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Food and Nutrition Security

What is nutrition security.

Building on and complementing our long-standing efforts to address food security, we are expanding our efforts to advance food and nutrition security. Nutrition security means all Americans have consistent and equitable access to healthy, safe, affordable foods essential to optimal health and well-being. Our approach to tackling food and nutrition insecurity aims to:

  • Recognize that structural inequities make it hard for many people to eat healthy and be physically active; and
  • Emphasize taking an equity lens to our efforts.

A household is food secure if all members, at all times, can access enough food for an active, healthy life . At a minimum, food security includes:

  • Readily available nutritionally adequate and safe foods, and
  • The ability to acquire those foods in socially acceptable ways (without resorting to emergency food supplies, scavenging, stealing, or other coping strategies).

Nutrition security means consistent access, availability, and affordability of foods and beverages that promote well-being, prevent disease, and, if needed, treat disease, particularly among racial/ethnic minority, lower income, and rural and remote populations including Tribal communities and Insular areas. Nutrition security is an emerging concept that complements efforts to increase food security while also:

  • Recognizing that Americans, in general, fall short of an active, healthy lifestyle aligned with Federal dietary and physical activity guidelines, and
  • Emphasizing equity to ensure our efforts serve all populations to promote access, availability, and affordability to foods and beverages, and address the connection between food insecurity and diet-related chronic diseases.

View the Infographic (PDF, 420 KB)

USDA Actions on Nutrition Security infographic

What is the problem?

Poor nutrition is a  leading cause  of illness in the United States, associated with more than half a million deaths per year. It is linked with increased risk of obesity, diabetes, and heart disease as well as broader impacts including higher health care costs and decreased productivity.

Poor nutrition is widespread

Though poor nutrition affects every demographic, diet-related diseases hit harder among historically underserved communities.

The overall diet quality score for Americans is  59 out of 100 , indicating that the average American diet does not align with Federal dietary recommendations. However, the resulting health burden is  not equally shared . Certain populations are at greater risk for diet-related disease. For example, Black and Indigenous children are more likely to have obesity than their white peers. Those who face food insecurity are also at greater risk.

Beyond the effect on health, poor nutrition and diet-related diseases have far-reaching impacts including decreased academic achievement and increased financial stress . That translates to societal impacts as well—lower productivity, weakened military readiness, widening health disparities, and skyrocketing health care  costs . For example, approximately 85 percent of current health care spending is related to management of diet-related chronic  disease .

To make progress on these problems, Americans need equitable access to healthy foods that promote well-being.

What is USDA doing?

USDA wants input from all Americans on ways we can improve nutrition security. The department is particularly focused on strengthening and building new partnerships with all levels of government, the private sector, community-based organizations, and families. Together, we can make progress that will change lives and ensure a healthier, more prosperous future for all Americans.

USDA’s work to advance nutrition security focuses on four pillars:  

Meaningful Support

Healthy Food

Collaborative Action

Equitable Systems

Research and evaluation

USDA’s work on nutrition security is driven by research and grounded in science. In addition to the extensive research performed by the Food and Nutrition Service , the Agricultural Research Service has six human nutrition research centers, the Economic Research Service studies numerous topics central to food and nutrition security, and the National Institute of Food and Agriculture advances food and nutrition security through research, education, extension, and innovation. Our work is also driven by the lived experiences – of our staff and our stakeholders.

Learn more about our nutrition security research .

Read the Role of FNS Report (PDF, 10.0 MB)

Three women smiling with The Role of the USDA Food and Nutrition Service overlay

Read the Actions on Nutrition Security (PDF, 792 KB) Read USDA Blogs on Nutrition Security

Browse all food and nutrition topics   

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  • Published: 08 August 2022

Systematic evidence and gap map of research linking food security and nutrition to mental health

  • Thalia M. Sparling   ORCID: orcid.org/0000-0002-8071-3232 1 ,
  • Megan Deeney   ORCID: orcid.org/0000-0002-4817-1170 1 ,
  • Bryan Cheng 2 ,
  • Xuerui Han 2 ,
  • Chiara Lier   ORCID: orcid.org/0000-0003-0868-1384 2 ,
  • Zhuozhi Lin 3 ,
  • Claudia Offner 1 ,
  • Marianne V. Santoso 4 ,
  • Erin Pfeiffer 5 ,
  • Jillian A. Emerson 6 ,
  • Florence Mariamu Amadi 7 ,
  • Khadija Mitu 8 ,
  • Camila Corvalan 9 ,
  • Helen Verdeli 2 ,
  • Ricardo Araya 10 &
  • Suneetha Kadiyala   ORCID: orcid.org/0000-0002-9101-1471 1  

Nature Communications volume  13 , Article number:  4608 ( 2022 ) Cite this article

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Metrics details

  • Epidemiology
  • Risk factors

Connections between food security and nutrition (FSN) and mental health have been analytically investigated, but conclusions are difficult to draw given the breadth of literature. Furthermore, there is little guidance for continued research. We searched three databases for analytical studies linking FSN to mental health. Out of 30,896 records, we characterized and mapped 1945 studies onto an interactive Evidence and Gap Map (EGM). In these studies, anthropometry (especially BMI) and diets were most linked to mental health (predominantly depression). There were fewer studies on infant and young child feeding, birth outcomes, and nutrient biomarkers related to anxiety, stress, and mental well-being. Two-thirds of studies hypothesized FSN measures as the exposure influencing mental health outcomes. Most studies were observational, followed by systematic reviews as the next largest category of study. One-third of studies were carried out in low- and middle-income countries. This map visualizes the extent and nature of analytical studies relating FSN to mental health and may be useful in guiding future research.

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Food security and nutrition (FSN) are key components of global health and development. Internationally, healthy diets are increasingly reported to be out of reach 1 and unaffordable 2 for people of lower socioeconomic status, leading to undernutrition (e.g., wasting, underweight, micronutrient deficiency, growth faltering) in low- and middle-income countries (LMIC) and nutrition-related chronic diseases (NRCD) in both LMIC and high-income countries (HIC) 3 . Despite progress in reducing overall hunger and food insecurity (especially in Asia and Africa), one in ten people were exposed to severe levels of food insecurity in 2019, with areas or populations experiencing much higher prevalence 4 . However, in most regions, improvements in food security have slowed (including West Asia and North Africa) or reversed (including Latin America and the Caribbean) in recent years 5 . Linear growth measures are slow to reduce in line with global development goals 6 , and one in every three people are overweight or have obesity 7 .

Mental health has also been identified as a major cause of disability 8 , although efforts to address global mental health burdens in low-resource settings is not commensurate with the magnitude of that burden 9 . Depressive disorders alone are thought to be the single-most contributor to health loss globally (7.5% of all Years Lived with Disability—YLD) 10 . Anxiety and stress, which along with depression are the common mental health disorders, are also leading causes of disability 11 . Despite improvements in measuring global mental health burdens, estimating the true burden remains a serious challenge. Transcultural identification and underreporting (especially due to stigma and differing social constructs) hinder the ability to make accurate global estimates 12 .

Each of these fields has evolved in the last several decades. Both have shifted from clinical and continuum of care frameworks to include influential factors of wider environments and contexts, leading to an understanding of complex and systems-driven aetiologies 12 . Furthermore, the connections between FSN and mental health have been increasingly investigated. Food insecurity has been shown to lead to poor mental health in many contexts 13 , 14 . There is mixed or poor quality evidence linking distinct nutrients to mental health 15 , 16 , 17 . Dietary patterns and diet quality have been shown to be related to depression and in some instances anxiety, although heterogeneity of different measures and indices hampers the inferences we can make 18 , 19 , 20 , 21 . The association between BMI and mental health has perhaps been the longest-standing topic of inquiry, although this literature is dominated by research carried out in HIC settings 22 , 23 . Poor mental health of parents, particularly mothers, has been associated with low dietary diversity, lack of micronutrients, anthropometric outcomes, and other illness and care measures of their children in several settings 23 , 24 , 25 , 26 , 27 , but not in others 28 , 29 . Mental health, for instance depression, has also been shown as a factor influencing nutritional risk and malnutrition (the nutritional aspects of frailty) in older adults 30 , 31 . Each of these investigations are further nuanced by their varying populations of interest and settings.

Systematic reviews on these topics are often (by nature) narrow in scope–usually in specific populations, using a particular subset of FSN and mental health indicators. Primary studies are often post-hoc or ad-hoc analyses derived from observational studies where FSN and mental health relationships are not primary outcomes. This limits the breadth and quality of the available evidence. Taking stock of the literature across interrelated aspects of FSN and mental health overall will allow for better identification and use of the strongest available evidence and more systematic efforts to research these intersections. It will also offer the possibility of creating an empirical framework that can guide hypothesis testing and causal identification going forward.

We aimed to systematically identify and map analytical studies associating FSN with mental health resulting in an interactive Evidence and Gap Map (EGM) that can offer both broad and granular views of this diverse body of literature. Our objectives were to describe the nature and range of evidence on (a) a wide range of constructs of food security and nutrition (food security, nutritional risk, diets, nutrient intakes, nutrient biomarkers, infant and young child feeding [IYCF], birth outcomes, and anthropometry), (b) linked to all types of common mental health problems (depression, anxiety, stress, and mental wellbeing), (c) across most healthy populations, settings, and study designs.

Search and screening results

The study selection process is shown in the PRISMA Flowchart (Fig.  1 ). A search of three databases retrieved 40,192 results total, 30,896 of which remained after removing duplicates and were screened on title and abstract. Of these, 3771 were included for full-text review. Most articles excluded at this stage were excluded on FSN measurement, in populations with underlying health conditions, were not analytical, or were non-systematic reviews, theses, comments, or abstracts. Finally, 1945 studies met the inclusion criteria and were mapped, as shown in the HTML map linked to this article . The cells in the EGM are segmented into population groups: children (green), pregnant women and mothers (blue), adults (yellow), and mid- to later-life populations (red). Summary statistics presented here forth are not additive to the total number of reports included, as many studies included multiple measures, populations, and settings. A simplified heat map of FSN and mental health studies is shown in Fig.  2 .

figure 1

Number of identified studies from search at each stage of screening.

figure 2

Rows are measures of mental health, columns are measures of food security and nutrition.

Food security and nutrition measures

Proportionally, the FSN measures in studies by group were comprised of: anthropometry (40%), diets (24%), nutrient intakes (14%), birth outcomes (13%), food scarcity (12%), nutrient biomarkers (10%), and IYCF indicators (6%).

Overall, BMI was the main indicator in 703, or 36% of all mapped studies, and was measured in almost 90% of studies including anthropometry. Studies measuring dietary patterns and quality (16%) and specific food groups (12%) were both prevalent. Of the studies measuring nutrient intake – via foods or supplements (14%), most were about macronutrients ( n  = 152/273), of which 94/152 were about polyunsaturated fatty acids (PUFA). The second largest group was vitamin intake ( n  = 110/273 studies). Of 110 studies on vitamins, various B vitamins (65%), calcium (40%), and vitamin C (29%) were most common. Of all nutrient intake studies, 87 measured supplement intake. Studies on nutrition-related birth outcomes ( n  = 245) primarily measured birth weight (84%). The majority of studies on food scarcity ( n  = 230) measured food security (71%) via many different indices. The most popular was the United States Department of Agriculture (USDA) scale used in national surveys in the US or adapted to other countries such as Canada or Korea ( n  = 70 including all versions). A small number of studies measured food scarcity through famine exposure ( n  = 9), and nutritional risk was mostly assessed in older populations ( n  = 70). Of the nutrient biomarkers in studies ( n  = 202), about half were on vitamins (55%), particularly for vitamin D (66%), folate (25%), and vitamin B12 (20%). Breastfeeding (including initiation, duration, or exclusivity) was the main FSN measure for nearly all IYCF studies ( n  = 114/124). A count of studies in each category is listed in Supplementary results  1 .

Mental health measures

Depression was by far the most common mental health measure, assessed in 61% of included studies. Hybrid domains of mental health—defined as capturing more than one aspect of mental health (e.g., a combination of depression and anxiety, a clinical interview for all common mental disorders)—were assessed in 26% of studies. Stress (12%), mental well-being (12%), and anxiety (10%) linked to FSN were the least studied.

Most studies (82%) used screening questionnaires to ascertain mental health status. Mental well-being and stress have no clinical diagnosis, so almost all of these were based on established indicators via questionnaires. For depression screening, the Center for Epidemiological Studies-Depression scale (CES-D) was the most common tool ( n  = 332), followed by the Edinburgh Postpartum Depression Scale (EPDS) ( n  = 183), the Geriatric Depression Scale ( n  = 105) and the Patient Health Questionnaire (PHQ) ( n  = 104). For hybrid domains, the Global Health Questionnaire (GHQ) was the most used screening tool ( n  = 76), as well as the Child Behavior Checklist (CBC) for measuring mental health in children ( n  = 41), the Hopkins Symptom Checklist (HSCL) ( n  = 36) and the Depression and Anxiety and Stress Scale (DASS) ( n  = 33). The State-Trait Anxiety Inventory (STAI) was by far the most common screening tool for anxiety ( n  = 64), and the Perceived Stress Scale (PSS) and Kessler Stress Inventory (KSI) were the most common stress measures used ( n  = 84 and n  = 46, respectively). For mental wellbeing ( n  = 229), 83 used the Short Form-36 questions, (also known as the Rand questionnaire). Many of these tools have been translated, adapted, and validated for cross-cultural use in LMIC contexts, and some tools have been developed specifically for these settings rather than adapted.

Clinical and diagnostic interviews were carried out in 9% of all studies, almost all of which (96%) were on depression or a general psychological or psychiatric interview which is used to diagnose multiple common mental health problems (hybrid domains). Some studies used a self-reported diagnosis, prescription medication as a proxy for diagnosis or medical records (8% of all studies). Only 14 studies investigated mental health using qualitative or mixed methods. There were 89 reviews or meta-analyses on depression, 58 on hybrid domains, 14 on anxiety, eight on stress, and three on mental wellbeing.

Relationships between FSN and mental health

The number of studies in each FSN and MH category and the proportion investigating linkages between them are presented in the Sankey diagram in Fig.  3 . The largest groups of BMI studies within anthropometry (90%) and overall (36%) were those examining BMI with: depression ( n  = 401, 21%), hybrid mental health measures ( n  = 192, 10%) and mental wellbeing ( n  = 109, 6%). The second largest intersection was diets (food groups, patterns, quality) with: depression ( n  = 278; 14%), hybrid mental health measures ( n  = 121, 6%) and mental wellbeing ( n  = 69, 4%).

figure 3

Categories of FSN measures on the left are linked to corresponding groups of MH measures listed on the right, with the width of the bands indicating the proportional number of studies connecting the groups.

Despite anthropometry and depression being the largest category, measures other than BMI and mental health besides depression were far less researched. Although there are some studies on child stunting, wasting, and underweight related to depression ( n  = 45 with depression, n  = 23 with hybrid domains), studies reporting relationships with other common mental health disorders such as anxiety and stress were few ( n  = 5).

