Cited by 660Food Security and Health in Diverse PopulationsNutritional Studies and DietObesity, Physical Activity, Diet

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Food insecurity and dietary quality in US adults and children: a systematic review

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Hanson, Karla L, Connor, Leah M·2014·The American Journal of Clinical Nutrition

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Abstract

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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Food Insecurity and Adequacy of Dietary Intake in Youth and Young Adults With Youth-Onset Type 1 and Type 2 Diabetes
Bercaw, H., Reid, L. A., Mendoza, J. A., Frongillo, E. A., Sauder, K. A., Reboussin, B. A., Mayer‐Davis, E. J., Dabelea, D., Marcovina, S. M., Mercado, C. I., et al. (2023) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2023.03.013 · Cited by 8
The Special Supplemental Nutrition Program for Women, Infants, and Children Fresh Start Randomized Controlled Trial: Baseline Participant Characteristics and Reliability of Measures
Noia, J. D., Monica, D., Gray, H. L., & Cullen, K. W. (2016) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2016.07.020 · Cited by 7
“More than half (55%) were food insecure, a factor adversely associated with dietary quality in adults, particularly nutrientrich F/V intakes.(48) Despite their young age, WFS participants had a higher mean age than did WIC participants nationwide, a finding that may reflect larger demographic trends.”
Background
Food insecurity and dietary intake by Supplemental Nutrition Assistance Program participation status among mainland US Puerto Rican adults after the 2009 American Recovery and Reinvestment Act
McClain, A. C., Tucker, K. L., Falcón, L. M., & Mattei, J. (2019) · Public Health Nutrition · doi:10.1017/s1368980019002209 · Cited by 7
“security and diet(15), we defined a binary food security sta-”
Background
Medical Mistrust Among Food Insecure Individuals in Appalachia
Thomas, M. K., Amstutz, C., Orr-Roderick, D., Horter, J., & Holben, D. H. (2023) · Family & Community Health · doi:10.1097/fch.0000000000000362 · Cited by 6
Diet quality, diet-related factors and disability status among male adults of reproductive age in the USA
Deierlein, A. L., Litvak, J., Liu, C., & Stein, C. R. (2023) · Public Health Nutrition · doi:10.1017/s1368980023001222 · Cited by 6
“…study, low diet quality scores among males with disabilities may be at least partially attributed to greater prevalence of food insecurity, participation in government food assistance programmes and consumption of fast foods, all of which have been associated with lower diet quality (31 – 33) .”
Background
Across-Agency Partnerships and Within-Agency Capacities Facilitate Holistic, Tailored Approaches to Addressing Food Insecurity: A Qualitative Study
Morales, L., Yowell, L., Molina, T., Smith, C. E., Arizcuren, J., & McClain, A. C. (2023) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2023.07.024 · Cited by 8
Food insecurity and risk of nutrition insecurity among Supplemental Nutrition Assistance Program participants in Rhode Island and Connecticut, USA
Oddo, V. M., Leider, J., Tovar, A., Powell, L. M., Elenio, E. G., & Vadiveloo, M. K. (2025) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2025.103002 · Cited by 6
The Association Between Food Insecurity and Adverse Health Outcomes in Adults: An Umbrella Review of Systematic Reviews and Meta-Analyses
Moosavian, S. P., Awlqadr, F. H., Mehrabani, S., Mazinani, K., Hosseini, M. S., Hodder, S., Ghoreishy, S. M., Jalili, F., Kermani, M. A. H., & Moradi, S. (2025) · Nutrition Reviews · doi:10.1093/nutrit/nuaf136 · Cited by 8
Diet quality among Indigenous and non-Indigenous children and youth in Canada in 2004 and 2015: a repeated cross-sectional design
Riediger, N. D., LaPlante, J., Mudryj, A., & Clair, L. (2021) · Public Health Nutrition · doi:10.1017/s1368980021002561 · Cited by 11
Depressive symptoms among adults is associated with decreased food security
Meshkat, S., Pang, H. Y. M., Tassone, V. K., Janssen‐Aguilar, R., Wu, M., Jung, H. J., Lou, W. Y. W., & Bhat, V. (2024) · PLoS ONE · doi:10.1371/journal.pone.0303345 · Cited by 6
Enhancing Healthcare Professionals’ Culinary Skills, Food Management, Counseling Confidence, and Mediterranean Diet Adherence Through a Culinary Medicine Boot Camp: A Pilot Implementation Program (PIP)
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“43 Numerous studies among adults have indicated that food insecurity is linked to poor dietary quality, 44,45 diabetes 46 and obesity among others.”
