Severe food insecurity is associated with obesity among Brazilian adolescent females

Objective: To determine whether household food insecurity (HFI) is associated with a higher prevalence of excessive weight (EW) in a large random sample of Brazilian female adolescents. Design: Nationally representative cross-sectional study. EW was the outcome variable (BMI >= 85th percentile of WHO reference for adolescents aged 15-18 years and BMI >= 25 kg/m(2) for those aged 19 years). HFI was measured with the Brazilian Food Insecurity Scale. Associations were measured using crude and adjusted prevalence ratios (PR) with 95% confidence intervals through Poisson regression models taking into account the complex sampling design. Setting: Data were derived from the third wave of the Demographic and Health Survey conducted in 2006-2007, in Brazil. Subjects: The sample included 1529 female adolescents aged 15-19 years. Results: The prevalence of any level of HFI was 40.8%, with 26.6% of households experiencing mild, 9.4% moderate and 4.8% severe food insecurity. The overall prevalence of EW was 21.9% (12.9% were overweight and 9.0% obese). EW prevalence among those living in severely, moderately and mildly food-insecure households was 36.8%, 14.9% and 16.5%, respectively (P for the overall association = 0.036). Women living in severely food-insecure households had an increased prevalence of EW compared with their food-secure counterparts (PR = 1.96; 95% CI 1.18, 3.27; P = 0.007), after adjusting for important confounders. Conclusions: The study suggests that severe but not mild or moderate HFI is independently associated with EW among adolescents residing in Brazil, a middle-income country undergoing the nutrition transition.