Although studies measuring nutrient intake were the third largest FSN group, 75% of these were analyzed for their relationship to depression, and an additional 18% to hybrid domains. Most of these studies linked macronutrients and vitamins to depression ( n  = 117 and n  = 77, respectively), while few studies linked to anxiety, stress, or mental well-being ( n  = 56 altogether). Eighty-nine studies linked PUFA intake to depression or hybrid domains, and 32 studies to vitamin D intake and depression. There was almost an identical distribution for nutrient biomarkers, where proportionally almost all studies on biomarkers were linked to depression and hybrid measures. Vitamin D ( n  = 66) was the most common biomarker linked to depression.

Almost 50% of studies about birth outcomes ( n  = 245 total) were about birth weight with depression, and an additional 35% with hybrid domains. Many studies measured multiple nutrition-related birth outcomes (31%) such as birth length and head circumference, however only 28/245 of these included mental health measures other than depression. Only 10 of these studies investigated foetal growth restriction in relationship with mental well-being or stress, for example.

Food scarcity was linked to depression in many studies as well, especially in the studies examining nutritional risk in the elderly ( n  = 56/70). Food security was often studied in relationship to depression ( n  = 72/163), however as food security is also associated with worry, stress, and anxiety, other measures of mental health were relatively more common in the studies than in other groups of FSN (40% measured hybrid domains, 19% measured stress, 9% measured anxiety and 9% measured wellbeing).

Breastfeeding and depression were examined in 91 studies. There were especially few studies on any IYCF measure with anxiety ( n  = 28), stress ( n  = 11), and mental well-being ( n  = 4). Child diets and complementary feeding was linked to depression or hybrid domains in six out of eight child diet studies. For instance, only three studies compared any measure of mental health with child dietary diversity.

Study methods

Hypothesis testing.

We included studies that hypothesized the relationship between FSN and mental health in either direction: with FSN constructs as the ‘exposure’ or independent factor and mental health as the ‘outcome’ or dependent factor and vice versa (shown in each iteration, segmented proportionally by study design, in Fig.  4 ). Most studies ( n  = 1291, 66%) hypothesized FSN constructs as the exposure or equivalent, including cross-sectional studies. Almost 28% of these studies were about BMI associated with depression or hybrid domains of mental health outcomes. Another 25% were about diets related to depression or hybrid domains of mental health.

figure 4

The top panel is the number of studies with food security and nutrition (FSN) as the hypothesized exposure and mental health as the studied outcome.  The middle panel is the number of studies with mental health as the exposure and FSN as the outcome, and the bottom panel is the number of studies where both hypotheses were investigated.

Mental health was treated as the exposure in 31% of studies ( n  = 600). Of these studies, 39% investigated mental health related to BMI as an outcome, of which 121 studied depression as an exposure, 69 studied hybrid domains of mental health, 60 studied stress, 27 studied anxiety, and 9 studied mental wellbeing. Birth outcomes were the second-largest group of mental health exposure studies, where 119/147 were about birth weight. Where IYCF was the outcome ( n  = 75), almost all were about breastfeeding ( n  = 67). There were relatively fewer studies on diets, nutrient intakes, and biomarkers than in either the EGM overall or where mental health was the outcome.

In a small number of studies ( n  = 54), investigators tested the hypothesis for relationships in both directions over time. For instance in a longitudinal cohort where dietary patterns could be isolated as an exposure among people who develop mental health problems, or alternatively within the same study population, those whose dietary patterns change over time linked to preceding mental health problems. Most of these studies investigated BMI and mental health ( n  = 31/54). These characteristics can be selected through the filter function on the interactive EGM.

Study design

The majority of studies were observational (83%), with 46% cross-sectional and 37% longitudinal (Supplementary results  2 ). An additional 3% of studies were case-control design. There were 142 systematic reviews, of which 48 offered a meta-analysis. Experimental studies were not common —only 65 Randomized Controlled Trials (RCTs) were identified, along with 20 quasi-experimental studies (12 of which used Mendelian Randomization or genetic instrumental variable methods). Only ten qualitative studies were identified, and 4 mixed methods studies, despite explicitly including qualitative eligibility and coding parameters.

Cross-sectional studies followed a similar pattern to the EGM as a whole on mental health measures, although regarding FSN there were proportionally more studies on food scarcity and BMI and fewer on birth outcomes and IYCF. There were proportionally more longitudinal studies on birth outcomes (double across all but one mental health category) and more IYCF studies, and less on nutrient intake, nutrient biomarkers, and food scarcity, although mental health measures were similar proportionally to the full EGM.

Systematic reviews and meta-analyses on diets linked to depression or hybrid domains were most common (reviews without meta-analysis = 28; reviews with meta-analysis = 9, meta-analysis without review = 4), and nutrient intakes with depression or hybrid domains were the second most common (systematic reviews = 42; 15 of these with meta-analyses). Almost all (14/15) meta-analyses on nutrient intakes were about supplements. There were 18 reviews on BMI and depression or hybrid domains (seven of these with meta-analysis), while nine others focused on child growth measures. There were 22 systematic reviews on mental health related to birth outcomes, 17 of which were about mental health of mothers and birth outcomes of their offspring. Of all 69 meta-analyses, 59 of them focused on depression or hybrid domains.

Most experimental studies were RCTs of nutrient intake exposures and mental health outcomes ( n  = 46/65 experimental studies), namely depression ( n  = 26) and hybrid domains ( n  = 16). Half of experimental studies included anxiety, stress, or mental well-being. Nutrient intakes were primarily measuring supplement intake ( n  = 38/47), especially those on B vitamins, Vitamin D, Zinc, and fatty acids. Sixteen RCTs exposed people to fatty acids, and 12 to Vitamin D. Several studies also exposed people to Vitamins A, C, or E and magnesium or manganese minerals. The second most common type of RCTs were those randomizing people to diets and measuring various measures of mental health (six on depression, 10 on hybrid domains, three on anxiety, seven on well-being, but none on stress). Sixteen studies intervened on: Mediterranean diet pattern ( n  = 4), low fat or low-calorie diet ( n  = 4), the DASH diet, high-protein diet, healthy diet, or fish/animal source foods ( n  = 2 each), low glycaemic diet, high protein diet and vegetarian diet ( n  = 1 each). Only three studies had mental health interventions with FSN outcomes: two on stress reduction interventions and BMI or food intake, and one on antenatal depression interventions and birthweight/child growth.

The geographic distribution of studies by country, defined by where the participants were located, is shown through a choropleth map in Fig.  5 . The most saturation (number of studies) was in the United States, Australia, and the United Kingdom, 521 studies came from across Europe, 418 from Asia, and 81 from Africa. Central and South America were represented in fewer studies ( n  = 18 and n  = 67 respectively). Overall, 23% ( n  = 446) were set in low- and middle-income countries (LMIC). Eight percent ( n  = 160) were ‘global’ studies, such as those in five or more nations across regions, or those using global datasets, such as the Gallup poll or World Bank data.

figure 5

The bar plot on the left shows the number of studies by region and political category, and the map on the right shows number of studies by country.

Heat maps segregated into HIC and LMIC evidence is provided in Supplementary results  3 . Overall, there were proportionally more studies on nutrient intakes in HIC (15% vs. 9% of FSN measures), and proportionally more studies on food scarcity in LMIC (18% vs. 10%).

For instance, there were proportionally more studies of BMI in HIC (95% of 611 studies) compared to LMIC (72% of 172 studies). In LMIC studies, there were more studies on relative height (20% vs. 1%) and relative weight (11% vs. 2%) in children. For mental health measurement, 82% of studies using validated diagnostic tools were from HIC. Studies including measures of anxiety, stress, and mental well-being were more common in HIC than LMIC (13% vs. 7% for mental well-being).

Almost all reviews and meta-analyses were global in nature. Eighty percent of experimental studies and 90% of quasi-experimental studies came from HIC. Populations of interest in studies from HIC were proportionally more focused on general or representative adult populations (52% vs. 42% in LMIC studies). LMIC studies shift focus to women (particularly pregnant women and mothers—35% of LMIC studies vs. 26% HIC studies), although only slightly more on children (39% of LMIC studies vs. 35% HIC studies). Studies on mid-to-later-life populations were similar in both HIC and LMIC contexts (21%).


The EGM linked to this paper is segmented in each cell by broad population categories. We also offer a more granular classification of populations of children, women, men, and pregnant women and mothers (available as filters). Figure  6 shows a bubble diagram proportional to the population groups of included studies. Almost half of studies in the EGM were conducted in general or representative adult populations (49%). Studies including only mid- to later-life populations (usually 60 or 65 years of age and older) made up 21% of the EGM. Of the studies that included children of any age ( n  = 695), 433 included children under 5 years, 221 included children 5 to 12 years old, and 248 focused on adolescents 13 to 18 years old. Children under 5 were not commonly assessed on their mental health status ( n  = 106 vs. 423 studies of under-five measurements of FSN) as these measures are difficult to obtain and not reliable in very young children. Pregnant, perinatal women, mothers, and fathers were studied in 28% of all studies. Far more studies in pregnant women and mothers measured mental health as the exposure than FSN (26% vs. 8%). Pregnant and postpartum women were assessed more on their mental health status (9% pregnant and 5% postpartum) than on their FSN status (3% pregnant and 1% postpartum). Studies with women-only populations (not including perinatal women or mothers) made up an additional 8% ( n  = 158). Studies focusing only on men were fewer ( n  = 42, 2%).

figure 6

Bubbles are proportional to the frequency of analyses based on each population group. Bubbles for ‘Children’ ( n  = 257), ‘Adolescents’ ( n  = 214), ‘Pregnant Women and Mothers’ ( n  = 149), ‘Adults’ ( n  = 735) and ‘Mid Later Life populations’ ( n  = 408) refer to studies in which the relationship between FSN and mental health is examined within the same study population group. The bubble for ‘Cross-cutting populations’ shows studies in which the FSN measure in one group is hypothesized to affect the mental health of another group or vice versa, this includes interactions between households, parents, and/or children.

Some studies measured FSN in one group (e.g., children) and mental health in another (e.g., parents) (Fig.  7 ) . Amongst these ( n  = 484), the mental health of pregnant women and parents and the FSN of their children through adolescence has been studied the most: 355 total studies, 329 on FSN of children under five years, 44 on FSN of children 5–12, and 17 on FSN of adolescents. Fathers, however, are only included in eight of these studies. Mental health of pregnant women and mothers has mostly been hypothesized as the exposure for FSN outcomes in children ( n  = 314), though far fewer considered an association whereby FSN in children is the exposure and mental health of pregnant women and parents is the outcome ( n  = 54). The association between food security measured in the household with mental health in individuals was reported in 107 studies, most of which were in general adult populations ( n  = 51) and pregnant women and mothers ( n  = 38).

figure 7

The size of the bubbles and width of the links between them is scaled according to the number of studies and frequency of hypothesized relationships in the literature. The direction of the arrows indicates the hypothesized direction of effect according to the studies, a double arrow in opposite directions shows that both directions have been hypothesised in different studies.

Time trends

Our analysis shows clearly that the overarching body of literature linking FSN to mental health has steadily grown since 2000 (Fig.  8 ). As we concluded our search half-way through 2020, the number of these studies is likely to increase annually, marking a continued interest in this cross-section of fields.

figure 8

The plotted line shows the increase in studies from 2000 until 2020.  The search concluded half-way through 2020, which accounts for the drop off in this year.

Evidence is steadily growing about links between many of the FSN and mental health constructs measured by included studies, and the EGM makes this clear. Studies on depression and studies on BMI dominated the map overall. Anxiety, stress and mental wellbeing, and IYCF were the least represented in the literature. Given that food insecurity, inaccessibility of healthy, diverse diets, and poor clinical nutrition are all likely to exacerbate worry and stress, the dearth of studies linking FSN to dimensions of anxiety, stress, and well-being, rather than depression alone, is notable. There may be strong evidence on how food security, certain nutrients (e.g., Vitamin D), dietary patterns, and BMI are associated with depression. On the other hand, evidence seems sparse on the relationships between other nutrients (e.g., selenium, antioxidants), IYCF practices, or child growth related to mental health, or vice versa.

Regarding study design, experimental studies were mostly about nutrient intakes; very few intervened on other FSN measures or mental health interventions with FSN outcomes. Overall, experimental, quasi-experimental studies, and systematic reviews with meta-analyses were far less common than the plethora of cross-sectional and cohort studies. Only 34% of systematic reviews were accompanied by a meta-analysis. There was much less qualitative or mixed methods evidence.

Geographically, studies with paticipants from the United States, Australia, and United Kingdom dominated the evidence. Although almost a quarter of studies were carried out in LMIC, 77 of these 446 were conducted in China and 75 in Iran, with few in Arab countries or Latin America. The studies with participants from Africa ( n  = 81) were mostly carried out in three countries (South Africa, Ghana, and Ethiopia). Three-quarters of studies carried out in South America were from Brazil. Of the LMIC countries represented in the EGM, evidence is largely based in industrialised countries, which suggests that the LMIC literature does not capture the diversity of less industrialized, poorer, or more rural countries. It is an especially important gap, given that food insecurity and undernutrition are the highest in the countries least represented by the literature base.

Most studies that measured FSN in one population group and MH in another were about mothers’ mental health and their children’s nutrition or growth status. Very rarely were FSN indicators in children investigated for their effect on parents’ mental health. Fewer studies still focus on fathers or parents together. As studies among women in LMICs can sometimes focus on reproduction, and without sufficient attention to other aspects of womens health, we highlight the lack of studies from LMICs that examine mental health impact on women’s nutritional status and vice versa.

Despite studies showing that FSN and mental health are related in many ways, there are still large gaps across the EGM of studies investigating causal mechanisms of these relationships. There were many studies showing relationships between FSN and mental health, but less with the combined design, contextual factors, and analysis to provide information most needed to design effective programs and policies. For example, there were few qualitative studies identified, even though the ethnographic lens of lived experience can provide important insights into why and how mental health is related to FSN, without relying on nosological distinctions that may be less important in certain contexts. Some of the qualitative studies raised interesting findings, for example the mental health toll from weighing trade-offs in types of food purchases (e.g., healthier options versus volume or calories) 32 , how rising food prices affect not just food security and nutrition, but contribute to multi-fold mental health consequences from constraining cultural practices like funerals and other ceremonies 33 , and the varied role of social support related food insecurity: in some contexts social connectedness increased shame and stigma, whereas in others it helped buffer the negative effects of food insecurity through shared resources 34 .

That said, there is scope to further investigate the shared and underlying determinants of FSN and mental health. From the existing literature, these include poverty (although interestingly poverty alone does not account for these burdens 35 ), lack of women’s agency, other health conditions, environment, and climate change, as well as conditions of violence, conflict, instability, and social strife 36 , 37 , 38 , 39 . Most of these factors have been identified through the respective bodies of literature on each, but some new work on the topic has tried to understand common determinants and mechanisms between FSN and mental health through innovative theoretical framing, study design, and more advanced statistical models 28 , 40 . Recent interventions that at the least measure and at the most include programmatic components of both FSN and mental health have begun to give insight into some of these mechanisms as well 41 .

Through this systematic synthesis and mapping, we were able to combine various intersections of measures, populations, study types, and cross-cultural settings into an interactive resource. This is the first paper to systematize the body of evidence linking FSN to mental health. The EGM can be used in various ways by selecting and describing the nature and extent of literature on this topic.

