To examine the association between household food insecurity score and Z-scores of childhood nutritional status indicators.

Population-based, cross-sectional survey, Nepal Demographic and Health Survey 2011.

A nationally representative sample of 11 085 households selected by a two-stage, stratified cluster sampling design to interview eligible men and women.

Children (n 2591) aged 0–60 months in a sub-sample of households selected for men’s interview.

Prevalence of moderate and severe household food insecurity was 23·2 % and 19·0 %, respectively, for children aged 0–60 months. Weighted prevalence rates for stunting (height-for-age Z-score (HAZ) <−2), wasting (weight-for-height Z-score (WHZ) <−2) and underweight (weight-for-age Z-score (WAZ) <−2) were 41·6 % (95 % CI 38·9, 44·3 %), 11·5 % (95 % CI 9·8, 13·2 %) and 30·1 % (95 % CI 27·5, 32·8 %), respectively. Prevalences of stunting, severe stunting (HAZ<−3) and underweight by level of household food insecurity were statistically significant (P<0·001). By multiple linear regression analyses and after adjustment for sociodemographic, child and environmental factors, household food access insecurity score was associated with HAZ (β=−0·02, P=0·01) and WAZ (β=−0·01, P=0·01) but was not associated with WHZ and BMI-for-age Z-score. A 10-point increase in household food access insecurity score was associated with a decrease in HAZ of 0·2 (95 % CI 0·05, 0·39) and decrease in WAZ of 0·1 (95 % CI 0·03, 0·27).

Our results from a nationally representative sample confirm the previously reported association of household food insecurity with stunting and underweight. Community nutrition interventions may use household food insecurity scales for identifying those households where children may be at risk of growth faltering.