ABSTRACT:
Background and

OBJECTIVE:
Household food insecurity (HFI) undermines equitable child health and may constrain families’ ability to choose healthy and sustainable foods. This study aimed to investigate the relationship between household food insecurity and (i) parental food literacy and food-choice motivations, and (ii) preschool children’s parent-reported anthropometric indicators and physician-diagnosed health conditions in Istanbul.

METHODS:
Cross-sectional study of 437 eligible parents of children aged 3–6 years attending a tertiary paediatric outpatient clinic in 2025. Measures included Turkish-validated versions of the Household Food Insecurity Survey Module–Short Form, the Short Food Literacy Questionnaire, and the Single-Item Food Choice Questionnaire, along with parent-reported child anthropometric indicators and physician-diagnosed conditions. Group comparisons used Chi-square/Fisher and t-test/Mann–Whitney U tests.

RESULTS:
Overall, 48.7% reported some level of HFI (28.6% marginal food security, 17.4% low food security, 2.7% very low food security). HFI was strongly patterned by socioeconomic vulnerability, particularly low income and lack of social security (p<0.001). Inadequate/limited food literacy was markedly more common among food-insecure households (95.5% vs 20.1%). Compared with food-secure households, children from food-insecure households more frequently had low weight-for-age (<3rd percentile; 6.8% vs 1.4%; p=0.008) and higher prevalences of physician-diagnosed iron deficiency (43.2% vs 17.8%; p<0.001) and vitamin D deficiency (22.7% vs 10.9%; p=0.003).

CONCLUSIONS:
In an urban middle-income setting, HFI affected nearly half of households, with observed disparities in anthropometric indicators and physician-diagnosed micronutrient deficiencies across food-security groups. Equity-oriented action should combine targeted social protection with food-literacy support and improve the affordability and availability of healthy, sustainable foods for vulnerable families.