P1443 - Food Insecurity and Digestive Diseases: A Systematic Review

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Katelyn Madigan, MD

Wake Forest Baptist Health
Winston-Salem, NC, United States

Katelyn Madigan, MD¹, Megan Carlin, BS², Sarah Cantrell, MLIS, AHIP³, Deepak Palakshappa, MD, MSHP⁴, David Leiman, MD, MSHP⁵
¹Wake Forest Baptist Health, Winston-Salem, NC; ²Duke Health, Durham, NC; ³Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, NC; ⁴Wake Forest University School of Medicine, Winston-Salem, NC; ⁵Duke Clinical Research Institute, Durham, NC

Introduction: Food insecurity (FI), the lack of consistent access to enough food for an active and healthy life, is widely prevalent globally and in the United States, and the incidence of FI has increased due to the COVID-19 pandemic. Previous studies have demonstrated the negative impact FI has on health outcomes, but few studies have examined the relationship between FI and gastrointestinal (GI) diseases. Therefore, we performed a systematic review to explore the relationship between FI and GI disorders worldwide.

Methods: The Embase (via Elsevier), Web of Science (via Clarivate), and PubMed/MEDLINE electronic databases were searched from inception through February 2021 for studies examining a relationship between FI and non-hepatic GI diseases. Additional studies were identified through bibliography review (Figure 1). Non-English studies and those without a comparison group were excluded. Studies not using a validated FI measure and those published before 1995, when the Household Food Security Survey Module was developed, also were excluded. The Newcastle-Ottawa Scale was used to assess study quality.

Results: The search strategy yielded 1931 studies and 12 (0.6%), of which 8 were from the US, were included in the systematic review (Table 1). Overall, the studies showed an association between FI and GI diseases. There were no clinical trials or studies that assessed a causative role of FI on GI diseases, though one longitudinal study showed an association between the presence of FI and heartburn (OR 4.56; 95% CI 1.45-14.3) among pregnant women. Six studies (3 cross-sectional, 2 cohort, and 1 case-control) demonstrated a relationship between FI and GI cancers, though causation could not be determined. The presence of FI was associated with an increase in the risk of diarrheal illnesses in children and FI was associated with an increased risk (OR 1.69; 95% 1.15, 2.49) of inflammatory bowel disease (IBD) as well as increased medication non-adherence compared to those without IBD.

Discussion: Despite the increasing incidence of FI and recognition of its impact on disease outcomes, we identified few studies that have examined the relationship between FI and GI diseases. Our systematic review reveals that while significant associations between FI and GI diseases exist, the apparent literature gap provides an opportunity for future work to investigate this problem further.

Figure: Figure 1: PRISMA flow diagram detailing systematic review.
Note: *refers to “2–4 reviewers screen independently”

