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Background: The association between food insecurity (FI) and obesity is now so well documented that scholars have dubbed it the “‘new’ food insecurity” and cited it as a leading cause of increased chronic disease (CD) risk. Here, the chain of causality is assumed to be FI → obesity → CD. However, this model overlooks the possible direct associations between FI and CD independent of obesity. Aim: This study assessed the literature on relationships between FI and CD. Methods: We conducted a systematic literature review of electronic databases. Selection criteria were designed to elicit studies that assessed FI and CD using a measure of CD other than obesity. Results: Fifty-one articles met the inclusion criteria. Forty-five studies (87%) reported a statistically significant association between FI and CD, but only 15 adjusted for obesity. The association was less consistent for asthma and dyslipidemia than for diabetes, hypertension, and other dietrelated CDs, and most were conducted in the USA or Canada. Conclusion: There is a body of literature documenting relationships between FI and CD, but it is heavily biased toward Western nations, ecological study designs, and type 2 diabetes as the CD of focus. A small subset of the literature controls for BMI, demonstrating that a portion of the FI-CD relationship cannot be fully explained by obesity. Possible direct pathways linking FI and CD include systematic effects of poverty that accompanies FI, micronutrient deficiencies, and environmental exposure to toxins; however, exploration of these alternative pathways is limited by study designs that fail to include obesity as a control variable.

A Systematic Review of the Literature on the Relationships between Chronic Diseases and Food Insecurity