# Associations between socioeconomic status, dietary habits and health-related quality of life among children in rural riverside communities: the mediation role of food insecurity

## TL;DR

This study shows how poverty and food insecurity in rural Amazonian communities affect children's quality of life through poor diet and limited food access.

## Contribution

The study reveals food insecurity as a key mediator linking socioeconomic status, diet quality, and children's health-related quality of life in rural riverine communities.

## Key findings

- Food insecurity directly reduces health-related quality of life in children.
- Socioeconomic status and household food availability influence food insecurity and diet quality.
- Higher consumption of ultra-processed foods is linked to poorer diet quality and worsened quality of life.

## Abstract

This study investigated the relationships between socioeconomic status (SES), housing conditions, BMI z-score, food availability and consumption, food insecurity, and health-related quality of life (HRQoL) in schoolchildren aged 5 to 10 years living in rural riverine communities.

This school-based cross-sectional study included 128 parent–child dyads living in rural riverside in the city of Coari, Amazonas, Brazil. SES, housing conditions, household food availability, consumption of ultra-processed foods and food insecurity data were gathered from children’s parents. Children’s nutritional status (BMI z-scores), diet quality and HRQoL [Kiddo-KINDL] were also assessed. Direct and indirect relationships between variables were examined through structural equation modelling.

Food insecurity was directly linked to poorer HRQoL. Worse socioeconomic status, lower availability of food at household, and poorer child’s diet quality were directly linked to food insecurity. Greater household food availability, higher children’s BMI z-score, and worse diet quality were directly linked to higher socioeconomic status. Availability of food at home was directly associated with higher consumption of ultra-processed foods, which, in turn, was directly associated with poorer diet quality. Food insecurity mediated the indirect associations of socioeconomic status, availability of food at household, consumption of ultra-processed foods, and diet quality with HRQoL.

The present findings elucidate the complex pathways between socioeconomic inequalities, food access and availability, diet quality, and children’s quality of life.

The online version contains supplementary material available at 10.1007/s11136-025-04137-0.

Children living in rural riverine communities face different health challenges because of social deprivation. Previous research showed that socioeconomic factors and food access are related to diet quality and quality of life. This study examined the possible interconnections between socioeconomic status, food availability, diet quality, food insecurity, and quality of life in this population. The results indicate that food insecurity was related to lower family socioeconomic status, less food at home, and poorer diet quality. Also, food insecurity was a meaningful pathway through which socioeconomic status, food availability, consumption of ultra-processed foods, and diet quality were associated with quality of life. These results highlight the intricate connections between socioeconomic factors, food access and food insecurity that affect children’s quality of life. Addressing food insecurity and improving diet quality could enhance children’s quality of life in these communities. These insights can help develop targeted interventions to improve children’s health and well-being.

The online version contains supplementary material available at 10.1007/s11136-025-04137-0.