Effects of a hospital-based food security programme for children with complex diseases in an upper-middle-income country: a before-and-after study

Background: To reduce health inequities in paediatric patients with complex diseases, our hospital developed a food security programme in 2022. The programme aims to mitigate food insecurity (FI) in paediatric patients with oncological, transplantation and congenital cardiovascular diagnoses, by providing a monthly nutritious food supply that covers up to 50% of the patient's family food intake, accompanied by social and nutritional follow-up. In this study, we aimed to assess the effect of the programme on FI and nutritional status and describe its implementation.

Method: We conducted a before-and-after study of patients who entered the programme in a 14-month period. We used the Escala Latinoamericana y Caribeña de Seguridad Alimentaria (ELCSA) scale score, FI level and nutritional status measures to assess the effect of the programme. We used the Wilcoxon and McNemar tests to assess changes in scores and proportions of patients with moderate and severe FI, respectively, 31.5%-14.4% (p=0.0008) and of moderate FI from 68.5% to 36.9%.

Results: 111 patients were included. They had a baseline median (IQR) ELCSA score=8 (7-11) that changed to 6 (4-9) (p<0.0001). Severe FI according to ELCSA changed from 31.5% to 14.4% (p<0.001) and moderate from 68.5% to 36.9% (p<0.001). We found no differences in nutritional status regarding height for age (49.5% vs 51.3%, p=0.76), weight for height (42.5% vs 59.1%, p=0.75) or body mass index for age (38% vs 46%, p=0.42) CONCLUSION: The programme reduced FI in families by improving its level to mild or moderate. Children who entered the programme maintained an appropriate nutritional status despite the considerable risk of malnutrition described for oncological paediatric patients and paediatric solid organ transplantation receptors.