Ally Sapin HSC 4730 November 25, 2013 Low-income families and nutritional intake Introduction There are

multiple studies to suggest that low-income families and nutritional intake have a strong correlation. Low-income families tend to have poor nutritional intake due to high cost of healthy foods. According to Leung, Willet, et al. (2012), many low-income adults exceeded the recommendation limits for meats, sweets-including desserts and sugar-sweetened beverages. A program was created called The Supplemental Nutrition Assistance Program (SNAP), which helps those low-income adults and families by providing benefits when purchasing nutritious foods. The adults are not the only ones affected by poor nutritional intake, but also their children. Parents teach, intentionally or without knowing, their children many things- including eating habits. Minority and poor children are at higher risk for becoming obese than their white peers and counterparts living at a higher socioeconomic status (Cluss, Ewing, et al. 2013). According to SNAP, the first hypothesized reason for high BMI amongst low-income families is consistent with the dietary behaviors, particularly consumption of inexpensive, energy-dense foods of minimal nutritional value (Leung, Ding, et al. 2012). The purpose of this systematic review is to see if there is a positive correlation between the income of families and nutritional intake they have acquired. This review includes studies that have been conducted to see if there is any relation between the two topics. The study that was conducted, interviewed low-income families that were given a certain amount of money to spend on groceries. The results included the items purchased and the reason for buying them in comparison to other items. Low-income families tend to be reasonable with their money in consistent with buying the cheapest, unhealthiest foods that fill them up the most. The nutritional

intake seems to be the least of their worries. This information is helpful in understanding why obesity among children in the United States is prevalent. The government needs to realize that the healthy foods are the most expensive items making it preposterous for low-income families to purchase. It is important to understand that pricing of food could possibly be the reason for poor nutritional intake among low-income families. Methods PubMed was used to locate relevant articles for this review. The parameters that were used to help narrow down the search included only full articles text, time period from 2003 to present, and languages only in English. The key words that filtered out the non-related articles and directed toward the specific articles were, low income AND nutrition, dietary intake, AND low income and health problems. The inclusion criteria included English, peer-reviewed, clinical trials, and full text articles. The exclusion criteria included Non-English, abstract only, and time period. For all articles included in this review the following information was extracted: author, sample size, intervention or exposure, outcome, and overall support. Results Table 1 summarizes the results of the five studies that were reviewed in this study shown below. The majority of study reviewed showed that there is a strong correlation between lowincome families and poor nutritional intake. According to Cluss, Ewing, and others (2013), studies have shown that one reason that could contribute to poor dietary intake amongst lowincome families is consistent with the lack of knowledge on nutritional guidelines. Green, Cornelsen, and others (2012), found that a contributing factor to poor nutritional intake is the increasing price of food, particularly in fruits and vegetables. Due to costly price, low-income families are not able to fulfill the recommended dietary intake for those two categories.

Leung, Ding, and others (2012), found that low-income families over intake on processed meats, sweets, and sweetened beverages secondary to the price being affordable. The government has not made enough policies to ensure that low-income families can get healthy food at an affordable price according to Lachat, Otchere, and others (2012). In addition, the government needs to take this issue into serious consideration because if they can lower prices in foods and promote healthy eating, then the health problems in the US could take a toll in decrease. Discussion The purpose of this systematic literature review was to identify the correlation between low-income families and poor nutritional intake. Families on a budget are not able to afford expensive foods, which happen to be the healthier choices. The findings showed that there was a strong connection between the nutritional intake and the low-income families. Furthermore, studies among low-income families and purchased goods showed that fruits and vegetables were amongst the high price goods consistent with the least items bought from poorer families. Most low-income families agreed that they always get the most for their money, meaning buying heavy filled carbohydrate meals. In addition, those families noted that they needed food that would fill them up the most, which would exclude salads that were considered fancy meals to some. The low-income families did not even consider the nutritional value in the food. While this review provided meaningful insight, it was without its limitations. There were a few limitations to this systematic literature review. The review was not thorough enough when evaluating the participants. Some examples include: the number of children in each family were not included, any health problems that resulted from their unhealthy eating, and where their food was bought. Another limitation included the lack of comparison to

