Association between food insecurity and key metabolic risk factors for diet-sensitive non-communicable diseases in sub-Saharan Africa: a systematic review and meta-analysis

Abstract

In previous studies, food insecurity has been hypothesised to promote the prevalence of metabolic risk factors on the causal pathway to diet-sensitive non-communicable diseases (NCDs). This systematic review and meta-analysis aimed to determine the associations between food insecurity and key metabolic risk factors on the causal pathway to diet-sensitive NCDs and estimate the prevalence of key metabolic risk factors among the food-insecure patients in sub-Saharan Africa. This study was guided by the Centre for Reviews and Dissemination (CRD) guidelines for undertaking systematic reviews in healthcare. The following databases were searched for relevant literature: PubMed, EBSCOhost (CINAHL with full text, Health Source - Nursing, MedLine). Epidemiological studies published between January 2015 and June 2019, assessing the associations between food insecurity and metabolic risk outcomes in sub-Saharan African populations, were selected for inclusion. Meta-analysis was performed with DerSimonian-Laird’s random-effect model at 95% confidence intervals (CIs). The I2 statistics reported the degree of heterogeneity between studies. Publication bias was assessed by visual inspection of the funnel plots for asymmetry, and sensitivity analyses were performed to assess the meta-analysis results’ stability. The Mixed Methods Appraisal Tool (MMAT) – Version 2018 was used to appraise included studies critically. The initial searches yielded 11,803 articles, 22 cross-sectional studies were eligible for inclusion, presenting data from 26,609 (46.8% males) food-insecure participants, with 11,545 (42.1% males) reported prevalence of metabolic risk factors. Of the 22 included studies, we identified strong evidence of an adverse association between food insecurity and key metabolic risk factors for diet-sensitive NCDs, based on 20 studies. The meta-analysis showed a significantly high pooled prevalence estimate of key metabolic risk factors among food-insecure participants at 41.8% (95% CI: 33.2% to 50.8%, I2 = 99.5% p-value < 0.00) derived from 14 studies. The most prevalent type of metabolic risk factors was dyslipidaemia 27.6% (95% CI: 6.5% to 54.9%), hypertension 24.7% (95% CI: 15.6% to 35.1%), and overweight 15.8% (95% CI: 10.6% to 21.7%). Notably, the prevalence estimates of these metabolic risk factors were considerably more frequent in females than males. In this systematic review and meta-analysis, exposure to food insecurity was adversely associated with a wide spectrum of key metabolic risk factors, such as obesity, dyslipidaemia, hypertension, underweight, and overweight. These findings highlight the need to address food insecurity as an integral part of diet-sensitive NCDs prevention programmes. Further, these findings should guide recommendations on the initiation of food insecurity status screening and treatment in clinical settings as a basic, cost-effective tool in the practice of preventive medicine in sub-Saharan Africa.PROSPERO registration number: PROSPERO 2019 CRD42019136638.

The prevalence of overweight/obesity and its association with household food insecurity among women living with HIV in rural Eswatini

“…While the prevalence of overweight is comparable to those reported in previous studies, the rates of obesity in our study were slightly higher than those reported among women in the general population of Eswatini [ 4 ]. The high rates of overweight/obesity observed among women living with HIV in our study are alarming, particularly due to their association with increased risk of NR-NCDs [ 2 , 9 , 10 , 24 ]. Furthermore, our findings show significantly higher rates of overweight/obesity among women who perceived themselves as being in good health.…”

“…Among studies in sub-Saharan Africa, household food insecurity has been adversely associated with an increased prevalence of multiple metabolic risk factors including overweight, obesity, dyslipidemia, and hypertension [ 24 ]. The impact of food insecurity on food choices, dietary intake, and nutritional status has long been recognized [ 21 , 45 , 46 ].…”

“…Potential mechanisms explaining the association between food insecurity and increased rates of overweight/obesity in our study may include the following: 1) an increase in consumption of diets comprised of high calorie foods in rural households (e.g. processed grains, fats/oil, and sugars) [ 1 , 24 , 27 ], 2) chronic periods of inadequate dietary intake/hunger combined with compensatory overconsumption of high calorie foods, potentially triggering the thrifty phenotype phenomenon among our study population [ 47 ], and 3) changes in dietary patterns as a result of nutrition transition with increased access to and availability of processed/calorie dense foods in these communities [ 1 , 48 ].…”

“…The purpose of the review was to assess associations between FIS and key metabolic risk factors among food-insecure individuals in the region. While findings from this review indicated positive associations between FIS and overweight, in the studies they reviewed, the authors observed a plethora of inconsistencies among previous studies, and noted the need for further research of the association between FIS and overweight in this region [ 24 ].…”

Indigenous Community-Led Programs to Address Food and Water Security: Protocol for a Systematic Review

“…Poor nutrition is a major risk factor for diet-related noncommunicable diseases (NCDs) [ 8 , 9 ]. Food insecurity is associated with worsening nutrition and increased NCDs [ 10 ]. Increased frequency of extreme weather events as a result of climate change, and more recent crisis events, including the current COVID-19 pandemic, have affected food and water security [ 2 , 11 ].…”