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2015 Dietary Guidelines Advisory Committee Systematic Reviews

Systematic Review Question

What is the relationship between household food insecurity (HFI) and measures of dietary intake and body weight?

Conclusion Statement

Limited and inconsistent evidence from studies conducted in adults and children ages three to six years suggests that a positive association may exist between persistent and progressing household food insecurity and higher body weight in older adults, pregnant women and young children. No studies reported a relationship with lower body weight.

2015 DGAC Grade: Limited

Insufficient evidence was available from prospective studies to assess the relationship between household food insecurity and dietary intake.

2015 DGAC Grade: Grade Not Assignable

Technical Abstract

Background

Food insecurity is a leading nutrition-related public health issue that is associated with reduced food intake or hunger because the household lacks money and other resources for food. Food insecurity can compromise nutritional intake, potentially leading to increased risk of chronic diseases.1 In addition, food insecurity may promote anxiety and psychological distress, further affecting the health and well-being of an individual or family.2,3 Household food insecurity is defined as “access to enough food for an active, healthy life. It includes at a minimum (a) the ready availability of nutritionally adequate and safe foods, and (b) an assured ability to acquire acceptable foods in socially acceptable ways.4 The causes of food insecurity are multifactorial and the types of nutrition-related problems resulting from food insecurity are diverse, differing across the life cycle. This review examines the relationship between food insecurity and diet quality and body weight with a focus on prospective cohorts.

Conclusion statement

Limited and inconsistent evidence from studies conducted in adults and children ages three to six years suggests that a positive association may exist between persistent and progressing household food insecurity and higher body weight in older adults, pregnant women and young children. No studies reported a relationship with lower body weight.

2015 DGAC Grade: Limited

Insufficient evidence was available from prospective studies to assess the relationship between household food insecurity and dietary intake.

2015 DGAC Grade: Not assignable

Methods

Literature searches were conducted using PubMed, Embase and Cochrane databases to identify studies published in English in peer-reviewed journals from January 2004 to May 2014. Included studies met the following inclusion and exclusion criteria established a priori to the review: prospective cohort studies; human subjects aged two years and older who were healthy or at elevated chronic disease risk; studies conducted in high or very highly developed countries (Human Development Index 2013); household food insecurity and measures of dietary intake including diet quality, foods, food groups, macronutrient intakes or proportions and measures of obesity, overweight, body mass index (BMI) and measures of weight, growth and body composition including waist circumference, body weight, percent body fat, weightfor-age, length and stature-for-age, weight for stature, BMI-for-age and BMI Z-score. Data from each included article were extracted, and risk of bias was assessed. The evidence was qualitatively synthesized, a conclusion statement was developed and the strength of the evidence (grade) was assessed using pre-established criteria including evaluation of the quality and risk of bias, quantity, consistency, magnitude of effect and generalizability of available evidence.

Findings

  • Among older adults, becoming food insecure during follow-up was positively associated with BMI in one large cohort
  • Among pregnant women, findings were inconsistent with one of two studies, suggesting no association between food insecurity and pregnancy weight gain outcomes. One study found null findings among marginally food secure but greater weight gain, adequacy of weight gain and severe pregravid obesity among foodinsecure women.
  • Among children, findings were inconsistent; however, there was some suggestion of an association between food insecurity and weight status for girls and those who had low birth weight.

Limitations

  • Heterogeneity in populations and methodology used to measure household food insecurity may contribute to mixed findings
  • Use of self-reported outcomes (such as height and weight) in adult studies, rather than investigator measured outcomes, increased risk for responder bias
  • The studies were not consistent in their selection of variables in multivariate analysis, so adjustments could be made to account in a similar fashion for potential confounding
  • Few studies were available with men, adolescent or middle-aged populations and racially diverse samples