Author Year Location	Study Design	Study Objective	Sample Size (male/female)	Baseline Characteristics	Measure of FI	% with Food Insecurity	GI disorder	Outcome	Newcastle-Ottawa Scale
Simmons et al. 2006 USA	Cohort	Proportion of cancer patients with food insecurity and food security	Total n=115 Male: 38 (33%) Female: 71 (61.7%) Other- 6 (5.2%)	Mean age: 56 Less than high school degree: n=27 (23.5%) Household annual incomes< $40,000: (n=54, 55.6%)	CFSM (6-item)	n=20 (17.4%)	Colorectal cancer and GI cancer	Colorectal cancer FI: 1/20, 5.0% FS: 6/95, 6.3% GI cancer FI: 0/20, 0% FS: 7/95, 7.4%	8
Hromi-Fiedler et al. 2011 USA	Prospective	Prenatal symptoms of depression among low-income pregnant Latina women	Total n = 135 Male: 0 (0%) Female: 135 (100%)	Mean age: 25 Less than high school degree: n=115 (85%) Household annual incomes< $40,000: Not reported	HFSSM (18-item)	n=49 (36.8%)	Heartburn	Heartburn not significantly correlated with food security (p=0.059)	8
Anderson et al. 2011 Ethiopia	Cross-sectional	Assess association between FI, maternal emotional distress, and childhood morbidity	Total = 936 Male: 489 (52.2%) Female: 477 (47.8%)	Mean age: 21.2 months Less than high school degree: Not reported Household annual incomes< $40,000: Not reported	7-item low-income country scale	n=364 (38.9%)	Diarrhea	Diarrhea with prior 2 weeks (24.8%). FI significantly associated with diarrhea (OR 1.44, 95%CI 1.03, 2.02)	7
Gany et al. 2014 USA	Cohort	Evaluate prevalence and predictors of FI among low-income urban cancer patients	Total n = 404 Male: 154 (38%) Female: 250 (62%)	Mean age: 57 Less than high school (188; 47%) Household annual incomes< $40,000: Not reported	HFSSM	n=226 (56%)	GI cancer	Presence of GI cancer significantly associated with FI (OR 2.03, 95%CI 1.73, 2.32)	8
Daneshi-Maskooni et al 2017 Iran	Case-control study	Determine association between FI and upper GI cancers in newly diagnosed patients	Total = 240 Male: 144 (60%) Female 96 (40%)	Mean age: 71 Less than high school degree: Not reported Household annual incomes< $40,000: Not reported	HFSSM	n=166 (69.2%)	Esophageal or gastric cancer	FI: 83 (69.2%) Presence of esophageal or gastric cancer significantly associated with FI (OR 2.57, 95%CI 1.41, 4.66)	9
Borji et al 2018 Iran	Cross-sectional	Determine relationship between nutritional status, FI, and causes of hospitalization children with infectious diseases	Total = 580 Male: 257 (44.3%) Female: 323 (55.7%)	Mean age: 4 Less than high school degree: Not applicable Household annual incomes< $40,000: Not reported	HFSSM	n=453 (78.1%)	Gastrointestinal infections (diarrhea, vomiting, gastroenteritis)	FI and GI infections: 37 (26.2%), which was significantly associated (p< 0.01)	8
Najafi et al. 2018 Iran	Cross-sectional	Evaluate relationship between FI and esophageal cancer among women in Iran	Total =580 Male: 0 (0%) Female: 580 (100%)	Mean age: Not reported Less than high school degree: Not reported Household annual incomes< $40,000: Not reported	HFSSM (6-item)	n=162 (28%)	Esophageal cancer	Relationship with esophageal cancer not reported	4
Tacket et al. 2018 USA	Cohort	Evaluate relationship between FI and history of food-induced anaphylaxis (FIA) in children with Food Allergy (FA)	Total=183 Male: 104 (57%) Female: 79 (43%)	Mean age: 7.5 Less than -high school degree: n=5 (3%) Household annual incomes< $40,000: n=29 (16%)	HFSSM	n=75 (41%)	Food allergy	FI and food-induced anaphylaxis: 80 (44%), which was significantly associated (p< 0.01)	8
Tacket et al. 2019 USA	Cohort	Compare caregiver report of FI and history of food-induced anaphylaxis (FIA) by sites of food purchase	Total= 172 Male: 99 (57.6%) Female: 73 (42.4%)	Mean age: 7.5 Less than high school degree: Not applicable Household annual incomes< $40,000: n=28 (16.3%)	HFSSM	n = 98 (57%)	Food allergy with symptoms reported as: - Nausea - stomach pain - Vomiting - Diarrhea	FI and food purchase location at a gas station, convenience mart, or bodega (versus supermarket or grocery store): 94, which was significantly associated (p< 0.001)	8
McDougall et al. 2020 USA	Cross-sectional	Characterize relationship between FI and treatment adherence among cancer survivors	Total=394 Male: 120 (30%) Female: 274 (70%)	Mean age: 50.8 (at time of diagnosis) Less than high school degree: n=191 (51.9%) Household annual incomes< $40,000: Not reported	2-time Hunger vital sign	Persistently food insecure-101 (26%) Newly food insecure-38 (10%) FI-139 (36%)	Colon cancer (n=75)	Persistently food insecure: 21% medications 19% treatment other than medications 25% specialists 27% follow-up care 18% mental health Persistently food insecure: Meds- OR: 3.04 (1.36, 6.77) Treatment- OR: 9.93 (3.53, 27.9) Specialists- OR: 3.93 (1.76, 8.78) Follow-up care-OR: 3.23 (1.70, 6.15) Mental health- OR: 5.76 (2.35, 14.1)	8
Nguyen et al. 2020 USA	Cross-sectional	Assess relationship between FI and inflammatory bowel disease (IBD), financial hardship, and medication non-adherence	Total =450, weighted sample 3.1 million Male: 42.4% Female: 57.6%	Low food security: Mean age: 51.7 (43.2, 60.3) Female-62% Less than high school-24% Income poor/low-85% Insurance-none-7% Very low food security: Mean age: 42.3 (36.1-48.4) Female-68% Less than high school-20% Income poor/low-89%	HFSSM (10-item)	13.5%	Inflammatory bowel disease (IBD)	Food insecurity associated with IBD (OR 1.69, 95%CI 1.15, 2.49)	9
Madigan et al. 2021 USA	Cross-sectional	Assess relationship between FI, GI cancers, and symptoms of depression	n=229 Weighted sample-1.5 million Male 56.8% Female 43.2%	Mean age = N/A Less than high school degree: 34.9% Household annual incomes< $40,000: not reported	HFSSM (10-item)	14.3%	Digestive cancers (esophageal, gastric, liver, pancreatic, colorectal)	Among GI cancer survivors, those with FI more likely to have depressive symptoms (OR 3.25, 95% CI )	7

Table: FI-food insecurity; HFSSM-Household food security survey model; CSFM: Core Food Security Module, 6-item questionnaire
Ages are in years except when specific as months.
Table 1: Data extraction for studies evaluating food insecurity in non-hepatic gastrointestinal diseases.

Disclosures:
Katelyn Madigan indicated no relevant financial relationships.
Megan Carlin indicated no relevant financial relationships.
Sarah Cantrell indicated no relevant financial relationships.
Deepak Palakshappa indicated no relevant financial relationships.
David Leiman indicated no relevant financial relationships.

Katelyn Madigan, MD¹, Megan Carlin, BS², Sarah Cantrell, MLIS, AHIP³, Deepak Palakshappa, MD, MSHP⁴, David Leiman, MD, MSHP⁵. P1443 - Food Insecurity and Digestive Diseases: A Systematic Review, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.