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Masoumi S M, Shahraki M, Eslahi H, Okati M. The Relationship between Food Insecurity and Some Socio-Economic Factors with Type 2 Diabetes in Patients Referring to Diabetes Clinic of Bu'ali Hospital in Zahedan , Iran. JNFS 2023; 8 (4) :686-693
URL: http://jnfs.ssu.ac.ir/article-1-593-en.html
URL: http://jnfs.ssu.ac.ir/article-1-593-en.html
Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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1 Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran; 2 Children and Adolescent Health Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran.
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The Relationship between Food Insecurity and Some Socio-Economic Factors in Patients Referring to Diabetes Clinic of Buali Hospital in Zahedan, Iran
Seyede Mahsa Masoumi; BSc1, Mansour Shahraki; PhD1,2, Hadi Eslahi MSc*1 & Mohammad Okati; MD1
Seyede Mahsa Masoumi; BSc1, Mansour Shahraki; PhD1,2, Hadi Eslahi MSc*1 & Mohammad Okati; MD1
1 Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran; 2 Children and Adolescent Health Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran.
| ARTICLE INFO | ABSTRACT | |
| ORIGINAL ARTICLE | Background: There is a close relationship between food insecurity and diabetes. It has been shown that some socio-economic factors can affect Type I diabetes. This study was conducted to investigate the relationship between food insecurity and some socio-economic factors with type 2 diabetes in patients referring to Diabetes Clinic of Buali Hospital in Zahedan city. Methods: This case-control study was conducted on 450 patients with type 2 diabetes as the case group and 450 similar participants without diabetes as the control group in 2021. The data were collected for the demographic and socioeconomic characteristics and food insecurity by the 18-item USDA household food security questionnaire. Results: The results showed that food insecurity was significantly higher in case group (7.27±5.25) compared to the control group (6.44±5.82). Participants with higher income had lower food insecurity (P=0.0001). Married participants had higher food security compared to other status in both groups (P=0.0001). Individuals with higher education had better food security and diabetic individuals had lower education compared to healthy people (P=0.001). Employee and housewife in case group had higher food security compared to participants with other jobs (P=0.0001). Conclusion: Food insecurity was higher in diabetic patients and socio-economic factors had a close relation with food insecurity. Policy makers must consider strategies for improving socio-economic factors in Zahedan city. Keywords: Economic factors; Food insecurity; Socioeconomic; Type 2 Diabetes |
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| Article history: Received: 6 Mar 2022 Revised: 7 May 2022 Accepted: 7 May 2022 |
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| *Corresponding author: hadi_eslahi2015@yahoo.com Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Postal code: 9816993353 Tel: +98 9039472662 |
Introduction
Food insecurity is a major problem worldwide that almost 800 million people have experienced it (Vilar-Compte et al., 2020). Based on Food and Agriculture Organization (2020) estimates, it has affected 51.6%, 31.70% 22.30%, and 7.90% of population in Africa, Latin America, Asia and North America, and Europe, respectively. Food insecurity is known as restrictions on access to nutritious food affecting lower income households (Flint et al., 2020). It is also defined as restricted access to safe foods and/or restricted ability for obtaining acceptable foods in socially acceptable ways (USDA ERS, 2021). Food insecurity has a positive correlation with increased poverty and inequality and also poor economic growth (Vilar-Compte et al., 2020). In addition, differences in socio-economic condition have significant effects on risk exposure and capability for preventing and coping with risks of food insecurity (Ogunniyi et al., 2021). A study reported a relationship between food insecurity with acculturation and socio-economic factors in Australia (Mansour et al., 2020). Socio-economic factors such as limited income, housing costs, unemployment, grocery taxes, climate change, natural disasters, and war can increase food insecurity (Thomas et al., 2021). In Iranian community, the prevalence of food insecurity is significant and studies have reported a rate of 58.40% in East Azerbaijan (Tabrizi et al., 2018), 82% among slum households in Kerman (Amiresmaeili et al., 2021), 56.10% in the elderly population in Qarchak city (Rafat et al., 2021), and 58.80% in Zahedan (Mortazavi et al., 2021).
