{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T05:06:39Z","timestamp":1789189599231,"version":"build-2803163510"},"reference-count":71,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Center for Advancing Translational Sciences of the National Institutes of Health","award":["UL1TR002378"],"award-info":[{"award-number":["UL1TR002378"]}]},{"name":"National Center for Advancing Translational Sciences of the National Institutes of Health","award":["TL1R002382"],"award-info":[{"award-number":["TL1R002382"]}]},{"award":["UL1TR002378"],"award-info":[{"award-number":["UL1TR002378"]}],"id":[{"id":"https:\/\/ror.org\/04pw6fb54","id-type":"ROR","asserted-by":"publisher"}]},{"award":["TL1R002382"],"award-info":[{"award-number":["TL1R002382"]}],"id":[{"id":"https:\/\/ror.org\/04pw6fb54","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Research Centers in Minority Institutions","award":["U54MD007602"],"award-info":[{"award-number":["U54MD007602"]}]},{"DOI":"10.13039\/100006545","name":"National Institute of Minority Health and Health Disparities","doi-asserted-by":"crossref","award":["R01MD017690"],"award-info":[{"award-number":["R01MD017690"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"crossref"}]},{"award":["R01MD017690"],"award-info":[{"award-number":["R01MD017690"]}],"id":[{"id":"https:\/\/ror.org\/0493hgw16","id-type":"ROR","asserted-by":"publisher"}]},{"name":"National Institutes of Health, Office of the Director: Regional Medical Centers","award":["1 OT2 OD026549"],"award-info":[{"award-number":["1 OT2 OD026549"]}]},{"name":"National Institutes of Health, Office of the Director: Regional Medical Centers","award":["1 OT2 OD026554"],"award-info":[{"award-number":["1 OT2 OD026554"]}]},{"name":"National Institutes of Health, Office of the Director: Regional Medical Centers","award":["1 OT2 OD026557"],"award-info":[{"award-number":["1 OT2 OD026557"]}]},{"name":"National Institutes of Health, Office of the Director: Regional Medical Centers","award":["1 OT2 OD026556"],"award-info":[{"award-number":["1 OT2 OD026556"]}]},{"name":"National Institutes of Health, Office of the Director: Regional Medical Centers","award":["1 OT2 OD026550"],"award-info":[{"award-number":["1 OT2 OD026550"]}]},{"name":"National Institutes of Health, Office of the Director: Regional Medical Centers","award":["1 OT2 OD 026552"],"award-info":[{"award-number":["1 OT2 OD 026552"]}]},{"name":"National Institutes of Health, Office of the Director: Regional Medical Centers","award":["1 OT2 OD026553"],"award-info":[{"award-number":["1 OT2 OD026553"]}]},{"name":"National Institutes of Health, Office of the Director: Regional Medical Centers","award":["1 OT2 OD026548"],"award-info":[{"award-number":["1 OT2 OD026548"]}]},{"name":"National Institutes of Health, Office of the Director: Regional Medical Centers","award":["1 OT2 OD026551"],"award-info":[{"award-number":["1 OT2 OD026551"]}]},{"name":"National Institutes of Health, Office of the Director: Regional Medical Centers","award":["1 OT2 OD026555"],"award-info":[{"award-number":["1 OT2 OD026555"]}]},{"name":"National Institutes of Health, Office of the Director: Regional Medical Centers","award":["AOD 16037"],"award-info":[{"award-number":["AOD 16037"]}]},{"name":"Federally Qualified Health Centers","award":["HHSN 263201600085U"],"award-info":[{"award-number":["HHSN 263201600085U"]}]},{"name":"Data and Research Center","award":["5 U2C OD023196"],"award-info":[{"award-number":["5 U2C OD023196"]}]},{"name":"Biobank","award":["1U24 OD023121"],"award-info":[{"award-number":["1U24 OD023121"]}]},{"name":"The Participant Center","award":["U24 OD023176"],"award-info":[{"award-number":["U24 OD023176"]}]},{"name":"Participant Technology Systems Center","award":["1U24 OD023163"],"award-info":[{"award-number":["1U24 OD023163"]}]},{"name":"Communications and Engagement","award":["3 OT2 OD023205"],"award-info":[{"award-number":["3 OT2 OD023205"]}]},{"name":"Communications and Engagement","award":["3 OT2 OD023206"],"award-info":[{"award-number":["3 OT2 OD023206"]}]},{"name":"Community Partners","award":["1 OT2 OD025277"],"award-info":[{"award-number":["1 OT2 OD025277"]}]},{"name":"Community Partners","award":["3 OT2 OD025315"],"award-info":[{"award-number":["3 