Food insecurity and the risk of undernutrition complications among children and adolescents: A systematic review and meta-analysis

•Food insecurity is a risk factor for undernutrition complications.•Food insecurity increased the risk of stunting and being underweight.•Those older than 5 y have a higher risk of undernutrition stunting and being underweight.•Severe food insecurity may increase the risks of stunting or being underweight.•Children and adolescent living in developing countries had higher risk of stunting. This systematic review and meta-analysis was performed to examine the association between household food insecurity and the risk of being underweight, stunting, and wasting in children and adolescents. Pertinent studies were identified by searching PubMed, Web of Science, and Scopus databases up to June 2018. A total of 21 studies met the inclusion criteria to be included in the pooled analysis. The risk ratio of 55 173 individuals from 12 different countries were pooled in these studies for our meta-analysis. It was found that food insecurity increased the risk of stunting (odds ratio [OR] = 1.17; 95% confidence interval [CI]: 1.09–1.25) and underweight (OR = 1.17; 95% CI: 1.01–1.36) but not of wasting (OR = 1.04; 95% CI: 0.96–1.12). Subgroup analysis by age indicated that food insecurity increased the risk of stunting (OR = 1.20; 95% CI: 1.02–1.39) and underweight (OR = 1.34; 95% CI: 1.02–1.77) in children older than 5 y. This association was significant just for stunting risk (OR = 1.14; 95% CI: 1.05–1.23) in children younger than 5 y. Furthermore, among children and adolescents, risk of stunting or being underweight increased by the intensification of the level of food insecurity in food-insecure households. Furthermore, subgroup analysis by country development levels showed that children and adolescents living in developing countries had higher risk of stunting (OR = 1.16; 95% CI: 1.05–1.27). Household food insecurity appears to be associated with higher risk of stunting and being underweight among children and adolescents. In addition, the intensification of the level of food insecurity and the increased age of children may increase the risk of stunting or being underweight in food-insecure households. Also, the level of economic development is an important factor in the effects of food insecurity on risk of stunting.