Food insecurity is associated with low-quality diets such as consumption of highly processed foods, added sugar, and saturated fat (Te Vazquez et al., 2021) that can cause other diseases such as diabetes. It was reported that food insecurity increases the chance of diabetes among adults (Robbiati et al., 2022). Indeed, a healthy diet is essential for preventing diabetes and food insecurity increases its prevalence (Gucciardi et al., 2014). The American Diabetes Association (2019) has recommended tailoring treatments and screening for patients with diabetes and food insecurity. Indeed, food insecurity can cause a twofold-threefold increase in the risk of being obese and diabetes (Vilar-Compte et al., 2020). A study reported that food-insecure individuals had poor glycemic levels (A1c of >8.5%) compared to food-secure ones owing to poor diet, medication adherence, self-management, and inability in coping with emotional stress (Seligman et al., 2012). In Iranian community, studies have reported a significant relationship between food insecurity and gestational diabetes mellitus (Hojaji et al., 2021), food insecurity, and Type 2 diabetes in children (Najibi et al., 2019).
The prevalence of food insecurity is increasing and various factors can affect it. The prevalence rate is different in each region and must be investigated and policy makers consider programs based on each region. According to literature review, there was no study conducted on the relation between food insecurity and type 2 diabetes in Zahedan city. This study aimed to investigate the relationship between food insecurity and some socio-economic factors with type 2 diabetes in patients referring to Diabetes Clinic of Buali Hospital in Zahedan city.
Food insecurity is associated with low-quality diets such as consumption of highly processed foods, added sugar, and saturated fat (Te Vazquez et al., 2021) that can cause other diseases such as diabetes. It was reported that food insecurity increases the chance of diabetes among adults (Robbiati et al., 2022). Indeed, a healthy diet is essential for preventing diabetes and food insecurity increases its prevalence (Gucciardi et al., 2014). The American Diabetes Association (2019) has recommended tailoring treatments and screening for patients with diabetes and food insecurity. Indeed, food insecurity can cause a twofold-threefold increase in the risk of being obese and diabetes (Vilar-Compte et al., 2020). A study reported that food-insecure individuals had poor glycemic levels (A1c of >8.5%) compared to food-secure ones owing to poor diet, medication adherence, self-management, and inability in coping with emotional stress (Seligman et al., 2012). In Iranian community, studies have reported a significant relationship between food insecurity and gestational diabetes mellitus (Hojaji et al., 2021), food insecurity, and Type 2 diabetes in children (Najibi et al., 2019).
The prevalence of food insecurity is increasing and various factors can affect it. The prevalence rate is different in each region and must be investigated and policy makers consider programs based on each region. According to literature review, there was no study conducted on the relation between food insecurity and type 2 diabetes in Zahedan city. This study aimed to investigate the relationship between food insecurity and some socio-economic factors with type 2 diabetes in patients referring to Diabetes Clinic of Buali Hospital in Zahedan city.
Materials and Methods
Study design and participants: This case-control study was conducted on 450 patients with type 2 diabetes as the case group and 450 similar participants without diabetes as the control group in 2021. This study was conducted in Diabetes Clinic of Buali Hospital in Zahedan city.
Sampling: The participants were selected based on convenience sampling method among people referring to Diabetes Clinic of Buali Hospital in Zahedan city.
Inclusion criteria: The inclusion criteria in the case group were diagnosis of diabetes by medical specialists, willingness to participate in the study, non-administration of insulin, and age range of 18-55 years. The criteria in control group were lack of involvement with diabetes and lack of close relationship with the case group.
Exclusion criteria: The exclusion criteria were lack of consent for participation in the study and other diseases in both groups.
Study settings: The studied individuals were screened and eligible people were referred to the principal investigator as the interviewer. The clinic is in a region that different social and economic classes refer to it.
Tools: After providing an explanation for the study, the questionnaires for general scales and food insecurity status were completed by the respondents. The general questionnaire included demographic and socioeconomic characteristics such as age, marital status, employment status, education level, family size, and monthly income. The food security status was investigated by the 18-item USDA household food security questionnaire (Bickel et al., 2000). Items of the questionnaire included worry about running out of food, inability to eat balanced meals, dependency for low-cost food for children, lack of enough food, low eating, decreased meal sizes, feeling hungry, losing weight, decreased food volume, lack of consumption of food for one day in adults and reduced food portion size of children. Score 1was given to options “often”, “sometimes”, “almost every month”, “some months”, and “yes” and score 0 to options “not correct”, “refused or did not know”, “only once or twice a month”, and “no”. Food security was scored as food secure (0-2 positive answers), food insecure without hunger (3-7 positive answers), food insecure with moderate hunger (8-12 positive answers), and food insecure with severe hunger (13-18 positive answers).
