BACKGROUND: While previous research has shown that food insecurity adversely affects diet quality in adults, this relationship is less consistently observed in children. However, studies in children have focused on those aged 2 years or older and the association of food insecurity with diet quality in children aged 12 through 23 months is unclear. OBJECTIVE: The objective was to determine the association of household food insecurity with diet quality, as indicated by Healthy Eating Index-Toddlers-2020 (HEI-Toddlers-2020), in US children aged 12 through 23 months. METHODS: The study used a cross-sectional design based on data from 2013-2014, 2015-2016 and 2017-March 2020 survey cycles of National Health and Nutrition Examination Survey (NHANES). The primary sample included 708 children aged 12-23 months with 1) complete data on food security, assessed via the US Food Security Survey Module (USFSSM)
2) at least one day of reliable 24-hour dietary recall data
and 3) reported energy intake from complementary foods/beverages (i.e., foods and beverages other than human milk or infant formula). Based on responses to USFSSM, households were classified as food secure or food insecure. Proxies, typically parents, reported child's dietary intake. Diet quality was assessed using the HEI-Toddlers-2020. Linear regression analyses examined the association of household food security status with HEI-Toddlers-2020 total and component scores, adjusted for demographic characteristics. RESULTS: Household food insecurity was significantly associated with lower HEI-Toddlers-2020 total score (estimate = -3.78
standard error=1.06
p=0.0007), as well as lower component scores for whole fruits (estimate = -0.56
standard error=0.18
p=0.003) and whole grains (estimate = -0.85
standard error=0.35
p=0.02). CONCLUSIONS: The association of household food insecurity with lower diet quality in this study suggests that toddlers may not be shielded from household food shortages. Although consumption of certain food groups, such as whole grains, was inadequate in the overall sample of US toddlers, food insecurity could exacerbate suboptimal intake of whole grains. Interventions to improve diet quality of young children must account for household food insecurity.