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Food insecurity and dietary quality in US adults and children: a systematic review
Open accessAbstract
Background Food insecurity is adversely associated with the physical and mental health of adults and children, and the mechanism that underlies this association has been assumed to be dietary intake of lower quality in food insecure than food secure individuals. A thorough understanding of observed associations between food insecurity and dietary quality is needed to test this assumption and may highlight pathways through which to improve the health of food-insecure adults and children.Objective We systematically reviewed all evidence of associations between food insecurity and dietary quality and contrasted associations observed in adults and those for children.Design Evidence came from studies that appeared in indexed, peer-reviewed journals and 1) sampled US residents, 2) separately sampled children and adults, 3) contained a measure of food insecurity or food insufficiency, and 4) included at least one measure of dietary quality.Results In adults, 170 associations between food insecurity and dietary quality were tested, and 50 associations (29%) suggested an adverse association. Food-insecure adults consumed fewer vegetables, fruit, and dairy products than did food secure adults and had lower intake of vitamins A and B-6, calcium, magnesium, and zinc. In children, 130 associations were tested, and 21 associations (16%) showed an adverse association. There was substantial evidence of only lower fruit consumption in food-insecure compared with food-secure children. Reporting and publication biases may have contributed to an overestimation of the association between food insecurity and dietary quality.Conclusions Food insecurity is adversely associated with dietary quality in adults, particularly intakes of nutrient-rich vegetables, fruit, and dairy that promote good health. However, food insecurity was less-consistently associated with lower dietary quality in children. The idea that parents effectively shield their children from compromised dietary quality because of food shortages is supported by the evidence.
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“Finally, prior evidence has shown that household-level food insecurity does not correlate with child-level food insecurity [36].”
From Material Hardship and Stress from COVID-19 in Immigrant Chinese American Families with Infants (2022) · cites this paper as [36]
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“Many of these diseases disproportionately affect older Americans, and as our nation’s demographics shift toward an aging population, the burden of diet-related ailments on society will accelerate (41, 42).”
BackgroundInfluentialDrisdelle, C., Kestens, Y., Hamelin, A.-M., & Mercille, G. (2020) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2020.03.020 · Cited by 61
Bergmans, R. S., Palta, M., Robert, S., Berger, L. M., Ehrenthal, D. B., & Malecki, K. M. C. (2018) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2017.12.003 · Cited by 60
Jun, S., Zeh, J., Eicher‐Miller, H. A., & Bailey, R. L. (2019) · Nutrients · doi:10.3390/nu11050965 · Cited by 57
“, low and very low food security) children, regardless of food-security scale [4,5]; however, some adverse associations of calcium and iron intakes with food insecurity among household children in older childre were reported [30,31].”
BackgroundResultPathways by Which Food Insecurity Is Associated With Atherosclerotic Cardiovascular Disease Risk
Palakshappa, D., Ip, E. H., Berkowitz, S. A., Bertoni, A. G., Foley, K. L., Miller, D. P., Vitolins, M. Z., & Rosenthal, G. E. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.121.021901 · Cited by 58
McClain, A. C., Xiao, R. S., Gao, X., Tucker, K. L., Falcón, L. M., & Mattei, J. (2018) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000628 · Cited by 56
“Previous studies consistently found that food-insecure adults had lower intakes of fruit, vegetables, dairy, and some micronutrients (70), but less consistently supported the hypotheses that FI facilitates intake of highly palatable, energy-dense foods (11,70,71).”
Calloway, E. E., Carpenter, L. R., Gargano, T., Sharp, J. L., & Yaroch, A. L. (2023) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-023-01451-z · Cited by 63
“Food insecurity is not merely a proxy measure for low socioeconomic status [10], but it exerts a direct influence on chronic disease risk, likely via compromises to dietary quality [11, 12] and trade-offs households make when allocating resources to food versus medical costs [13].”
BackgroundYau, A., White, M. J., Hammond, D. G., White, C. M., & Adams, J. M. (2020) · Public Health Nutrition · doi:10.1017/s1368980020000087 · Cited by 54
“In a systematic review, food insecure adults were found to have lower intake of fruit, vegetables and dairy compared to food secure adults(14).”
BackgroundSurviving a Shut-Off: U.S. Households at Greatest Risk of Utility Disconnections and How They Cope
Hernández, D., & Laird, J. D. (2021) · American Behavioral Scientist · doi:10.1177/00027642211013401 · Cited by 51
Jun, S., Cowan, A., Tooze, J. A., Gahche, J. J., Dwyer, J. T., Eicher‐Miller, H. A., Bhadra, A., Guenther, P. M., Potischman, N. A., Dodd, K. W., et al. (2018) · Nutrients · doi:10.3390/nu10091212 · Cited by 51
Varela, E., McVay, M. A., Shelnutt, K. P., & Mobley, A. R. (2022) · Advances in Nutrition · doi:10.1016/j.advnut.2022.12.001 · Cited by 54
Jomaa, L., Naja, F., Kharroubi, S. A., & Hwalla, N. C. (2018) · Public Health Nutrition · doi:10.1017/s1368980018003245 · Cited by 52
“Studies have shown that household FI is associated with inadequate nutrient intakes((16,17)), increased risk of mental health problems and depression((18)), and poor pregnancy outcomes among women and mothers, including low birth weight and gestational diabetes((17)).”
BackgroundResultHanson, K. L., Kolodinsky, J., Wang, W., Morgan, E. H., Pitts, S. J., Ammerman, A. S., Sitaker, M., & Seguin‐Fowler, R. A. (2017) · Nutrients · doi:10.3390/nu9070726 · Cited by 51
Self-citationWright, B. N., Bailey, R. L., Craig, B. Α., Mattes, R. D., McCormack, L. A., Stluka, S., Franzen-Castle, L. D., Henne, B., Mehrle, D., Remley, D. T., et al. (2018) · Nutrients · doi:10.3390/nu10050583 · Cited by 49
“Food insecurity in adults is associated with lower intake of vegetables, fruits, dairy products, vitamins A and B6, calcium, magnesium, and zinc compared to food-secure adults [3].”
BackgroundRoyer, M. F., Guerithault, N., Braden, B. B., Laska, M. N., & Bruening, M. M. (2021) · International Journal of Translational Medicine · doi:10.3390/ijtm1030015 · Cited by 55
Lindow, P., Yen, I. H., Xiao, M., & Leung, C. W. (2021) · Public Health Nutrition · doi:10.1017/s1368980021002743 · Cited by 54
“you take the picture?; (2) how does the picture make you feel?; (3) what does the picture illustrate about your day-today life, your physical health and/or mental health?; and (4) what do you want lawmakers, advocates or researchers to know about your picture? Parents were compensated $40 for their participation.”
BackgroundInfluentialOrtiz-Marrón, H., Ortiz-Pinto, M. A., Lanza, M. U., Pujadas, G. C., Pino, V. V., Cortés, S. B., Gascón, T. G., & Gavín, M. O. (2022) · BMC Public Health · doi:10.1186/s12889-022-14308-0 · Cited by 47
Frequency of Food Pantry Use Is Associated with Diet Quality among Indiana Food Pantry Clients
Liu, Y., Zhang, Y., Remley, D. T., & Eicher‐Miller, H. A. (2019) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2019.02.015 · Cited by 47
Yang, Q., Yuan, T., Yang, L., Zou, J., Ji, M., Zhang, Y., Deng, J., & Lin, Q. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16234778 · Cited by 47
“We also find that the frequency consumption of animal source food in HFI children is lower than those who are food-secure, similar to other research results [43,44].”
ResultWalker, S. E., & Baum, J. (2021) · Nutrition Reviews · doi:10.1093/nutrit/nuab019 · Cited by 56
Prayogo, E. D., Chater, A., Chapman, S., Barker, M. E., Rahmawati, N., Waterfall, T. J., & GRIMBLE, G. K. (2017) · Journal of Public Health · doi:10.1093/pubmed/fdx133 · Cited by 46
“countries, as it adversely affects dietary quality (6), health status (7), and indirectly”
Erokhin, V. L., Diao, L., Tianming, G., Andrei, J. V., Григорьевна, И. А., & Zong, Y. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18147356 · Cited by 58
Banks, A. R., Bell, B. A., Ngendahimana, D., Embaye, M., Freedman, D. A., & Chisolm, D. J. (2021) · BMC Public Health · doi:10.1186/s12889-021-11465-6 · Cited by 45
“, race, ethnicity, and age) contributing to health inequities across populations [7, 8].”