Ethical considerations: The current study has been confirmed by the Research Council and Ethics Committee of Zahedan University of Medical Sciences, with IR.ZAUMS.REC.1399.475 code number. The participants signed the informed consent form.
Data analysis: The data for demographic data were reported as frequency. The results for age, family size and food insecurity score were analyzed by t-test. The chi-square test was used to investigate food insecurity status in case and control groups. Data were analyzed by SPSS software (version 23). A P<0.05 was considered significant.
Sampling: The participants were selected based on convenience sampling method among people referring to Diabetes Clinic of Buali Hospital in Zahedan city.
Inclusion criteria: The inclusion criteria in the case group were diagnosis of diabetes by medical specialists, willingness to participate in the study, non-administration of insulin, and age range of 18-55 years. The criteria in control group were lack of involvement with diabetes and lack of close relationship with the case group.
Exclusion criteria: The exclusion criteria were lack of consent for participation in the study and other diseases in both groups.
Study settings: The studied individuals were screened and eligible people were referred to the principal investigator as the interviewer. The clinic is in a region that different social and economic classes refer to it.
Tools: After providing an explanation for the study, the questionnaires for general scales and food insecurity status were completed by the respondents. The general questionnaire included demographic and socioeconomic characteristics such as age, marital status, employment status, education level, family size, and monthly income. The food security status was investigated by the 18-item USDA household food security questionnaire (Bickel et al., 2000). Items of the questionnaire included worry about running out of food, inability to eat balanced meals, dependency for low-cost food for children, lack of enough food, low eating, decreased meal sizes, feeling hungry, losing weight, decreased food volume, lack of consumption of food for one day in adults and reduced food portion size of children. Score 1was given to options “often”, “sometimes”, “almost every month”, “some months”, and “yes” and score 0 to options “not correct”, “refused or did not know”, “only once or twice a month”, and “no”. Food security was scored as food secure (0-2 positive answers), food insecure without hunger (3-7 positive answers), food insecure with moderate hunger (8-12 positive answers), and food insecure with severe hunger (13-18 positive answers).
Ethical considerations: The current study has been confirmed by the Research Council and Ethics Committee of Zahedan University of Medical Sciences, with IR.ZAUMS.REC.1399.475 code number. The participants signed the informed consent form.
Data analysis: The data for demographic data were reported as frequency. The results for age, family size and food insecurity score were analyzed by t-test. The chi-square test was used to investigate food insecurity status in case and control groups. Data were analyzed by SPSS software (version 23). A P<0.05 was considered significant.
Results
Table 1 shows the results for demographic characteristics in both groups. The results showed that women had higher participation compared to men in both groups. Most of participants had education lower than diploma and were housekeeper in both groups. Monthly income was lower than 22 million riyals for most participants in the case and control groups. Married participants comprised a major part of participants. The results showed that the mean age was significantly higher in the case group compared to the control group (P=0.041). In addition, food insecurity (P=0.026) and family size (P=0.001) were significantly higher in case group compared to control group.
Table 2 shows the relationship between demographic characteristics with food insecurity status in participants with and without type 2 diabetes. The results showed significant differences in the groups, so that participants with higher income had lower food insecurity (P=0.0001). Most of the participants had lower income than 22 million riyals. Moreover, significant differences were found between participants in diabetic group (P=0.0001) and control group (P=0.034). Married participants had higher food security compared to others in both groups. Most of the participants were married in both groups. The results for the case (P=0.0001) and control (P=0.0001) groups showed that individuals with higher education had better food security. In addition, patients with diabetes had lower education compared to healthy people (P=0.001). A significant difference was also observed in case group, so that employees
and housewives had higher food security (P=0.0001).