OT2 OD025315"]}]},{"name":"Community Partners","award":["1 OT2 OD025337"],"award-info":[{"award-number":["1 OT2 OD025337"]}]},{"name":"Community Partners","award":["1 OT2 OD025276"],"award-info":[{"award-number":["1 OT2 OD025276"]}]},{"award":["1 OT2 OD025277"],"award-info":[{"award-number":["1 OT2 OD025277"]}],"id":[{"id":"https:\/\/ror.org\/05kmb8d23","id-type":"ROR","asserted-by":"publisher"}]},{"award":["3 OT2 OD025315"],"award-info":[{"award-number":["3 OT2 OD025315"]}],"id":[{"id":"https:\/\/ror.org\/05kmb8d23","id-type":"ROR","asserted-by":"publisher"}]},{"award":["1 OT2 OD025337"],"award-info":[{"award-number":["1 OT2 OD025337"]}],"id":[{"id":"https:\/\/ror.org\/05kmb8d23","id-type":"ROR","asserted-by":"publisher"}]},{"award":["1 OT2 OD025276"],"award-info":[{"award-number":["1 OT2 OD025276"]}],"id":[{"id":"https:\/\/ror.org\/05kmb8d23","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Food insecurity (FI) affects a substantial proportion of pregnant individuals in the United States and varies across geographic contexts. Rural and urban communities differ in food access, socioeconomic conditions, and environmental exposures, yet how these differences relate to maternal biology remain misunderstood. Methods: This study examined associations between FI, geographic context, and metabolic, nutritional, and inflammatory biomarkers among pregnant participants in the Southeastern United States (SE-US) using data from the All of Us (AoU) Research Program. Survey, clinical, and laboratory data were integrated with ZIP3-level geographic and food environment indicators. Analyses were conducted using biomarker-specific complete-case cohorts and multivariable regression models. Results: This study found that FI was more prevalent among rural participants than urban participants. However, in the overall cohort, FI was associated with higher body mass index, higher non-fasting glucose, higher C-reactive protein, and lower high-density lipoprotein cholesterol. Pregnant food-insecure participants also exhibited lower concentrations of vitamin B12, albumin, vitamin D, and folate, while ferritin did not differ. Stratified analyses demonstrated variability in these associations by urbanicity, with stronger and more consistent differences observed in urban populations and fewer significant differences in rural settings. Conclusions: Limitations of this study include potential residual confounding, EHR-related selection bias, exposure misclassification, and limited generalizability. Despite the limitations, recent self-reported household FI, assessed at enrollment and referring to the preceding 12 months, was associated with differences in several metabolic and nutritional biomarkers, with patterns varying by geographic context. Further longitudinal research is needed to clarify these associations and inform targeted interventions.<\/jats:p>","DOI":"10.3390\/nu18182965","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T09:13:03Z","timestamp":1789031583000},"page":"2965","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Geographic and Environmental Differences in Associations Between Food Insecurity and Nutritional and Inflammatory Biomarkers Among Pregnant Participants in the All of Us Research Program"],"prefix":"10.3390","volume":"18","author":[{"given":"Alaijah","family":"Bashi","sequence":"first","affiliation":[{"name":"Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviane","family":"Schuch","sequence":"additional","affiliation":[{"name":"Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1965-4041","authenticated-orcid":false,"given":"Amber","family":"Dawning","sequence":"additional","affiliation":[{"name":"Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3448-6823","authenticated-orcid":false,"given":"Tyana T.","family":"Joseph","sequence":"additional","affiliation":[{"name":"Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9808-0501","authenticated-orcid":false,"given":"Peter","family":"Baltrus","sequence":"additional","affiliation":[{"name":"Community Health and Preventative Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla J.","family":"Moore","sequence":"additional","affiliation":[{"name":"Clinical Research Center, Morehouse School of Medicine, Atlanta, GA 30310, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3230-8715","authenticated-orcid":false,"given":"Erica L.