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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COVID-19 Benefits and Dietary Behaviors Among Mothers From Low-Income, Food-Insecure Households
Molitor, F., & Kehl, S. (2023) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2022.10.009 · Cited by 3
Identifying Nutritional Insecurity Among Families in an Urban Pediatric Practice
Lax, Y., Cullen, D. L., Silver, M. P., & Avner, J. R. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.1709 · Cited by 3
Food Insecurity Moderates Association Between Perceived Fresh Fruit and Vegetable Access and Vegetable Intake in the Rural Southern US
Antonacci, C. C., Hermstad, A. K., Haardörfer, R., & Kegler, M. C. (2023) · Medical Research Archives · doi:10.18103/mra.v11i5.3823 · Cited by 3
Household Food Insecurity and Maternal-Toddler Fruit and Vegetable Dietary Concordance
Duh‐Leong, C., Ortiz, R., Messito, M. J., Katzow, M. W., Kim, C. N., Teli, R., & Gross, R. S. (2023) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2023.10.018 · Cited by 3
The Mental Cost of Food Insecurity among LGBTQ+Americans
Morales, D. X. (2024) · Population Research and Policy Review · doi:10.1007/s11113-024-09881-8 · Cited by 4
“Lesser education is a known risk factor for food insecurity (Hanson & Connor, 2014).”
Reconsidering Household Food Insecurity: Assessing the Impact of Neighborhood and Household Characteristics
Tiwari, S., & Ambinakudige, S. (2024) · Journal of Hunger & Environmental Nutrition · doi:10.1080/19320248.2024.2355938 · Cited by 1
“5,42,43 Another drawback of these studies is the use of response which is a categorical construct of an underlying continuous spectrum of food adequacy.”
Sleep duration, overweight status, and the modifying role of food insecurity in a sample of 10- to 14-year-old Mexican early adolescents
Orta‐Aleman, D., & Laraia, B. A. (2024) · Sleep Health · doi:10.1016/j.sleh.2024.06.005 · Cited by 4
Relationship Between Food Insecurity and Healthy Eating Behavior for Gestational Diabetes Risk Reduction Among American Indian and Alaska Native Adolescent and Young Adult Females: A Qualitative Exploration
STOTZ, S. A., Hebert, L. E., Scarton, L. J., Begay, K., Gonzales, K. L., Garrow, H., Manson, S. M., Sereika, S. M., & Charron-Prochownik, D. (2024) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2024.06.004 · Cited by 4
Food and Housing Insecurity, COVID-19 Pandemic Effects on Health-Related Activities, and Care Plans for Children with Obesity
Egan, K. A., Fiore, J. G., Luo, M., Kelly, S., Adams, W. G., Taveras, E. M., Simione, M., & Kistin, C. J. (2024) · Academic Pediatrics · doi:10.1016/j.acap.2024.10.010 · Cited by 3
Household food insecurity and dental caries in Korean adults
Lee, M. H., Park, J., & Kwon, Y. (2020) · Community Dentistry And Oral Epidemiology · doi:10.1111/cdoe.12541 · Cited by 3
Moving Beyond Giving Free Food: Specific Targeting and Tailoring in Response to Child Food Insecurity
Fram, M. S., & Frongillo, E. A. (2020) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2020.07.024 · Cited by 3
Food Insecurity: Hidden Problems, Real Remedies
Fleegler, E. W., Frank, D. A., & Brett-Fleegler, M. B. (2021) · Springer eBooks · doi:10.1007/978-3-030-65672-0_13 · Cited by 3
Cross-sectional study of food insecurity and medical expenditures by race and ethnicity
Lee, W., Lin, S., Yang, T., & Serag, H. (2022) · Ethnicity and Health · doi:10.1080/13557858.2022.2161090 · Cited by 3
“In return, food insecurity contributes to a higher prevalence of chronic health conditions, despite that some food insecure individuals fully understand the benefit of healthy eating (Garcia, Haddix, and Barnett 2018; Hanson and Connor 2014; Leung et al. 2020).”
