Lack of access to adequate nutritious food is a worldwide health challenge – it exists for two thirds of people in low-income countries, and in disadvantaged households in high-income countries, a review of food insecurity's effect on global health has found.
- Up to one in three Australian households feeling the effects of food insecurity
- Inadequate food and essential nutrients from a diverse diet contribute to development of chronic disease – in rich and poor countries
- Poor diet is linked to gut microbiome disruption and liver inflammation, mental health disorders, and poor general health.
- Feast and famine cycle due to availability of seasonal foods and the pay cycle can induce insulin resistance which contributes to several chronic diseases
Published in the prestigious New England Journal of Medicine, the review by Professor Danielle Gallegos, from QUT's School of Exercise and Nutrition Science, said that failure to eat a nutritious diet was increasingly recognised as the largest contributor to the international disease burden.
"While food and nutrition insecurity (FNI) is associated with malnutrition, growth faltering, infections, poor maternal and child health, it also leads to chronic conditions such as diabetes, hypertension and heart disease," Professor Gallegos said.
The UN's Food and Agriculture Organization (FAO) defines food and nutrition security as enough safe and nutritious food for an active and healthy life. The concept includes not only the availability of food but also the ability to have social, physical and economic access.
"During conflict or other emergencies in low-income countries, or poverty in high-income countries, people can have inadequate quantities of food (energy deficits), combined with a lack of important nutrients such as protein, and micronutrients," Professor Gallegos said.
"In these conditions people tend to rely on cheaper, starchy, staple foods (rice, bread, potatoes, and cassava), with fewer high-quality protein sources and foods that supply essential micronutrients necessary for health and well-being.
"In general, people with FNI eat more energy-dense, hyperpalatable (mainly ultra-processed foods high in calories, fat, sugar, and salt, but low in nutrients, fibre, and water) foods and fewer fruits and vegetables."
Professor Gallegos said FNI occurred on a spectrum from marginal where households are worried about putting food on the table, to moderate where they change the quality of what they are eating (filling foods rather than nourishing foods) and then severe when adults and children may skip meals and go hungry.
"FNI contributed to systemic inflammation, abdominal obesity, and an elevated risk of noncommunicable diseases via multiple pathways – nutritional, psychological and behavioural.
"Lack of food and poor diets are linked to gut microbiome disruption and are implicated in liver inflammation, mental health disorders, and poor general health.
"The unpredictability of the cycle of 'feast and famine' – in low-income countries characterised by seasonal variations and in higher-income countries by the pay cycle - may trigger insulin resistance which is a known contributor to many chronic conditions.
"These aspects of food and nutrition insecurity contribute to the worldwide health burden of overweight, obesity and cardiometabolic disease."
"Globally, FNI accounts for:
- almost half of all deaths in children under five, from undernutrition and increased infection susceptibility,
- developmental delay, poor cognitive and academic outcomes, withdrawal and acting out behaviours in children, poor interpersonal skills,
- children being less ready for school with increased need for educational support.
- in adolescents: increased risk of suicidal ideation, mood and anxiety disorders, psychological distress and loneliness.
- premature death, and increased all-cause mortality in adults in all countries
- in low-income countries: increased susceptibility to respiratory-tract infections, diarrheal disease, HIV infection, and tuberculosis; FNI associated with worse outcomes of HIV infection and tuberculosis
- negative weight effects: in low-income countries: underweight among the poorest women; in higher income countries: increase risk of overweight, underweight in women with severe FNI
- non-communicable diseases: metabolic syndrome, coronary artery disease, diabetes, and hypertension, in a dose-dependent manner; chronic pain, restrictive lung disease, asthma, poor dental health, kidney stones, and metabolic dysfunction."
Professor Gallegos is urging all health professionals and services to be proactive in identifying and managing FNI – by asking about it, acting to provide a food safety net and advocating for prevention.
"In Australia the cost-of-living crisis has seen a surge in families experiencing FNI - up to one in three households are feeling the effects," she said.
"Given the impact of FNI on health and health costs, the time to act is now."
Effects of Food and Nutrition Insecurity on Global Health was published in The New England Journal of Medicine.