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2887","DOI":"10.1017\/S1368980016001166","article-title":"Measurement of the dimensions of food insecurity in developed countries: A systematic literature review","volume":"19","author":"Ashby","year":"2016","journal-title":"Public Health Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1177\/0033354916664154","article-title":"Food Insecurity: A Public Health Issue","volume":"131","author":"Murthy","year":"2016","journal-title":"Public Health Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1089\/heq.2023.0116","article-title":"Understanding Food Insecurity as a Determinant of Health in Pregnancy Within the United States: An Integrative Review","volume":"8","author":"Pasha","year":"2024","journal-title":"Health Equity"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Whiteoak, B., Dawson, S.L., Callaway, L., de Jersey, S., Eley, V., Evans, J., Kothari, A., Navarro, S., and Gallegos, D. (2024). Food Insecurity Is Associated with Diet Quality in Pregnancy: A Cross-Sectional Study. Nutrients, 16.","DOI":"10.3390\/nu16091319"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e2324005","DOI":"10.1001\/jamanetworkopen.2023.24005","article-title":"Patterns in Food Insecurity During Pregnancy, 2004 to 2020","volume":"6","author":"Hinkle","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e2455955","DOI":"10.1001\/jamanetworkopen.2024.55955","article-title":"Food Insecurity in Pregnancy, Receipt of Food Assistance, and Perinatal Complications","volume":"8","author":"Chehab","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"ref_7","first-page":"4","article-title":"Food Matters: Food Insecurity among Pregnant Adolescents and Infant Birth Outcomes","volume":"6","author":"Grilo","year":"2015","journal-title":"J. Appl. Res. Child"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"mxaf001","DOI":"10.1093\/epirev\/mxaf001","article-title":"Food insecurity during pregnancy and associated perinatal outcomes: A scoping review","volume":"47","author":"Kinsey","year":"2025","journal-title":"Epidemiol. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"107294","DOI":"10.1016\/j.appet.2024.107294","article-title":"Food insecurity, poor diet, and metabolic measures: The roles of stress and cortisol","volume":"197","author":"Chiu","year":"2024","journal-title":"Appetite"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.biopsych.2018.06.021","article-title":"The Interplay Between Nutrition and Stress in Pregnancy: Implications for Fetal Programming of Brain Development","volume":"85","author":"Lindsay","year":"2019","journal-title":"Biol. Psychiatry"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.2105\/AJPH.2011.300551","article-title":"The association between food insecurity and inflammation in the US adult population","volume":"102","author":"Gowda","year":"2012","journal-title":"Am. J. Public Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S156","DOI":"10.3122\/jabfm.2023.230454R1","article-title":"Food Insecurity Is Associated with Vitamin B12 Deficiency: The All of Us Database","volume":"37","author":"Parente","year":"2024","journal-title":"J. Am. Board Fam. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"805","DOI":"10.3390\/epidemiologia5040055","article-title":"The Interplay Between Vitamin D Deficiency, Iron Status, and Anemia Risk in Moroccan Women of Reproductive Age: A Cross-Sectional Analysis","volume":"5","author":"Zouine","year":"2024","journal-title":"Epidemiologia"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Krasnovsky, L., Crowley, A.P., Naeem, F., Wang, L.S., Wu, G.D., and Chao, A.M. (2023). A Scoping Review of Nutritional Biomarkers Associated with Food Security. Nutrients, 15.","DOI":"10.3390\/nu15163576"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Carter, M.A., Dubois, L., Tremblay, M.S., and Taljaard, M. (2012). Local social environmental factors are associated with household food insecurity in a longitudinal study of children. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-1038"},{"key":"ref_16","first-page":"8","article-title":"Individual, Family, and Neighborhood Characteristics and Children\u2019s Food Insecurity","volume":"3","author":"Kimbro","year":"2012","journal-title":"J. Appl. Res. Child."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1136\/bmjnph-2023-000663","article-title":"Food environment and obesity: A systematic review and meta-analysis","volume":"7","author":"Pineda","year":"2024","journal-title":"BMJ Nutr. Prev. Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1016\/j.ajcnut.2023.12.019","article-title":"Food Insecurity, Neighborhood Food Environment, and Health Disparities: State of the Science, Research Gaps and Opportunities","volume":"119","author":"Brown","year":"2024","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1016\/j.ajcnut.2024.02.022","article-title":"Birth outcomes in relation to neighborhood food access and individual food insecurity during pregnancy in the Environmental Influences on Child Health Outcomes (ECHO)-wide cohort study","volume":"119","author":"Aris","year":"2024","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1093\/jn\/120.suppl_11.1555","article-title":"Core indicators of nutritional state for difficult-to-sample populations","volume":"120","author":"Anderson","year":"1990","journal-title":"J. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Bartha, J.L. (2025). New Evidence on Nutrition and Metabolic Influences on Pregnancy Outcomes: Insights from This Special Issue. Nutrients, 17.","DOI":"10.3390\/nu17162628"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Walden, N., Tabak, R., Brown, D.S., Luby, J., Warner, B., Smyser, T., Rogers, C., Barch, D., England, S.K., and Oberly, T. (2026). African American Food Environments and Anti-Inflammatory Intake in Pregnancy. Int. J. Environ. Res. Public Health, 23.","DOI":"10.3390\/ijerph23050646"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Fatima, N., Yaqoob, S., Rana, L., Imtiaz, A., Iqbal, M.J., Bashir, Z., Shaukat, A., Naveed, H., Sultan, W., and Afzal, M. (2025). Micro-nutrient sufficiency in mothers and babies: Management of deficiencies while avoiding overload during pregnancy. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1476672"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Triggianese, P., Ramirez, G.A., Cedola, F., Nicola, S., Costanzo, G., Brussino, L., Chiereghin, F., Firinu, D., Della-Morte, D., and Patella, V. (2026). Micronutrients in Autoimmune Diseases: Shining a Light on Vitamin D, Cobalamin, Folate, and Iron Metabolism. Nutrients, 18.","DOI":"10.3390\/nu18040561"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e70085","DOI":"10.1111\/jrh.70085","article-title":"Rural-urban differences in dietary intake across pregnancy trimesters: A multisite prospective cohort study","volume":"41","author":"Crisp","year":"2025","journal-title":"J. Rural Health"},{"key":"ref_26","unstructured":"All of Us Research Program Genomics Investigators (2024). Genomic data in the All of Us Research Program. Nature, 627, 340\u2013346."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Rabbitt, M.P., Reed-Jones, M., Hales, L.J., Suttles, S., and Burke, M.P. (2025). Household Food Security in the United States in 2024.","DOI":"10.32747\/2025.9458834.ers"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1542\/peds.2009-3146","article-title":"Development and validity of a 2-item screen to identify families at risk for food insecurity","volume":"126","author":"Hager","year":"2010","journal-title":"Pediatrics"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Glover, B., Mao, L., Hu, Y., and Zhang, J. (2022). Enhancing the Retail Food Environment Index (RFEI) with Neighborhood Commuting Patterns: A Hybrid Human\u2212Environment Measure. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191710798"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1850","DOI":"10.1017\/S1368980023001179","article-title":"A longitudinal assessment of racial and ethnic inequities in food environment exposure and retail market concentration","volume":"26","author":"Jiang","year":"2023","journal-title":"Public Health Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"17608","DOI":"10.1073\/pnas.0801021105","article-title":"Revealing the spatial distribution of a disease while preserving privacy","volume":"105","author":"Wieland","year":"2008","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Allison, P.D. (2009). Fixed Effects Regression Models, SAGE Publications.","DOI":"10.4135\/9781412993869"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"(2019). The All of Us Research Program Investigators. The \u201cAll of Us\u201d Research Program. N. Engl. J. Med., 381, 668\u2013676.","DOI":"10.1056\/NEJMsr1809937"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e198","DOI":"10.1016\/j.fertnstert.2022.08.564","article-title":"The association between serum thyroid hormone, vitamin D, vitamin B12, folate, ferritin, and zinc levels and female infertility. A compassion with healthy pregnant subjects","volume":"118","author":"Aghayeva","year":"2022","journal-title":"Fertil. Steril."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez-Ludlow, I., Rodr\u00edguez-Cano, A.M., Mendoza-Ortega, J.A., Rodr\u00edguez-Hern\u00e1ndez, C., Su\u00e1rez-Rico, B.V., Estrada-Gutierrez, G., Tolentino-Dolores, M., Parra-Hern\u00e1ndez, S.B., S\u00e1nchez-Mart\u00ednez, M., and Acevedo-Gallegos, S. (2025). Maternal Folate and Vitamin B 12 Concentrations During Pregnancy Influence Neonatal Nutritional Status and Adiposity: Results from the OBESO Cohort. Nutrients, 17.","DOI":"10.3390\/nu17030372"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1017\/S0029665108008732","article-title":"Assessment and interpretation of micronutrient status during pregnancy: Symposium on \u2018Translation of research in nutrition II: The bed\u2019","volume":"67","author":"Wheeler","year":"2008","journal-title":"Proc. Nutr. Soc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/nop\/npab049","article-title":"Understanding the effect of categorization of a continuous predictor with application to neuro-oncology","volume":"9","author":"Gupta","year":"2021","journal-title":"Neuro-Oncol. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"97814","DOI":"10.5662\/wjm.v15.i1.97814","article-title":"Beyond statistical significance: Embracing minimal clinically important difference for better patient care","volume":"15","author":"Jeyaraman","year":"2025","journal-title":"World J. Methodol."},{"key":"ref_39","unstructured":"Balio, C.P., Pack, R.P., Hagaman, A., Meit, M., Beatty, K., and Mathis, S. (2026, January 26). Use of the Area Deprivation Index and Rural Applications in Peer-Reviewed Literature. Rural Health Research Gateway, 2024. Available online: https:\/\/www.ruralhealthresearch.org\/projects\/1010."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1038\/s41370-022-00435-8","article-title":"Assessing community-level exposure to social vulnerability and isolation: Spatial patterning and urban-rural differences","volume":"33","author":"Deziel","year":"2023","journal-title":"J. Expo. Sci. Environ. Epidemiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1093\/jn\/nxz021","article-title":"Inflammation and Stress Biomarkers Mediate the Association between Household Food Insecurity and Insulin Resistance among Latinos with Type 2 Diabetes","volume":"149","author":"Wagner","year":"2019","journal-title":"J. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1111\/j.1475-6773.2008.00900.x","article-title":"What\u2019s the Risk? A Simple Approach for Estimating Adjusted Risk Measures from Nonlinear Models Including Logistic Regression","volume":"44","author":"Kleinman","year":"2009","journal-title":"Health Serv. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1007\/s10900-022-01176-3","article-title":"Food Insecurity and Stress Among Rural Residents in South Carolina: The Moderating Influences of Household Characteristics, Neighborhood Social Environment and Food Environment","volume":"48","author":"Koob","year":"2023","journal-title":"J. Community Health"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Ng, C.D., Zhang, P., and Kowal, S. (2025). Validating the Social Vulnerability Index for alternative geographies in the United States to explore trends in social determinants of health over time and geographic location. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1547946"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1007\/s13679-017-0285-4","article-title":"Ultra-processed Food Intake and Obesity: What Really Matters for Health-Processing or Nutrient Content?","volume":"6","author":"Poti","year":"2017","journal-title":"Curr. Obes. Rep."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1093\/epirev\/mxad010","article-title":"\u201cWe adjusted for race\u201d: Now what? A systematic review of utilization and reporting of race in American Journal of Epidemiology and Epidemiology, 2020\u20132021","volume":"45","author":"Coles","year":"2023","journal-title":"Epidemiol. Rev."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Areba, A.S., Akiso, D.E., Haile, A., Abire, B.G., Kanno, G.G., Tirore, L.L., and Abame, D.E. (2024). Factors associated with food insecurity among pregnant women in Gedeo zone public hospitals, Southern Ethiopia. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1399185"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"21501319241277411","DOI":"10.1177\/21501319241277411","article-title":"Identifying Areas of High Vulnerability for Rural Veteran Food Insecurity","volume":"15","author":"Bradley","year":"2024","journal-title":"J. Prim. Care Community Health"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Byker Shanks, C., Andress, L., Hardison-Moody, A., Pitts, S.J., Patton-Lopez, M., Prewitt, T.E., Dupuis, V., Wong, K., Kirk-Epstein, M., and Engelhard, E. (2022). Food Insecurity in the Rural United States: An Examination of Struggles and Coping Mechanisms to Feed a Family among Households with a Low-Income. Nutrients, 14.","DOI":"10.3390\/nu14245250"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Abdul Razak, S., Atoloye, A.T., Antrum, C.J., Niroula, K., Bannor, R., Ray, S., Coman, E., Huedo-Medina, T., Duffy, V.B., and Stowers, K.C. (2025). Food Swamps and Transportation Access: Intersecting Structural Determinants of Food Shopping and Access in Marginalized Urban Communities. Int. J. Environ. Res. Public Health, 22.","DOI":"10.3390\/ijerph22101481"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"656","DOI":"10.3122\/jabfm.2022.04.210413","article-title":"A Systematic Review and Meta-Analysis of Food Insecurity and Dyslipidemia","volume":"35","author":"Arenas","year":"2022","journal-title":"J. Am. Board Fam. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.ypmed.2015.05.009","article-title":"Food insecurity and dyslipidemia in a representative population-based sample in the US","volume":"77","author":"Shin","year":"2015","journal-title":"Prev. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s13668-016-0153-y","article-title":"The Relationship between Food Insecurity, Dietary Patterns, and Obesity","volume":"5","author":"Morales","year":"2016","journal-title":"Curr. Nutr. Rep."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e2216406","DOI":"10.1001\/jamanetworkopen.2022.16406","article-title":"Association of Socioeconomic and Geographic Factors With Diet Quality in US Adults","volume":"5","author":"McCullough","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.tjnut.2023.12.030","article-title":"Differences in Intakes of Select Nutrients by Urbanization Level in the United States Population 2 Years and Older, NHANES 2013\u20132018","volume":"154","author":"Wambogo","year":"2024","journal-title":"J. Nutr."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1093\/nutrit\/nuz003","article-title":"Randomized controlled trials investigating the relationship between dietary pattern and high-sensitivity C-reactive protein: A systematic review","volume":"77","author":"Pickworth","year":"2019","journal-title":"Nutr. Rev."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"992120","DOI":"10.3389\/fnut.2022.992120","article-title":"The role of nutrients in human neurodevelopment and their potential to prevent neurodevelopmental adversity","volume":"9","author":"Heland","year":"2022","journal-title":"Front Nutr."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Jembere, F., and Dewey, D. (2024). Prenatal Vitamin B12 and Children\u2019s Brain Development and Cognitive, Language and Motor Outcomes: A Scoping Review. Children, 11.","DOI":"10.3390\/children11050558"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.jneb.2013.04.268","article-title":"Determinants of Diet Quality in Pregnancy: Sociodemographic, Pregnancy-specific, and Food Environment Influences","volume":"45","author":"Nash","year":"2013","journal-title":"J. Nutr. Educ. Behav."