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. Metaanalysis was performed with DerSimonian-Laird’s random-efect model at 95% confdence intervals
(CIs). The I
2
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 identifed 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 signifcantly high pooled prevalence estimate of key metabolic risk factors
among food-insecure participants at 41.8% (95% CI: 33.2% to 50.8%, I
2 = 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 fndings highlight the
need to address food insecurity as an integral part of diet-sensitive NCDs prevention programmes.
Further, these fndings should guide recommendations on the initiation of food insecurity status.
