Table 1.

Selected characteristics of included studies of adults

Author, year	Study design	Setting	Sample size	Follow-up	Key findings
Overweight/obesity
van der Velde et al.,2020	Cross-sectional	“Deprived” urban area in Netherlands	250	n/a	Food insecurity associated with obesity (OR = 2.51, 95% CI 0.98, 6.48), but not with overweight (OR 1.15, 95% CI 0.46, 2.85)
Castañeda et al. 2019	Cross-sectional	Migrant farm workers in agribusiness areas of Northwest Mexico	146	n/a	Household food insecurity associated with obesity overall (OR 5.18, 95% CI: 1.37,19.58), but association changes sign between women (higher risk) and men (lower risk)
Caspi et al. 2017	Cross-sectional	Boston, MA	828	n/a	Those experiencing food hardship were more likely to be obese (RR 1.17, 95% CI 1.07, 1.29) than those not experiencing food hardship
Ashe and Lapane 2017	Cross-sectional	USA, nationally representative survey of women age ≥ 40 years	4,672	n/a	Food-insecure woman had 1.4 the odds of obesity. (95% CI 1.22, 1.62).
El Zein, et al. 2020	Cross-sectional	College students at 8 US universities	683	n/a	Marginal food security and food insecurity were associated with 3.16 (95% CI: 1.55, 6.46) and 5.13 (95% CI: 2.63, 10.00) greater odds of obesity
Lund et al. 2018	Cross-sectional	Denmark	1,877	n/a	Association between food insecurity and obesity not significant in adjusted models for women or men
Nagata et al. 2019	Cross-sectional	USA, nationally representative survey	14,786	n/a	In young adults (age 24–32 years), food insecurity not associated with obesity in adjusted models (OR 1.12, 95% Cl 0.97, 1.29)
Moradi et al. 2019	Meta-analysis	31 studies from 14 countries	115,993 (across all studies)	n/a	Adults in food-insecure households are more at risk of obesity (OR 1.15, 95% CI 1.06, 1.23). In food-insecure households, women had a higher risk of obesity than men (OR 1.26, 95% CI 1.05, 1.46).
Keenan et al. 2021	Cross-sectional	UK	604	n/a	In structural equation models, food insecurity was indirectly associated with higher BMI via greater distress and eating to cope
Hypertension
Nagata et al. 2019	Cross-sectional	USA, nationally representative survey	14,786	n/a	Food-insecure young adults (aged 24–32) have greater odds of hypertension (1.40, 95% CI 1.14, 1.72) compared with food-secure young adults
Berkowitz et al. 2017	Cross-sectional	USA, nationally representative survey	21,196	n/a	Age-standardized rates of food insecurity are greater in participants with hypertension (14.1% vs. 11.1%, P = 0.0003)
Leung et al. 2020	Cross-sectional	USA, nationally representative sample of older adults	2,048	n/a	Food insecurity not significantly associated with hypertension (40.3% hypertension among food-secure adults vs. 46.7% among food-insecure adults, P = 0.10)
da Silva Miguel et al. 2020	Systematic review	International	n/a	n/a	Direct association between food insecurity and hypertension after adjusting for sociodemographic, economic, and lifestyle characteristics
Diabetes mellitus
Lee et al. 2018	Cross-sectional	USA, nationally representative survey of participants aged 20–39	3,684	n/a	Significantly greater odds of prediabetes/diabetes after adjustment for age, sex, and income (OR 1.36, 95% CI 1.00, 1.85)
Walker et al. 2018	Cross-sectional	Primary care clinics in the Southeast United States	615	n/a	Food insecurity associated with direct pathway to increased hemoglobin A1c (r = 0.66, P = 0.03)
Murillo et al. 2017	Cross-sectional	USA, nationally representative survey	19,048	n/a	Food insecurity associated with pre-diabetes in women (OR 1.62, 95% CI 1.22, 2.16)
Vaccaro and Huffman 2017	Cross-sectional	USA, nationally representative survey of adults aged ≥ 55 years	3,871	n/a	Food-insecure men have lower odds of diabetes in comparison to women (OR: 0.39, 95% CI 0.23, 0.66)
Abdurahman et al. 2018	Meta-analysis of cross-sectional studies	International	55,353,915 (across all included studies)	n/a	Household food insecurity significantly associated with odds of type 2 diabetes (OR 1.27, 95% CI 1.11, 1.42)