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Hurrell, R.F. (2022). Ensuring the Efficacious Iron Fortification of Foods: A Tale of Two Barriers. Nutrients, 14.","DOI":"10.3390\/nu14081609"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e13065","DOI":"10.1111\/mcn.13065","article-title":"High dietary micronutrient inadequacy in peri-urban school children from a district in South India: Potential for staple food fortification and nutrient supplementation","volume":"16","author":"Madhari","year":"2020","journal-title":"Matern. Child Nutr."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"146502","DOI":"10.1155\/2014\/146502","article-title":"Understanding barriers and facilitators to healthy eating and active living in rural communities","volume":"2014","author":"Seguin","year":"2014","journal-title":"J. Nutr. Metab."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"101912","DOI":"10.1016\/j.pmedr.2022.101912","article-title":"Food insecurity, food environments, and disparities in diet quality and obesity in a nationally representative sample of community-dwelling older Americans","volume":"29","author":"Choi","year":"2022","journal-title":"Prev. Med. Rep."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1377\/hlthaff.2022.01406","article-title":"The Neighborhood Atlas Area Deprivation Index For Measuring Socioeconomic Status: An Overemphasis On Home Value","volume":"42","author":"Hannan","year":"2023","journal-title":"Health Aff."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"513","DOI":"10.12688\/f1000research.163042.1","article-title":"Paving the way: Urban Health, Food Systems, and the Imperative for Holistic City-Led Action","volume":"14","author":"Lundberg","year":"2025","journal-title":"F1000Research"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"13920","DOI":"10.1038\/s41598-026-44534-0","article-title":"Maternal intake of inadequate dietary folate, and low serum folate levels during pregnancy are associated with increased risk of preterm birth in rural Ethiopia: A prospective cohort study","volume":"16","author":"Mayisso","year":"2026","journal-title":"Sci. Rep."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"619176","DOI":"10.3389\/fendo.2021.619176","article-title":"Maternal Vitamin B12 Status During Pregnancy and Its Association With Outcomes of Pregnancy and Health of the Offspring: A Systematic Review and Implications for Policy in India","volume":"12","author":"Behere","year":"2021","journal-title":"Front. Endocrinol."},{"key":"ref_68","first-page":"9394060","article-title":"Limitations of Serum Ferritin in Diagnosing Iron Deficiency in Inflammatory Conditions","volume":"2018","author":"Dignass","year":"2018","journal-title":"Int. J. Chronic Dis."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"3745","DOI":"10.1182\/bloodadvances.2024013460","article-title":"Physiologically based trimester-specific serum ferritin thresholds for iron deficiency in US pregnant women","volume":"8","author":"Mei","year":"2024","journal-title":"Blood Adv."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1086\/695328","article-title":"Food Insecurity among Households with Children: The Role of the State Economic and Policy Context","volume":"91","author":"Bartfeld","year":"2017","journal-title":"Soc. Serv. Rev."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.amepre.2015.08.031","article-title":"Precision Public Health for the Era of Precision Medicine","volume":"50","author":"Khoury","year":"2016","journal-title":"Am. J. Prev. Med."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/2965\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T04:20:12Z","timestamp":1789186812000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/2965"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":71,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["nu18182965"],"URL":"https:\/\/doi.org\/10.3390\/nu18182965","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]}}}