Background
Food Security Status and Overweight/Obesity Among 2- to 5-Year-Old Boys and Girls in a Community-Based Clinic
Gipson-Jones, T. L., O’Neal, L. J., Sheats, J. L., Thorpe, R. J., Beech, B. M., & Bruce, M. A. (2019) · Family & Community Health · doi:10.1097/fch.0000000000000218 · Cited by 3
Planting Seeds for Food Is Medicine: Pre-Implementation Planning Methods and Formative Evaluation Findings From a Multi-Clinic Initiative in the Midwest
Wetherill, M. S., Bridges, K. M., Talavera, G. E., Harvey, S. P., Skidmore, B., & Burger, E. S. (2024) · Journal of Primary Care & Community Health · doi:10.1177/21501319241241465 · Cited by 2
Food security among black breast cancer survivors in Maryland: insights from an online pilot study
Tu, Y., Ho, K. L., Dibble, K. E., Visvanathan, K., & Connor, A. E. (2024) · Cancer Causes & Control · doi:10.1007/s10552-024-01899-9 · Cited by 2
“Individuals facing food insecurity often have lower intakes of essential nutrients, as they struggle to access sufficient quantities of vegetables, fruits, and dairy [4].”
Are Remitters at Risk for Lower Food Security and Dietary Quality? An Exploratory Study of Mexican Immigrants in NYC
Cruz-Salazar, D., Hwang, N. S., Chatterjee, S., Derose, K. P., & Flórez, K. R. (2025) · Community Health Equity Research & Policy · doi:10.1177/2752535x251355455 · Cited by 2
“13 Third, our study focuses on Mexican immigrants living in the Bronx Borough of NYC ( “ the Bronx ” ), one of the largest immigration hubs in the US.”
Diabetes management in the context of social needs
Walker, D. M., Swoboda, C. M., Coovert, N., Garner, J. A., Garrity, K., Hefner, J. L., McAlearney, A. S., Bose‐Brill, S., & Joseph, J. J. (2025) · Health Care Management Review · doi:10.1097/hmr.0000000000000453 · Cited by 2
Medically Tailored Grocery Delivery for Food Pantry Clients with Diabetes
Short, E., Li, J., Selig, J. P., Bounds, K. R., Rowland, B., Faitak, B., Lane, J., Solis-Garcia, R., Felix, H. C., Langston, K., et al. (2025) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2025.08.006 · Cited by 3
Dairy foods support healthy dietary patterns and nutrition security in the United States: a nutrient adequacy and affordability perspective
Unger, A. L., Comerford, K. B., Brown, K. A., Lamin-Bangura, K., Slimko, M. L., & Cifelli, C. J. (2025) · Frontiers in Sustainable Food Systems · doi:10.3389/fsufs.2025.1669062 · Cited by 4
Examining Foods and Beverages Served and Child Food Insecurity across Early Care and Education (ECE) Programs in Communities with High Rates of Obesity and Food Insecurity
Srivastava, D., Zheng, L. R., & Dev, D. A. (2022) · Journal of Hunger & Environmental Nutrition · doi:10.1080/19320248.2022.2032897 · Cited by 2
“Food insecure households have shown to consume foods high in energy, fat, and sugar, and low in nutritional value.(3) Nationally, the childhood obesity rate is 13.”
Background
Relationship Between Food Security Status in a Caregiver's Family of Origin and Current Feeding Practices Among Low-Income, Single, Female Primary Caregivers
Lappan, S. N., Harman, T., Pavela, G., & Hendricks, P. S. (2022) · Family & Community Health · doi:10.1097/fch.0000000000000347 · Cited by 2
A community focused approach toward making healthy and affordable daily diet recommendations
Germino, J., Szymanski, A., Eicher‐Miller, H. A., Metoyer, R., & Chawla, N. V. (2023) · Frontiers in Big Data · doi:10.3389/fdata.2023.1086212 · Cited by 2
A Systematic Review of Interventions for Obesity Among Adults With Food Insecurity
Bach, R., Hui, A., & Chao, A. M. (2023) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000001028 · Cited by 2
Food insecurity and childhood outcomes: a cross-sectional analysis of 2016–2020 National Survey of Children’s Health data
Elenwo, C., Fisch, C., Hendrix-Dicken, A., Coffey, S. M., Wetherill, M. S., & Hartwell, M. L. (2024) · Journal of Osteopathic Medicine · doi:10.1515/jom-2024-0016 · Cited by 2
Association between food security status and dietary patterns in a cohort of first-time food-aid users
Teasdale, E., Mercille, G., Roncarolo, F., Riva, M., Sylvestre, M., Blanchet, R., & Potvin, L. (2024) · Canadian Journal of Public Health · doi:10.17269/s41997-024-00932-3 · Cited by 2
“Individuals living in food-insecure households are also at higher risk of having poorer dietary quality than those in food-secure households (Hanson & Connor, 2014), because of limited access to healthy foods (An et al., 2019; Eicher-Miller, 2020).”
