Household Food Insecurity and Physical Activity Behavior in Ecuadorian Children and Adolescents: Findings from the ENSANUT-2018

Objective: Ecuador has a high prevalence of household food insecurity (HFI) and is undergoing nutritional and epidemiologic transition. Evidence from high-income countries has reported negative or null associations between HFI and physical activity (PA) in children. It remains uncertain whether the same is true of those from low- and middle-income countries like Ecuador whose environmental and sociodemographic characteristics are distinct from those of high-income countries. We aimed to investigate the association of HFI with PA, sedentary behavior (SB), and anthropometric indicators in children. Design: Cross-sectional analysis of data from the nationally representative 2018 Ecuadorian National Health and Nutrition Survey. Data were collected on HFI, PA, SB, sociodemographic characteristics, and measured height and weight. Unadjusted and adjusted linear, log-binomial, and multinomial logistic regression analyses assessed the relationship of HFI with PA, SB, stunting, and BMI-for-age. Setting: Ecuador Participants: 23,621 children aged 5-17 years Results: Marginal and moderate-severe HFI was prevalent in 24% and 20% of the households, respectively. HFI was not associated with PA, SB, stunting nor underweight. Moderate-severe HFI was associated with a lower odds of overweight and obesity. However, adjustment for household assets attenuated this finding for overweight (adjusted OR:0.90, 95% CI:0.77, 1.05) and obesity (adjusted OR: 0.88, 95% CI: 0.71, 1.08). Conclusion: HFI is a burden in Ecuadorian households, but is not associated with PA, SB nor anthropometric indicators in children aged 5 -17. However, a concerning prevalence of insufficient PA was reported, emphasizing the critical need for evidence-based interventions aimed at promoting PA and reducing SB.