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Showing content from https://pubmed.ncbi.nlm.nih.gov/35977189 below:

Interventions to Address Food Insecurity Among Adults in Canada and the US: A Systematic Review and Meta-analysis

Meta-Analysis

. 2021 Aug 6;2(8):e212001. doi: 10.1001/jamahealthforum.2021.2001. eCollection 2021 Aug. Interventions to Address Food Insecurity Among Adults in Canada and the US: A Systematic Review and Meta-analysis

Affiliations

¹ Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.
² David Geffen School of Medicine, University of California, Los Angeles.
³ National Clinician Scholars Program, University of California, Los Angeles.
⁴ RAND Corporation, Southern California Evidence-based Practice Center, Santa Monica, California.
⁵ Humana Inc, Louisville, Kentucky.

PMID: 35977189
PMCID: PMC8796981
DOI: 10.1001/jamahealthforum.2021.2001

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Meta-Analysis

Interventions to Address Food Insecurity Among Adults in Canada and the US: A Systematic Review and Meta-analysis

Carlos Irwin A Oronce et al. JAMA Health Forum. 2021.

. 2021 Aug 6;2(8):e212001. doi: 10.1001/jamahealthforum.2021.2001. eCollection 2021 Aug. Affiliations

¹ Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.
² David Geffen School of Medicine, University of California, Los Angeles.
³ National Clinician Scholars Program, University of California, Los Angeles.
⁴ RAND Corporation, Southern California Evidence-based Practice Center, Santa Monica, California.
⁵ Humana Inc, Louisville, Kentucky.

PMID: 35977189
PMCID: PMC8796981
DOI: 10.1001/jamahealthforum.2021.2001

Item in Clipboard

Abstract

Importance: Inadequate access to food is a risk factor for poor health and the effectiveness of federal programs targeting food insecurity, such as the Supplemental Nutrition Assistance Program (SNAP), are well-documented. The associations between other types of interventions to provide adequate food access and food insecurity status, health outcomes, and health care utilization, however, are unclear.

Objective: To review evidence on the association between food insecurity interventions and food insecurity status, clinically-relevant health outcomes, and health care utilization among adults, excluding SNAP.

Data sources: A systematic search for English-language literature was performed in PubMed Central and Cochrane Trials databases (inception to January 23, 2020), the Social Interventions Research and Evaluation Network database (December 10, 2019); and the gray literature using Google (February 1, 2021).

Study selection: Studies of any design that assessed the association between food insecurity interventions for adult participants and food insecurity status, health outcomes, and health care utilization were screened for inclusion. Studies of interventions that described addressing participants' food needs or reporting food insecurity as an outcome were included. Interventions were categorized as home-delivered food, food offered at a secondary site, monetary assistance in the form of subsidies or income supplements, food desert interventions, and miscellaneous.

Data extraction and synthesis: Data extraction was performed independently by 3 reviewers. Study quality was assessed using the Cochrane Risk of Bias Tool, the ROBINS-I (Risk of Bias in Non-Randomized Studies of Interventions) tool, and a modified version of the National Institutes of Health's Quality Assessment Tool for Before-After Studies With No Control. The certainty of evidence was based on GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria and supplemented with mechanistic and parallel evidence. For outcomes within intervention categories with at least 3 studies, random effects meta-analysis was performed.

Main outcomes and measures: Food insecurity (measured through surveys; eg, the 2-item Hunger Vital Sign), health outcomes (eg, hemoglobin A_1c), and health care utilization (eg, hospitalizations, costs).

Results: A total of 39 studies comprising 170 605 participants were included (8 randomized clinical trials and 31 observational studies). Of these, 14 studies provided high-certainty evidence of an association between offering food and reduced food insecurity (pooled random effects; adjusted odds ratio, 0.53; 95% CI, 0.33-0.67). Ten studies provided moderate-certainty evidence of an association between offering monetary assistance and reduced food insecurity (pooled random effects; adjusted odds ratio, 0.64; 95% CI, 0.49-0.84). There were fewer studies of the associations between interventions and health outcomes or health care utilization, and the evidence in these areas was of low or very low certainty that any food insecurity interventions were associated with changes in either.

Conclusions and relevance: This systematic review with meta-analysis found that providing food and monetary assistance was associated with improved food insecurity measures; however, whether it translated to better health outcomes or reduced health care utilization was unclear.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Oronce reports support from the Veterans Affairs Office of Academic Affiliations through the National Clinician Scholars Program, during the conduct of the study. No other disclosures were reported.

Figures
Figure 1.. PRISMA Flow Diagram of Study…

Figure 1.. PRISMA Flow Diagram of Study Selection

^a After deduplication. ^b Not mutually exclusive.…

Figure 1.. PRISMA Flow Diagram of Study Selection

^a After deduplication. ^b Not mutually exclusive. Exclusion terminology: metrics refers to how food insecurity was measured; out-of-scope studies were those of hospitalized patient populations, indigenous populations in Canada, or populations that were non-Canada/US; linkage refers to screening and referral with the outcome being how many patients completed the referral process; blended SDOH were interventions addressing multiple social determinants with no separate outcome for food insecurity; healthy eating defines interventions and/or primary outcomes that promote healthy eating; SDOH denotes the Social Determinants of Health; SIREN, Social Interventions Research and Evaluation Network database; and SNAP, Supplemental Nutrition Assistance Program.

Figure 2.. Association Between Food Insecurity and…

Figure 2.. Association Between Food Insecurity and Intervention Type, by Study ^a

Odds ratios indicate the…

Figure 2.. Association Between Food Insecurity and Intervention Type, by Study^a

Odds ratios indicate the difference in the odds of being food insecure in the intervention vs the control group. The diamond marker indicates the pooled estimate and 95% CI for each type of intervention; RCT denotes randomized clinical trial. ^a The study by Aiyer et al was an outlier and was not included in the pooled analysis.

Figure 3.. Association Between Food Insecurity Interventions…

Figure 3.. Association Between Food Insecurity Interventions and Health Outcomes by Study

SMD indicates standardized…

Figure 3.. Association Between Food Insecurity Interventions and Health Outcomes by Study

SMD indicates standardized mean difference for each outcome. The diamond markers indicate pooled estimates and 95% CIs for each health outcome. I² indicates the I² statistic, and higher I² values (closer to 100%) indicate greater study heterogeneity. BMI, denotes body mass index (calculated as weight in kilograms divided by height in meters squared); RCT, randomized clinical trial; HbA_1c, hemoglobin A_1c; and HRQOL, health-related quality of life.