A Systematic Review Of The Impact Of Food Insecurity On The Risk Of Developing Asthma, Or Having Poor Asthma Control, In Childhood

Introduction: Adverse nutritional factors in early life, such as food insecurity, may affect the risk of developing asthma in childhood, and worsen asthma control. Aim: To systematically review literature on the impact of family food insecurity on prevalence of childhood asthma, and asthma control. Methods: We included cohort, case-control, and cross-sectional studies evaluating food insecurity and the risk of children developing asthma in childhood or having poor asthma control. We used the SCOPUS platform to search several databases, using a predefined strategy. We used the CASP tool to evaluate study quality. We extracted effect sizes for risk of developing asthma or having poor asthma control. Results: From 109 abstracts we included 8 studies. The studies were of adequate quality but methodological heterogeneity precluded meta-analysis. Six studies evaluated the impact of food insecurity on the risk of developing childhood asthma. Of these, five large studies (n 54,207) found that family food insecurity significantly increased risk of children developing asthma (Odds ratio 1.04 – 2.08). One study (n 486) found no increased risk. Two studies evaluated the impact of food insecurity on asthma control. In one (n 553) food insecurity doubled the risk of poor asthma control (OR 2.01) but in the other (n 127) there was no increased risk. Conclusions: Food insecurity may increase the risk of childhood asthma but the impact on asthma control is uncertain. Large epidemiological studies with standardised methodology are required to evaluate the impact of food insecurity on childhood asthma outcomes.