Comparative analysis of European Union countries based on selected aspects of food security
Matejková, E., Májek, M., Qineti, A., & Sojková, Z. (2024) · Agricultural Economics (Zemědělská ekonomika) · doi:10.17221/16/2024-agricecon · Cited by 6
Household food insecurity and novel complementary feeding methods in New Zealand families
Katiforis, I., Smith, C. E. L., Haszard, J. J., Styles, S. E., Leong, C. S.-F., Taylor, R. W., Conlon, C. A., Beck, K. L., von Hurst, P. R., Morenga, L. T., et al. (2024) · Maternal and Child Nutrition · doi:10.1111/mcn.13715 · Cited by 6
“It is a serious public health problem with potential wide ‐ ranging impacts on children including poorer diet quality (Hanson & Connor, 2014; Hutchinson & Tarasuk, 2022), delays in child development, behavioural and emotional problems, and negative impacts on academic performance (Gallegos et al.,…”
Flavonoid intake according to food security in Korean adults: Based on the Korea National Health and Nutrition Examination Survey 2007~2012
Jun, S., Hong, E.-J., & Joung, H. (2015) · Journal of Nutrition and Health · doi:10.4163/jnh.2015.48.6.507 · Cited by 6
Impact of COVID-19 stress on food insecurity and fruit and vegetable consumption among college students
Levy, T. M., Williams, R. D., Odum, M., Housman, J. M., & McDonald, J. D. (2022) · Journal of American College Health · doi:10.1080/07448481.2022.2098033 · Cited by 8
COVID-19 epidemic lockdown-induced remarkable decrease in dairy products consumption of Iran population: does it really matter? National Food and Nutrition Surveillance
Nikooyeh, B., Rabiei, S., Amini‎, M., Ghodsi, D., Rasekhi, H., Doustmohammadian, A., Abdollahi, Z., Minaie, M., Sadeghi, F., & Neyestani, T. R. (2022) · BMC Nutrition · doi:10.1186/s40795-022-00612-w · Cited by 6
“Food insecurity has adverse effects on dietary quality with consequent lower intake of nutrient-dense foods including dairy products [19].”
Background
Qualitative Research on the Perceptions of Factors Influencing Diet and Eating Behaviors Among Primarily Latinx Seventh-Grade Students
Masek, E., Gonzalvez, A., Rankin, L., Vega‐Luna, B., Valdez, H. J., Hartmann, L., Lorenzo, E., Bruening, M. M., Marsiglia, F. F., Harthun, M. L., et al. (2023) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2023.02.009 · Cited by 8
An integrated approach to address diabetes in the context of food insecurity: Delivering health study protocol
Short, E., Gannon, M. A., Bounds, K. R., Faitak, B., Martin, P., Moore, S., Shannon, D., Selig, J. P., English, E. S., Felix, H. C., et al. (2023) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2023.101139 · Cited by 6
Associations between Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Maternal Diet Quality
Herrera, Y. M., Tovar, A., Oaks, B. M., Quashie, N. T., & Vadiveloo, M. K. (2023) · Journal of Nutrition · doi:10.1016/j.tjnut.2023.08.021 · Cited by 12
Food insecurity is associated with muscle dysmorphia symptomatology among a sample of Canadian adolescents and young adults
Ganson, K. T., Pang, N., Testa, A. M., Jackson, D. B., & Nagata, J. M. (2023) · Body Image · doi:10.1016/j.bodyim.2023.101628 · Cited by 7
A Formative Evaluation of an Online Meal Kit and Grocery Platform for Supplemental Nutrition Assistance Program Recipients
Chiong, R., Salas, J. F., Kohn, J., John, E. S., & Figueroa, R. (2023) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2023.10.016 · Cited by 9
The Development, Implementation, and Evaluation of Innovative Strategies to Reduce Food Insecurity among Children in the United States
Burke, M. P., Singh, A. P., Berman, D., & Law, K. (2020) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2020.10.025 · Cited by 6
“Of particular concern is when food insecurity occurs in households with children, as it is associated with lower fruit consumption, iron-deficient anemia, lower learning and social development, and mental health disorders.(1-4) In 2018, among households with children and incomes <185% of the federal poverty level, the…”
Background
Food security and adherence to the Mediterranean diet: An interplay of socio-demographic characteristics
Grammatikopoulou, M. G., Gkiouras, K., Tranidou, A., & Goulis, D. G. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-818649-7.00008-4 · Cited by 6
Farmers’ Market Nutrition Program Educational Events Are Broadly Accepted and May Increase Knowledge, Self-Efficacy and Behavioral Intentions
Hanson, K. L., Meng, X., Volpe, L. C., Pitts, S. J., Bravo, Y., Tiffany, J. S., & Seguin‐Fowler, R. A. (2022) · Nutrients · doi:10.3390/nu14030436 · Cited by 6
“Consumption of FV is even lower among adults in low-income [6] and food insecure households [7].”