We employed rigorous, expert-led screening and coding processes, including a search strategy designed by an information specialist using an index list of known literature. We followed state-of-the-art guidance on creating EGMs, which stop short of offering a synthesis effects observed but do include interactive filters to sort evidence according to study characteristics. Conducting a meaningful and feasible quality assessment of almost 2000 studies or pool results was beyond the scope of this EGM.

We also created parameters that limited our analysis in certain ways. We searched only papers published from 2000, did not search non-English repositories or include grey literature, and our chosen databases may not have been as likely to include qualitative reports, all which may have introduced some bias. That said, we are confident that collectively, the large number of studies identified and included serve as a basis from which to draw conclusions about trends, gaps, and characteristics of the available evidence on FSN and mental health.

The most important exclusion criteria were for studies in populations with underlying health problems, such as diabetes, cardiovascular disease, HIV, tuberculosis, or hospitalized patients, as well as niche characteristics (e.g., female endurance athletes or male textile factory workers). Although there is literature relevant for these populations, we aimed to identify evidence that minimized the confounding nature of other health conditions or characteristics. We also excluded FSN measures that were not direct measures of food security, intake, or nutrition status, such as eating behaviours, stimulant foods, or breastfeeding intentions.

In line with current trends to measure mental health globally through a symptom-based framework rather than a diagnostic criterion (which can bias and confound locally appropriate constructs of mental health) 42 , 43 , 44 , we included mental well-being and mental health quality of life measures. We also included qualitative literature on the topic, which might not fit within the traditional depression, anxiety, and stress groupings. For instance, a systematic review of qualitative literature about depression experience globally found that DSM model and standard instruments derived from the DSM fall short of capturing the experience of depression worldwide or regionally. Specifically, half of the 15 features of depression identified in non-western populations were not captured in current diagnostic tools 42 . However, measures of mental well-being were often difficult to disentangle from general happiness, life satisfaction, or other physical health quality of life measures. Many were mixed across these domains. We thus relied on expert guidance from Teachers College Global Mental Health Lab, who assessed each measure identified across all categories for eligibility and classified them.

We propose that this EGM is a tool to navigate a diverse literature base that will be primarily driven by the interests and expertise of the user. It can identify key gaps in the literature and thus direct novel efforts in research. This might include planning new primary studies or synthesis of existing primary research. When interpreting cells with fewer studies, it is important to carefully examine the quality of those studies and the clinical or practical relevance of research efforts to fill the gaps. Some research may be less strategic from a policy and planning perspective, for instance conducting new studies on IYCF related to anxiety and stress may have more application than new studies on minerals related to mental wellbeing, both of which appear as gaps on the EGM.

Furthermore, a cluster of studies in a cell (particularly certain study types—such as RCTs and reviews—commonly deemed further up on the hierarchy of evidence) still might prove worthy of further investigation. For instance, the most common subject of studies in the EGM is adiposity and depression, and there are several large, rigorous reviews with meta-analyses included on this topic. However, there is no pooled analysis of this relationship in low-income settings, where the observed effects may be quite different. This example highlights that the EGM as a whole can bring focus to understudied regions or populations: if used to highlight broad contextual factors, this might spur research that changes the conclusions we draw from either combining all available evidence (which may not all act in the same direction) or making assumptions based on the most prevalent literature (e.g., from high-income settings).

The overarching goal of building the EGM was to lay the groundwork for an evidence-based, empirical framework highlighting linkages that are known and hypothesized between FSN and mental health. This would entail selecting and synthesizing the strongest evidence within each cell, insofar as combining certain groups of studies is appropriate. This will serve to direct and support future inquiries into these relationships, as well as systematize our knowledge on the topic (Supplementary discussion  1 , Box 1). Furthermore, a new understanding of and emphasis on these relationships can become part of advocacy, programs, strategic planning, and policy to support progress towards health goals such as the SDGs and others.

Through a systematic literature search, we comprehensively identified analytical studies investigating relationships between a broad array of FSN and mental health constructs. We mapped 1945 eligible studies onto an interactive EGM which can provide visualization of this diverse field of literature. The EGM overall allows readers to step back and take stock of the body of literature, as well as dive into specific intersections of food security, nutritional risk, diets, nutrients, nutrition-related birth outcomes, IYCF indicators, and anthropometry with depression, anxiety, stress, and mental wellbeing. The EGM also allows for narrowing of each intersection through an extensive list of filters that can be combined in various ways to select characteristics of interest.

The analysis and map highlight thematic trends (such as the proliferation of evidence linking BMI and depression) as well as gaps (stress and mental well-being related to nutrients or child diets). It also shows the nature of the literature—an increasing number of studies on the topic that are dominated by observational designs in high-income countries. Studies from Central and South America, Arab nations, and Africa are less prevalent, as well as studies using qualitative, mixed, quasi-experimental and experimental methods. Many different populations are investigated through this wide array of studies, although studies comparing associations between populations are dominated by mothers and their children.

We imagine that this analysis and EGM will serve as a basis for future inquiry, whether it be original research, evidence synthesis, and analysis, funding priorities, or the development of synergistic and integrated public health programmes and policies.

This systematic Evidence and Gap Map, including accompanying analysis, relied on publicly accessible documents as evidence, without including personal, sensitive, or confidential information from participants, thus complying with current ethical standards.

Search strategy

Following PRISMA guidelines, we conducted a systematic search of three published literature databases: Web of Science, CAB Global Health, and PsychInfo, searching from January 1 2000 until July 28, 2020. We chose the year 2000 as a cut-off as preliminary searches revealed diminishing returns in the eligibility and relevance of previous studies in this area. Broadly, the search was operationalized by including synonyms for mental health, stress, distress, anxiety, depression, or mood disorders, and synonyms for food security, micronutrients, diet, nutrition, or anthropometry, as well as all kinds of study designs. Results from the searches were deduplicated and loaded into EPPI Reviewer 4 and web-based software. All analysis and graphics were produced in Excel version 16 or the web-based Flourish Studio. The full search strategy, designed by an information specialist, is specified in Supplementary methods  1 . The screening and coding guidelines are listed in Supplementary methods  2a–d .


We included only papers published in peer-reviewed journals and in English, from 2000 until July 28, 2020, that presented empirical links between measures of food security and nutrition and mental health in human populations from anywhere in the world. We only included analytical research (studies associating mental health to FSN), excluding descriptive or prevalence studies. We included population-based quantitative and qualitative studies of any design. We included systematic reviews based on their eligibility criteria; to be included, at least one study in the review had to fit our overall eligibility criteria.

We included any quantitative indicator for: food scarcity (including food security, exposure to famine or hunger, and nutritional risk [usually in the elderly]); diets (specific food groups and dietary patterns or quality); nutrient intake (including vitamins, minerals, macronutrients, polyphenols/antioxidants via food intake or supplements); nutrient biomarkers (vitamins, minerals, macronutrients, and polyphenols/antioxidants measured through blood, urine, fat); Infant and Young Child Feeding (standard WHO indicators as well as breastfeeding initiation, duration or exclusivity); nutrition-related birth outcomes (e.g., birth weight, birth length, intrauterine growth restriction [IUGR] or small-for-gestational age [SGA], head circumference); and nutrition-related anthropometry (e.g., BMI, body composition, body ratios, relative weight, relative height). We used ‘relative weight’ as an umbrella group for wasting and weight-for-height z-scores (WHZ) and ‘relative height’ as a group including stunting, height-for-age z-score (HAZ), growth faltering, and other height measures of child growth. We also included studies that measured these elements of food security and nutrition through qualitative methods.

For mental health, we included studies that measured common mental disorders (CMDs) under the International Classification of Diseases version 10 (ICD-10), as well as general distress and mental well-being in order to capture transcultural and qualitative literature on the intersections of mental health and FSN. We used the following broad categories: depression; hybrid domains; anxiety; stress; and mental wellbeing (e.g., mental health-related quality of life). These could be assessed through qualitative interviews, screening questionnaires, self-report of diagnosis, prescription medication (as a proxy for diagnosis), or clinical and/or diagnostic interviews. The list of eligible screening measures was assessed and categorized by the mental health specialists at the Global Mental Health Lab.


We did not include grey literature in our search. Studies in populations with comorbid health conditions, such as hypertension, diabetes, HIV, or surgical patients were excluded as both the nutritional and mental health correlates of these populations is likely to be unique. We also excluded studies in populations where all participants were already identified as overweight or having obesity, low birth weight, or having mental illness. We excluded case reports ( n  < 10), theoretical or simulation-based modelling, studies in solely clinical setting, non-systematic reviews, theses, commentaries, and abstracts.

On FSN, we excluded studies on: dietary practices and attitudes without intake measures (e.g., eating family dinners, dieting); amino acids, hormones, single, specialized or stimulant foods (e.g., arginine, seaweed, walnuts only, coffee, caffeine, alcohol); proprietary or specialized supplement or food formulas; attitudes or preferences related to infant and young child care; preterm birth (as often an outcome of non-nutritional factors); and weight change, loss or trajectories. A full list of included and excluded measures with examples and justification are included in Supplementary methods  3a, b .

On mental health, we excluded mental illnesses other than CMDs (e.g., compulsive disorders, trauma-related stress disorders, phobic anxiety disorders, and developmental disorders). Measures that had no experiential component were excluded. Measures of cortisol were excluded as this hormone fluctuates for various reasons besides experience of stress (e.g., early in the morning, during birth, during exercise), as well as stressful event inventories or circumstances without ascertainment of perceived impact. General happiness or satisfaction measures were excluded as they are not direct measures of mental health, rather an indication of heightened risks or protective factors. We also excluded general health-related quality of life focusing only on physical health without mental health components separated. Lastly, we excluded studies where common mental illness could not be disentangled from other mental illness such as psychosis, bipolar disorder, substance use, eating disorders, or other mental health problems.

Some of our FSN or mental health measures (especially BMI) were included as covariables in studies for which they were not the main outcome or exposure of interest. Studies that did not report results directly linking FSN to mental health were therefore excluded.

Screening and study selection

A team of screeners were trained and double-screened reports on title and abstract until 85% agreement rate was reached, whereafter 85% of reports were single-screened and at least 15% (sometimes more with sensitivity checking) were double-screened by a senior researcher. Patterns and disagreements were discussed and additional written guidance offered. Eligible reports based on title and abstract were reviewed in full text. We undertook a similar training process, whereby once agreement rates were reached, screeners were allowed to single screen. A third of records were double screened to ensure good sensitivity. In addition to this, several iterations of backchecking and targeted searches were re-screened throughout the process.

Data coding and analysis

Data was classified through a mix of a priori and iterative coding strategies. Fields that were decided a priori (e.g., groups of FSN and mental health measures, countries, study designs, etc.) served to identify both trends and gaps. Iterative coding included the specific measures within FSN and mental health groups. For example, although we had pre-identified a list of common and validated measures of anxiety or depression, or food security, there were many more measures that emerged beyond initial lists. These were grouped into a code if more than one study employed the measure. We used a coding form built in EPPI Reviewer to extract data on eligible reports. Only analytical comparisons and their characteristics were considered for data extraction.

We extracted information on publication year, country (or countries) and regions, study design, hypothesized direction of association between FSN and mental health (exposure-outcome relationship) and specific categories of measures and indicators, study population characteristics and sample size, and whether the analysis was adjusted or not (with at least two covariables). For the hypothesized relationship, we coded based on the authors’ stated aims and methods even for cross-sectional and qualitative studies. The ‘adult’ population category included any age range over 18, whereas studies with populations limited to older people (usually 60 or 65+ years old) were coded with ‘mid- to later-life populations only’.

Data extraction was carried out by single coding of included studies with a full review of all data extraction forms by a second researcher and targeted sensitivity checks. Given the breadth of evidence included and the aims of an evidence and gap map, quality appraisal of individual studies was not feasible or meaningful at this stage.

>All studies that met the inclusion criteria were mapped into an EGM using standard methods 45 . The EGM framework consists of columns of categories and sub-categories of FSN constructs, and rows of mental health constructs as well as measurement categories. These rows and columns are collapsed (as the map opens) and then expanded to see all sub-categories. The cells can be segmented into four groups indicated by different colours. The bubbles scale proportionally to the number of studies in the group. The user can scroll over a cell to see a summary of studies or click on the cell to see a classified bibliography of selected studies. There is also a list of filters (codes), which can be used to select studies with specific characteristics for which data was extracted. A full coding structure is provided in Supplementary results  1 .

Reporting summary

Further information on research design is available in the  Nature Research Reporting Summary linked to this article.

Data availability

All scientific reports included in the Evidence and Gap Map were identified via Web of Science, PsychInfo, and CAB Abstracts Global Health repositories. The dataset (essentially included studies) generated during the current study are available within the HTML Evidence and Gap Map, and analysed within the manuscript and supplementary files. The full database (including initial search results and screening codes) can be accessed upon reasonable request from the corresponding author, as this is contained within EPPI Reviewer software which requires a user account.

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We thank the IMMANA team for their ideas, logistical and dissemination support, especially Sylvia Levy for supporting the ANH Academy Mental Health Working Group. Maria Palar, Lambert Felix, Venus Mahmoodi, Vildana Hodzic, Pema Payang, Srishti Sardana, Elliot Golden, and Justine Wright each contributed to the screening and coding of articles and we wholeheartedly thank them for their contributions. Herbert Aimiani and Nadine Seward also contributed to the ANH Academy Working Group on Mental Health which produced this work. Funding for this study was provided by the Innovative Methods and Metrics for Agriculture, Nutrition and Health Actions (IMMANA) Programme, funded by FCDO and the Bill and Melinda Gates Foundation, which specifically funded the time of TS, MD, CO, and SK. We received in-kind support from the Global Mental Health Lab at Teachers College, Columbia University.

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TS conceived of the EGM and led the review, along with support from the ANH Academy Mental Health Working Group, consisting of TS, BC, MD, MS, EP, JE, FMA, KM, CC, HV, RA, and SK. TS, MD, and BC oversaw the methods and training for study identification. Screening and coding of studies was carried out by MD, TS, XH, CL, ZL, CO, and BC. TS drafted the manuscript, map, and figures, supported by CO and MD. The manuscript was reviewed by all authors, with further editing and revision support from CO, MD, BC, and SK.

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Sparling, T.M., Deeney, M., Cheng, B. et al. Systematic evidence and gap map of research linking food security and nutrition to mental health. Nat Commun 13 , 4608 (2022). https://doi.org/10.1038/s41467-022-32116-3

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  • The ready availability of nutritionally adequate and safe foods
  • Assured ability to acquire acceptable foods in socially acceptable ways (that is, without resorting to emergency food supplies, scavenging, stealing, or other coping strategies)

Building on and complementing our long-standing efforts to address food security, the USDA is expanding our efforts to advance food and nutrition security .  Nutrition security  means all Americans have consistent and equitable access to healthy, safe, affordable foods essential to optimal health and well-being. Our approach to tackling food and nutrition insecurity aims to:

  • Recognize that structural inequities make it hard for many people to eat healthy and be physically active; and
  • Emphasize taking an equity lens to our efforts.  

