Food insecurity and hypertension: A systematic review and meta-analysis

Abstract

Background Food insecurity (FIS) is an important public health issue associated with cardiovascular risk. Given the association of FIS with diets of poorer nutritional quality and higher salt intake as well as chronic stress, numerous studies have explored the link between FIS and hypertension. However, no systematic review or meta-analysis has yet to integrate or analyze the existing literature. Methods We performed a wide and inclusive search of peer-reviewed quantitative data exploring FIS and hypertension. A broad-terms, systematic search of the literature was conducted in PubMed, Embase, Scopus, and Web of Science for all English-language, human studies containing primary data on the relationship between FIS and hypertension. Patient population characteristics, study size, and method to explore hypertension were extracted from each study. Effect sizes including odds ratios and standardized mean differences were extracted or calculated based on studies’ primary data. Comparable studies were combined by the random effects model for meta-analyses along with assessment of heterogeneity and publication bias. Results A total of 36 studies were included in the final analyses. The studies were combined into different subgroups for meta-analyses as there were important differences in patient population characteristics, methodology to assess hypertension, and choice of effect size reporting (or calculability from primary data). For adults, there were no significantly increased odds of elevated blood pressures for food insecure individuals in studies where researchers measured the blood pressures: OR = 0.91 [95%CI: 0.79, 1.04; n = 29,781; Q(df = 6) = 7.6; I2 = 21%]. This remained true upon analysis of studies which adjusted for subject BMI. Similarly, in studies for which the standardized mean difference was calculable, there was no significant difference in measured blood pressures between food secure and FIS individuals: g = 0.00 [95%CI: -0.04, 0.05; n = 12,122; Q(df = 4) = 3.6; I2 = 0%]. As for retrospective studies that inspected medical records for diagnosis of hypertension, there were no significantly increased odds of hypertension in food insecure adults: OR = 1.11 [95%CI: 0.86, 1.42; n = 2,887; Q(df = 2) = 0.7; I2 = 0%]. In contrast, there was a significant association between food insecurity and self-reports of previous diagnoses of hypertension: 1.46 [95%CI: 1.13, 1.88; n = 127,467; Q(df = 7) = 235; I2 = 97%]. Only five pediatric studies were identified which together showed a significant association between FIS and hypertension: OR = 1.44 [95%CI: 1.16, 1.79; n = 19,038; Q(df = 4) = 5.7; I2 = 30%]. However, the small number of pediatric studies were not sufficient for subgroup meta-analyses based on individual study methodologies. Discussion In this systematic review and meta-analysis, an association was found between adult FIS and self-reported hypertension, but not with hypertension determined by blood pressure measurement or chart review. Further, while there is evidence of an association between FIS and hypertension among pediatric subjects, the limited number of studies precluded a deeper analysis of this association. These data highlight the need for more rigorous and longitudinal investigations of the relationship between FIS and hypertension in adult and pediatric populations.

Food insecurity, type 2 diabetes, and hyperglycaemia: A systematic review and meta‐analysis

“…SMD metaanalyses found no significant differences in FBG or HbA1c levels between food insecure and food secure adults. Instead, similar to a prior review by the authors, 22 this study demonstrated that FIS is specifically associated with increased self-reported T2DM among adults. For paediatric patients, SMD meta-analysis found no significant difference in HbA1c levels between paediatric patients with and without FIS.…”

“…Second, the majority of the studies cited involved a self-reported diagnosis (rather than a clinically determined one), a confounding factor identified in other meta-analyses related to FIS, 22 The findings of our review also contrast with two additional recent systematic reviews by da Silva Miguel et al 87 and Vazquez et al 88 , both of which were identified during the review process and concluded that FIS is associated with T2DM. However, we note that (a) neither study included meta-analyses; (b) these reviews did not distinguish between self-reported versus clinically determined T2DM; and (c) Vazquez et al relied heavily upon the findings of Abdurahman et al in making their conclusions, without the addition of other available data.…”

“…Among the 46 adult studies included in this systematic review, 18 studies (Table S1) contained primary data on the association between FIS and self-reported T2DM (combined n = 182,542). [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] Given previously noted differences in results for studies measuring self-reported versus clinically determined chronic disease among food insecure patients, 22 these 18 studies were analysed separately from studies which involved clinical diagnoses of T2DM.…”

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

“…However, no meta-analysis was performed, and some of these studies used self-reported dyslipidemia. A recent review by Beltran et al 57 showed that most studies in the USA that indicate a correlation between food insecurity and hypertension correspond to self-reporting of conditions. They stated that a likely anxiety connection complicates the relationship between self-reported metabolic risk factors and food insecurity (since anxiety is also increased in food-insecure patients) 58 .…”

Diet, Food Insecurity, and CVD Risk in Sexual and Gender Minority Adults

“…In 2019, an estimated one in ten people were exposed to severe food insecurity worldwide [ 40 ]. Further, findings from systematic reviews indicate that food insecurity is associated with a higher risk for incident hypertension, type 2 diabetes, and CVD, as well as greater cardiovascular mortality [ 41 – 45 ]. Certain groups of SGM adults, including lesbian women and bisexual and transgender adults, have higher rates of poverty compared to their non-SGM counterparts, which may increase their risk for food insecurity [ 46 , 47 ].…”