School of Health and Related Research, University of Sheffield, Sheffield, UK.
School of Health and Related Research, University of Sheffield, Sheffield, UK.
Lancet. 2023 Nov;402 Suppl 1:S16. doi: 10.1016/S0140-6736(23)02139-6.
Household food insecurity (HHFI) has detrimental impact on child health outcomes. The primary aim of this work was to describe the mechanisms, defined as statistically quantified processes or systems, that explain the association between HHFI and poor child health outcomes. The secondary aim was to identify which child health outcomes were significantly associated with HHFI.
In this rapid review, we included real-world evidence studies in children and adolescents aged 3-24 years, from high-income countries. We searched peer-reviewed literature through the databases Medline, Embase, Web of Science and The Cochrane Library on March 10, 2022, with a 15-year time restriction. Key search terms included "food insecurity", "food poverty", "statistics", "structural equation model*", "regression", "conceptual model*", and "theoretical model*". We identified additional studies by searching citations and references. Papers were selected using pre-defined criteria and non-English Language studies were excluded. We extracted summary data of published studies using the Cochrane data extraction template as a guide. We included a broad range of health outcomes to identify what aspects of health are affected by HHFI, including metabolic risk factors (eg, BMI), conditions (eg, depression), biological processes (eg, sleep) and parent-child interactions (eg, feeding styles). We performed a narrative synthesis, as heterogeneity precluded statistical synthesis. We used the Quality in Prognosis Studies tool to assess the mechanism studies.
We included 70 systematic reviews (six mechanism and 64 association reviews) from the UK, Canada, USA, Australia, and Ireland (including 18 887 mechanism studies and 986 759 association studies). Low-to-moderate bias was detected in mechanism studies, and there was variability in HHFI measures. Maternal depression and parenting stress during childhood played a mechanistic role between HHFI and adolescent depression (b=0·008, 95% CI 0·002-0·016) and anxiety (b=0·012, 0·002-0·026). Maternal stress mediated the association between HHFI and child overweight (odds ratio [OR] 1·79, 0·82-3·92, p<0·01), via restrictive feeding styles (OR 1·81, 1·15-2·85, p=0·010) that had negative impact on diet (p<0·01). Ethnicity, income, employment, and education moderated the relationship between HHFI and child health outcomes (p<0·001).
Two key mechanistic pathways between HHFI and child health outcomes were diet and mental health of both child and parent, which appeared interrelated. Interventions targeting HHFI in children, should consider these pathways alongside sociodemographic factors. A strength of this review was that it was the first literature summary explaining the mechanisms between HHFI and child health, using evidence from high-income countries. A limitation was that HHFI measures were inconsistent between studies and countries, disallowing study comparisons.
University of Sheffield.
家庭食物不安全（HHFI）对儿童健康结果有不利影响。这项工作的主要目的是描述机制，即解释 HHFI 与儿童健康不良结果之间关联的经过统计量化的过程或系统。次要目的是确定哪些儿童健康结果与 HHFI 显著相关。
在本次快速综述中，我们纳入了年龄在 3-24 岁的来自高收入国家的儿童和青少年的真实世界证据研究。我们于 2022 年 3 月 10 日通过 Medline、Embase、Web of Science 和 The Cochrane Library 等数据库检索同行评议文献，并设置了 15 年的时间限制。主要检索词包括“食物不安全”“食物贫困”“统计学”“结构方程模型*”“回归”“概念模型*”和“理论模型*”。我们还通过搜索引文和参考文献来确定其他研究。使用预先定义的标准选择论文，并排除非英语语言的研究。我们使用 Cochrane 数据提取模板提取已发表研究的汇总数据作为指南。我们纳入了广泛的健康结果，以确定 HHFI 影响哪些健康方面，包括代谢风险因素（如 BMI）、疾病（如抑郁）、生物学过程（如睡眠）和亲子互动（如喂养方式）。由于存在异质性，我们进行了叙述性综合，而未进行统计学综合。我们使用预后研究质量工具评估机制研究。
我们纳入了来自英国、加拿大、美国、澳大利亚和爱尔兰的 70 项系统评价（6 项机制研究和 64 项关联研究）（包括 1888 项机制研究和 986759 项关联研究）。机制研究中检测到低至中度偏倚，并且 HHFI 测量存在差异。儿童期母亲抑郁和育儿压力在 HHFI 与青少年抑郁（b=0.008，95%CI 0.002-0.016）和焦虑（b=0.012，0.002-0.026）之间起着机制作用。母亲压力通过限制喂养方式（OR 1.81，1.15-2.85，p=0.010）介导 HHFI 与儿童超重之间的关联，该方式对饮食有负面影响（p<0.01）。种族、收入、就业和教育调节 HHFI 与儿童健康结果之间的关系（p<0.001）。
HHFI 与儿童健康结果之间的两个关键机制途径是儿童和父母的饮食和心理健康，这两者似乎相互关联。针对儿童 HHFI 的干预措施应考虑这些途径以及社会人口因素。本综述的一个优势是，它首次使用来自高收入国家的证据，总结了解释 HHFI 与儿童健康之间关系的机制。一个局限性是研究之间和国家之间的 HHFI 测量不一致，不允许进行研究比较。
谢菲尔德大学。