Table 2 shows the relationship between demographic characteristics with food insecurity status in participants with and without type 2 diabetes. The results showed significant differences in the groups, so that participants with higher income had lower food insecurity (P=0.0001). Most of the participants had lower income than 22 million riyals. Moreover, significant differences were found between participants in diabetic group (P=0.0001) and control group (P=0.034). Married participants had higher food security compared to others in both groups. Most of the participants were married in both groups. The results for the case (P=0.0001) and control (P=0.0001) groups showed that individuals with higher education had better food security. In addition, patients with diabetes had lower education compared to healthy people (P=0.001). A significant difference was also observed in case group, so that employees
and housewives had higher food security (P=0.0001).
| Table 1. Demographic characteristics of case and control groups. | |||
| Variables | Control group | Case group | P-valuesa |
| Gender Men Women |
258(57.3)b 192(42.7) |
294(65.30) 156(34.7) |
0.31 |
| Education Under diploma Diploma |
383(85.11) 67(14.89) |
218(48.45) 67(14.89) |
0.03 |
| Occupation Housekeeper Unemployment Employee Worker Self-employed Student |
187(41.60) 48(40.70) 97(21.60) 35(7.80) 62(13.80) 21(4.70) |
286(63.50) 10(2.20) 71(15.80) 51(11.40) 32(7.10) 0(0.00) |
0.04 |
| Monthly income (Rial) <22000000 22000000-50000000 50000000< |
230(51.10) 113(25.10) 107(23.80) |
248(55.20) 84(18.70) 2118(6.10) |
0.042 |
| Marital status Single Married Deceased spouse Divorced |
31(6.90) 404(89.80) 3(0.70) 12(2.80) |
3(0.7) 422(93.80) 5(1.10) 20(4.50) |
0.787 |
| Age (year) | 37.70 ± 12.33c | 48.84 ± 4.31 | 0.041 |
| Food insecurity score | 6.44 ± 5.82 | 7.27 ± 5.25 | 0.026 |
| Family size | 3.92 ± 1.37 | 4.53 ± 1.51 | 0.001 |
| a: P-values were obtained from independent samples t‑test for continuous variables and Chi‑square test for categorical ones; b: n(%); c: Mean ± SD | |||
| Table 2. The relationship between demographic characteristics with food insecurity in case and control groups. | |||
| Variables | Insecurity status | Case | Control |
| Monthly income | Food secure |
2 (0.8)a |
1 8 (8.0) |
| <2.2 million riyals | Food insecure without hunger | 30 (12.0) | 33 (14.0) |
| Food insecure with moderate hunger | 129 (52.0) | 82 (36.0) | |
| Food insecure with severe hunger | 87 (35.0) | 97 (42.0) | |
| Food secure | 17 (20.0) | 54 (48.0) | |
| 22-50 million riyals | Food insecure without hunger | 40 (48.0) | 38 (34.0) |
| Food insecure with moderate hunger | 20 (24.0) | 18 (16.0) | |
| Food insecure with severe hunger | 7 (8.0) | 3 (2.0) | |
| Food secure | 99 (85.0) | 90 (85.0) | |
| >50 million riyals | Food insecure without hunger | 12 (10.0) | 11 (10.0) |
| Food insecure with moderate hunger | 5 (4.0) | 5 (4.0) | |
| Food insecure with severe hunger | 1 (1.0) | 1 (1.0) | |
| P-valueb | 0.0001 | 0.0001 | |
| Marital status | Food secure |
1 (33.0) |
9 (29.0) |
| Single | Food insecure without hunger | 2 (66.7) | 9 (29.0) |
| Food insecure with moderate hunger | 0(0.0) | 8 (26.0) | |
| Food insecure with severe hunger | 0(0.0) | 5 (16.0) | |
| Food secure | 117 (28.0) | 151 (37.0) | |
| Married | Food insecure without hunger | 77 (18.0) | 73 (18.0) |
| Food insecure with moderate hunger | 145 (34.0) | 93 (23.0) | |
| Food insecure with severe hunger | 83 (20.0) | 87 (22.0) | |
| Food secure | 0(0.0) | 0(0.0) | |
| Deceased spouse | Food insecure without hunger | 2 (40.0) | 0(0.0) |
| Food insecure with moderate hunger | 2 (40.0) | 1 (33.0) | |
| Food insecure with severe hunger | 1 (20.0) | 2 (67.0) | |
| Food secure | 1 (5.0) | 2 (17.0) | |
| Divorced | Food insecure without hunger | 1 (5.0) | 0.00 |
| Food insecure with moderate hunger | 7 (35.0) | 3 (25.0) | |
| Food insecure with severe hunger | 11 (55.0) | 7 (58.0) | |
| P-value | 0.0001 | 0.034 | |
| Education | Food secure |
81 (21.14) |
38 (16.30) |
| Under diploma | Food insecure without hunger | 64 (16.70) | 47 (20.20) |
| Food insecure with moderate hunger | 146 (38.12) | 70 (30.00) | |
| Food insecure with severe hunger | 92 (24.02) | 78 (33.50) | |
