Article Text

Download PDFPDF

Food insecurity and maternal–child nutritional status in Mexico: cross-sectional analysis of the National Health and Nutrition Survey 2012
  1. Teresa Shamah-Levy1,
  2. Verónica Mundo-Rosas1,
  3. Carmen Morales-Ruan1,
  4. Lucia Cuevas-Nasu1,
  5. Ignacio Méndez-Gómez-Humarán2,
  6. Rafael Pérez-Escamilla3
  1. 1 Center for Nutrition and Health Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
  2. 2 Center for Research in Mathematics (CIMAT), Aguascalientes, Mexico
  3. 3 Yale School of Public Health, New Haven, Connecticut, USA
  1. Correspondence to Dr. Teresa Shamah-Levy; tshamah{at}


Objective To examine the association between household food insecurity (HFI) and risk of childhood stunting and to determine whether this association is modified by maternal–child overweight/obesity.

Design Observational cross-sectional study.

Setting Data come from the Mexican National Health and Nutrition Survey (ENSANUT 2012 by its initials in Spanish), representative of rural and urban areas.

Participants Our study sample included 5087 mother–preschool child pairs and 7181 mother–schoolchild pairs.

Main outcome measures Differences in the prevalence (95% CI) of each HFI category by socioeconomic characteristics and maternal–child nutritional status were estimated. A logistic regression model was conducted for stunting and overweight among preschool children and for stunting and overweight/obesity among schoolchildren, adjusting for pertinent covariates. HFI was measured according to the Latin American and Caribbean Food Security Scale (ELCSA by its initials in Spanish). Weight and recumbent lenght or height measures were obtained from children. Overweight and obesity in women were determined according to the WHO Growth Reference Charts. The following covariates were included: sex of the child. urbanicity (urban/rural), region of residence and maternal education. Benefiting from food assistance programmes and socioeconomic status index were also included. Results were expressed as adjusted ORs.

Results Stunting proved more prevalent in preschool children with moderate or severe HFI (16.2% and 16.8%, respectively) (p=0.036 and p=0.007, respectively) than in their counterparts with mild or no HFI (13.2% and 10.7%, respectively). Furthermore, the interaction between HFI and maternal obesity had a significant impact on stunting in preschool children (p<0.05). Severe HFI increased risk of stunting in children with non-obese mothers but not in those with obese mothers.

Conclusion We have discovered a new relationship between HFI and maternal obesity on the one hand and risk of childhood stunting on the other hand. This may reflect a shared mechanism involving dual forms of malnutrition.

  • Nutrition & dietetics
  • Public health
  • epidemiology

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors The responsibilities of the authors were distributed as follows: TS-L and IM-G-H contributed to data analysis and interpretation. They drafted the manuscript based on the input and feedback of all the coauthors. VM-R, LC-N and CM-R contributed to the study design and critical review of the manuscript. TS-L and RP-E contributed to the study design, interpretation of results and critical review of the manuscript. All the authors read and approved the final version of the manuscript.

  • Funding The National Health and Nutrition Survey (ENSANUT 2012) was funded by the Mexican Ministry of Health.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval All study procedures involving human participants were approved by the Ethics Committee of the National Institute of Public Health in Mexico.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.