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Zelber-Sagi S, Carrieri P, Pericàs JM, Ivancovsky-Wajcman D, Younossi ZM, Lazarus JV. Food inequity and insecurity and MASLD: burden, challenges, and interventions. Nat Rev Gastroenterol Hepatol 2024:10.1038/s41575-024-00959-4. [PMID: 39075288 DOI: 10.1038/s41575-024-00959-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2024] [Indexed: 07/31/2024]
Abstract
Liver disease prevalence, severity, outcomes and hepatic risk factors (for example, unhealthy diet) are heavily affected by socioeconomic status and food insecurity. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver disease globally and is likely to co-occur with other liver diseases associated with food insecurity. Though weight reduction and adopting a healthy diet can reverse the course of MASLD, gaps between recommendations and practice transcend individual responsibility and preference. Broader sociocultural determinants of food choices (social nutrition) include food insecurity, community and social norms and the local environment, including commercial pressures that target people experiencing poverty, ethnic minorities and children. Food insecurity is a barrier to a healthy diet, as a low-quality diet is often less expensive than a healthy one. Consequently, food insecurity is an 'upstream' risk factor for MASLD, advanced fibrosis and greater all-cause mortality among patients with liver disease. Intervening on food insecurity at four major levels (environment, policy, community and health care) can reduce the burden of liver disease, thereby reducing social and health inequities. In this Review, we report on the current research in the field, the need for implementing proven interventions, and the role liver specialists can have.
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Affiliation(s)
- Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
- The Global NASH Council, Washington, DC, USA.
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Juan M Pericàs
- Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institute for Research, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain
- Johns Hopkins University-Pompeu Fabra University Public Policy Center, Barcelona, Spain
| | - Dana Ivancovsky-Wajcman
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Zobair M Younossi
- The Global NASH Council, Washington, DC, USA
- Beatty Liver and Obesity Research Program, Inova Health System, Falls Church, VA, USA
| | - Jeffrey V Lazarus
- The Global NASH Council, Washington, DC, USA
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA
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Arzhang P, Abbasi SH, Sarsangi P, Malekahmadi M, Nikbaf-Shandiz M, Bellissimo N, Azadbakht L. Prevalence of household food insecurity among a healthy Iranian population: A systematic review and meta-analysis. Front Nutr 2022; 9:1006543. [PMID: 36458165 PMCID: PMC9707736 DOI: 10.3389/fnut.2022.1006543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/05/2022] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Food security is a fundamental human right that must be upheld to preserve excellent general welfare, and mental, physical, and social health. However, according to the United Nations Food and Agriculture Organization (FAO) report in 2020, the level of food insecurity in the world is increasing. OBJECTIVE Determining the prevalence of food insecurity in Iran will be beneficial for Iran and other low-middle-income countries. METHODS We searched both English and Persian (Iranian) databases including PubMed, Scopus, Web of Science, Google Scholar, SID, Irandoc, Magiran, Civilica, and Iranian Medical Sciences Theses System from 01 January 1990 to 01 February 2022. Observational studies that reported the prevalence of household food insecurity among a healthy Iranian population and assessed food insecurity at the individual or household level using validated questionnaires were included. RESULTS One hundred six studies and/or theses with a total of 152, 300 participants met the review criteria. Our analyses demonstrated that the prevalence of food insecurity among the healthy Iranian population was 55.9% (95% CI: 52.6-59.2%) and the highest prevalence of food insecurity was in the western regions with 64.8% (95% CI: 57.7-72.0%). Subgroup analyses showed that food insecurity among women at 51.3% (95% CI: 45.1-57.6%) and rural inhabitants at 66.1% (95% CI: 58.8-73.4%) was significantly higher than men at 47.8% (95% CI: 41.8-53.8%) and urban residents at 47.1% (95% CI: 44.1-50.0%), respectively. Among the age groups, the highest prevalence of food insecurity was in adults at 56.5% (95% CI: 51.7-61.2%). CONCLUSION The prevalence of food insecurity in a healthy Iranian population was higher than the global average. Women, rural residents, and residents of the western regions of Iran had a higher prevalence of food insecurity. These groups should be prioritized in programs to reduce the prevalence of food insecurity in Iran. SYSTEMATIC REVIEW REGISTRATION www.crd.york.ac.uk/PROSPERO, identifier: CRD42022328473.
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Affiliation(s)
- Pishva Arzhang
- Qods Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - S. Haniye Abbasi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Peyman Sarsangi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Malekahmadi
- Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Nick Bellissimo
- School of Nutrition, Toronto Metropolitan University, Toronto, ON, Canada
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Okati-Aliabad H, Ansari-Moghaddam A, Kargar S, Jabbari N. Prevalence of Obesity and Overweight among Adults in the Middle East Countries from 2000 to 2020: A Systematic Review and Meta-Analysis. J Obes 2022; 2022:8074837. [PMID: 35154826 PMCID: PMC8831052 DOI: 10.1155/2022/8074837] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obesity has become a significant public health issue worldwide, and it is a major risk factor for many noncommunicable diseases. This systematic review aimed to identify the prevalence of obesity and overweight in the Middle East region and different countries in this region. MATERIALS AND METHODS PubMed, Google Scholar, and MEDLINE databases were searched from 2000-2020 to identify relevant studies in the Middle East area. The survey was carried out using combinations of Medical Subject Headings (Mesh) keywords like "body mass index", "obesity", "overweight", "prevalence", "Middle-East", and "Countries in the Middle East area". Analysis of the data was done using STATA-14, and a random-effects model was used to estimate the pooled prevalence. RESULTS A total of 101 studies with 698905 participants have been identified that met inclusion criteria for this meta-analysis. The pooled estimates of the prevalence of obesity and overweight in the Middle East area were 21.17 (95% CI: 17.05-26.29) and 33.14 (95% CI: 26.87-40.87), respectively. The findings showed that obesity prevalence increased with age so that the highest prevalence of obesity and overweight was observed in people >40 years old. Obesity prevalence in the Middle East area remained steady between 2000-2006 and 2014-2020 (23%). During these time intervals, the prevalence of overweight decreased from 34.83 (95% CI: 32.40-37.45) to 32.85 (95% CI: 31.39-34.38). CONCLUSIONS Despite the relative stabilization of the overweight and obesity trend in the Middle East, current interventions to combat the overweight epidemic need to be maintained and strengthened because the prevalence of overweight and obesity in this region is still very high. The prevalence of obesity increases with age so that people over 40 have the highest percentage of obesity and overweight. Therefore, implementing intervention programs to prevent and control obesity and overweight in the Middle East is essential.
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Affiliation(s)
- Hassan Okati-Aliabad
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Shiva Kargar
- MSc of Epidemiology, Gerash University of Medical Sciences, Gerash, Iran
| | - Neda Jabbari
- Department of Environment Health Engineering, School of Health, Zahedan University of Medical Sciences, Zahedan, Iran
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Tutunchi H, Saghafi-Asl M, Ebrahimi-Mameghani M, Ostadrahimi A. Food Insecurity and Lipid Profile Abnormalities Are Associated with an Increased Risk of Nonalcoholic Fatty Liver Disease (NAFLD): A Case-Control Study. Ecol Food Nutr 2021; 60:508-524. [PMID: 33573415 DOI: 10.1080/03670244.2021.1875453] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This case-control study aimed to assess the relationship between food insecurity, its related risk factors and NAFLD among 210 subjects. The demographic and socioeconomic characteristics, anthropometric indices, and food insecurity and depression status were assessed. The prevalence of food insecurity was 56.8% and 26.1% in cases and controls (p < .001), respectively. The chance of NAFLD in the food insecure, depressed, overweight, and obese subjects was 2.2 (95%CI: 1.12-3.43), 1.9 (95%CI: 1.02-3.62), 2.6 (95%CI: 1.81-3.92), and 2.9 (95%CI: 2.02-5.34) times higher than food secured, normal, and normal weight subjects, respectively. A higher waist circumference (men, OR = 2.9, p < .001; women, OR = 2.6, p < .001), a high waist-to-hip ratio (men, OR = 2.3, p < .001; women, OR = 2.7, p < .001), an increased waist-to-height ratio (OR = 2.9, p < .001), and a higher body fat percentage (men, OR = 3.0, p < .001; women, OR = 3.3, p < .001) were associated with an increased risk of NAFLD. The odds of NAFLD increased by increment in serum triglyceride (TG) levels (OR = 2.6, p < .001) and decreased by increase in serum high-density lipoprotein cholesterol (HDL-C) (OR = 0.34, p < .001). Compared to controls, patients with NAFLD were more likely to have higher TG/HDL-C ratio (OR = 3.3, p < .001). It seems food insecurity was an important risk factor for NAFLD. Additionally, some indicators of dyslipidemia significantly increased the risk of NAFLD.
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Affiliation(s)
- Helda Tutunchi
- Student Research Committee, Nutrition Research Center, School of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Saghafi-Asl
- Nutrition Research Center, School of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrangiz Ebrahimi-Mameghani
- Social Determinant of Health Research Center, School of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, School of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Is Food Insecurity Associated With Iron Deficiency Anemia and Vitamin D Deficiency Among Women of Reproductive Age? TOP CLIN NUTR 2020. [DOI: 10.1097/tin.0000000000000218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pérez W, Contreras M, Peña R, Zelaya E, Persson LÅ, Källestål C. Food insecurity and self-rated health in rural Nicaraguan women of reproductive age: a cross-sectional study. Int J Equity Health 2018; 17:146. [PMID: 30227875 PMCID: PMC6145199 DOI: 10.1186/s12939-018-0854-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/31/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Access to food is a basic necessity, and food insecurity may impair the individual's well-being and health. Self-rated health measurements have frequently been used to assess population health. Little is known, however, as to whether food security is associated with self-rated health in low- and middle-income settings. This study aims at analyzing the association between food security and self-rated health among non-pregnant women of reproductive age in a rural Nicaraguan setting. METHODS Data was taken from the 2014 update of a health and demographic surveillance system in the municipalities of Los Cuatro Santos in northwestern Nicaragua. Fieldworkers interviewed women about their self-rated health using a 5-point Likert scale. Food insecurity was assessed by the household food insecurity access (HFIAS) scale. A multilevel Poisson random-intercept model was used to calculate the prevalence ratio. RESULTS The survey included 5866 women. In total, 89% were food insecure, and 48% had poor self-rated health. Food insecurity was associated with poor self-rated health, and remained so after adjustment for potential confounders and accounting for community dependency. CONCLUSION In this Nicaraguan resource-limited setting, there was an association between food insecurity and poor self-rated health. Food insecurity is a facet of poverty and measures an important missing capability directly related to health.
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Affiliation(s)
- Wilton Pérez
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Mariela Contreras
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Rodolfo Peña
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Pan American Health Organization, Tegucigalpa, Honduras
| | - Elmer Zelaya
- Asociación para el Desarrollo Económico y Social de El Espino (APRODESE), Cinco Pinos, Nicaragua
| | - Lars-Åke Persson
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Carina Källestål
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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Moradi S, Mirzababaei A, Dadfarma A, Rezaei S, Mohammadi H, Jannat B, Mirzaei K. Food insecurity and adult weight abnormality risk: a systematic review and meta-analysis. Eur J Nutr 2018; 58:45-61. [PMID: 30219965 DOI: 10.1007/s00394-018-1819-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/11/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE Research into the relationship between food insecurity and weight abnormality has yielded varied and contradictory results. Therefore, a systematic review and meta-analysis were carried out to examine the association between food insecurity and weight abnormality in adults. METHODS Pertinent studies were identified by searching PubMed and Scopus databases, up to February 2018. Data were available from 31 studies. These studies were conducted in 14 different countries. The odds ratio of 115,993 individuals in these studies was pooled for the meta-analysis. RESULTS The present meta-analysis showed that adults in food-insecure households are more at risk of obesity (OR 1.15, 95% CI 1.06-1.23). Subgroup analysis by gender also revealed that women had a higher risk of obesity compared to men in food-insecure households (OR 1.26, 95% CI 1.05-1.46). Furthermore, subgroup analysis by food insecurity level implied that a severe level of household food insecurity may be associated with a higher risk of underweight (49%) than overweight (37%) or obesity (29%) among adults. In addition, subgroup analysis revealed that with lower levels of national economic development, the risk of weight abnormality shifted from obesity to underweight. CONCLUSION It seems that adults in food-insecure households, especially women, are at higher risk of obesity. The weight abnormality risk may increase with the intensification of the level of food insecurity. Also, the level of economic development is an important factor in the effects of food insecurity on weight status. However, due to the high heterogeneity among studies, the results should be interpreted with caution.
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Affiliation(s)
- Sajjad Moradi
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Halal Research Center of IRI, FDA, Tehran, Iran
| | - Atieh Mirzababaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran
| | - Alireza Dadfarma
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Shahabeddin Rezaei
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Students Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran.
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Is Food Insecurity Associated With Lipid Profile and Atherogenic Indices in Iranian Adults? A Population-Based Study. TOP CLIN NUTR 2018. [DOI: 10.1097/tin.0000000000000124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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