Mechanisms underlying food insecurity in the aftermath of climate-related shocks: a systematic review

Food insecurity is prevalent, affecting 1·2 billion people globally in 2021. However, the effects of food insecurity are unequally distributed across populations and climate-related shocks threaten to exacerbate food insecurity and associated health consequences. The mechanisms underlying this exacerbation at the household level are largely unknown. We aimed to synthesise the available evidence on the mechanisms connecting extreme climate events to household-level food insecurity and highlight the research gaps that must be addressed to inform better food security and health policy. For this systematic review, a comprehensive literature search was done by a medical librarian in February, 2021 for articles about food security and climate-related shocks. Relevant publications were identified by searching the following databases with a combination of standardised index terms and keywords: MEDLINE, Embase, CINAHL, GreenFILE, Environment Complete, Web of Science Core Collection, and Global Health. Searches were limited to human studies published in English. Included studies measured food security outcomes using indicators developed by the UN Food and Agricultural Organization (ie, consumption patterns, livelihood change, malnutrition, and mortality) and explained the mechanism behind the household-level or population-level food insecurity. Purely theoretical, modelling, and review studies were excluded. Quality assessment was conducted using the appropriate Joanna Briggs Institute Critical Appraisal Tool. Data were analysed using thematic analysis of the categories of mechanism (interpreted using internationally accepted frameworks), risk and resilience factors, and author policy recommendations. We found a paucity of data with only 18 studies meeting criteria for inclusion out of 337 studies identified for full-text review. All the studies that were included in our analysis showed worse food security outcomes after climate-related shocks. Food availability was the most common mechanism cited (17 studies), although most studies addressed at least one additional mechanism (15 studies). Studies were of mixed methodologies with nuanced discussions of risk and resilience factors, and of policy recommendations. This systematic review shows that there is an incomplete assessment of food security at the household and community level after climate-related shocks in the literature and finds that food availability is the primary mechanism studied. The low number of studies on this topic limits subgroup analysis and generalisability; however, the good quality of the studies allows for important policy recommendations around improving resilience to climate shocks and suggestions for future research including the need for a more granular understanding of mechanisms and feasible adaptation solutions.

Food Security, Access, and Challenges in New Mexico during COVID-19

BACKGROUND

The novel coronavirus disease 2019 (COVID-19) pandemic disrupted food systems and economies across the United States. Public health measures, including stay-at-home orders, led to employment disruptions and food system shocks that increased barriers to food access.

OBJECTIVES

We aimed to examine food insecurity and food access challenges in New Mexico (NM) during the COVID-19 pandemic.

METHODS

A cross-sectional study using a validated survey was conducted in NM in May and June 2020. Adults 18 y and older were recruited through convenience sampling via email, websites, and targeted social media ads from major universities, nongovernmental organizations, state agencies, and media outlets. Survey questions assessed food insecurity and food-related challenges and worry. Bivariate and multivariate logistic regression examined relations between food insecurity and demographic characteristics. z Tests were used to compare the proportions of individuals who responded affirmatively to food challenge and worry questions between food-secure and food-insecure respondents.

RESULTS

A total of 1487 residents participated in the study. Thirty percent of respondents reported experiencing food insecurity and 16% experienced very low food security since the pandemic started. Food insecurity was associated with each of 7 characteristics examined in bivariate logistic regression analyses. Multivariate logistic regression results showed that Hispanic (adjusted OR: 1.70; 95% CI: 1.18, 2.44) and female (adjusted OR: 1.78; 95% CI: 1.09, 2.90) respondents were more likely to experience food insecurity than non-Hispanic white and male respondents. Larger household sizes were associated with higher odds of food insecurity except for those in the lowest and highest income categories. z Tests showed that a higher proportion of food-insecure respondents experienced food-related challenges and worry than food-secure respondents.

CONCLUSIONS

Disparities in food insecurity persisted during the COVID-19 pandemic and food-insecure individuals were more likely to report experiencing food-related challenges and worry. Researchers and policy makers in NM may consider continuing efforts to mitigate food access issues as the pandemic continues.

A Multi-Site Analysis of the Prevalence of Food Insecurity in the United States, before and during the COVID-19 Pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support and identify long-term impacts and needs.

OBJECTIVE

The National Food Access and COVID research Team (NFACT) was formed to assess food security over different US study sites throughout the pandemic, using common instruments and measurements. This study presents results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic.

