Food insecurity and pediatric malnutrition related to under- and overweight in the United States: An evidence analysis center systematic review

Authors: SPOEDE, ELIZABETH - Texas Children'S Hospital; CORKINS, MARK - University Of Tennessee; SPEAR, BONNIE - University Of Alabama; BECKER, PATRICIA - Academy Of Nutrition And Dietetics; GUNNELL BELLINI, SARAH - Brigham Young University; Hoy, M Katherine; PIEMONTE, TAMI - Academy Of Nutrition And Dietetics; ROZGA, MARY - Academy Of Nutrition And Dietetics

Submitted to: Journal of the Academy of Nutrition and Dietetics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/10/2020
Publication Date: 5/10/2020
Citation: Spoede, E., Corkins, M., Spear, B., Becker, P., Gunnell Bellini, S., Hoy, M.K., Piemonte, T.A., Rozga, M. 2020. Food insecurity and pediatric malnutrition related to under- and overweight in the United States: An evidence analysis center systematic review. Journal of the Academy of Nutrition and Dietetics. https://doi.org/10.1016/j.jand.2020.03.009.
DOI: https://doi.org/10.1016/j.jand.2020.03.009

Interpretive Summary: Food insecurity has been associated with poor health outcomes, and children in households that are food-insecure are at increased risk of being in poor general health. It may be important to include food insecurity in nutrition screening as a risk factor for malnutrition. A review of studies published between January 2002 through November 2017 was conducted to examine the association between childhood food insecurity and malnutrition related to undernutrition and overnutrition. Relevant articles were identified and the quality of the evidence was graded. Studies differed in how food insecurity was determined, how weight and body composition were measured, and what settings and populations were studied. Results from large cross-sectional studies suggested there was a relationship between food insecurity and overweight. However, findings among studies were not consistent and varied according to sub-populations. There were no clear relationships between food insecurity and malnutrition that warrant incorporating food security as a factor in nutrition screening. However, food insecurity should be considered on an individual basis during nutrition assessment.

Technical Abstract: Food insecurity has been associated with poor health outcomes. Children in households that are food-insecure are at increased risk of being in poor general health. Therefore, it may be important to evaluate food insecurity during nutrition screening. Studies that have examined the association between childhood food insecurity and malnutrition related to undernutrition and overnutrition are inconsistent. To determine the association between food insecurity and risk of malnutrition related to undernutrition or overnutrition (defined by anthropometrics) in the pediatric population in the United States, a systemic review of the literature was done. A literature search was conducted using Medline, Embase and CINAHL databases for studies that addressed the research objective and were published from January 2002 through November 2017 in the English language. Articles were screened for relevance, data was extracted and summarized, and evidence quality was graded. Included studies were heterogeneous in regards to tools used to assess food insecurity, anthropometric measures, settings and populations examined. While large, cross-sectional studies suggest a potential positive relationship between food insecurity and overweight or obesity status, these findings were not consistent throughout the literature, and findings differentially varied according to sub-populations examined. Based on a systematic review, there was no clear relationships between food insecurity and malnutrition that warrant incorporating food insecurity as a factor in nutrition screening. However, because of the mixed and complex relationships elucidated, food insecurity should be considered on an individual basis during nutrition assessment.