Silbert et al. 2018	Narrative review	International	n/a	n/a	Food insecurity associated with increased hypoglycemia risk
Tait et al. 2018	Longitudinal	Ontario, CA	4,739	Median of 11.6 years	Food insecurity associated with increased risk of developing T2D (HR 2.40, 95% CI 1.17, 4.94)
Berkowitz et al. 2018	Longitudinal	Massachusetts	391	Mean of 37 months	Food insecurity associated with greater HbA1c (difference of 0.6 percentage points, 95% CI 0.4, 0.8 percentage points)
Shalowitz et al. 2017	Longitudinal	Multi-site federally qualified health center in Midwestern USA	336	24 months	Food insecurity participants had higher hemoglobin A1c at baseline and difference did not resolve over 2 years of follow-up
Schroeder et al. 2018	Longitudinal	Colorado	2,968	12 months	Association between food insecurity and emergency department visits and hospitalizations not significant after adjustment
Blitstein et al. 2020	Interventional, pre/post	Federally qualified health centers, Midwestern USA	398	6–9 months	Intervention combining food insecurity screening, nutritional education, and assistance with accessing food resources associated with lower hemoglobin A1c (−0.22 percentage points, P = 0.01) post-intervention
Berkowitz et al. 2019	Interventional, crossover RCT	Massachusetts	42	6 months	Healthy Eating Index diet quality score was 71.3 (SD 7.5) while receiving meals and 39.9 (SD 7.8) when not receiving meals (difference 31.4 points, P < 0.0001)
Ferrer et al. 2019	Interventional, RCT	Primary care practice in San Antonio, Texas	43	6 months	Hemoglobin A1c decreased 3.1 percentage points in the intervention group vs. 1.7 percentage points in the control group (P = .01)
Seligman et al. 2018	Interventional, RCT	Food banks in Oakland, CA, Detroit, MI, and Houston, TX	568	6 months	Intervention did not result in decreased hemoglobin A1c (difference between intervention and control group 0.24 percentage points; 95% CI −0.09, 0.58) but did reduce food insecurity (risk ratio 0.85. 95% CI 0.73, 0.98) and increase fruit and vegetable consumption
Coronary heart disease, congestive heart failure, and stroke
Venci and Lee 2018	Cross-sectional	USA, nationally representative survey	30,010	n/a	Very low food security was associated with greater odds of having been diagnosed with coronary heart disease (OR: 1.75, 95% CI: 1.37, 2.24)
Berkowitz et al. 2017	Cross-sectional	USA, nationally representative survey	21,196	n/a	Food insecurity was more prevalent in individuals with coronary heart disease (20.5% vs. 11.9%, P <.001) and congestive heart failure (18.4% vs. 12.1%, P = .004), compared with individual who did not have the condition
Charkhchi et al. 2018	Cross-sectional	Representative sample of 11 US states and 1 US territory	84,353	n/a	History of cardiovascular disease was associated with a greater likelihood of food insecurity (OR 1.75, 95% CI 1.12, 2.73)
Hummel Scott et al. 2018	Interventional, RCT	Michigan and New York, USA	66	3 months	Those who received the meals had greater increases in quality of life than usual care participants (Kansas City Cardiomyopathy Questionnaire Clinical Summary Score increased from a mean of 47 to 65 in the intervention arm vs. 45 to 55 in the control arm; P = 0.053)
Chronic kidney disease
Leung et al. 2020	Cross-sectional	USA, nationally representative sample of older adults	2,048	n/a	Chronic kidney disease was more common in those with food insecurity, compared with those who were not (5.6% vs. 2.0%, P = .005)
Banerjee et al. 2017	Longitudinal	USA, nationally representative survey, adults with household income ≤ 400% of the federal poverty level	12,768	Median of 12 years	Of those with CKD at baseline, those who reported being food insecure were more likely to progress to end-stage renal disease than those who were food secure (relative hazard 1.38, 95% CI 1.08, 3.10)
Crews et al. 2018	Narrative review	International	n/a	n/a	Food insecurity is more prevalent in areas with greater CKD prevalence

RCT, randomized clinical trial; CKD, chronic kidney disease; ESRD, end-stage renal disease; T2D, type 2 diabetes