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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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“Food insecure households face many risk factors for disease, including poor diet quality.(4,5) Understanding the strategies through which food insecure households are accessing food is essential to address their health needs.”
BackgroundFood insecurity and oral health care experiences during pregnancy
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“Our findings were in accordance with prior studies((2,5,19)).”
BackgroundResultSalvageable Food Losses from Vermont Farms
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“Studies commonly associate food insecurity with reduced intake of fruits and vegetables (Hanson & Connor, 2014); therefore, strengthened food recovery could enable increased consumption among those in need.”
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“Moreover, recent research has shown that adults in households with children take steps to protect the children against household food shortages by limiting or reducing the quality and quantity of their own meals [18,19].”
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“In many of these studies, food insecurity has been associated with a lower consumption of nutrient-dense foods (8,16,17) and a higher consumption of energy-dense foods of lower nutritional value (8,18) .”
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“Adults in food-insecure households have been observed to skip or reduce their meals to ‘ shield ’ children from the effects of hunger and undernourishment leading to a detrimental effect on the adult ’ s diet quality (26) .”
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BackgroundDiet, Food Insecurity, and CVD Risk in Sexual and Gender Minority Adults
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BackgroundFood Insecurity and Age at Menarche in Tampa Bay, Florida
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“As a result, food insecurity is associated with overweight, obesity, and higher risks for adult-onset diseases (Hadley and Crooks 2012; Hanson and Connor 2014).”
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“However, children in food-insecure households may experience food shortages differently; in some households, parents may shield or protect their children from experiencing food shortages (8).”
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Food Insecurity and Malnutrition
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“Food insecurity is associated with poor nutrition [7,8] and consumption of less fruits and vegetables [8–11].”
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Taylor, C. A., Spees, C., Markwordt, A. M., Watowicz, R. P., Clark, J. K., & Hooker, N. H. (2017) · Journal of Consumer Affairs · doi:10.1111/joca.12166 · Cited by 15
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“In the state of Indiana, SNAP-Ed has been successful at reducing food insecurity in women and families [33,34]; this suggests that SNAP-Ed has the potential to improve diet and health as food insecurity has been directly linked with poor diet quality [35], and suboptimal biomarkers of nutrition status [36,37], and man…”
BackgroundMaterial Hardship and Stress from COVID-19 in Immigrant Chinese American Families with Infants
Duh-Leong, C., Yin, H. S., Yi, S. S., Chen, S. L., Mui, A., Perrin, E. M., Zhao, Q., & Gross, R. S. (2022) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-021-01267-8 · Cited by 14
“Finally, prior evidence has shown that household-level food insecurity does not correlate with child-level food insecurity [36].”
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“, any food insecurity—past 12 months, and dietary recall—last 24 h) [4].”
BackgroundResultInfluentialThe association between food insecurity, diet quality, and untreated caries among US children
Bahanan, L. O., Singhal, A., Zhao, Y., Scott, T. E., & Krall, E. A. (2021) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2021.03.024 · Cited by 14
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Associations of Food Insecurity with Dietary Inflammatory Potential and Risk of Low Muscle Strength
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“A systematic review of 26 previous studies [11] and subsequent large national representative studies in the US [50], Canada [50], Brazil [51], and Korea [34,49] consistently reported that food insecure adults adhere less to a healthy diet and consume fewer vegetables and fruits and less fiber and polyunsaturated fat,…”
BackgroundResultInfluentialMedical Financial Hardship and Food Security among Cancer Survivors in the United States
Hallgren, E., Narcisse, M., Andersen, J. A., Willis, D. E., Thompson, T., Bryant-Smith, G., & McElfish, P. A. (2023) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-22-1044 · Cited by 14
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Food Insecurity in US Military Veterans
Cypel, Y., Katon, J. G., Schure, M. B., & Smith, S. E. (2020) · Food and Nutrition Bulletin · doi:10.1177/0379572120963952 · Cited by 14
Anthropometric Profile of Latin American Population: Results From the ELANS Study
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“This evidence comes from quantitative data that associates FI with decreased dietary diversity and lower nutritional quality [42, 43] as well as qualitative data that explores the experiences of food insecure households.”
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“insecurity and low intake of fruits, vegetables, and dairy, as well as nutrients commonly found in these foods such as calcium, vitamin A, magnesium, and fiber (33).”
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“7,8 Food insecurity may affect children ’ s dietary intake differently depending on age group.”