| Food secure | 38 (56.71) | 124 (54.60) | |
| Diploma | Food insecure without hunger | 18 (26.86) | 35 (15.41) |
| Food insecure with moderate hunger | 8 (12.00) | 35 (15.41) | |
| Food insecure with severe hunger | 3 (4.40) | 33 (14.50) | |
| P-value | 0.0001 | 0.0001 | |
| Job | Food secure |
57 (20.0) |
37 (20.0) |
| Housewife | Food insecure without hunger | 39 (14.0) | 31 (17.0) |
| Food insecure with moderate hunger | 113 (39.0) | 59 (32.0) | |
| Food insecure with severe hunger | 77 (27.0) | 60 (32.0) | |
| Food secure | 0 (0.0) | 2 (4.0) | |
| Unemployment | Food insecure without hunger | 3 (30.0) | 8 (17.0) |
| Food insecure with moderate hunger | 7 (70.0) | 13 (27.0) | |
| Food insecure with severe hunger | 0 (0.0) | 25 (52.0) | |
| Food secure | 56 (79.0) | 77 (80.0) | |
| Worker | Food insecure without hunger | 11 (15.0) | 14 (14.0) |
| Food insecure with moderate hunger | 4 (6.0) | 4 (4.0) | |
| Food insecure with severe hunger | 0 (0.0) | 2 (2.0) | |
| Food secure | 6 (19.0) | 30 (48.0) | |
| Self-employed | Food insecure without hunger | 20 (62.0) | 19 (31.0) |
| Food insecure with moderate hunger | 4 (13.0) | 11 (18.0) | |
| Food insecure with severe hunger | 2 (6.0) | 2 (3.0) | |
| Food secure | 6(19.0) | 14 (67.0) | |
| Student | Food insecure without hunger | 0(0.0) | 4 (19.0) |
| Food insecure with moderate hunger | 0(0.0) | 2 (9.5) | |
| Food insecure with severe hunger | 0(0.0) | 1 (4.5) | |
| P-value | 0.001 | 0.26 | |
| a: n(%); b: P-values were obtained from independent samples t‑test for continuous variables and Chi‑square test for categorical ones. | |||
Discussion
This study investigated the relationship between food insecurity and some socio-economic factors with type 2 diabetes in patients referring to Diabetes Clinic of Buali Hospital in Zahedan. The findings showed that food insecurity was significantly higher in diabetic patients. The results are consistent with results reported by other studies indicating that higher food insecurity in diabetic patients compared to healthy people (Abdurahman et al., 2019, Fitzgerald et al., 2011, Flint et al., 2020, Gucciardi et al., 2009, Hopkins and Holben, 2018, Najibi et al., 2019, Seligman et al., 2007). Food insecurity causes a decrease in spending on food and dietary intake, and changes the consumed food type, all of which can be closely related to diabetes (Najibi et al., 2019). Based on the findings, people with low income and education had greater food insecurity. It shows that having more income can increase food accessibility and also preparation of high quality food. In addition, higher education helps to prepare foods with higher quality that can alleviate and/or prevent diabetes. Indeed, food insecurity is associated with diets poor in quality, not necessarily quantity.
Family size was significantly higher in diabetic patients. The results are in agreement with results reported by other studies (Najibi et al., 2019). A cross-sectional study on patients with diabetes in Tehran showed a positive relationship between family size and risk of diabetes (Farvid et al., 2010). Families with higher size consume low fruits and vegetables and other foods protecting against diabetes and are at higher risk of diabetes. In addition, greater size of family affects both food quality and quantity which can lead to diabetes.
The results showed that people with lower incomes had higher food insecurity in both groups. In agreement with the findings, other studies have reported a positive relation between food insecurity and low income (Farrell et al., 2018; Penne & Goedemé, 2021). Insufficient income in people with food insecurity cause them to buy cheaper and high-calorie food leading to obesity and increased susceptibility to metabolic disorders such as diabetes (Najibi et al., 2019).
Moreover, married people in both groups had lower food insecurity compared to others. The results are not in line with findings of other studies indicating that marital status did not have any significant association with food insecurity (Najibi et al., 2019). However, the results are in agreement with studies showing a significant relation between marital condition and food insecurity (Lee et al., 2020)).
