Food Insecurity and Appetitive Traits: A Prospective Analysis in Generation XXI Cohort.

Objective: To evaluate the association between food insecurity at age 10 and appetitive traits at age 13.

Methods: The analysis included a subsample of participants from the Generation XXI birth cohort with available data on the variable of interest. Household food security status was assessed using the US Household Food Security Survey Module, completed by the primary caregiver. In addition, children's perceptions of food security at age 10 were evaluated using the Self-Administered Food Security Survey Module. Appetitive traits were assessed at age 13 by the Children's Eating Behavior Questionnaire. Linear regression models, adjusted for socio-demographic variables, estimated the associations between food insecurity and appetitive traits (n = 2495).

Results: At age 10, 5.8% of participants lived in food-insecure households. These participants showed greater responsiveness to food ( $\hat{\beta }$ = 0.27, 95% CI 0.13, 0.42), enjoyed foods more ( $\hat{\beta }$ = 0.22, 95% CI 0.08, 0.35), had a higher desire to drink ( $\hat{\beta }$ = 0.26, 95% CI 0.14, 0.37), and more emotional overeating ( $\hat{\beta }$ = 0.28, 95% CI 0.15, 0.41) and emotional undereating ( $\hat{\beta }$ = 0.15, 95% CI 0.01, 0.28) 3 years later compared to those from food-Secure households. Analysis using child-reported perceived food security status showed similar relationships, except for emotional undereating, where there was no significant association.

Discussion: Experience of food insecurity in childhood was associated with increased food approach appetitive traits at age 13, reflecting amplification of an avid appetite phenotype and acquisition of emotional eating. These results highlight food insecurity's potential long-term health consequences during critical developmental periods.

Public significance statement: Children who experienced food insecurity at age 10 showed a stronger response to food, a greater interest in eating, and a tendency to eat in response to negative emotions by age 13. These behaviors are known to increase the risk of obesity. Early food insecurity can have long-lasting effects on children's health and eating behaviors.