Food insecurity in the development of metabolic diseases.

This Review discusses the current evidence on the relationship between food insecurity, obesity, metabolic syndrome and type 2 diabetes mellitus (T2DM), and identifies potential interventions to mitigate the effect of food insecurity on these conditions. Studies in adults (mainly cross-sectional) have consistently found associations between food insecurity and several cardiometabolic diseases, including obesity (mainly among women), hyperlipidaemia, metabolic syndrome, hypertension, cardiovascular disease and T2DM. These associations represent plausible causal relationships given that food insecurity can be a powerful psycho-emotional stressor that can cause distress, anxiety and depressive symptoms across the life course; poor dietary quality can increase the risk of metabolic syndrome and T2DM through increased visceral adiposity and insulin resistance, inflammation and an unhealthy microbiome; and food insecurity can cause healthcare behavioural trade-offs such as prioritizing purchasing food over medications for T2DM prevention or management. Community-based, healthy lifestyle promotion, early-life nutrition and Food as Medicine programmes could mitigate the negative effect of food insecurity on T2DM risk and metabolic health. There is a need to rigorously evaluate the results of promising large-scale interventions on food insecurity and cardiometabolic health outcomes.