BackgroundImpacts of Food Insecurity on Child Development: Strengthening the Role of Childcare
Casey, E. G., & Winsler, A. (2025) · Nutrients · doi:10.3390/nu17152427 · Cited by 16
“Food-insecure children are less likely to eat enough of some recommended food groups such as fruits and whole grains [33,34], and more likely to eat added sugars [35].”
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“Research demonstrates that low-income and food-insecure populations are less likely to achieve dietary recommendations compared with more affluent and food-secure populations (9, 10).”
Food Insecurity and Blood Pressure in a Multiethnic Population
Ing, C. T., Clemens, B., Ahn, H. J., Kaholokula, J. K., Hovmand, P. S., Seto, T. B., & Novotny, R. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20136242 · Cited by 14
“Individuals with food insecurity have higher weight and blood pressure compared to those without food insecurity [15,45].”
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“To date, most (systematic) reviews exploring the effects of food insecurity on children’s nutrition have reviewed quantitative studies [14, 26, 27].”
BackgroundFood insecurity and allergic diseases: A call to collective action
Jones, S. M., Anvari, S., Coleman, A. T., Pesek, R. D., Kloepfer, K. M., Perry, T. T., Jefferson, A. A., Doan, D. T., Andres, A., Doderer, M., et al. (2023) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2023.10.019 · Cited by 13
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“A reduction in diet quality commonly follows with the overconsumption of energy-dense, non-nutritious foods, and lower intakeof core foods such as fruits and vegetables, and important nutrients including fibre (13,14) .”
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“Individuals experiencing food insecurity have limited options to obtain food for their family and are more likely to purchase inexpensive and unhealthy food [12–14], thus consuming fewer vegetables, fruits, and dairy products compared to those without food insecurity [15].”
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Changes in Precarious Employment and Health in the United States Amidst the COVID-19 Pandemic
Oddo, V. M., Jones‐Smith, J. C., & Knox, M. A. (2023) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2023.102113 · Cited by 13
“Because food insecurity is correlated with diet quality (Hanson and Connor, 2014) and retrospective dietary recall would not be reliable, we use food insecurity as a proxy indicator of diet quality.”
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“Food insecure adults rely more heavily on energy-dense foods while consuming less fruits, vegetables, and dairy products compared to food secure adults.(3,4) These disparities likely contribute to the higher rates of obesity and nutrition-related chronic disease amongst food insecure individuals.”
BackgroundChild Food Insecurity Is Associated with Energy Intake among Fourth- and Fifth-Grade Girls
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Food insecurity is linked to poorer dietary quality in prebariatric surgery patients
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Distribution of Dietary Risk Factors in Iran: National and Sub-National Burden of Disease
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“The association between food insecurity and lower diet quality is clearer in adults than in children [2], but there is evidence of lower diet quality in children when food insecurity is child-reported [3,4].”
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Effects of water, energy, and food security on household well-being
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Advances in methods for characterising dietary patterns: a scoping review
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“Several socio-demographic characteristics are indicators of systemic health inequity and have been shown to be associated with dietary patterns among populations (61 – 63) .”
Food Insecurity, Physical Activity, and Sedentary Behavior in Middle to Older Adults
Chen, S., Li, Z., Zhang, Y., Chen, S., & Li, W. (2025) · Nutrients · doi:10.3390/nu17061011 · Cited by 14
Food Bank Operations during the COVID-19 Pandemic in Germany
Simmet, A., & Stroebele‐Benschop, N. (2021) · Journal of Hunger & Environmental Nutrition · doi:10.1080/19320248.2021.1943590 · Cited by 11
Food insecurity and food consumption among children who receive federal food assistance
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“Food-insecure individuals had less healthy food, which lowered the amount and frequency of fruit and vegetable consumption [16,17].”
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“…to poor nutritional outcomes and cardiovascular risk factors, including obesity, diabetes and hypertension, which can be largely explained by the relative affordability of energy-dense, low-nutrient foods (Franklin et al., 2012; Gucciardi et al., 2014; Hanson & Connor, 2014; Wells et al., 2020).”
BackgroundAntrum, C. J., Waring, M. E., & Stowers, K. C. (2023) · Discover Food · doi:10.1007/s44187-023-00048-6 · Cited by 11
“Specifically, food insecure adults experienced lower intake of essential micronutrients, such as vitamins A and B-6, zinc, and magnesium [3].”
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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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