an average, middle-class families nutritional intake to the low-income families intake. Public health practitioners can use the results of this review to improve health amongst the low-income families in many ways. They can bring nationwide awareness in hopes of the government to be involved by holding farmers markets, where healthy foods can be purchased for cheaper. In addition, the government will then see the increase intake of fruits and vegetables secondary to lowering prices of those goods, making it affordable for low-income individuals and families. Public health practitioners need to help educate the low-income families of the importance of nutritional value in foods in order to live longer, healthier lives. Change can only happen if everyone, including the government, is aware of the importance of nutritional intake amongst low-income families.

References Cluss, P., Ewing, L., King, W., Reis, E., Dodd, J., & Penner, B. (2013, February 28). Nutrition knowledge of low-income parents of obese children. Translational Behavioral Medicine. Retrieved from http://link.springer.com/article/10.1007%2Fs13142-013-02036/fulltext.html Green, R., Cornelsen, L., Dangour, AD., Turner, R., Shankar, B., Mazzocchi, M., Smith, RD. (2013, June 17). The effect of rising food prices on food consumption: systematic review with meta-regression. British Medical Journal. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3685509/ Lachat, C., Otchere, S., Roberfroid, D., Abduali, A., Maria, F., Seret, A., Milesevic, J., Xuereb, G., Candeias, V., Kolsteren, P. (2013, June 11). Diet and Physical Activity for the Prevention of Noncommunicable Diseases in Low- and Middle-Income Countries: A Systematic Policy Review. Plos Medicine (10)6, 1-19. Retrieved from http://www.plosmedicine.org/article/fetchObject.action?uri=info%3Adoi%2F10.1 371%2Fjournal.pmed.1001465&representation=PDF Leung, C., Ding, E., Catalano, P., Villamor, E., Rimm, E., & Walter, W. (2012, October 3). Dietary intake and dietary quality of low-income adults in the Supplemental Nutrition Assistance Program. The American Journal of Clinical Nutrition 96(5), 977-988. Retrieved from http://ajcn.nutrition.org/content/96/5/977.long Leung, C., Willet, W., & Ding, E. (2011, December 14). Low-income Supplemental Nutrition Assistance Program participation is related to adiposity and metabolic risk factors. The American Journal of Clinical Nutrition 95(1), 17-24. Retrieved from http://ajcn.nutrition.org/content/95/1/17.long

Table 1 Low-income families and the relation to nutritional intake Author Green, Cornelsen, and others (2012) Sample size 162 Interventions/exposure Low-income families are most affected by increasing food prices. Outcome Increased cost of foods results in a larger reduction in food consumption amongst lowcome families. Government policies only included minimal actions to promote healthier diets and physical activity. Lack of basic nutrition knowledge among parents in the US is a contributor to child obesity. Few lowincome adults consumed the recommended intake for whole grains, fruits, and vegetables, but exceeded in meats and sweets. 32.8% of obese adults have elevated BMI. Overall Changes in global food prices will have a greater effect on food consumption in lower income families. Government policy makers need to realize the importance of developing a policy to improve dietary quality. Increase in education to low-income parents will help decrease the obesity in their children. Diets of all low-income adults still need major improvement, but SNAP participants had lowerquality diets.

Lachat, Otchere, and others (2012)

140

Assessment of diet-related non-communicable diseases in low- and middle-income families.

Cluss, Ewing, and others (2013)

135

Minority and low-income children are the majority of the obese US children.

Leung, Ding, and others (2012)

3835

Dietary intake amongst low-income adults participating in Supplemental Nutrition Assistance Program compared to regular lowincome adults.

Leung, Willett, and others (2012)

2250

Association of adiposity and metabolic risk factors amongst low-come US adults.

BMI and dietary intake must be controlled.