METHODS

A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA 6-item module. Food security prevalence was analyzed using ANOVA by sampling method to assess statistically significant differences.

RESULTS

Respondents (n = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, compared with before the pandemic. In nearly all study sites, there is a higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but a statistically higher prevalence of food insecurity among high-risk compared with convenience surveys.

CONCLUSIONS

This comprehensive study demonstrates a higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to the survey implementation method.

Emergency medicine physicians' knowledge and perceptions of training, education, and resources in eating disorders

BACKGROUND

Feeding and eating disorders present with a variety of medical complications, some of which may be life-threatening. Emergency Medicine (EM) physicians may interact with patients with eating disorders, however, EM physicians' knowledge and perceptions of resources for treating patients with eating disorders have not been examined. The purpose of this study was to explore previous training/education, perceptions of available resources, and educational needs in treating eating disorders in practicing EM physicians.

METHODS

An investigator-developed survey was used in this cross-sectional pilot study, distributed to EM Residency Program Coordinators in the United States to distribute to EM physicians and residents. The survey assessed EM physicians' previous training and education in treating and diagnosing eating disorders. The primary outcomes assessed were participants' previous training/education in eating disorders, knowledge of local resources for patients, and educational needs on a variety of topics related to adult and adolescent eating disorders. Data were described descriptively and SAS 9.4 was used to analyze data.

RESULTS

Of the 162 participants, just 1.9% completed a rotation on eating disorders during residency. Ninety-three percent were unfamiliar with the American Psychiatric Association's Practice Guideline for the Treatment of Patients with Eating Disorders; 95% were unfamiliar with the publication, "Emergency Department management of patients with eating disorders" by Trent et al. The majority were not aware of resources for patients with eating disorders including community and online support groups, the National Eating Disorders Association, and local treatment programs. At least 50% agreed additional education on 15 of the 19 topics examined would be useful; 85% agreed to wanting education on the assessment of patients with eating disorders in the Emergency Department.

CONCLUSIONS

Most EM physicians lack training in eating disorders and knowledge of resources available for patients post-Emergency Department discharge. EM physicians agree additional education on a number of topics would be beneficial, particularly assessment of eating disorders in the Emergency Department, medical complications of eating disorders, and hospital admission criteria for those with eating disorders.

Implementation Science in Evidence-based Nutrition Practice: Considerations for the Registered Dietitian Nutritionist

Nutrition and dietetics practice should be based on the highest-quality and most recent available evidence. Unfortunately, translating research to day-to-day practice often involves long lag times. Implementation science is an emerging field that evaluates methods that promote uptake of research findings into daily practice. Numerous theories and frameworks have been developed to provide guidance for implementation research and operationalization of recommendations. This paper provides a broad overview of implementation science and highlights frameworks such as the Normalization Process Theory that can be used by registered dietitian nutritionist (RDNs) to encourage systematic uptake of evidence into practice.

Rural-Urban Differences in Baseline Dietary Intake and Physical Activity Levels of Adolescents

INTRODUCTION

Differences in dietary intake and physical activity may explain the higher prevalence of obesity among adolescents living in rural versus urban settings. The objective of this cross-sectional secondary analysis was to compare baseline dietary intake and physical activity of adolescents by rurality.

METHODS

We analyzed data on 940 adolescents who participated in ACTION PAC (Adolescents Committed to Improvement of Nutrition and Physical Activity), an obesity prevention and management intervention trial conducted from 2014 through 2017 in 8 public high schools in the southwestern United States. Dietary intake was assessed with the Block Food Screener, and participants completed an exercise log and wore an accelerometer to provide data on physical activity. We compared data by rural-urban commuting area (RUCA) codes and log population density by using multilevel models, with students nested within zip code and repeated measures for accelerometer analysis.

RESULTS

After adjusting for socioeconomic status and ethnicity, accelerometer data indicated that moderate-to-vigorous physical activity was 8.17 min/d (P = .02) higher and sedentary time was 20.42 min/d (P = .02) lower in moderately urban areas than in the urban reference area. Each 1-unit increase in log population density was associated with higher reported intake of whole grains (0.02 ounce equivalents, P = .03), potatoes (0.01 cup equivalents, P = .02), and added sugar (0.37 tsp, P = .02) after adjusting for socioeconomic status and ethnicity.