Importance of Food & Nutrition Security

Food insecurity creates enormous strain on worker productivity, healthcare spending, and military readiness and disproportionately impacts racial/ethnic minority populations, lower income populations, and rural and remote populations. The  USDA Economic Research Service (ERS)  noted food insecurity rates peaked at 14.9% in 2011 and dropped slowly to 10.5% in 2019 – illustrating the length of time – about 8 years – that it took to return to pre-recession (2007) levels. During the early stages of the COVID-19 pandemic, the US Census Bureau  reported  how food insecurity and food insufficiency was a challenge and disproportionately impacted communities of color, lower-income communities, and rural/remote communities. Often, food insecurity and diet-related chronic diseases  co-exist . Diet-related chronic diseases are  the leading causes of death  in this country and disproportionately affect communities of color, lower-income communities, and rural/remote communities. Ensuring food and nutrition security for everyone in this country will require a better understanding of the complex causes and corresponding solutions of food insecurity and diet-related illnesses and  disparities . As detailed on our  Nutrition and Food Systems Topic Page , NIFA’s approach to advancing food and nutrition security supports the convergence of science and technology needed to transform our food system to shorten supply chains, optimize agricultural productivity, minimize negative environmental impacts, and ensure a resilient, flexible food system that is safe, affordable, and nutritious. 

NIFA’s Impact

NIFA recognizes nutrition as a cost-effective approach to address many of the societal, environmental, and economic issues faced across the globe today. NIFA works to ensure a safe, nutritious, and secure food supply while also developing, delivering, and disseminating evidence-based  nutrition education  and promotion to prevent chronic diseases, improve health, and prioritize  nutrition security . NIFA partners with the  Land-Grant University System  and government, private, and non-profit organizations to support science. Our agency also invests in developing nutrition scientists across all stages of professional development to use an integrated approach to prioritizing nutrition security and ensuring sustainable agricultural systems through research, education, and extension. NIFA invests more than $220 million in research, education, extension, and innovation to advance USDA’s goal to tackle food and nutrition insecurity.

NIFA aims to help prioritize nutrition security by focusing on:

  • Using Innovative Trans-Disciplinary Solutions to Promote Healthy Eating Patterns and Behaviors  to tackle the “whole picture” regarding underlying factors and most promising strategies.
  • Production (e.g., agroecology, community and home food gardening, urban agriculture, farmers’ markets, regional food systems)
  • Preparation (e.g., ensuring sufficient, safe, and nutritious food preparation in culturally, contextually, and economically sensitive ways including disaster preparedness)
  • Promotion (e.g., Fostering a circular economy in rural areas by promoting local and regional food supply chains)
  • Consumption (e.g., enabling positive and sustained healthy eating behavior to decrease the health and financial burden of diet-related non-communicable diseases and health disparities)
  • Increase access to and improve the nutritional quality of our federal nutrition safety net
  • Disposal (e.g., limit food waste while ensuring food safety)
  • Integrating with  Climate-Smart Agriculture  on transformative discoveries, education, and engagement.
  • Engaging Individual, Family, and Community Agency and Capacity   Building

The following  NIFA Topic pages  further explain our efforts to prioritize nutrition security (stay tuned a few pages are under development):

  • Climate Change
  • Food Loss and Waste 
  • Food Quality
  • Food Safety 
  • Nutrition and Food Systems
  • Sustainable Agriculture
  • Global Food Security  

Key NIFA nutrition security programs include:

  • Expanded Food and Nutrition Education Program (EFNEP)
  • Gus Schumacher Nutrition Incentive Program (GusNIP)
  • Community Food Projects
  • Food and Agriculture Service Learning Program (FASLP)
  • Agricultural and Food Research Initiative (AFRI) A1344 Diet, Nutrition and the Prevention of Chronic Diseases  

NIFA also supports additional programs that help prioritize nutrition security:

  • 4-H Youth Development Program
  • 1890 Institution Teaching, Research and Extension Capacity Building Grants (CBG) Program
  • Alaska Native-Serving and Native Hawaiian-Serving Institutions (ANNH) Competitive Education Grants Program
  • Hispanic-Serving Institutions Education Grants Program (HSI)
  • Resident Instruction Grants for Institutions of Higher Education in Insular Areas (RIIA) Programs
  • Tribal Extension Grant Program
  • Federally-Recognized Tribes Extension Program
  • A1364 Novel Foods and Innovative Manufacturing Technologies
  • A1531 Biorefining and Bioengineering
  • A1641 Economics, Markets and Trade
  • A1642 Social Implications of Food and Agricultural Technologies
  • A1712 Rapid Response to Extreme Weather Events  
  • A1721 Extension, Education & USDA Climate Hubs Partnership
  • A1741 Center for Research, Behavioral Economics, and Extension on Food Loss & Waste
  • A9201 Sustainable Agricultural Systems
  • Beginning Farmer and Rancher Development Program (BFRDP)
  • Children, Youth and Families at Risk (CYFAR)
  • CYFAR 4-H Military Partnership Professional Development & Technical Assistance (CMPC-PDTA)
  • Enhancing Agricultural Opportunities for Military Veterans (AgVets)
  • Master Gardener Program , as well as Master Health and  Master Food Preserver  Programs
  • National Center for Home  Food Preservation
  • New Technologies for Ag Extension (NTAE)
  • Organic Agriculture Research and Extension Initiative
  • Regional Rural Development Centers
  • Rural Health & Safety Education
  • Small Business Innovation Research (SBIR)
  • Sustainable Agriculture Research and Education (SARE) Program
  • Urban, Indoor, and Emerging Agriculture 
  • WIC Workforce Development Initiative  

Integrating Youth Perspective

Our efforts aim to foster youth voice and integrate youth perspective where possible. Learn more from these relevant resources:

  • NIFA 4-H Youth Development Program  
  • National 4-H Conference | National Institute of Food and Agriculture (usda.gov)          
  • 2024 National 4-H Conference Information Session | National Institute of Food and Agriculture (usda.gov) 
  • ASCEND for Better Health | Nutrition.gov  
  • Engagement | Nutrition.gov 
  • Youth Perspectives on Food, Nutrition, and Health, Washington, DC | Nutrition.gov  

Indigenous Traditional Ecological Perspective

Across all of our efforts, we are prioritizing the integration of diversity, equity, inclusion, and accessibility principles. We have also elevating the importance of integrating Indigenous Traditional Ecological Perspective. We are also working to help build the evidence base and translate the evidence into action for promoting Indigenous Food Sovereignty. Learn more from these relevant resources:

  • USDA-DOI Treaty Database
  • Tepary Beans resource  
  • Intertribal Buffalo Council
  • Returning Buffalo with Native Nations Forum  
  • White House Releases First-of-a-Kind Indigenous Knowledge Guidance for Federal Agencies    
  • National Park Service Indigenous Knowledge and Traditional Ecological Knowledge  
  • First Nations  
  • ASCEND for Better Health: Building a Healthy Community Together, Bismarck
  • United Tribes Technical College, Health & Wellness
  • USDA ARS, North Great Plains Research Laboratory
  • Great Plains Tribal Leaders’ Health Board Good Health & Wellness

Learn more listening to our  NIFA Nutrition Security Webinar Series .  

Consumer Resources  –  USA.gov Government Benefits  explains how to apply for and find social support programs, including nutrition assistance.  Nutrition.gov  is a USDA sponsored website that offers credible information to help you make healthful eating choices.

Nutrition Professional Resources  – The  USDA National Agricultural Library’s Food and Nutrition Information Center  provides access to a range of  resources from both government and non-government sources.

Nutrition Security Research Resources  –  The USDA Economic Research Service (ERS)  conducts economic research on numerous topics central to food and nutrition security and provides links to selected ERS research and resources on these topics.

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Exploration of Food Security Challenges towards More Sustainable Food Production: A Systematic Literature Review of the Major Drivers and Policies

Sabreen wahbeh.

1 Faculty of Business, University of Wollongong in Dubai, Dubai 20183, United Arab Emirates

Foivos Anastasiadis

2 Department of Agribusiness and Supply Chain Management, Agricultural University of Athens, 11855 Athens, Greece

Balan Sundarakani

Ioannis manikas, associated data.

Not applicable.

Food security is a central priority for international policy as one of the world’s most significantly urgent targets to achieve. It is considered one of the most pressing issues in many countries, the degree of food security representing the level of self-sufficiency and well-being of citizens. In particular, in the current COVID-19 pandemic era, it has more than ever become a mission-critical goal. In this research, we report on the food security drivers and the current state of recommended policies addressing chronic food insecurity aimed at ensuring the sustainability of future food production. Mapping the determinants of food security contributes to a better understanding of the issue and aids in the development of appropriate food security policies and strategies to enhance the sustainability of food production in all facets; namely environmental, social, and economic. Adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) data screening and selection guidelines and standards, we carried out a comprehensive, reliable, systematic, and rigorous review of research from the last ten years in order to identify the most frequently mentioned drivers and policies of food security in the literature available in two databases: Scopus and Web of Science (WOS). The number of extracted articles was 141 papers in total. An analysis revealed 34 drivers of food security and 17 most recommended policies for the mitigation of food insecurity. The existence of food loss and waste (FLW) policies was the primary driver of food security, followed by food security policies (FSP) in their different forms. However, FSP were the most recommended policies, followed by FLW policies. The identified food security drivers and recommended policies should be used by policy-makers to improve food security, thus contributing to sustainable food production. Our research findings, reflected in the latest version of the Global Food Security Index (GFSI), resulted in more tangible policy implications, suggesting the addition of two dimensions regarding food security. We also identified elements not listed under the GFSI that could be considered in its future revision, including environmental policies/indicators, consumer representation, and traceability throughout the entire supply chain. Overall, it can be concluded that food security is a complicated and multi-faceted issue that cannot be restricted to a single variable, necessitating the deeper integration of various multi-disciplinary interventions.

1. Introduction

Food security (FS) is “a situation that exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life” [ 1 ] p.3. It is a significant priority for international policy [ 2 ], and has been perceived as being among the key challenges worldwide [ 3 ] as it represents a country’s degree of self-sufficiency and the well-being of its citizens [ 4 ]. Securing a nation’s self-sufficiency has become a top priority in the context of the current COVID-19 global epidemic era, even more so than earlier [ 5 ]. Economic expansion, rising incomes, urbanization, and growing population are driving up the demand for food, as people adopt more diverse and resource-intensive dietary habits [ 2 , 6 ]. The world’s current population is steadily increasing, placing significant pressure on the available natural resources to feed the growing population [ 7 , 8 , 9 ]; however, this dramatic growth in the global population is anticipated mainly in developing countries, which already suffer from devastating hunger and food insecurity [ 7 ]. One of the biggest obstacles to ensuring global food security is the need to roughly double food production within the coming few decades, particularly in the context of the developing world’s rapidly increasing demand [ 10 , 11 ]. The natural resources such as land, water, energy, and other resources used in food production are all subject to increasing competition [ 12 , 13 ]. Climate change poses difficulties for agricultural production [ 14 ], mainly in developing nations, while some existing farming practices harm the environment and contribute significantly to greenhouse gas emissions (GHG) [ 15 , 16 ]. There is a real danger that less developed countries may be forced to reverse direction. The FAO’s statistics on world hunger in 2009 showed a dramatic rise to 1.023 billion people, demonstrating precisely such a situation. When commodity prices fell the following year, this number dropped to 925 million, which was still more prominent than in 2007 (i.e., before the price spike) [ 17 ]. According to recent data published by the Global Hunger Index, the number of malnourished people grew from 785 million in 2015 to 822 million in 2018. Moreover, 43 out of 117 countries reported extreme hunger [ 18 ]. Approximately 20% of developing countries lack the resources and physical access necessary to provide their citizens with the most basic food. Children in developing countries face vitamin and nutritional deficiencies and being underweight, which puts them at risk for various sicknesses due to food insecurity [ 12 ]. National and global imbalances brought on by food insecurity are expected to worsen human suffering and make it harder for people to survive [ 12 ]. Despite the efforts of multiple global organizations such as the FAO and the UN, the problem of food insecurity is worsening [ 19 ], which means that more effective and sustainable solutions must be provided to ensure the alleviation of food insecurity and the sustainability of food production. Hence, policy-makers must understand that in a world that is becoming more globalized, food insecurity in one region could have significant political, economic, and environmental impacts elsewhere [ 2 ].

Throughout the twentieth century, policy-makers used the concept of food security as a key notion in formulating food-related policies [ 17 ]. Lang and Barling [ 17 ] have proposed two main schools of thought on food security: the first focused on increased production as the primary solution to under-consumption and hunger, while the second is a newer one that is more socially and environmentally conscious and accepts the need to address a wide range of issues, not just production. The former is primarily concerned with agriculture, while the latter is concerned with food systems. One approach to solve the food security challenge is to intensify agricultural production in ways that impose much less environmental stress and do not jeopardize our long-term ability to continue producing food [ 2 ]. The above sustainable intensification strategy comprises a policy agenda for several governments worldwide, but has also drawn criticism for being overly production-focused or incoherent [ 2 ]. The central mission of the twenty-first century is to establish a sustainable food system, which calls for a more concrete policy framework than that which is currently in place [ 17 ]. This mission has been disrupted by competing solutions for policy focus and policies that have, so far, failed to incorporate the complex array of evidence from social, environmental, and economic components into such an integrated and comprehensive policy response [ 17 ]. Millions of people are being pushed into a cycle of food insecurity and poverty due to climate change; however, we can combat both food insecurity and climate change by implementing climate-friendly agricultural production methods [ 12 ]. Tsolakis and Srai [ 20 ] have stated that any comprehensive food security policy should entail multi-dimensional policies considering aspects such as resilience, trade, self-sufficiency, food waste, and sustainability. As it is traditionally understood, food security concerns individuals, while ecological and environmental concepts operate locally and at supra-national, regional, and international levels [ 1 ]. According to Guiné, Pato [ 21 ], the four pillars of food security—availability, access, utilization, and stability—should be reconsidered to include additional factors such as climate change. Clapp, Moseley [ 22 ] has also stressed that it is time to officially update the existing food security definition to involve two further dimensions—sustainability and agency—containing broader dynamics that have an impact on hunger and malnutrition [ 23 ]. Sustainability relates to the long-term ability of food systems to ensure food and nutrition security in a way that does not jeopardize the economic, social, and environmental foundations that generate food and nutrition security for upcoming generations [ 22 , 23 ]. Agency represents the ability of people or groups to decide what they consume, what they produce, and how they produce, process, and distribute their food within food systems, as well as their capacity to participate in processes that shape the food system’s policies and governance [ 22 , 23 ]. Instead of dismissing food security as being insufficient, Clapp, Moseley [ 22 ] has contended that the inclusion of two extra dimensions—agency and sustainability—into food security policy and assessment frameworks will help to guarantee that every human has access to food, not just now but also in the future. Sustainability can be viewed as a pre-requisite for long-term food security [ 1 ]. Environmental aspects—particularly climate and the availability of natural resources—are pre-requisite for food availability and biodiversity protection [ 24 ]. The availability of food for everybody depends on economic and social sustainability. Food utilization, too, is influenced by social sustainability. The three components of sustainability—social, economic, and environmental—ensure the continuity of the three food security dimensions and the food system stability on which they rely. As confirmation of the vital relationship between food security and sustainability, “The International Food Policy Research Institute” has launched a 2020 Vision of Food Security to achieve food security, stating that “a world where every person has economic and physical access to sufficient food to sustain a healthy and productive life, where malnutrition is absent, and where food originates from efficient, effective, and low-cost food and agricultural systems that are compatible with sustainable use and management of natural resources” [ 12 ] (p357). Many policies, priorities, technologies, and long-term solutions must be developed and implemented worldwide to achieve the 2020 food security vision [ 10 , 11 , 12 ]. However, there is a scarcity of systematic studies analyzing the food security drivers and the recommended policies to improve food security.

