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

Sphamandla Josias Nkambule,Desmond Kuupiel,Indres Moodley,Tivani P Mashamba-Thompson

doi:10.1038/s41598-021-84344-0

Sphamandla Josias Nkambule, Desmond Kuupiel + Show 2 more

Open Access

https://doi.org/10.1038/s41598-021-84344-0

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Abstract

In previous studies, food insecurity has been hypothesised to promote the prevalence of metabolic risk factors on the causal pathway to diet-sensitive non-communicable diseases (NCDs). This systematic review and meta-analysis aimed to determine the associations between food insecurity and key metabolic risk factors on the causal pathway to diet-sensitive NCDs and estimate the prevalence of key metabolic risk factors among the food-insecure patients in sub-Saharan Africa. This study was guided by the Centre for Reviews and Dissemination (CRD) guidelines for undertaking systematic reviews in healthcare. The following databases were searched for relevant literature: PubMed, EBSCOhost (CINAHL with full text, Health Source - Nursing, MedLine). Epidemiological studies published between January 2015 and June 2019, assessing the associations between food insecurity and metabolic risk outcomes in sub-Saharan African populations, were selected for inclusion. Meta-analysis was performed with DerSimonian-Laird’s random-effect model at 95% confidence intervals (CIs). The I2 statistics reported the degree of heterogeneity between studies. Publication bias was assessed by visual inspection of the funnel plots for asymmetry, and sensitivity analyses were performed to assess the meta-analysis results’ stability. The Mixed Methods Appraisal Tool (MMAT) – Version 2018 was used to appraise included studies critically. The initial searches yielded 11,803 articles, 22 cross-sectional studies were eligible for inclusion, presenting data from 26,609 (46.8% males) food-insecure participants, with 11,545 (42.1% males) reported prevalence of metabolic risk factors. Of the 22 included studies, we identified strong evidence of an adverse association between food insecurity and key metabolic risk factors for diet-sensitive NCDs, based on 20 studies. The meta-analysis showed a significantly high pooled prevalence estimate of key metabolic risk factors among food-insecure participants at 41.8% (95% CI: 33.2% to 50.8%, I2 = 99.5% p-value < 0.00) derived from 14 studies. The most prevalent type of metabolic risk factors was dyslipidaemia 27.6% (95% CI: 6.5% to 54.9%), hypertension 24.7% (95% CI: 15.6% to 35.1%), and overweight 15.8% (95% CI: 10.6% to 21.7%). Notably, the prevalence estimates of these metabolic risk factors were considerably more frequent in females than males. In this systematic review and meta-analysis, exposure to food insecurity was adversely associated with a wide spectrum of key metabolic risk factors, such as obesity, dyslipidaemia, hypertension, underweight, and overweight. These findings highlight the need to address food insecurity as an integral part of diet-sensitive NCDs prevention programmes. Further, these findings should guide recommendations on the initiation of food insecurity status screening and treatment in clinical settings as a basic, cost-effective tool in the practice of preventive medicine in sub-Saharan Africa.PROSPERO registration number: PROSPERO 2019 CRD42019136638.

Highlights

In this meta-analysis, we extracted and used measures of associations that were the most adjusted for one or more sets of potential confounders such as socio-demographic and lifestyle factors only to reduce confounding and measurement errors, ensure consistency across studies and reduce bias
The systematic review revealed evidence on the associations between food insecurity and specific key metabolic risk factors on the causal pathway to diet-sensitive non-communicable diseases (NCDs). These metabolic risk factors are dyslipidaemia, underweight, left ventricular mass, obesity, hypertension, acute respiratory infections (ARI), and overweight observed in children (00–14 years), youths (15–24 years), adults (25–64 years), and senior (≥ 65 years) participants, pooled across sub-Saharan African countries
Notwithstanding the inconsistencies of results across studies examining the associations between food insecurity and key metabolic risk factors; the random-effect meta-analytic component of the current review provides the opportunity to present estimates of the prevalence of the spectrum of metabolic risk factors associated with food insecurity after identifying these metabolic risk factors among the food insecure population in sub-Saharan Africa

Summary

Introduction

In this meta-analysis, we extracted and used measures of associations that were the most adjusted for one or more sets of potential confounders such as socio-demographic and lifestyle factors only to reduce confounding and measurement errors, ensure consistency across studies and reduce bias. For more detail, missing details or inconsistencies, the authors of the included studies were contacted by e-mail, if any, with up to three attempts. The studies concerned were excluded after three unsuccessful attempts to contact the author

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Conclusion