Food insecurity was significantly higher in people with low education. The results are in agreement with previous studies that showed a negative association between low education and higher food security (Najibi et al., 2019). People with higher education are aware of food security, consume high quality food, and care about their health. They spend more on high-quality food types that affect diabetes and diabetes prevention.
The results showed a close relationship between food insecurity and occupation. Employees and housewives had lower food insecurity. Other studies have also reported a significant relation between food insecurity and employment (Gucciardi et al., 2014, Najibi et al., 2019). Having a secure job provides enough income to purchase high-quality food. In addition, housewives monitor the quality of food and food considerations.
The study had some limitations. In the case-control study, they generally do not allow calculation of incidence and sampling is slow due to selecting newly diagnosed patients and specific clinics. Moreover, some patients did not cooperate.
Family size was significantly higher in diabetic patients. The results are in agreement with results reported by other studies (Najibi et al., 2019). A cross-sectional study on patients with diabetes in Tehran showed a positive relationship between family size and risk of diabetes (Farvid et al., 2010). Families with higher size consume low fruits and vegetables and other foods protecting against diabetes and are at higher risk of diabetes. In addition, greater size of family affects both food quality and quantity which can lead to diabetes.
The results showed that people with lower incomes had higher food insecurity in both groups. In agreement with the findings, other studies have reported a positive relation between food insecurity and low income (Farrell et al., 2018; Penne & Goedemé, 2021). Insufficient income in people with food insecurity cause them to buy cheaper and high-calorie food leading to obesity and increased susceptibility to metabolic disorders such as diabetes (Najibi et al., 2019).
Moreover, married people in both groups had lower food insecurity compared to others. The results are not in line with findings of other studies indicating that marital status did not have any significant association with food insecurity (Najibi et al., 2019). However, the results are in agreement with studies showing a significant relation between marital condition and food insecurity (Lee et al., 2020)).
Food insecurity was significantly higher in people with low education. The results are in agreement with previous studies that showed a negative association between low education and higher food security (Najibi et al., 2019). People with higher education are aware of food security, consume high quality food, and care about their health. They spend more on high-quality food types that affect diabetes and diabetes prevention.
The results showed a close relationship between food insecurity and occupation. Employees and housewives had lower food insecurity. Other studies have also reported a significant relation between food insecurity and employment (Gucciardi et al., 2014, Najibi et al., 2019). Having a secure job provides enough income to purchase high-quality food. In addition, housewives monitor the quality of food and food considerations.
The study had some limitations. In the case-control study, they generally do not allow calculation of incidence and sampling is slow due to selecting newly diagnosed patients and specific clinics. Moreover, some patients did not cooperate.
Conclusion
Food insecurity was significantly higher in diabetic patients and it had a significant relationship with income, occupation, education, and marital status. It is suggested that policy makers plan to increase food accessibility and also increase food quality for people of Zahedan, especially people with diabetes.
Acknowledgment
We appreciate Zahedan University of Medical Sciences for approving the study and also all people who completed the questionnaires.
Authors’ contributions
Masoumi SM and Okati M designed the study and collected the data. Eslahi H analyzed the data and wrote the first draft of the paper. Shahraki M critically reviewed the paper.
Authors’ contributions
Masoumi SM and Okati M designed the study and collected the data. Eslahi H analyzed the data and wrote the first draft of the paper. Shahraki M critically reviewed the paper.
Conflict of interest
None
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Thomas MK, Lammert LJ & Beverly EA 2021. Food insecurity and its impact on body weight, type 2 diabetes, cardiovascular disease, and mental health. Current cardiovascular risk reports. 15: 1-9.
Vilar-Compte M, Gaitán-Rossi P, Flores D, Pérez-Cirera V & Teruel G 2020. How do context variables affect food insecurity in Mexico? Implications for policy and governance. Public health nutrition. 23 (13): 2445-2452.
Amiresmaeili M, Yazdi‐Feyzabadi V & Heidarijamebozorgi M 2021. Prevalence of food insecurity and related factors among slum households in Kerman, south of Iran. International journal of health planning and management. 36 (5): 1589-1599.
Bickel G, Nord M, Price C, Hamilton W & Cook J 2000. Guide to measuring household food security, revised 2000, https://ageconsearch.umn.edu/record/337157/.