Following a review of the academic literature, we discovered a scarcity of research that systemically summarizes the major drivers of food security, outlines the recommended policies to improve food security, ensures the sustainability of future food production, and provides policy recommendations to enhance food security based on a country’s context. In response to this gap in the literature, we carried out a comprehensive, reliable, systematic, and rigorous review of previous research from the last ten years in order to identify the most frequently mentioned drivers/policies in the scanned literature. The rationale behind this study is to identify and list food security drivers and the current state of recommended policies that address chronic food insecurity to ensure the sustainability of future food production, utilizing a systematic literature review (SLR) methodology. Moreover, we hope to identify drivers/policies in order to aid policy-makers in selecting the most appropriate policies based on each nation’s context (e.g., agricultural production, natural resource availability, climate, political stability, and so on). Most importantly, policy-makers can use the identified drivers of food security and the recommended policies in the literature to customize appropriate policies that ensure the sustainability of future food production and, hence, ensure food sustainability for future generations. Based on the evidence reported in the literature, the identified food security drivers and recommended policies will aid the policy- and decision-makers of various countries in sustainably improving the food security situation. The need to identify the main drivers of food security arises from the notable increase in households and individuals suffering from food shortages and insecurity globally [ 25 ]. Finally, the findings of this research will be used to inform the GFSI developers in order to include more comprehensive indicators expected to contribute to the sustainability of future food production.

2. Materials and Methods

This research aims to report on food security drivers and the current state of recommended policies that address chronic food insecurity in order to ensure the sustainability of future food production through the use of a systematic literature review (SLR) methodology. We highlight existing food security drivers and outline recommended policies to alleviate food insecurity following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) data screening and selection guidelines [ 26 ]. The extraction process was meticulously documented in order to ensure the transparency and replicability of this systematic literature review [ 27 ]. A panel of researchers was formed, following the systematic review guidelines [ 26 ], to define the research field and questions, select keywords and the intended databases, and develop the sets of inclusion and exclusion criteria.

The research began by formulating the research questions to guide this systematic review based on identified gaps in the literature, guiding us in an attempt to answer the following research questions:

  • Q1. What are the main drivers of food security?
  • Q2. What are the main recommended policies to alleviate food insecurity?

By answering these questions, this paper provides a reference that policy-makers and practitioners can use to identify the main drivers of food security and the recommended policies in the literature in order to customize and choose appropriate policies that ensure the sustainability of future food production. The identified food security drivers and recommended policies are expected to aid policy- and decision-makers in improving the state of FS. This study also provides a roadmap for future research based on the evidence reported in the literature.

A specific research criterion was used to ensure that the research sources selected were sufficient and comprehensive enough to capture all of the significant and salient points to adequately answer the research questions [ 26 ]. To this end, we provide a critical review of the existing literature that has been published in two databases—Scopus and Web of Science (WOS)—between 2010 and 15 March 2021, to answer the abovementioned research questions. The time limit was set to cover the period following the global financial crisis of 2008/2009 and its effect on rising food prices, increased unemployment rates, and increasing food insecurity worldwide [ 28 , 29 , 30 ]. This period allows for consideration of policies designed to ensure global food security following the food shortage crisis. The use of Scopus and Web of Science (WOS) databases helped us to include most potential published works in a broad scope of journals, thereby limiting the risks of bias and possible exclusions associated with the use of fewer journals.

We employed a set of identified keywords, which are summarized in detail in Table 1 . A critical analysis was conducted regarding the most relevant concepts that are available in the literature and which affect each of the four dimensions of FS: Food availability, food access, food utilization, and food stability. For instance, the research string “Agrifood supply chain” OR “Agri food supply chain” OR “Agri-food supply chain” was added as a secondary search string, because food availability is highly dependent on the food supply chain and how well its activities are managed. The food supply chain is exposed to many factors that can negatively impact the country’s food security level, such as severe weather conditions [ 31 , 32 ]. Therefore, it is critical to consider some characteristics of the food supply chain, such as biophysical and organoleptic features, shelf life, transport conditions, production time, and storage, to efficiently and effectively manage it [ 33 ]. Effective supply chain management is seen as a significant contributor to gaining and enhancing industrial competitive advantage and efficiency at the company level, possibly impacting food security positively [ 34 ]. “MENA Region” OR “Middle East and North Africa” OR “Middle East” OR “North Africa” research string was added due to the severity of food insecurity there and to ensure the inclusion of papers that address the problem in these countries and propose strategies to overcome food insecurity. According to the GFSI data [ 25 ], MENA region countries are experiencing a decline in food security; moreover, the number of households and individuals suffering from food shortages and insecurity is dramatically increasing.

Primary and secondary search strings used in this research.

The research string “Sustainable supply chain” OR “Resilient supply chain” was added due to much research that stressed the impact of designing a proper supply chain structure due to its significant impact on the future improvement of its performance [ 33 ]. The central mission of the twenty-first century is to establish a sustainable food system, which calls for a more concrete policy framework than what is currently in place [ 17 ]. Sustainability can be viewed as a prerequisite for long-term food security [ 1 ]. The environment, particularly climate and the availability of natural resources, is a prerequisite for food availability and biodiversity protection [ 24 ]. The availability of food for everybody depends on economic and social sustainability. Food utilization, too, is influenced by social sustainability. The three components of sustainability—social, economic, and environmental—assure the continuity of the three food security dimensions and the food system stability on which they rely. Moreover, food security is increasingly considered a prerequisite for long-term sustainability [ 1 ]. Adopting a “sustainable production and consumption approach throughout the global food supply chain” is a solution that will help reduce the amount of food waste along the food supply chain [ 35 , 36 ]. Cooper and Ellram [ 37 ] argued that building a resilient supply chain has many advantages such as decreasing inventory time, which will lead to cost and time savings, increasing the availability of goods, reducing the order cycle time, improving customer service and satisfaction, and gaining a competitive advantage. Stone and Rahimifard [ 38 ] stressed the importance of having a resilient agricultural food supply chain to achieve food security due to the incremental increase in volatility across the supply chain.

The research string “Food Safety” OR “Food diversity” OR “Food quality” OR “Food standards” OR “Micronutrient availability” was added due to one of the food security dimensions: utilization, which is concerned with all aspects of food safety, and nutrition quality [ 39 ]. According to FAO (2019), the utilization dimension should assess food diversity, food safety, food standards, and micronutrient availability. It is inadequate to provide enough food to someone unable to benefit from it because they are constantly sick due to a lack of sanitary conditions. It indicates that in the country, individuals are taking advantage of the food they receive or have access to, with extra emphasis on the dietary quality that contains nutritious ingredients such as vitamins (vitamin-A) and minerals (Iron, Zinc, Iodine) [ 40 ]. According to the World Health Organization, people diagnosed with malnutrition usually suffer from micronutrient deficiencies, protein deficiency, obesity, or undernutrition. The lack of micro-ingredients can increase the risk of developing severe chronic and infectious diseases for people in general and children in particular (toddlers 9–24 months). These diseases have an irreversible negative impact on people’s health, which enhances the persistence of poverty and food insecurity. It is critical to invest in the health and nutrition elements on a global scale by ensuring safe drinking water, immunization, enhancing sewage discharge, improving public health services, and reducing poverty levels [ 41 ].

The research string “Agricultural infrastructure” OR “Agricultural production volatility” OR “Vulnerability assessment” was chosen because much research has emphasized the importance of investing in a strong agricultural infrastructure to improve food security levels, especially in light of current challenges such as climate change, increased urbanization, water scarcity, and the shift away from using cropland for non-agricultural activities [ 7 , 8 , 41 ]. Food security is vulnerable to severe weather conditions, whereas harsh weather conditions may adversely impact the food supply chain in weak areas [ 31 , 32 ]. Therefore, it is critical to assess the vulnerability level of each country to protect the food supply chain. The use of the “Food loss” OR “Food waste” OR “Food waste and loss” research string was due to the general agreement among researchers on the importance of reducing food waste to improve food security [ 35 , 42 , 43 ]. According to the Food and Agriculture Organization (2013), around one-third of the food produced globally (1.3 billion tons) is wasted or lost. Most wasted food is either fresh and perishable or leftovers from eating and cooking [ 36 , 42 ]. Basher, Raboy [ 43 ] argued that eliminating just one-fourth of the food waste would be enough to feed all the currently undernourished people. One of the Sustainable Development Goals established by the United Nations, “SDG 12.3 Food Waste Index” stresses that decreasing the amount of food loss and waste will help reduce hunger levels, promote sustainable production and consumption, and enhance food security [ 44 ].

The use of “Policy description” OR “Policy assessment” OR “Policy recommendation” OR “Policymaking” OR “Policy-making” OR “Policy making” research string was due to the impact of adequate and proper policy formulation on food security ( Table 1 ). Establishing effective and efficient food policies that ensure that each individual has an optimal level of food security is critical in every country because it directly enhances the country’s competitive advantage and efficiency [ 34 , 45 ]. Timmer [ 46 ] emphasized that designing the proper set of policies to end hunger based on each country’s context is challenging and requires collaborative participation from multiple stakeholders. Murti Mulyo Aji [ 34 ] stressed the role of the government’s policies in developing a collaborative supply chain that creates value throughout the supply chain by improving information, logistics, and relationship management. Effective and efficient supply chain management significantly impacts managing long-term partnerships and corporations among a wide range of firms that vary in size and sectors (public or private). This collaboration will enhance prediction of changes in customer demands in domestic and international markets. If previous policies were insufficient to ensure that country’s true competitive advantage, it could cause market distortion [ 34 , 47 ]. Countries are encouraged to gradually reduce the adoption of inequitable trade policies to focus on enhancing their true competitive advantage, demonstrating fair competition, and increasing economic efficiency, particularly in the spirit of trade liberalization [ 34 ].

The selection of research sources was accomplished in March 2021, and the search for keywords was enabled for titles, abstracts, and full texts in both electronic search engines (i.e., Scopus and WOS). Several keywords were identified to retrieve the available literature, and search strings consisted of primary and secondary keywords. The primary search string used was as follows: “food security” OR “food insecurity” OR “food availability” OR “food affordability” OR “food access” OR “food utilization” OR “food stability”. The reason behind including these multiple strings was to cover the maximum number of articles that handle the topic of food security or any of its four dimensions.

Specific exclusion and inclusion criteria were applied in order to develop high-quality evidence [ 26 ]. A reasonable number of articles were limited for deep analysis by following the specific exclusion and inclusion criteria to control the quality of the review in the food security field, as detailed in Table 2 above. Only peer-reviewed journal articles were included within the time frame (2010–15 March 2021) and only those written in English. Furthermore, due to this study’s nature and to ensure consistency with the topic area, the most common and effective approach for examining drivers and recommended policies were limited to the business, management, accounting, and agricultural fields [ 48 ]. We have used the “business, management and accounting” research field in the Scopus database to ensure that all the included articles were business-related. Then, we restricted the research field to” Economics, business, and agriculture Economics” in the WoS database to ensure the inclusion of agriculture-related papers and maximize the inclusion of a diverse range of articles. Another round of retrieval was applied using a set of secondary keywords in order to narrow down the search to specific areas of food security. For this purpose, the primary keywords were escorted each time with “AND” and other secondary keywords, as listed in Table 2 .

Inclusion and exclusion criteria.

The initial search using the primary keywords (“food security” OR “food insecurity” OR “food availability” OR “food affordability” OR “food access” OR “food utilization” OR “food stability”) revealed a total of 113,709 documents (Scopus, n = 63,860; WOS, n = 49,849). Strict selection criteria were applied to the first search pool in order to maintain transparency and guarantee the selection of relevant material that answers the research questions. To ensure academic rigor, the search was restricted to including only peer-reviewed publications [ 49 ] (Scopus, n = 47,673; WOS, n = 40,305). The research was then restricted by publication date to between 2010 and 15 March 2021 (Scopus, n = 34,789; WOS, n = 31,278). Only journal articles published in English were selected (Scopus, n = 33,292; WOS, n = 30,313). Then, advanced research was conducted by combining the primary keywords with one of the secondary keywords. The results and the number of articles identified in each search step are detailed in Figure 1 . After removing duplicate articles from each database, a total of 281 journal articles (Scopus, n = 140; WOS, n = 141) were revealed. After combining both databases, 248 journal articles were obtained. These collected 248 journal articles were scanned by reading their abstracts in order to check their applicability to answering the research questions. At this point, 107 articles were excluded as they were considered irrelevant and outside the scope of the research. Finally, the total number of extracted articles was 141, as can be seen in Figure 1 . Data extraction and analysis were performed by a single reviewer (SW), and all extracted data and revealed results were double-checked by three researchers (FA, IM, and BS) to enhance the research and reduce bias in study selection. A complete description of the validity threats (Construct, Internal, External, and Conclusion Validity) following the validation process of Zhou, Jin [ 50 ] is provided in detail in Table 3 .

An external file that holds a picture, illustration, etc.
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Research protocol following the PRISMA guidelines.

A reporting of validity threats in this systematic literature review.

Among the selected 141 articles, 28 (19.86%) were published in the Journal of Cleaner Production , 20 (14.18%) were published in Food Policy , and 5 (3.55%) were published in Quality-Access to Success . The rest of the journal names are visualized in Figure 2 .

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The most popular journals publishing the 141 included articles. Others denotes journals that were cited once or twice.

After the 141 articles have been extracted, they were analyzed and summarized individually by listing all the discussed food security drivers, as well as the recommended policies for the improvement of food security and sustainable food production. Then, we synthesized the extracted information from all sources in order to identify the gaps, list the similarities between all the resources, and extract significant insights regarding the main drivers of food security and the recommended policies [ 26 ].

3.1. The Major Drivers of Food Security

Analysis of the retrieved literature revealed 34 different drivers of food security, as visualized in Figure 3 . Detailed information, along with a full citation list for all the drivers, is provided in Appendix A .

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Summary of the major drivers of food security.

Most papers discussed food loss and waste (FLW) and emphasized its impact on food security [ 6 , 19 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 ]. Around one-third of the food produced globally (1.3 million tons) is wasted or lost [ 96 ]. Basher, Raboy [ 43 ] has argued that, if we could save just one-fourth of the wasted food, it would be enough to feed all the world’s undernourished people, contributing positively to FS. The previous finding supports our research findings that FLW is the primary driver of FS. To reduce FLW, Halloran, Clement [ 6 ] has argued that effective communication, more efficient food packaging, and a better consumer understanding of food packaging could lead to solutions. To decrease food loss, Garcia-Herrero, Hoehn [ 62 ] has suggested improving food labelling, enhancing consumer planning, and developing technological advances in packaging and shelf life for perishable products. Morone, Falcone [ 83 ] has suggested the repetition of large-scale research to help define a set of policies encouraging the transition to a new model for consumption that promotes sustainably procured food and dramatically reduces the amount of waste (more details are provided in Section 3.2 ).

