Food insecurity and anaemia risk: a systematic review and meta-analysis

Abstract

Objective: Increasing evidence has suggested an association between food insecurity and the risk of anaemia. Therefore, a systematic review and meta-analysis were performed to examine the associations between food insecurity and anaemia risk.

Setting: Pertinent studies were identified by searching PubMed and EMBASE databases up to August 2017. Data were available from nineteen studies; seventeen studies were cross-sectional and two studies were longitudinal. Risk ratios of 95993 individual participants from twelve different countries in these studies were pooled for the meta-analysis.

Results: The results showed that there was an overall positive relationship between food insecurity and anaemia risk (OR=1·27; 95 % CI 1·13, 1·40). Similar results were observed for Fe-deficiency anaemia (OR=1·45; 95 % CI 1·04, 1·86). These results revealed that food insecurity at two levels, including mild food insecurity (OR=1·15; 95 % CI 1·00, 1·31) and moderate food insecurity (OR=1·36; 95 % CI 1·23, 1·48), increased the risk of anaemia. In addition, it was found that age had an impact on the associations between food insecurity and anaemia risk (OR=1·22; 95 % CI 1·09, 1·36). Age subgroup analysis indicated that food insecurity significantly increased the risk of anaemia among infants/toddlers (OR=1·17; 95 % CI 1·05, 1·29) and adult women (OR=1·35; 95 % CI 1·16, 1·54).

Conclusions: It seems that infants, toddlers and adult women in food-insecure households are at a higher risk of anaemia. To prevent anaemia in food-insecure households, these age groups may require more nutritional support.

Keywords: Anaemia risk; Food insecurity; Meta-analysis; Systematic review.

Fig. 1

(colour online) PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart^{( 58 )} describing the systematic literature search and selection of studies on food insecurity and anaemia risk

Fig. 2

(colour online) Forest plot showing the pooled OR and 95 % CI of the association of food insecurity with anaemia risk in all included studies. The study-specific OR and 95 % CI are represented by the black diamond and horizontal line, respectively; the area of the grey square is proportional to the specific-study weight to the overall meta-analysis. The centre of the open diamond and the vertical dashed line represent the pooled OR, and its width represents the pooled 95 % CI

Fig. 3

(colour online) Forest plots showing the pooled OR and 95 % CI of the association of food insecurity with iron-deficiency anaemia risk. The study-specific OR and 95 % CI are represented by the black diamond and horizontal line, respectively; the area of the grey square is proportional to the specific-study weight to the overall meta-analysis. The centre of the open diamond and the vertical dashed line represent the pooled OR, and its width represents the pooled 95 % CI

Fig. 4

(colour online) Forest plot showing the pooled OR and 95 % CI of the association of specific levels of food insecurity with anaemia risk. The study-specific OR and 95 % CI are represented by the black diamond and horizontal line, respectively; the area of the grey square is proportional to the specific-study weight to the overall meta-analysis. The centre of the open diamond and the vertical dashed line represent the pooled OR, and its width represents the pooled 95 % CI

Fig. 5

(colour online) Forest plot showing the pooled OR and 95 % CI of the association of food insecurity with anaemia risk according to age subgroup. The study-specific OR and 95 % CI are represented by the black diamond and horizontal line, respectively; the area of the grey square is proportional to the specific-study weight to the overall meta-analysis. The centre of the open diamond and the vertical dashed line represent the pooled OR, and its width represents the pooled 95 % CI

Fig. 6

Forest plot showing the pooled OR and 95 % CI of the association of food insecurity with anaemia risk from sensitivity analyses in which the given named study is omitted. Meta-analysis estimates of the pooled OR and 95 % CI with the given named study omitted are represented by the open circle and the dotted horizontal line, respectively; the solid vertical lines (from left to right) represent the lower 95 % CI, the pooled OR and the upper 95 % CI for all included studies

Fig. 7

(colour online) Funnel plot with pseudo 95 % CI (– – –) for evaluation of publication bias in studies () included in the meta-analysis of the association of food insecurity with anaemia risk

Fig. 8

Filled funnel plot with pseudo 95 % CI (– – –) accounting for publication bias in studies (○, included studies; ◘, filled studies) included in the meta-analysis of the association of food insecurity with anaemia risk