Association of food insecurity with feeding tube dependence and increased healthcare utilization in pediatric gastroenterology

Objectives Food insecurity (FI) is a critical determinant of child health associated with increased healthcare utilization and poorer health outcomes. Our objectives were to (1) characterize differences between individuals seen in a pediatric gastroenterology clinic who screen positive versus negative for FI, including demographics, anthropometric data, gastrointestinal (GI) diagnoses, and presence of dietary restrictions and (2) identify specific GI diagnoses associated with greater health care utilization among individuals who screen positive for FI. Methods Retrospective study of all patients screened for FI from August 2022 to March 2025 at a single center. Data collected included the FI screen, demographics, anthropometric data, GI diagnoses, emergency department (ED) utilization, hospitalizations, and missed office visits. Results A total of 1789 individuals were screened for FI. Compared to individuals without FI, the FI group had significantly higher proportions of individuals identify as Black or African American, Hispanic or Latino, report Spanish as their primary language, and use Medicaid insurance (all p < 0.001). FI was also associated with a diagnosis of enteral feeding tube use ( p < 0.001). The FI cohort had greater odds of missed office visits (multivariate: odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.02–2.05, p = 0.036), ED visits (multivariate: OR 1.58, 95% CI: 1.02–2.39, p = 0.035), and hospitalizations (multivariate: OR 2.21, 95% CI: 1.19–3.93, p = 0.009), compared to patients without FI adjusting for age, gender, race, ethnicity, and use of enteral tube. Conclusions In a cohort of pediatric GI patients, FI was associated with a diagnosis of an enteral feeding tube use. FI was further associated with a greater odds of missed office visits, ED visits, and hospitalizations.