BackgroundSelf-citation
Investigating the mediating role of physical activity within the association between food insecurity and BMI
Gough, T., Brown, O., Christiansen, P., Hardman, C. A., & Keenan, G. S. (2024) · Appetite · doi:10.1016/j.appet.2024.107724 · Cited by 5
Association of household food insecurity with diet quality in a nationally representative sample of United States toddlers: a cross-sectional study
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Socio-economic status, food security and adherence to the Mediterranean diet in five Mediterranean countries: the DELICIOUS project
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“Factors strictly related to food security or insecurity, such as diet quality and the intake of specific food groups, have been previously analysed (Hanson and Connor 2014; Litton and Beavers 2021).”
Associations between socioeconomic status, dietary habits and health-related quality of life among children in rural riverside communities: the mediation role of food insecurity
Pereira, L. D. L., Herkrath, F. J., Siqueira, J. H., Leal, M. D. C., de Abreu, F. M., Lopes, A. F., & Vettore, M. V. (2026) · Quality of Life Research · doi:10.1007/s11136-025-04137-0 · Cited by 5
“A previous review suggested that food insecurity itself leads to lower food availability [44].”
Universal Screening of Hunger, Tiredness, and Sickness: Implications for Kindergarten Readiness and Racial/Ethnic Disparities
Steyer, L., Townley-Flores, C., Sulik, M. J., & Obradović, J. (2022) · Early Education and Development · doi:10.1080/10409289.2022.2067430 · Cited by 6
“The distinction between HFI and child hunger is an important one: Children living in food-insecure households may not themselves experience hunger due to caregivers’ efforts to shield them from HFI’s direct effects (Hanson & Connor, 2014).”
Background
Sociocultural Considerations for Food-Related Quality of Life in Inflammatory Bowel Disease
Aswani-Omprakash, T., & Shah, N. D. (2022) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2022.07.013 · Cited by 5
Translational science approaches for food insecurity research
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The Role of Food Security in Mediterranean Diet Adherence Among Adolescents: Findings from the EHDLA Study
Aquino-Blanco, A., Jiménez‐López, E., Victoria‐Montesinos, D., Gutiérrez‐Espinoza, H., Arancibia, J. E. O., Sepulveda, R. A. Y., Martín‐Calvo, N., & López‐Gil, J. F. (2025) · Foods · doi:10.3390/foods14030414 · Cited by 5
Nutritional adequacy of charitable food aid packages to the needs of different household-types: a case study in Spain
Álvarez, E. C., Muñoz-Martínez, J., Cussó-Parcerisas, I., Linares, I. P., Casucci, M., & Günes, K. (2025) · BMC Nutrition · doi:10.1186/s40795-025-01122-1 · Cited by 5
Relationships of food security with skeletal muscle mass and handgrip strength by sex
Lee, K. (2022) · Nutrition · doi:10.1016/j.nut.2022.111746 · Cited by 5
A Randomized Intervention of Supplemental Nutrition Assistance Program–Education Did Not Improve Dietary Outcomes Except for Vitamin D Among Lower-Income Women in Indiana
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Food insecurity, poor dietary intake and a lack of free meal uptake amongst 16–17‐year‐old college students in the northeast of England, UK
Graham, P., Haskell‐Ramsay, C. F., Fothergill, M. A., & Young, J. (2022) · Children & Society · doi:10.1111/chso.12623 · Cited by 6
Food insecurity, body mass index, socio-economic status, and food intake in lactating and non-lactating mothers with children under two years
Rajabzadeh-Dehkordi, M., Mohammadi‐Nasrabadi, F., Nouri, M., Ahmadi, A., & Faghih, S. (2023) · BMC Nutrition · doi:10.1186/s40795-023-00718-9 · Cited by 5
“Food insecurity is adversely associated with dietary quality in US adults, particularly intakes of nutrient-rich vegetables, fruit, and dairy that promote good health [34].”
Background
The Association of Supplemental Nutrition Assistance Program Participation and Food Insufficiency among Households with Children in the United States during COVID-19
Li, Y., Zhang, S., Wang, L., Lu, G., Pfeiffer, R. M., & Zou, Z. (2023) · Journal of Nutrition · doi:10.1016/j.tjnut.2023.08.020 · Cited by 5

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)
DOI: 10.3945/ajcn.114.084525
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 3122 d)
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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Food insecurity and dietary quality in US adults and children: a systematic review

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