Additionally, several authors have considered food security policy (FSP) as a driver of food security in its different forms [ 56 , 63 , 65 , 69 , 70 , 74 , 79 , 85 , 94 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 ]. The primary goal of establishing food security policies that consider the factors influencing individuals and groups is to reduce poverty and eliminate hunger. One example is safety-net programs or public food assistance programs (FAPs). The main goal of providing safety-net programs is to increase food consumption among poor people and improve food security [ 102 ].

Many papers have discussed the importance of technological advancement as an enabler of food security [ 56 , 57 , 58 , 63 , 69 , 71 , 74 , 77 , 85 , 90 , 94 , 95 , 109 , 116 , 119 , 120 , 121 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 ]. The use of technology to promote behavioral changes has increasingly become a vital instrument to reduce food waste and indirectly improve food security [ 130 ]. Mobile applications offer households helpful guidance on increasing shelf life and experimenting with dishes using leftovers [ 58 ]. Shukla, Singh [ 130 ] has elaborated that, at present, farmers have access to mobile applications that provide them with reasonably and timely priced information.

Some authors have discussed sustainable agricultural development and practices as enablers of food security [ 56 , 57 , 59 , 64 , 71 , 73 , 94 , 97 , 105 , 109 , 111 , 119 , 120 , 121 , 124 , 130 , 132 , 134 , 136 , 137 , 139 , 142 , 143 , 144 , 145 , 146 , 147 ]. Some authors have discussed local production enhancement as a driver of food security to enhance the self-reliance of countries [ 57 , 69 , 85 , 87 , 89 , 94 , 98 , 103 , 105 , 109 , 112 , 117 , 120 , 134 , 137 , 144 , 148 , 149 ]. For example, Ahmed, Begum [ 98 ] has emphasized how, following the GCC ban, Qatar took several successful steps to foster local production, support domestic businesses, and promote the consumption of locally produced food by its citizens. Some authors have argued that building the capacities of small farmers is essential to achieving FS. Education policies are critical for educating farmers, building their capacities, and increasing their human capital; moreover, educational programs should also include food preparation and health education programs in order to ensure the safety of consumed food [ 101 ].

The government’s role in managing a country’s agriculture can also be seen as a driver of food security [ 67 , 75 , 84 , 86 , 100 , 109 , 116 , 117 , 119 , 121 , 137 , 138 , 147 , 150 , 151 , 152 ], as it is responsible for various aspects such as designing, testing, and implementing the right policies to ensure the welfare of its citizens, while providing the necessary assistance to small-scale farmers and ensuring their safety and security in all aspects of life. Governments in developing nations must focus on R&D, agriculture infrastructure (e.g., technologies for irrigation and soil preservation), expansion services, early warning systems, or subsidized farm income in order to alter the production function of the population [ 101 ].

Many authors have discussed the importance of food safety policies as an enabler of food security [ 61 , 64 , 69 , 103 , 105 , 111 , 112 , 129 , 149 , 153 , 154 , 155 , 156 , 157 , 158 , 159 ]. Food safety policies include food and water safety at several points throughout the supply chain where food-borne diseases might develop [ 69 ]. Environmental policies are also seen as a fundamental enabler of food security [ 59 , 73 , 121 , 124 , 130 , 135 , 139 , 147 , 159 , 160 , 161 , 162 , 163 ]. Regardless of the various approaches discussed by the authors, they all agreed that environmental protection would help to ensure food availability for current and future generations. According to some authors, trade policies [ 69 , 94 , 95 , 103 , 111 , 112 , 114 , 123 , 129 , 141 , 146 , 161 , 164 ] and import policies [ 69 , 95 , 100 , 103 , 120 , 124 , 126 , 129 , 146 ] are enablers of food security. Regulating international trade can help to ensure food security. Lowering trade barriers, for example, has been proposed as a way to mitigate the adverse effects of market regulation caused by climate change [ 141 ].

Many authors have recognized policies that promote consumer education on sustainable consumption and increase consumer awareness and knowledge of the environmental impact of their purchases as a driver of food security [ 52 , 60 , 67 , 69 , 86 , 133 , 144 , 151 , 163 , 165 , 166 , 167 ]. Others have stressed proper communication among all stakeholders as a driver of food security [ 6 , 56 , 68 , 69 , 84 , 92 , 129 , 130 , 156 , 157 , 168 ]. Some authors have considered risk management as an enabler of food security [ 94 , 117 , 118 , 137 , 138 , 139 , 145 , 154 , 155 , 157 ]. For example, the aims of building a disaster risk reduction framework in the Pacific include boosting resilience, protecting investments (e.g., in infrastructure, operations, and FS), and decreasing poverty and hunger [ 169 ].

Some authors have proposed the effective gleaning process as a driver of food security [ 70 , 72 , 74 , 80 , 84 , 92 , 142 , 170 ]. Gleaning is the collection of the remaining crops in agricultural fields after their commercial harvest, or just in crop fields where their harvest is not cost-effective. Some old cultures have fostered gleaning as an early form of social assistance [ 80 ]. Some authors have considered the management of government food reserves to be a food security driver [ 64 , 104 , 112 , 117 , 118 , 124 , 136 ]. Despite the high cost of storing food, any country must maintain adequate food reserves to serve the country in case of a crisis scenario [ 171 ]. Some authors have considered integrative policies (i.e., food–water–energy, food–energy, or water–food) as a driver of food security due to their impact on environmental improvement through natural resource handling efficiency [ 56 , 73 , 133 , 139 , 172 , 173 ]. Some authors have considered establishing dietary standard policies as an enabler of food security [ 69 , 151 , 163 , 174 ]. The government should impose policies on healthy food consumption to prevent obesity, such as prohibiting trans-fats. Moreover, they should restrict trans-fat usage in food outlets, establish institutional food standards, implement menu labelling regulations for chain restaurants, and ensure that disadvantaged people have better access to healthy meals [ 151 ].

Authors have highlighted various additional arguments or policies that are considered drivers for FS such as establishing public programs to influence diets in a healthy manner, reducing yield volatility [ 85 , 94 , 105 , 119 , 124 , 126 , 175 ], the country’s natural resources [ 85 , 105 , 119 , 124 , 137 , 145 , 162 , 163 , 176 ], geopolitical and political stability [ 69 , 98 , 104 , 117 , 123 , 124 , 142 ], agricultural infrastructure [ 64 , 114 , 116 , 118 , 142 , 146 , 175 ], food distribution infrastructure [ 71 , 75 , 76 , 112 , 177 , 178 ], economic integration [ 109 , 112 , 123 , 179 , 180 ], collaboration among all supply chain stakeholders [ 75 , 130 , 134 , 157 ], proper measurement of food security dimensions [ 123 , 181 , 182 , 183 ], urban agriculture policies [ 56 , 147 , 148 ], adjustments in dietary structure [ 59 , 86 , 163 ], establishing employment programs for poor household representatives [ 110 , 152 ], customer engagement in designing public policies [ 158 ], and trust in public institutions [ 166 ].

3.2. The Recommended Policies to Alleviate the Food Insecurity

Analysis of the 141 retrieved papers revealed 17 major recommended policies, as visualized in Figure 4 . We also determined sub-policies under each category which were grouped based on common characteristics, relevance, and how they were categorized in the papers. The complete list of sub-policy categories and related references is provided in Appendix B .

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The main 17 recommended policies and statistics.

Most authors recommended establishing FSP, in general, as a primary solution for food insecurity in developing and developed countries [ 56 , 57 , 63 , 64 , 65 , 69 , 81 , 85 , 87 , 89 , 91 , 94 , 97 , 98 , 99 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 126 , 127 , 130 , 131 , 133 , 134 , 137 , 142 , 144 , 145 , 148 , 149 , 151 , 152 , 175 , 177 , 180 , 182 , 184 , 185 ]. Many authors have suggested food consumption policies that offer safety-net programs or public food assistance programs (FAPs) such as food price subsidies, cash-based programs, structural pricing adjustments, or micro-credits as enablers of FS. The main goal of providing safety-net programs is to increase food consumption among poor people and improve food security [ 102 ]. Given the solid bidirectional causal link between poverty and malnutrition, FAPs have been recognized as critical components of the overall poverty reduction strategy. Food aid policies and initiatives can fill the gaps left by the for-profit food system and the informal (non-profit) social safety nets, ensuring food security for disadvantaged individuals, families, and communities [ 108 ]. Several authors have recommended establishing policies to enhance the performance and asset bases of small-scale farmers, such as loans, subsidies, access to information, and knowledge-sharing, to address food insecurity. Governments should adopt direct interventions such as structural price adjustments and targeted food subsidies to enhance the food access of farmers by lowering market prices and stabilizing consumption during high food price inflation [ 116 ]. Others have recommended establishing government input subsidy programs (input subsidy policies) that provide farmers with subsidies for investment into high-yielding technology (e.g., automation, fertilizers, high-yield seed). They all claimed this as an effective policy instrument for agricultural development, but each focused on a different mechanism. Shukla, Singh [ 130 ], for example, has discussed public distribution programs; Sinyolo [ 131 ] has emphasized policies aimed at increasing the amount of land planted with enhanced maize varieties among smallholder farmers; Wiebelt, Breisinger [ 124 ] has suggested investments in water-saving technologies, while Tokhayeva, Almukhambetova [ 137 ] have proposed the development of an agricultural innovation system. Others have recommended rural development policies to reduce yield volatility and improve the agricultural infrastructure (e.g., irrigation and water-saving technologies). Governments in developing nations must focus on R&D, agricultural infrastructure (technologies for irrigation and soil preservation), expansion services, and early warning systems [ 101 ]. Technological advancement, in general, is seen as a vital element in reducing yield volatility [ 85 ]. Capacity-building policies (e.g., educational, training, and technical support) have received considerable attention in the literature as a fundamental component of urban farming initiatives, and as attempts to promote self-reliance and networking. Capacity building in many areas connected to urban agriculture is essential for equipping residents with knowledge and expertise [ 148 ]. To enhance FS, some researchers have suggested policies supporting locally produced food, diversified agricultural production policies, policies that impact farm-level commodity pricing, food stock policies, establishing policies to increase the income of farmers, buffer stock policies, and resource allocation policies (for a complete list of references, see Appendix B ).

Many authors have proposed different policy recommendations to reduce food waste and, thus, food insecurity [ 6 , 19 , 51 , 52 , 56 , 57 , 58 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 91 , 92 , 93 , 94 , 103 , 130 , 138 , 144 , 150 , 160 , 167 , 168 , 170 , 177 ]. Many have agreed on the importance of policies that promote information and education campaigns that spread awareness at household and public levels by improving meal planning and management in consumers. However, each author suggested a different approach. For example, Schanes, Dobernig [ 58 ] have discussed face-to-face door-stepping campaigns (online and in traditional newspaper leaflets), word-of-mouth, and television shows or movies. However, Septianto, Kemper [ 66 ] have highlighted the importance of social marketing campaign design and framing (having vs. not having) in conveying the intended message to consumers. Tucho and Okoth [ 73 ] have asserted the advantages of producing bio-wastes and bio-fertilizers from food waste and human excreta (in a food–energy–sanitation nexus approach), and also advocated for educating families on how to do so at the household level. Xu, Zhang [ 86 ] has argued that governments should help society to develop a logical perspective on food consumption and aggressively promote the habit of eating simple meals, particularly in social catering. Von Kameke and Fischer [ 52 ] and Zorpas, Lasaridi [ 60 ] have emphasized the importance of teaching customers about efficient meal planning to reduce food waste. Von Kameke and Fischer [ 52 ] have proposed using the Nudging tool rather than campaigning. Xu, Zhang [ 86 ] have suggested initiating suitable policy instruments to nudge individuals to adopt sustainable consumption habits, with important implications for decreasing food waste and increasing food security in China. Smart (innovative) food packaging and labelling policies have received significant attention in the literature, as they are critical in reducing food waste and, thus, improving FS. The nature, size, and labelling of the packaging impact the lifetime of the food. Smart packaging innovations and new technologies are steadily penetrating markets, thus increasing the shelf-life of foods through enhanced protection, communication, convenience, and control [ 58 ].

Food banks, food sharing, and food rescue policies have also received significant attention in the global literature, as they help reduce food waste and improve FS. Food banking is a critical long-term rescue policy for re-distributing surplus food to those in need and reducing poverty and food insecurity [ 80 , 92 ]. Several authors have recommended positive sanctions such as financial rewards, tax credits, federal and state funding, vouchers, or reduced taxes to decrease food waste and improve FS. Positive sanctions consist mainly of financial incentives to encourage restaurants and grocery retailers to donate their leftover food [ 60 ]. Addressing liability concerns might be one incentive, as the research participants have highlighted this as a universal barrier and that this issue, in particular, must be handled [ 51 ]. Negative sanction policies have received considerable attention in the literature as a tool for reducing food waste and improving FS. These include fines and fees imposed on companies and individuals accountable for food waste [ 58 ]. Taxes and fines are a potential way to manage and motivate restaurants and retailers to donate their leftover food to charities and community centers [ 65 ].

The establishment of policies that regulate the sharing of information and knowledge among supply chain stakeholders has received some attention in the literature in terms of reducing food waste and improving food security. Comprehensive food waste legislation has been discussed as a potential enabler of food security. A possible regulatory tool would be to revise and remove unnecessary food safety requirements that result in excessive food waste levels [ 58 ]. According to Halloran, Clement [ 6 ], food waste increased due to European food safety regulations and standardization. Food waste recycling policies have been used as a method to reduce food waste. Food waste can be utilized for value generation at any point of the food supply chain process through efficient techniques, then reincorporated into the cycle [ 77 ]. Food waste has a long history as a source of ecologically friendly animal feed [ 61 ].

A few authors have highlighted the impact of technological advancement (e.g., mobile applications) as a strategy to reduce food waste. Some authors have proposed implementing gleaning operation policies that provide tax incentives and government assistance to gleaners in order to decrease food waste. Some authors have proposed implementing peak storage reduction policies, such as stock-holding incentives. Nudging tools (which nudge people toward forming sustainable consumption behaviors) have been mentioned by a few authors.

Food safety policies received significant attention in the retrieved literature [ 61 , 64 , 69 , 70 , 103 , 105 , 111 , 112 , 120 , 125 , 129 , 130 , 137 , 138 , 149 , 153 , 154 , 155 , 156 , 157 , 158 , 159 ]; however, they have been discussed in various different forms. Few authors have discussed food quality and food hygiene compliance certifications. Compliance with sanitary standards is required to maintain the best practices for preventing food-borne diseases and food security threats [ 155 ]. Other authors have discussed the importance of food safety standards. Meanwhile, few authors have emphasized the importance of food safety throughout the supply chain, but each proposed a different strategy to achieve it. For example, some authors have suggested using an effective IT system [ 130 ], RFID [ 138 ], or developing food safety training policies [ 155 ].

