Household Food Insecurity Is Associated With Heterogeneous Patterns of Diet Quality Across Urban and Rural Regions of Malawi

The nutritional consequences of food insecurity in rural as compared to urban regions of low-and middle-income countries (LMICs) have not been well differentiated. We aimed to determine the region-specific associations of food security with diet diversity, consumption of foods associated with the nutrition transition, and child stunting and overweight. We used data on 12,271 households from the 2010-2011 Malawi Third Integrated Household Survey (IHS3). We used multiple logistic regression analyses to assess the relation between household food security, measured using an adapted version of the Coping Strategies Index (CSI), and consumption of specific food groups and beverages as well as height-for-age Z-score (HAZ) and weight-for-height Z-score (WHZ) of preschool-aged children. Analyses were stratified by urban and rural region. Food insecurity was associated with less diverse diets (p<0.001), and among urban residents, higher odds of consumption of refined grains and processed vendor foods, and lower odds of consumption of millets (p<0.05). In adjusted analyses, food security was not strongly associated with child anthropometry. Food insecure urban residents may be especially vulnerable to poor health outcomes associated with both poor access to nutrient-dense foods and diets high in refined and processed foods.