ABSTRACT Food insecurity is known to be associated with metabolic and cardiovascular disease in adults. However, there is a gap in our knowledge; specifically a lack of studies investigating factors that influence the emergence of cardiometabolic risks from food insecurity during childhood and adolescence. An improved understanding of the role of timing and severity of food insecurity on children’s cardiometabolic health (CMH), the mechanisms/pathways between food insecurity and CMH, and the factors that buffer against or exacerbate this risk are needed to inform intervention development to prevent later cardiometabolic disease amongst children who are food insecure. The main objective of this prospective study is to understand how cardiometabolic risk arises from food insecurity during childhood and identify malleable factors for intervention to buffer the negative health impact of food insecurity on adolescent’s CMH. We will leverage an established cohort of racially/ethnically diverse children from low-income households (n=627) participating in a prospective, longitudinal study examining childhood obesity disparities (HL126171: Berge PI). Survey and ecological momentary assessment (EMA) data have already been collected, including measures of food insecurity, household environment (e.g., food environment, family functioning), child health behavior (e.g., diet quality, sleep, physical activity) and parent behaviors (e.g., feeding practices, stress, coping) at two time points (~24 months apart) at ages 5-10. New measures proposed at ages 11-16 will include: (1) measures of CMH (Life’s Simple 7 and state-of-the-science measures of body composition, metabolic and cardiovascular function, oxidative stress and inflammation (i.e., cytokines)), (2) Geographical Information Services (GIS) data, and (3) focus groups with families, school representatives, community organizations, and healthcare providers to identify intervention targets and refine policies to reduce harmful health effects of food insecurity. Specifically, this state-of-the art study will: (1) determine the impact of exposure to household food insecurity (i.e., severity, timing) on child/adolescent CMH; (2) identify mechanisms/pathways between food insecurity and CMH; (3) evaluate the extent to which child behaviors, parent factors, and access to resources impact the relationship between food insecurity and CMH; and (4) using mixed-methodologies (biomarkers, focus groups, EMA, GIS), prospectively examine the dynamics (e.g., severity, timing) of household food insecurity throughout childhood and adolescence, and identify risk and protective factors at the level of the family, neighborhood, school, and community to inform intervention and policy development. This approach is innovative because it represents a departure from the status quo by focusing on when and how cardiometabolic risk emerges from food insecurity during childhood and the multi-level factors which buffer against or exacerbate this risk, and significant because it is expected to have implications for intervention development to prevent future cardiometabolic diseases among adolescents from food insecure households.

PROJECT NARRATIVE This study will identify multi-level (e.g., individual, household, neighborhood, school/community) correlates and consequences of food insecurity in households (n=627) with racially/ethnically diverse children ages 5-16. Using mixed-methods (e.g., ecological momentary assessment (EMA), biomarkers, Geographical Information Services (GIS) data, focus groups), this study will examine when and how cardiometabolic risk emerges from food insecurity in childhood, mechanisms/pathways between food insecurity and cardiometabolic health, and multi-level factors that buffer against or exacerbate food insecurity to inform multi-sector interventions.