Food insufficiency, Supplemental Nutrition Assistance Program status, and variability in weight and body composition: Longitudinal analysis of the National Health and Aging Trends Study Cohort 2012–2021
Na, M., Sliwinski, M. J., & Kris‐Etherton, P. M. (2024) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2024.11.025 · Cited by 2
The relationship between food security, fruit and vegetable consumption, and health-related factors in the late COVID-19 pandemic in Czechia: a cross-sectional study
Ohno, M., Vávra, J., & Jehlička, P. (2025) · BMC Public Health · doi:10.1186/s12889-025-23154-9 · Cited by 2
Enhancing food insecurity screening in pediatric celiac disease using a quality improvement framework
Cheung, T., Setty, M., Riray, E., Green, B., Wadhwani, S. I., & Patel‐Sanchez, N. (2025) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1002/jpn3.70169 · Cited by 2
Associations of diet quality and food security with risks of cardiovascular diseases among people living with HIV: a scoping review
Oyetunji, I. O., Fadipe, Y. W., Duncan, A., & Harbron, J. (2026) · Discover Public Health · doi:10.1186/s12982-026-01602-0 · Cited by 2
“Similar associations have been demonstrated in the general population [20], and global evidence from the FAO further underscores the consistent link between food insecurity and suboptimal dietary patterns [21].”
Living arrangements and food security of a sample of older Palestinian refugees in Lebanon
Sahyoun, N. R., Sassine, A. J., Vaudin, A., Ashour, F. S., & Ghattas, H. (2020) · Journal of Global Health Reports · doi:10.29392/001c.13070 · Cited by 2
Healthy Mondays or Sundays? Weekday Preferences for Healthy Eating and Cooking among a Food Insecure Population in a U.S. Urban Environment
Ali, S. H., Gu, Y., Yan, S., Craig, H. C., Adams, L., Poirier, L., Park, R., Gunen, B., & Gittelsohn, J. (2020) · Journal of Hunger & Environmental Nutrition · doi:10.1080/19320248.2020.1804032 · Cited by 2
Assessing food insecurity
Simon, K., & DeBrew, J. K. (2021) · Nursing · doi:10.1097/01.nurse.0000734036.21689.cd · Cited by 2
Food insecurity and physical functioning in Boston area Puerto Rican older adults
Kuehl, L., Lee, J., Dinesh, D., Na, M., Tucker, K. L., & Palacios, N. (2022) · Public Health Nutrition · doi:10.1017/s1368980022000301 · Cited by 2
“As systematic review examining food insecurity and dietary quality in USA adults has shown that food insecure individuals consume fewer vegetables, fruits and dairy products compared with food secure individuals(10).”
Background
Exploring dimensions of social capital in relation to healthy eating behaviours in the US rural south
Antonacci, C. C., Haardörfer, R., Hermstad, A. K., Mayo‐Gamble, T. L., Arriola, K. J., & Kegler, M. C. (2023) · Public Health Nutrition · doi:10.1017/s1368980023000022 · Cited by 2
“Food insecurity has inversely associated with SC in studies of different populations, including rural adults(4,13), and has associated with lower fruit and vegetable consumption(28) and greater SSB consumption among adults in rural and urban areas(5).”
Food insecurity: addressing a challenging social problem with supply chains and service ecosystems
García-Dastugue, S. J., Garcia-Contreras, R., Stauss, K. A., Milford, T., & Leuschner, R. (2024) · The International Journal of Logistics Management · doi:10.1108/ijlm-03-2023-0113 · Cited by 2
Testing a Biobehavioral Model of Chronic Stress and Weight Gain in Young Children (Family Stress Study): Protocol and Baseline Demographics for a Prospective Observational Study
Pare, S. M., Gunn, E., Morrison, K. M., Miller, A. L., Duncan, A. M., Buchholz, A. C., David, W. L., Tremblay, P. F., Vallis, L. A., Mercer, N. J., et al. (2024) · JMIR Research Protocols · doi:10.2196/48549 · Cited by 2
“While evidence for an association between food insecurity and obesity risk in children has been mixed [45], food insecurity is a prevalent source of stress among families, affecting 1 in 6 Canadian children [46], and has been shown to be associated with poorer diets in children [47].”
WISH4Campus: Evaluating College Food Insecurity and Promoting Solutions for Student Wellbeing
Hagedorn, R. L. (2019) · doi:10.33915/etd.3905 · Cited by 2
Food Insecurity, Cardioprotective Diets, and Mortality Among US AdultsPreprint
Ambrosini, A. P., Fishman, E. S., Mangalesh, S., Babapour, G., Akman, Z., Wang, S. Y., Mahajan, S., Murugiah, K., Haynes, N., Desai, N. R., et al. (2024) · medRxiv · doi:10.1101/2024.05.07.24307023 · Cited by 2

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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