Many authors have advocated for the implementation of trade policies to address food insecurity in developing and developed countries [ 94 , 95 , 101 , 103 , 111 , 112 , 119 , 123 , 129 , 136 , 141 , 146 , 148 , 149 , 152 , 157 , 161 , 164 , 178 , 180 ], but in different contexts. For example, some have suggested establishing infrastructure development policies that target agricultural logistic infrastructure, or improving the speed and quality of shipping logistics. In contrast, some authors have agreed on the importance of state trading and private trade-supporting policies. Others have suggested the removal of tariff and non-tariff barriers, while a few authors recommended reliable marine connection and transportation logistics policies.

Environmental policies are a fundamental enabler of food security [ 59 , 73 , 94 , 120 , 121 , 124 , 130 , 135 , 139 , 141 , 145 , 147 , 159 , 160 , 161 , 162 , 163 , 166 ]. However, authors have focused on many different aspects of these policies. Some authors, for example, have emphasized the importance of establishing policies to mitigate the effects of climate change. Others were too specific, suggesting greenhouse gas reduction policies, and proposed penalizing non-compliance. Due to the strong links between climate change, poverty, and food insecurity, some authors have proposed establishing coordinating policies among the three. Other authors have stressed the consideration of policies that encourage the optimization of fertilizer use.

Many authors have considered food import policies as a solution to food insecurity [ 94 , 95 , 100 , 103 , 104 , 105 , 109 , 112 , 116 , 117 , 119 , 120 , 124 , 126 , 134 , 146 ]; however, most authors provided different opinions regarding the most effective policy to implement. For example, some authors have stressed the importance of policies that provide direct government financial assistance to local agriculture, or the importance of policies that sustain local agricultural product prices compared to imported products. Some have recommended providing temporary tax benefits for agricultural investment, while others recommended import ban (substitution) policies. A few authors have recommended direct budget subsidies, subsidized loan interest rates, and strategies for the diversification of imported food origin.

Many authors have discussed the importance of establishing a common agricultural policy (CAP) to address sustainable agriculture [ 56 , 57 , 64 , 89 , 109 , 111 , 118 , 119 , 132 , 142 , 143 , 149 , 161 , 172 , 184 , 186 ]. Others have stressed the importance of food surplus policies in enhancing a country’s food security status [ 51 , 58 , 70 , 72 , 75 , 76 , 79 , 82 , 84 , 90 , 91 ]. Some authors have suggested strategies to regulate a company’s liability regarding the donation of surplus food. A few authors have proposed food policies that subsidize the purchase of surplus food—also known as “ugly food”—by controlling for prices and surplus item characteristics. Some authors have suggested establishing food loss policies. However, few authors have specified the need for policies promoting food loss quantification.

Many authors have discussed the policies that promote traceability across the whole supply chain as an enabler for food security [ 56 , 69 , 103 , 128 , 129 , 130 , 137 , 138 , 168 , 178 ]. However, the different authors discussed different technologies such as investment into information technology such as RFID, effective IT systems, ICT systems, and blockchain technology. Government policies should promote investments into traceability systems that focus on rapid withdrawal in unsafe food scenarios such as product recall regulations, fines imposed on hazardous product distributors, and food-borne food risk monitoring [ 129 ]. Many authors have discussed various risk management strategies to improve a country’s food security [ 94 , 117 , 118 , 137 , 138 , 139 , 145 , 154 , 155 , 157 ]. However, each considered a different approach to overcome the risk. Specifically, they have discussed food scandal policies, the COVID-19 pandemic, programmed risk identification, proactive policy measures to handle flood crises, early warning systems for natural disasters, or risk management throughout the food supply chain. Some authors have highlighted water quality policies such as efficient water-use policies, improving water resources policies, using water-efficient crops, investments into water-saving technologies, and food and water safety throughout the supply chain.

Some authors have discussed the management of government food reserves as an enabler of food security [ 64 , 104 , 112 , 117 , 118 , 124 , 136 ], and others have discussed integrative and coherent policies between food, water, and energy (as a nexus) [ 56 , 73 , 133 , 139 , 172 , 173 ]. Meanwhile, other authors have discussed policies that promote consumer education on sustainable consumption, improving consumer status awareness and knowledge regarding the ecological impact of their purchases [ 60 , 69 , 133 , 144 , 163 , 165 ]. Few authors have addressed the importance of dietary standard policies [ 69 , 151 , 163 , 174 ], urban agriculture policies [ 56 , 147 , 148 ], and food-aid policies [ 118 , 150 ].

Some policies were suggested in one paper only such as devising the right population policy in China [ 85 ], flexible retail modernization policies [ 158 ], policies that facilitate short-term migration [ 187 ], policies to stimulate equitable economic growth through manufacturing and services [ 95 ], and sound research governance policies [ 140 ].

4. Discussion

In this section, we discuss the polices and drivers in the greater areas, then compare them based on specific contexts. This approach serves to provide better understanding, thus informing decision-makers about the importance of choosing the right policies through considering many food security dimensions. By looking deeply at the extracted food security drivers and policies and the way in which they can be applied to each country’s context, we take an example from the MENA region. The MENA region includes a diverse range of nations, including low-income and less-developed (e.g., Sudan, Syria, and Yemen), low–middle-income (e.g., Algeria, Egypt, Iran, Morocco, and Tunisia), upper middle-income (e.g., Jordan, Lebanon, and Libya), and high-income (e.g., the UAE, Qatar, Oman, Bahrain, Israel, Kuwait, and Saudi Arabia) countries [ 126 ]. As food availability is a serious problem in the MENA region low-income countries (Syria and Yemen), due to war and violent conflicts [ 188 ], policies aimed at increasing food availability continue to pique the interest of policy-makers. In these countries, where citizens are incapable of fulfilling their basic food needs [ 189 ], the existence of food security policies in different forms is crucial for achieving food security [ 53 , 97 , 98 , 124 , 184 ], more than FLW policies. Policy-makers should focus on ensuring the availability of either locally produced or imported food, which requires appropriate trade policies to deal with food shortages and improve the availability dimension in these countries. Trade policies should focus on creating infrastructure development policies that target agricultural logistic infrastructure, improve the speed and quality of shipping logistics, and establish reliable marine connections and transportation logistics policies that remove tariff and non-tariff barriers.

Policy-makers should establish import policies that sustain local agricultural product prices compared to imported products, provide direct government financial assistance to local agriculture, and provide temporary tax benefits for agricultural investment.

Additionally, the governments should improve food access in the MENA region low-income countries by reducing or stabilizing consumer and producer food prices. To enhance food access, FSPs (e.g., education policies in general and capacity-building policies) may help to improve individual human capital. Governments also must provide supplemental feeding programs, typically targeting vulnerable groups in need of special diets, such as pregnant women and children [ 101 ].

Moreover, the government should improve credit access through the following means: policies that enhance the performance and asset base of small-scale farmers; the existence of policies that impact farm-level commodity pricing, thus retaining farmers and increasing local production; the existence of government input subsidy programs for individuals, and the existence of policies supporting locally produced food. These are all possible policies to improve the MENA region FS. Governments and global health organizations should promote food utilization in MENA low-income countries through the development of policies that monitor overall food quality, such as access to clean water and micronutrient fortification, or through individual educational programs on safe food preparation [ 155 ]. Finally, enhancing food quality can optimize the individual nutrient absorption [ 101 ].

In contrast, discussions of food security in the MENA region high-income countries have indicated that food availability, access, and utilization are generally higher and not a problem. However, food stability is low, which requires the attention of policy-makers to improve FS. Food stability impacts the other food security pillars (access, availability, and utilization). Moreover, it requires the economic, political, and social sustainability of food systems, which are vulnerable to environmental conditions, land distribution, available resources, conflicts, and political situations [ 190 ]. Food stability necessitates increased efforts and expenditures to achieve food security in the sustainable development goals, especially in light of increased academic and governmental interest in incorporating sustainability values into policies.

As food waste is prevalent in these countries, FLW policies are more critical than FSP, which is in alignment with our findings regarding food security drivers. FLW makes it difficult for the poor in developing countries to access food by significantly depleting natural resources such as land, water, and fossil fuels while raising the greenhouse gas emissions related to food production [ 115 ]. Addressing food loss and waste in these countries can hugely influence the reduction of wasted food and indirectly enhance food security. The number of food-insecure individuals may be reduced in developing regions by up to 63 million by reducing food loss, which will directly reduce the over-consumption of cultivated areas, water, and greenhouse gas emissions related to food production [ 115 ]. According to Abiad and Meho [ 189 ], food waste produced at the household level differs across MENA-region countries. For example, it ranges from 68 to 150 kg/individual/year in Oman, 62–76 kg/individual/year in Iraq, 194–230 kg/individual/year in Palestine, and 177–400 kg/individual/year in the UAE. It is critical to take more aggressive but scientifically sound initiatives to minimize FLW, which will require the participation of everyone involved in the food supply chain such as policy-makers, food producers and suppliers, and the final consumers [ 191 , 192 ]. Food waste reflects an inefficient usage of valuable agricultural input resources and contributes to unnecessary environmental depletion [ 191 , 193 ]. Furthermore, food loss is widely recognized as a major obstacle to environmental sustainability and food security in developing nations [ 194 ]. Preventing FLW can result in a much more environmentally sustainable agricultural production and consumption process by increasing the efficiency and productivity of resources, especially water, cropland, and nutrients [ 115 , 191 , 192 , 195 ]. Preventing FLW is crucial in areas where water scarcity is a prevalent concern, as irrigated agriculture makes up a sizeable portion of total food production, and yield potential may not be fully achieved under nutrient or water shortages [ 191 , 196 , 197 ]. According to the study of Chen, Chaudhary [ 197 ], food waste per capita in high-income countries is enough to feed one individual a healthy balanced diet for 18 days. Chen, Chaudhary [ 197 ] also found that high-income countries have embedded environmental effects that are ten times greater than those of low-income countries, and they tend to waste six times more food by weight than low-income countries. Consequently, implementing proper FLW policies in high-income countries can help to alleviate the food insecurity problem while maintaining the economic, social, and environmental sustainability of future food production.

Implementing effective food storage techniques and capacities is considered a key component of a comprehensive national food security plan to promote both food utilization and food stability; furthermore, proper food storage at the household level maintains food products for a more prolonged period [ 198 ]. Encouragement of economic integration between MENA region countries is very applicable considering the heterogeneity of these countries. For example, countries with limited arable land and high income, such as the UAE and Saudi Arabia, can invest in countries with a lower middle income, such as Egypt, and use its land to benefit both countries. On the other hand, Boratynska and Huseynov [ 101 ] have proposed food technology innovation as a sustainable driver of food security and a promising solution to the problem of food insecurity in developing countries. Due to the higher food production demand to support the expanding urban population while having limited water and land availability, higher investments in technology and innovation are needed to ensure that food systems are more resilient [ 190 ]. Boratynska and Huseynov [ 101 ] have argued that, in general, using innovative technologies to produce healthy food products is frequently a concern. However, improving the probability that innovative food technology will enable the production of a diverse range of food products with enhanced texture and flavor while also providing a variety of health advantages to the final consumer is essential. Jalava, Guillaume [ 193 ] have argued that, along with reducing FLW, shifting people’s diets from animal- to plant-based foods can help to slow environmental degradation.

The MENA region example described above can be adapted to different regions based on their food security situation, and relevant policies can be devised to improve food security more sustainably.

5. Conclusions

Food security is a complicated and multi-faceted issue that cannot be restricted to a single variable, necessitating the deeper integration of many disciplinary viewpoints. It is essential to admit the complexity of designing the right policy to improve food security that matches each country’s context [ 46 ] while considering the three pillars of sustainability. Furthermore, it is of utmost importance to implement climate-friendly agricultural production methods to combat food insecurity and climate change [ 12 ]. Mapping the determinants of food security contributes to better understanding of the issue and aids in developing appropriate food security policies to enhance environmental, social, and economic sustainability.

This research contributes to the body of knowledge by summarizing the main recommended policies and drivers of food security detailed in 141 research articles, following a systematic literature review methodology. We identified 34 food security drivers and outlined 17 recommended policies to improve food security and contribute to sustainable food production. Regarding the drivers, one of the foremost priorities to drive food security is reducing FLW globally, followed by food security policies, technological advancement, sustainable agricultural development, and so on (see Appendix A ). Regarding the recommended policies, most studies have detailed the contents and impacts of food security policies, food waste policies, food safety policies, trade policies, environmental policies, import policies, the Common Agricultural Policy (CAP), food surplus policies, and so on (see Appendix B ).

5.1. Policy Implications

We assessed the obtained results in comparison to the latest version of the GFSI. Using the GFSI (2021) indicators as a proxy resulted in the identification of gaps and specific policy implications of the results. The idea was to identify which of the policies and drivers have been already implemented and which have not (or, at least, have not been very successfully implemented). We used the GFSI as it is a very well-established benchmarking tool used globally by 113 countries to measure the food security level. We examined the indicators mentioned under each of the four dimensions of food security, and listed associations with the identified policies and drivers found in the literature. Accordingly, we suggest the addition of two dimensions to the current index:

  • Sustainability

The first dimension relates to measuring the sustainability dimensions that each participating country adopts in its food production process. We noticed that many authors stressed the importance of the existence of clear environmental policies that drive long-term food security. However, the current GFSI lacks indicators measuring this dimension. The reviewed literature suggested environmental indicators considering optimized fertilizer use, carbon taxes, aquaculture environment, bio-energy, green and blue infrastructure, gas emissions reduction policies, policies to reduce the impacts of climate change, and heavy metal soil contamination monitoring.

  • Consumer representation

The second dimension is related to consumer voice representation within the GFSI. The reviewed literature suggested implementing policy measures that promote consumer education on sustainable consumption and improve the consumer status, consciousness, and knowledge regarding the ecological impact of their purchases. Any sustainability initiative should be supported and implemented by the final consumer.

Additional gaps in the policies and drivers of food security were identified and allocated under the relevant indicators in the GFSI based on the four dimensions of food security. Under the affordability dimension, we found a lack of policies in the reviewed literature addressing the Inequality-adjusted income index. Regarding the Change in average food costs indicator, we observed that the policies that exist in the literature concern the farmer level only (e.g., policies that impact farm-level commodity pricing and policies supporting locally produced food), and not all of the citizens at the national level. Additionally, policies that promote traceability across the whole supply chain were missing. There were no policies in the reviewed literature under the food quality and safety dimension representing the following: the dietary diversity indicator; micronutrient availability (e.g., dietary availability of vitamin A, iron, and zinc); regulation of the protein quality indicator; the food safety indicator (specifically the two sub-indicators of food safety mechanisms and access to drinking water), and illustration of the national nutrition plan or strategy indicator. Therefore, future research should pay more attention to and emphasize the importance of such policies, particularly in developed countries seeking to improve their food security status and score high on the GFSI.

