The Association Between Food Insecurity and Adverse Health Outcomes in Children and Adolescents: An Umbrella Review

Abstract

This umbrella review examined the certainty and validity of available meta-analyses for the association between food insecurity (FI) and adverse health outcomes (AHOs) in children and adolescents. A comprehensive systematic search was conducted using three databases: PubMed/MEDLINE, Web of Science, and Scopus, until August 20, 2024. Effect sizes were recalculated using random effects models. The GRADE tool assessed evidence certainty, while AMSTAR-2 and the Newcastle-Ottawa Scale evaluated study quality. Twelve meta-analyses comprising of 108 pooled analyses (557,700 individuals) were included in this umbrella review. Food insecurity was found to be significantly associated with the increased risk of several AHOs in children and adolescents: anemia (OR: 1.50, 95 CI: 1.23 to 1.82; moderate certainty), obesity (OR: 1.16, 95 CI: 1.06 to 1.27; moderate certainty), stunting (OR: 1.12, 95 CI: 1.05 to 1.19; moderate certainty), and dental caries (OR: 1.70, 95 CI: 1.43 to 2.03; low certainty). Regarding mental health in children and adolescents, FI was found to be associated with an increased risk of suicidal ideation (OR: 1.08, 95 CI: 1.01 to 1.16; moderate certainty) and suicide plans (OR: 1.32, 95 CI: 1.14 to 1.54; moderate certainty). Further, there was found to be an increased risk in developmental outcomes (OR: 1.32, 95 CI: 1.10 to 1.59; moderate certainty) and externalizing behaviors (OR: 1.25, 95 CI: 1.08 to 1.44; low certainty). A protective association was observed for cognitive/math development disorders (OR: 0.84, 95 CI: 0.73 to 0.96; low certainty), which may be attributed to methodological limitations, though this finding requires further investigation. Food insecurity was shown to be associated with multiple AHOs in children and adolescents, with moderate to low certainty evidence. Findings should be interpreted cautiously due to substantial heterogeneity and the inclusion of low-quality meta-analyses. The observed heterogeneity and methodological limitations of the included meta-analyses suggest cautious application in designing prevention programs, particularly in designing evidence-informed nutritional and lifestyle interventions.