Abstract
BackgroundIn previous studies, food insecurity has been hypothesised to promote the prevalence of metabolic risk factors on the causal pathway to diet-sensitive non-communicable diseases (NCDs). This prevalence has been shown to differ between gender and populations. However, evidence of this association in resources-limited settings with high levels of food insecurity such as sub-Saharan African countries remains elusive.PurposeWe aimed to identify the association between food insecurity and key metabolic risk factors on the causal pathway to diet-sensitive NCDs in sub-Saharan African population.MethodsWe did a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Relevant studies published between January 2015 and October 2019 were searched in PubMed, Web of Science (SCiELO Citation Index), and five other databases followed by explicit and reproducible hand-searches of included studies which were peer-reviewed epidemiological studies conducted in sub-Saharan Africa, directly measured food insecurity, and compared food insecurity to a metabolic risk factor outcome. Two reviewers extracted all the necessary data from individual studies independently and employed the Mixed Methods Appraisal Tool (MMAT) – Version 2018 to evaluate the risk of bias. Prevalence estimates from individual studies were pooled using the random-effect model.ResultsThe initial searches yielded 11 803 articles, 22 were eligible for inclusion, presenting data from 26 609 food-insecure participants and 11 545 incident of metabolic risk factor cases. Most studies confirmed an adverse association between food insecurity and key metabolic risk factors for diet-sensitive NCDs. The Meta-analysis showed a significantly high pooled prevalence estimate of key metabolic risk factors at 41.8 per cent (95% CI: 33.2% to 50.8%, I2 = 99.5% p-value < 0.00). The most prevalent type of metabolic risk factors was dyslipidaemia 27.6 per cent (95% CI: 6.5% to 54.9%), hypertension 24.7 per cent (95% CI: 15.6% to 35.1%), and overweight 15.8 per cent (95% CI: 10.6% to 21.7%). Notably, the prevalence estimates of these metabolic risk factors were considerably more frequent in females than males.ConclusionThis study is the first to systematically review or meta-analyse the association between food insecurity and key metabolic risk factors for diet-sensitive non-communicable diseases (NCDs) in sub-Saharan African countries, in order to generate an integrated, evidence-based, comprehensive summary of how key metabolic risk factors are patterned by food insecurity. Further high-quality longitudinal data and mediation analysis are warranted to understand the basis of this findings to support targeted prevention and control strategies for those confronted with food insecurity.PROSPERO registration number: PROSPERO 2019 CRD42019136638
Co-occurrence of risk factors for non-communicable diseases among in-school adolescents in Tanzania: an example of a low-income setting of sub-Saharan Africa for adolescence health policy actions
