Summary of findings 5. Food and nutrition subsidies compared to no intervention for food security.

Food and nutrition subsidies compared to no intervention for food security
Patient or population: primary schools and households and members of healthcare plan Setting: urban and rural settings in LMICs Intervention: food and nutrition subsidies Comparison: no intervention
Outcomes	Impact	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Prevalence of undernourishment	—	—	—	0 included studies reported this outcome.
Proportion of household expenditure on food assessed with: ratio of healthy to total food expenditure follow‐up: 28 months	1 study reported that food rebates of 10% improved the ratio of healthy, to total food expenditure	169,485 households (1 prospective controlled study)	⊕⊝⊝⊝ Very lowa,b	The evidence is very uncertain about the effects of food rebates on household expenditure on healthy foods.
Food security	—	—	—	0 included studies reported this outcome.
Dietary diversity	1 study reported a clear effect favouring nutrition subsidies.	656 children (1 RCT)	⊕⊕⊝⊝ Lowc,d	Nutrition subsidies may improve dietary diversity among school children
Stunting	—	—	—	0 included studies reported this outcome.
Wasting	—	—	—	0 included studies reported this outcome.
Cognitive function and development	—	—	—	0 included studies reported this outcome.
LMIC: low‐ and middle‐income country; RCT: randomised controlled trial.
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

^aDowngraded one level for risk of bias: high risk of selection bias due to disparate baseline expenditure on healthy food as a ratio of total expenditure between households in the intervention and control group.
^bDowngraded one level for indirectness: results are from a single study that assessed food rebates at a supermarket in South Africa. The population was restricted to members of the health insurance company's program, who are usually healthier and wealthier in general. Effects in other populations may differ.

cDowngraded one level for indirectness: results are from a single study that assessed the effects of providing nutrition subsidies to schools. Subsidies to individuals or households may have different effects.
^dDowngraded one level for risk of bias: study was at high overall risk of bias due to attrition bias.