Fitzgerald N, Hromi-Fiedler A, Segura-Pérez S & Pérez-Escamilla R 2011. Food insecurity is related to increased risk of type 2 diabetes among Latinas. Ethnicity & disease. 21 (3): 328.
Flint KL, Davis GM & Umpierrez GE 2020. Emerging trends and the clinical impact of food insecurity in patients with diabetes. Journal of diabetes. 12 (3): 187-196.
Gucciardi E, Vahabi M, Norris N, Del Monte JP & Farnum C 2014. The intersection between food insecurity and diabetes: a review. Current nutrition reports. 3: 324-332.
Gucciardi E, Vogt JA, DeMelo M & Stewart DE 2009. Exploration of the relationship between household food insecurity and diabetes in Canada. Diabetes care. 32 (12): 2218-2224.
Hojaji E, et al. 2021. Household food insecurity associations with pregnancy hypertension, diabetes mellitus and infant birth anthropometric measures: a cross-sectional study of Iranian mothers. Hypertension in pregnancy. 40 (2): 109-117.
Hopkins LC & Holben DH 2018. Food insecure community gardeners in rural Appalachian Ohio more strongly agree that their produce intake improved and food spending decreased as a result of community gardening compared to food secure community gardeners. Journal of hunger & environmental nutrition. 13 (4): 540-552.
Lee JW, Shin W-K & Kim Y 2020. Impact of sex and marital status on the prevalence of perceived depression in association with food insecurity. PloS one. 15 (6): e0234105.
Mansour R, Liamputtong P & Arora A 2020. Prevalence, determinants, and effects of food insecurity among middle eastern and north African migrants and refugees in high-income countries: a systematic review. International journal of environmental research and public health. 17 (19): 7262.
Mortazavi Z, Dorosty AR, Eshraghian MR, Ghaffari M & Ansari-Moghaddam A 2021. Nutritional education and its effects on household food insecurity in Southeastern Iran. Iranian journal of public health. 50 (4): 798.
Najibi N, et al. 2019. Food insecurity is an important risk factor for type 2 diabetes: a case-control study of new referrals to the University clinics, Shiraz, Southern Iran. BMC public health. 19 (1): 1-8.
Ogunniyi AI, et al. 2021. Socio-economic drivers of food security among rural households in Nigeria: Evidence from smallholder maize farmers. Social indicators research. 155: 583-599.
Rafat R, Rezazadeh A, Arzhang P & Alipourr A 2021. The association of food insecurity with sociodemographic factors and depression in the elderly population of Qarchak city–Iran. Nutrition & food sScience. 51 (1): 114-124.
Robbiati C, Armando A, da Conceição N, Putoto G & Cavallin F 2022. Association between diabetes and food insecurity in an urban setting in Angola: a case–control study. Scientific reports. 12 (1): 1084.
Seligman HK, Bindman AB, Vittinghoff E, Kanaya AM & Kushel MB 2007. Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999–2002. Journal of general internal medicine. 22: 1018-1023.
Seligman HK, Jacobs EA, Lopez A, Tschann J & Fernandez A 2012. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes care. 35 (2): 233-238.
Tabrizi JS, Nikniaz L, Sadeghi-Bazargani H, Farahbakhsh M & Nikniaz Z 2018. Socio-demographic determinants of household food insecurity among Iranian: a population-based study from northwest of Iran. Iranian journal of public health. 47 (6): 893.
Te Vazquez J, Feng SN, Orr CJ & Berkowitz SA 2021. Food insecurity and cardiometabolic conditions: a review of recent research. Current nutrition reports. 10 (4): 243-254.
Thomas MK, Lammert LJ & Beverly EA 2021. Food insecurity and its impact on body weight, type 2 diabetes, cardiovascular disease, and mental health. Current cardiovascular risk reports. 15: 1-9.
Vilar-Compte M, Gaitán-Rossi P, Flores D, Pérez-Cirera V & Teruel G 2020. How do context variables affect food insecurity in Mexico? Implications for policy and governance. Public health nutrition. 23 (13): 2445-2452.
Type of article: orginal article |
Subject:
public specific
Received: 2022/03/6 | Published: 2023/11/20 | ePublished: 2023/11/20
Received: 2022/03/6 | Published: 2023/11/20 | ePublished: 2023/11/20
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