prev Chronic Dis. 2015;12:E125.PubMed
54.
Olson CM. Nutrition and health outcomes associated with food insecurity and hunger. J Nutr. 1999;129(2S Suppl):521s–4s.PubMedCrossRef
55.
Araujo ML, Mendonca RD, Lopes Filho JD, Lopes ACS. Association between food insecurity and food intake. Nutrition. 2018;54:54–9.PubMedCrossRef
56.
Tutunchi H, Ebrahimi-Mameghani M, Ostadrahimi A, Asghari-Jafarabadi M. What are the optimal cut-off points of anthropometric indices for prediction of overweight and obesity? Predictive validity of waist circumference, waist-to-hip and waist-to-height ratios. Health Promot Perspect. 2020;10(2):142–7.PubMedPubMedCentralCrossRef
Metadata
Title
Is the modified household food security survey (HFSS) questionnaire a practical tool for screening food insecurity? Evidence from northwest of Iran
Authors
Helda Tutunchi
Mehrangiz Ebrahimi-Mameghani
Mohammad Asghari-Jafarabadi
Nazila Farrin
Sirous Tabrizi
Elnaz Vaghef-Mehrabany
Alireza Ostadrahimi
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2020
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-020-09014-8

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