CONCLUSION

Differences in reported dietary intake and physical activity level by measures of rurality were small and inconsistent in direction to explain the disparities observed in rural versus urban areas.

Motivational Interviewing to Treat Adolescents With Obesity: A Meta-analysis

CONTEXT

Successful treatment approaches are needed for obesity in adolescents. Motivational interviewing (MI), a counseling approach designed to enhance behavior change, shows promise in promoting healthy lifestyle changes.

OBJECTIVE

Conduct a systematic review of MI for treating overweight and obesity in adolescents and meta-analysis of its effects on anthropometric and cardiometabolic outcomes.

DATA SOURCES

We searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, PsychINFO, Web of Science, Cochrane Library, and Google Scholar from January 1997 to April 2018.

STUDY SELECTION

Four authors reviewed titles, abstracts, and full-text articles.

DATA EXTRACTION

Two authors abstracted data and assessed risk of bias and quality of evidence.

RESULTS

Seventeen studies met inclusion criteria; 11 were included in the meta-analysis. There were nonsignificant effects on reducing BMI (mean difference [MD] -0.27; 95% confidence interval -0.98 to 0.44) and BMI percentile (MD -1.07; confidence interval -3.63 to 1.48) and no discernable effects on BMI z score, waist circumference, glucose, triglycerides, cholesterol, or fasting insulin. Optimal information size necessary for detecting statistically significant MDs was not met for any outcome. Qualitative synthesis suggests MI may improve health-related behaviors, especially when added to complementary interventions.

LIMITATIONS

Small sample sizes, overall moderate risk of bias, and short follow-up periods.

CONCLUSIONS

MI alone does not seem effective for treating overweight and obesity in adolescents, but sample size and study dose, delivery, and duration issues complicate interpretation of the results. Larger, longer duration studies may be needed to properly assess MI for weight management in adolescents.

Nutrition status, bone mass density, and selective serotonin reuptake inhibitors

The association between selective serotonin reuptake inhibitor (SSRI) use and bone mass density (BMD) has been debated. Inadequate diet, which may occur in depressed individuals prescribed SSRIs is also associated with decreased BMD. This study seeks to determine if SSRI use in adults is associated with lower than average BMD while controlling for nutrition related variables. Further, it investigates whether there are potential interactions between micronutrients and SSRI use on BMD. Adults, 655 with an SSRI prescription ≥180 days and 12,372 non-users, were identified in the 2005-2014 National Health and Nutrition Examination Survey (NHANES) data. Survey respondents were propensity score matched on propensity to have an SSRI prescription and compared on femoral neck BMD t-scores. A sub-analysis within SSRI users was conducted to calculate the odds ratio (OR) of having a low (osteopenia or osteoporosis) BMD t-score given SSRI exposure and inadequate daily micronutrient intake. Inadequate daily micronutrient intake was common; over half of SSRI users and non-users had inadequate calcium, vitamin D, and potassium. SSRI use was associated with an absolute reduction of 0.11 in BMD t-score. Inadequate daily vitamin D intake was associated with lower BMD t-scores in both SSRI users and non-users. The interaction of SSRI use and inadequate daily intake of zinc was also associated with low BMD (OR: 1.11, 95% CI: 1.01-1.23). Patient health may be improved by nutritional education, referral to a dietitian, or by micronutrient monitoring by the prescribing physician.

Relationships Between Alanine Aminotransferase, Serum Triglycerides, Body Mass Index and Nonalcoholic Fatty Liver Disease in an Outpatient Pediatric Clinic Population

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in children and adolescents. The goal of this study was to describe the demographic, anthropometric and biochemical data of children and adolescents diagnosed with NAFLD during a seven-year period in an outpatient pediatric clinic in the Southwest region of the US and to evaluate relationships between race, BMI, ALT, triglyceride levels, age and gender with a diagnosis of NAFLD. A retrospective medical record review of patients who attended an outpatient pediatric clinic with a billing diagnosis ICD-9 code of 571.8 was conducted. Forty-one patients met these criteria. The majority was male (74%) Hispanic (32%), Hispanic/Latino (68%) and obese. The small number of patients diagnosed with NAFLD in our study is consistent with previously reported results. Our results indicate that the population of this culturally diverse, high-risk population has significant clinical markers that are indicative of NAFLD.