BackgroundDutch food bank parcels do not meet nutritional guidelines for a healthy diet
Neter, J. E., Dijkstra, S. C., Visser, M., & Brouwer, I. A. (2016) · British Journal Of Nutrition · doi:10.1017/s0007114516002087 · Cited by 44
“Food insecure people have a lower intake of fruits and vegetables (4 – 9) and a lower nutrient intake (6,8 – 12) , which may lead to micronutrient de fi ciencies and malnutrition (11,13) .”
Jansen, E. C., Kasper, N. M., Lumeng, J. C., Brophy‐Herb, H. E., Horodynski, M. A. O., Miller, A. L., Contreras, D. A., & Peterson, K. E. (2017) · Social Science & Medicine · doi:10.1016/j.socscimed.2017.04.003 · Cited by 44
“A lack of association has been explained by parents shielding their children from dietary insufficiencies by limiting the quality and/or quantity of their own consumption rather than the children’s (Hanson & Connor, 2014).”
BackgroundKihlström, L., Burris, M., Dobbins, J. M., McGrath, E. L., Renda, A. M., Cordier, T., Song, Y., Prendergast, K., Arce, K. S., Shannon, E., et al. (2018) · Ecology of Food and Nutrition · doi:10.1080/03670244.2018.1559160 · Cited by 44
“It is a critical public health concern which currently affects at least one in eight Americans (Coleman-Jensen et al. 2018; Pereira and Hodge 2015; Hanson and Connor 2014; Holben 2010; Gundersen and Ziliak 2015; Fisher 2017; Gundersen 2013).”
BackgroundSaha, S., Behnke, A., Oldewage-Theron, W. H., Mubtasim, N., & Miller, M. (2021) · Journal of Nutrition in Gerontology and Geriatrics · doi:10.1080/21551197.2021.1988027 · Cited by 44
“Women are thus more vulnerable to food insecurity than their male counterparts, which shows alignment with our study results.(71,72) Food insecure older adults are more likely to not purchase and take the high-cost medication to meet their other household basic needs.”
BackgroundResultBell, Z., Scott, S., Visram, S., Rankin, J. M., Bambra, C. L., & Heslehurst, N. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2022.115313 · Cited by 45
“To date, most systematic reviews exploring the effects of food insecurity on nutrition have reviewed quantitative studies (Dinour et al., 2007; Hanson and Connor, 2014; Larson and Story, 2011; Myers et al., 2020).”
BackgroundMajowicz, S. E., Meyer, S. B., Kirkpatrick, S. I., Graham, J. L., Shaikh, A., Elliott, S. J., Minaker, L. M., Scott, S., & Laird, B. D. (2016) · BMC Public Health · doi:10.1186/s12889-016-3142-6 · Cited by 43
“For example, relationships between food insecurity and diet [172] were not included in our final set of articles, and although our search identified ‘means of food storage and preservation’ as linked to food insecurity [130], it did not identify known links between this driver and infectious foodborne illness [173].”
BackgroundFood Insecure College Students and Objective Measurements of Their Unused Meal Plans
van Woerden, I., Hruschka, D. J., Vega‐López, S., Schaefer, D. R., Adams, M. A., & Bruening, M. M. (2019) · Nutrients · doi:10.3390/nu11040904 · Cited by 43
Metadata
- Authors
- Hanson, K. L., & Connor, L. M.
- Affiliations
- Cornell University (US)
- ORCID
- Hanson, Karla L
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2014-08
- Volume
- 100
- Issue
- 2
- Pages
- 684-692
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2079925881
- Cited by
- 660
- References
- 54
- Citations by year
- 2026: 58 · 2025: 62 · 2024: 77 · 2023: 84 · 2022: 84 · 2021: 94 · 2020: 66 · 2019: 55 · 2018: 37 · 2017: 16 · 2016: 15 · 2015: 11
- FWCI
- 2.40
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Food Security and Health in Diverse Populations
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- food insecurity, diet quality, food insufficiency, children, adults, fruit consumption, vegetable consumption, dairy consumption, nutrient intake, publication bias, health disparities
- MeSH terms
- Adult, Child, Child Nutritional Physiological Phenomena, Dairy Products, Diet, Family Characteristics, Female, Food Supply, Fruit, Health Promotion, Humans, Male, Nutritive Value, Patient Compliance, Socioeconomic Factors, Vegetables, Nutrition Policy
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