Clarifying the Association Between Food Insecurity and Chronic Disease: Why Methods Matter

PURPOSE OF REVIEW: Food insecurity (FIS), limited or uncertain access to adequate, nutritious food, is frequently cited as associated with various chronic health conditions. With the goal of determining how these data might influence public policy and/or clinical practice, this narrative review synthesizes methodological insights from prior systematic reviews and more recent studies to critically examine the associations between FIS and the conditions of depression, anxiety, hypertension, diabetes, and dyslipidemia. RECENT FINDINGS: Numerous studies, including meta-analyses, have found that individuals screening positive for FIS are also significantly more likely to screen positive for depression or anxiety using validated tools for establishing these conditions. In contrast, the associations between FIS and cardiometabolic conditions such as hypertension, diabetes and dyslipidemia have been inconsistent, with rigorous meta-analyses failing to demonstrate strong associations of FIS with these conditions. These variations in findings reflect the use of self-reported disease diagnosis in contrast to measurement of blood pressure or disease biomarkers to indicate disease presence/activity; regional/geographic differences in the populations studied; and potential confounding by other conditions. While there is consistent evidence for associations of depression and anxiety with FIS, the associations between FIS and cardiometabolic diseases are complex and much less clear. In furthering our understanding of these associations and their implications for policy and clinical care, future studies should (i) emphasize measurable indicators of disease presence/activity over self-reports of disease; (ii) give greater attention to regional and population heterogeneity to better contextualize the data; (iii) more consistently account for key covariates in cross-sectional and longitudinal studies; and (iv) assess respondents' overall health-related worry or somatic symptom burden, when self-reports are used as indicators of disease.