Relationship of food insecurity to women's dietary outcomes: a systematic review

Abstract

Context: Food insecurity matters for women's nutrition and health.

Objective: This review sought to comprehensively evaluate how food insecurity relates to a full range of dietary outcomes (food groups, total energy, macronutrients, micronutrients, and overall dietary quality) among adult women living in Canada and the United States.

Data sources: Peer-reviewed databases (PubMed/MEDLINE, CINAHL, Scopus, Web of Science) and gray literature sources from 1995 to 2016 were searched.

Data extraction: Observational studies were used to calculate a percentage difference in dietary intake for food-insecure and food-secure groups.

Results: Of the 24 included studies, the majority found food-insecure women had lower food group frequencies (dairy, total fruits and vegetables, total grains, and meats/meat alternatives) and intakes of macro- and micronutrients relative to food-secure women. Methodological quality varied. Among high-quality studies, food insecurity was negatively associated with dairy, fruits and vegetables, grains, meats/meats alternatives, protein, total fat, calcium, iron, magnesium, vitamins A and C, and folate.

Conclusions: Results hold practical relevance for selecting nutritional targets in programs, particularly for nutrient-rich foods with iron and folate, which are more important for women's health.

Figure 1

Flow diagram of the literature search process. This figure was based on PRISMA example. Database searching included PubMed/MEDLINE, CINAHL, Scopus and ISI Web of Science, and we located additional references in the gray literature. The exact PubMed/MEDLINE search strategy was: “(women[mh] OR women[tiab] OR woman[tiab]) AND (diet[mh] OR dietary intake[tw] OR dietary intake[tiab] OR diet quality[tiab]) AND (hunger[mh] OR hunger[tiab] OR food supply[mh] OR food access[tiab] OR household food availability[tiab] OR food insecurity[tiab] OR food security[tiab] OR food insecure[tiab] OR food secure[tiab]).” All studies (n=2471) were screened using the title and abstract. During screening, we excluded studies that were not related to the topic, the population, or not written in English. Ninety references were potentially related and reviewed more carefully using the full-text of the research paper or report. Twenty-four research studies were eligible for this review and included in the final set of studies. Each included study reported a different number of associations with dietary outcomes. For example, there were seven studies reporting the association with dairy. Abbreviations: AHEI, Alternative Healthy Eating Index; HEI, Healthy Eating Index; DQI-P, Diet Quality Index for Pregnancy; PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses