Negative health outcomes associated with food insecurity status in the United States of America: A systematic review of peer-reviewed studies

Abstract

Introduction: Social determinants of health, such as food security, are an important target for health providers, particularly in the care of patients from underserved populations, including the uninsured and socially marginalized. Preliminary research has shown that food insecurity status (FIS) is associated with negative health outcomes.Objective: We aim to present a concise, yet comprehensive resource that lists the health outcomes associated with FIS. This guide is meant to provide innovative health providers with the tools needed to justify the importance of using FIS screening and treatment as a preventive medicine intervention.Methods: We conducted a systematic review of peer-reviewed manuscripts that studied FIS in the United States of America (USA) and at least one health outcome. We searched PubMed, Embase, Web of Science, and Scopus and had multiple reviewers examine each abstract and manuscript. We only retained peer-reviewed studies that contained USA data, directly measured FIS, and directly compared FIS to a health outcome.Results: The initial search yielded 1,817 manuscripts. After screening abstracts for duplicates and inclusion criteria, a total of 117 manuscripts were retained and fully examined. Several manuscripts showed significant association between FIS and neurologic, cardiac, endocrine, and pulmonary health outcomes. Studies in the USA population show robust associations between FIS and poor mental health (including depression, anxiety, sleep disorders, impaired cognitive functioning, and epilepsy), metabolic syndrome, hyperlipidemia, greater risk for bone fracture in children, higher risk of end-stage renal disease in patients with chronic kidney disease, self-reported poor health, and higher mortality in patients with the human immunodeficiency virus. Though other literature reviews show positive associations between FIS and health outcomes such as diabetes, body mass index, and hypertension, our systematic review showed mixed results.Conclusions: FIS leaves underserved populations at risk for negative health outcomes. More research should be done to examine the effects of FIS alleviation as a preventative medicine intervention.

Association Between Food Insecurity and Key Metabolic Risk Factors for Diet-Sensitive Non-Communicable Diseases in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

“…However, at the same time, affirms the need to tackle food insecurity in order to effectively promote population health and the prevention and control of diet-sensitive NCDs in the region. 46 Similar to our systematic review, Arenas et al 5 found an adverse association between exposure to food insecurity and dyslipidemia, reported from 7 peer-reviewed manuscripts published between 2006-2015. By contrast, the review by Arenas et al 5 found that there is no consistent literature-wide association between body mass index and food insecurity-status; only 18 studies out of 37 reported a statistically significant association, which is more studies than we report in our current review.…”

“…46 Similar to our systematic review, Arenas et al 5 found an adverse association between exposure to food insecurity and dyslipidemia, reported from 7 peer-reviewed manuscripts published between 2006-2015. By contrast, the review by Arenas et al 5 found that there is no consistent literature-wide association between body mass index and food insecurity-status; only 18 studies out of 37 reported a statistically significant association, which is more studies than we report in our current review. These findings have implications for research, as the inconsistencies of results across studies merit careful assessment of the various methodologies used in the original studies.…”

“…One such factor is food insecurity, defined as the lack of access to nutritionally adequate foods caused by poverty and other socio-economic stressors. [4][5][6][7] The World Health Organization (WHO) and the United Nations General Assembly, among other professional organisations, recently identified food insecurity as an important proximate driver of the prevalence of metabolic risk factors on the causal pathway to diet-sensitive NCDs. 8 This premise is rooted in the hypothesis that exposure to food insecurity results in compensatory behaviours, which often includes less intake of fruit and vegetables, 9 skipping meals, or reducing portion sizes, 10 and overconsumption of low-cost foods that are high in calories yet deficient in nutritional value.…”

Assessing Food Insecurity among US Adults during the COVID-19 Pandemic

“…Our findings are also consistent with a wealth of research that links food insecurity to negative physical and mental health symptoms, such as depressive symptoms and generalized anxiety. [13][14][15]17,18,32,37,[48][49][50] Race, ethnicity, and income remain important factors in helping account for food insecurity variability in the U.S. Additionally, mental health symptoms and the uncertainty or generalized anxiety manifested as fear of COVID-19 matter, as well, highlighting how different these times are and how important it is that we are better prepared for the emotional uncertainty that can impact individual's sustained access to food. Many states are reporting large increases in demand for food among service providers feeding low-income, food insecure populations in America.…”

Food insecurity requires nursing action

“…Living with food insecurity contributes to a host of poor outcomes that are not only immediate, hunger, and malnutrition, but long‐lasting, such as cardiovascular disease, diabetes, depression, anxiety, and even suicidal ideation (Abdurahman et al., 2019; Arenas et al., 2018; Gregory & Coleman‐Jensen, 2017; Hanson & Connor, 2014; Kamdar et al., 2021; Vercammen et al., 2019). For children, being food insecure is associated with depressive symptoms, reduced concentration, poor school performance, developmental delays, dysregulated behavior, more frequent illness with slower recoveries, and more emergency department visits and forgone medical care (Council on Community Pediatrics Committee on Nutrition, 2015; Hanson & Connor, 2014; Nagata et al., 2019; Thomas et al., 2019).…”