Moreover, the reviewed literature suggested “developing food safety training policies” to improve food safety and FS; however, no indicators or sub-indicators within the GFSI represent such training policies. The GFSI developers should pay more attention to safety training practices and include them in the index’s future development. Under the availability dimension, the reviewed literature suggested establishing a food loss policy that promotes the quantification of food loss under the food loss indicator. This indicator should be enhanced through well-articulated policies that address the problem of food loss and attempt to mitigate its impact. However, while there were various policies concerning food waste or surplus, there were no indicators within the GFSI that represented food loss. As food loss and waste was identified as the primary driver of food security in this study, we recommend expanding the GFSI to include food loss quantification and reduction policies under the availability dimension. Finally, under the political commitment to adaptation dimension, some policies were identified in the reviewed literature in two sub-indicators: early warning measures/climate-smart agriculture (e.g., proactive policy measures to handle flood crises, programmed risk identification, and early warning systems for natural disasters) and disaster risk management (e.g., food scandals, COVID-19, and risk management throughout the food supply chain). However, under the other two relevant sub-indicators—commitment to managing exposure and national agricultural adaptation policy—there were no identified policies.

5.2. Contributions of the Study

The key contributions of this study to the existing literature are threefold. First, we identified the (34) main food security drivers and the (17) most-recommended policies to improve food security and enhance the future food production sustainability. Several studies have partially covered this area, but none have employed a systematic literature review of 141 papers covering such an scope in this topic. The gravity of food security worldwide is well established; hence the contribution of this work. Second, we provide a reflection of policies/drivers on the latest version of the GFSI, resulting in more tangible policy implications (see Section 5.1 ). Third, through a systematic literature review, we identified elements not listed under the GFSI that could be considered in its future revision. Examples include environmental policies/indicators such as optimized fertilizer use, carbon taxes, aquaculture environment, bio-energy, green and blue infrastructure, gas emission reduction, policies to reduce the impact of climate change, and heavy metal soil contamination monitoring; consumer representation, as the reviewed literature suggested policy measures that promote consumer education on sustainable consumption, as well as improving consumer status, consciousness, and knowledge regarding the ecological impact of their purchases; and traceability throughout the entire supply chain.

5.3. Study Limitations and Future Research

In this study, we identified the major drivers and the recommended policies to improve food security and enhance the future food production sustainability based on the reviewed literature. However, we recommend conducting a Delphi research study in consultation with policy-makers and industry experts. A Delphi study can be used to validate the findings of this systematic literature review based on a specific country’s context. This research was conducted using only 141 articles from two databases; therefore, we suggest replicating this research using different databases, which will allow for the inclusion of more related papers. Moreover, this research included only peer-reviewed articles, which may be considered, based on the guidelines of Keele [ 185 ], as a source of publication bias. Future research may consider including gray literature and conference proceedings. This research did not include the three sustainability pillars within its research string; therefore, we recommend considering the inclusion of the three pillars in future research. Future research should also investigate the use of alternative protein food technology innovation, such as plant-based protein, cultured meat, and insect-based protein, as a sustainable solution to the food security problem. Additionally, understanding the factors influencing acceptance of various technologies by the final consumer is particularly important given some regional characteristics such as harsh arid environments and the scarcity of arable land, freshwater, and natural resources.

Appendix A. Summary Table of Major Drivers of Food Security

Appendix b. summary table of most-recommended policies, funding statement.

This research was funded by the UAE Ministry of Education, Resilient Agrifood Dynamism through evidence-based policies-READY project, grant number 1733833.

Author Contributions

Conceptualization, S.W., F.A., B.S. and I.M.; methodology, S.W., F.A., B.S. and I.M.; validation, S.W., F.A., B.S. and I.M.; formal analysis, S.W.; investigation, S.W., F.A., B.S. and I.M.; resources, I.M. and B.S.; data curation, S.W.; writing—original draft preparation, S.W.; writing—review and editing, F.A.; visualization, S.W.; supervision, F.A., B.S. and I.M.; project administration, B.S. and I.M.; funding acquisition, B.S. and I.M. All authors have read and agreed to the published version of the manuscript.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

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Science and Innovations for Food Systems Transformation pp 165–189 Cite as

A Review of Evidence on Gender Equality, Women’s Empowerment, and Food Systems

  • Jemimah Njuki 5 ,
  • Sarah Eissler 6 ,
  • Hazel Malapit 7 ,
  • Ruth Meinzen-Dick 7 ,
  • Elizabeth Bryan 7 &
  • Agnes Quisumbing 7  
  • Open Access
  • First Online: 02 January 2023

18k Accesses

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Achieving gender equality and women’s empowerment in food systems can result in greater food security and better nutrition, as well as more just, resilient and sustainable food systems for all. This chapter uses a scoping review to assess the current evidence on pathways between gender equality, women’s empowerment and food systems. The chapter uses an adaptation of the food system framework to organize the evidence and identify where evidence is strong, and where gaps remain. Results show strong evidence on women’s differing access to resources, shaped and reinforced by contextual social gender norms, and on links between women’s empowerment and maternal education and important outcomes, such as nutrition and dietary diversity. However, evidence is limited on issues such as gender considerations in food systems for women in urban areas and in aquaculture value chains, best practices and effective pathways for engaging men in the process of women’s empowerment in food systems, and how to address issues related to migration, crises and indigenous food systems. While there are gender-informed evaluation studies examining the effectiveness of gender- and nutrition-sensitive agricultural programs, evidence indicating the long-term sustainability of such impacts remains limited. The chapter recommends key areas for investment: improving women’s leadership and decision-making in food systems, promoting equal and positive gender norms, improving access to resources, and building cross-contextual research evidence on gender and food systems.

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1 Introduction

Women are key actors in food systems as producers, wage workers, processors, traders, and consumers. They do this work despite many constraints and limitations, including lower access to opportunities, technologies, finance and other productive resources, and weak tenure and resource rights. These constraints and limitations are shaped and reinforced by social and structural inequalities in food systems. Stark gender inequalities are both a cause and outcome of unsustainable food systems and unjust food access, consumption and production. In the agriculture sector, for example, evidence shows that women have unequal access, and, in some cases, unequal rights, to important resources, such as land, water, pasture, seeds, fertilizers, chemical inputs, technology and information, and extension and advisory services, all of which reduces their potential to be productive in agriculture, become empowered to make strategic decisions and act on those decisions, and realize their rights (Doss 2018 ; Meinzen-Dick et al. 2019a , b ; Mulema and Damtew 2016 ; Madzorera and Fawzi 2020 ). In addition, compared with men, women are more vulnerable to chronic food and nutrition insecurity, as well as shock-induced food insecurity (Madzorera and Fawzi 2020 ; Theis et al. 2019 ).

2 Conceptual Framing

We conceptualize gender as an important lever for progress across all aspects of food systems (Fig. 1 ) and draw upon key terms and definitions of women’s empowerment, women’s economic empowerment, and gender-transformative approaches (see definitions in Annex ). Food system drivers are anchored in a gendered system with structural gender inequalities and are shaped by shocks and vulnerabilities that affect men and women in different ways. Structural gender inequalities and gendered shocks and vulnerabilities thus influence the ways in which men and women experience these drivers of food systems, which, in turn, shape the three main components of food systems: value chains, the food environment, and consumer behavior.

A block diagram represents gender in food systems, which includes drivers with structural gender inequalities and gendered shocks and vulnerabilities. These drivers have three components namely, value chains, food environment, and consumer behavior and they interact with other agencies to get resources and policies which results in various outcomes.

Gendered food systems. (Source: Adapted from de Brauw et al. 2019 )

This conceptualization of gender in food systems recognizes and highlights the linkages and interconnectedness across these three components. For example, strengthened access to nutritious foods (food environment) is an important source and pathway to strengthening individual and household resilience (drivers), particularly as adverse effects of climate change will continue to negatively influence access to and consumption of diverse nutrient-rich foods (Fanzo et al. 2018 ; Theis et al. 2019 ). And, as food systems are both contributors to and impacted by climate change, nature-positive production schemes (production), such as sustainable agricultural intensification strategies, enable food systems to reduce their contribution to and mitigate the impacts of climate change, thus strengthening resilience (drivers) (Campbell et al. 2014 ).

These three components of the food system interact with gender equality/inequality in a four-dimensional space: individual and systemic, formal and informal. Transforming food systems in equitable ways requires changes in gender equality at the individual and systemic levels and at the formal and informal levels. Changes must occur in: women’s and men’s consciousness, capacity, behavior and awareness (individual; informal); access to resources, services and opportunities (individual, formal); informal and implicit cultural norms, deep structure and the social values that undergird the way in which institutions operate(informal, systemic); and in formal policies, laws, and institutional arrangements (formal, systemic) in place to protect against social and gender discrimination and advance equality (Gender at Work n.d. ). Change must go beyond simply reaching women through interventions, and requires facilitating the empowerment process so that women can benefit from food system activities (namely, increasing wellbeing, food security, income, and health) and can make and act upon strategic life decisions within food systems. Footnote 1 Women’s agency, differences in access to and control over resources, gendered social norms, and existing policies and governance influence how men and women can participate in and benefit from food systems, leading to differences in overall outcomes (Fig. 1 ).

3 Methodology

This chapter uses a scoping review (Harris et al. 2021 ; Liverpool-Tasie et al. 2020 ) to assess the current evidence on gender issues in food systems. Given the broad range of key topics related to gender in food systems, topically relevant and published systematic reviews were purposively sampled to provide a baseline state of the evidence. After purposively sampling and identifying 16 systematic and scoping reviews to inform the baseline, additional articles were collected. Three databases (Google Scholar, ScienceDirect, and IFPRI’s Ebrary) were used to gather and collect additional articles using key word searches aligned with 42 unique terms cross-referenced with the terms “gender” and “women.” A total of 198 articles were selected from these databases for review after meeting the following inclusion criteria: the articles had to be empirical and peer-reviewed, published in English, and have a geographic focus in low- or middle-income countries (LMICs). The article also had to make an explicit reference to gender or women’s empowerment and the key thematic term. For articles meeting these initial criteria, additional criteria were used to exclude some from the review, including if the methodology was inadequate to account for biases, or if the article was not relevant to agriculture or food systems. Duplicate articles from across the searches were eliminated from the database. Finally, additional articles were identified for inclusion from the citations in the articles collected above. All collected articles were managed in Zotero reference manager software. Footnote 2

This section presents the main findings of evidence relevant to the components of the gendered food system conceptual framework (Fig. 1 ): drivers and cross-cutting levers, shocks and stressors, food and value chains, food environment, consumer behavior, and outcomes.

In general, the evidence reveals that women are important actors and contributors to food systems, but their contributions are typically undervalued, unpaid, or overlooked in food systems research. A 2021 map of food systems and nutrition evidence from the International Initiative for Impact Evaluation (3ie) indicates that, although women have a major role in food systems, relatively few studies have examined strategies for or the effectiveness of interventions aimed at improving women’s decision-making power or have measured outcomes related to empowerment (Moore et al. 2021 ). Many food system interventions have not collected evidence regarding gender, an oversight that may result in poor outcomes or the inefficient use of funds to improve food systems (Moore et al. 2021 ).

Overall, the literature is largely in agreement as to how to advance gender equality and women’s empowerment in food systems, but offers little evidence on causal pathways or mechanisms (Moore et al. 2021 ). The existing evidence, in general, offers locally or contextually specific findings; limited evidence exists that applies across contexts or at a geographic scale. Footnote 3

4.1 Drivers: Shocks and Stressors

Men and women are differently exposed and vulnerable to shock and stress events. As a result of social norms and differing access to important resources, men and women have different capacities to mitigate risk and respond to these events (Mahajan 2017 ; Codjoe et al. 2012 ). The types of capacities needed include absorptive, adaptive, and transformative capacities, which are built by developing and leveraging resources and networks to reduce the risk of adverse impacts and facilitate faster recovery from shock and stress events. Gendered impacts of shocks are nuanced, context-specific, and often unexpected (Quisumbing et al. 2018 ; Rakib and Matz 2014 ; Nielsen and Reenberg 2010 ). Gendered perceptions of climate change and ensuing effects are based on livelihood activities and household and community roles and responsibilities, and often influence how men and women can leverage adaptation strategies to respond (Quisumbing et al. 2018 ; Aberman et al. 2015 ; Nielsen and Reenberg 2010 ).

Many studies indicate that gender-differentiated access to or ownership of important resources—such as women having fewer assets and lacking access to information services or credit—is linked to different capacities to mitigate, adapt to, and recover from shock and stress events (Bryan et al. 2013 ; de Pinto et al. 2020 ; Fisher and Carr 2015 ). However, women’s participation in collaborative farming schemes or group networks facilitates broader access to resources and additional social networks and types of social capital, which strengthen women’s capacity to respond to these events (Vibert 2016 ). For example, participation in community groups and access to credit options in Mali have been positively associated with an uptake in climate-smart agriculture practices and technologies (Ouédraogo et al. 2019 ).

Women have fewer adaptation options than men, as social norms restrict women’s mobility, freedom of movement, and access to transportation, as do time burdens associated with domestic and care responsibilities (Jost et al. 2016 ; Naab and Koranteng 2012 ; de Pinto et al. 2020 ). However, de Pinto et al. ( 2020 ) note evidence that certain components of women’s empowerment led to increased crop diversification among small-scale agricultural producers in Bangladesh, suggesting that women do play an important and positive role in climate change adaptation. Access to context-specific and relevant climate information and appropriate technologies is a key determinant of adopting climate change adaptation practices, and women and men have different needs for and access to such information (see section below on Gendered Access to Services and Technology) (Bryan et al. 2013 ; Tambo and Abdoulaye 2012 ; Twyman et al. 2014 ; Mudege et al. 2017 ).

4.2 Food System Components

4.2.1 agrifood value chains.

Women are actively engaged across various roles in agricultural value chains, although women’s positions are typically undervalued and overlooked in food systems research (Doss 2013 ). In Ethiopia, Abate ( 2018 ) found that women were predominately responsible for storage preparation, post-harvest processing, milk processing, barn cleaning, care for newborn livestock, cooking, grinding, fetching, and collecting fuelwood, and worked with men to weed, harvest, thresh, and protect crops from wildlife. Qualitative evidence from Benin suggests that women are predominately engaged in agricultural processing activities and, if they have access to land, are also engaged in production activities (Eissler et al. 2021a ). Studies from Benin and Tanzania also found that, regardless of the producer, men manage higher-value sales and marketing, while women only manage the marketing and negotiation of small-value sales (Eissler et al. 2021a ; Mwaseba and Kaarhus 2015 ). Gupta et al. ( 2017 ) provided evidence that improving women’s market access is strongly correlated with increased levels of women’s empowerment in India.

Agriculture both contributes to and is affected by anthropogenic climate change. As population pressures continue to increase and place demands on food production, agricultural livelihoods across agrifood value chains must adapt approaches that will sustainably meet rising demand, reduce risk associated with adverse climatic events, and mitigate contributions to climate change. Such approaches include sustainable intensification (Tilman et al. 2011 ; Rockström et al. 2017 ), conservation agriculture (Montt and Luu 2020 ), and climate-smart and climate-resilient agriculture (Gutierrez-Montes et al. 2020 ; Duffy et al. 2020 ), among others. A growing body of evidence indicates that women producers are less able to adopt such sustainable and resilient production practices or methods given their limited access to necessary resources, including land, time, labor, information, and technologies (Theriault et al. 2017 ; Ndiritu et al. 2014 ; Grabowski et al. 2020 ; Farnworth et al. 2016 ; Meinzen-Dick et al. 2019a , b ; Doss et al. 2015 ; Perez et al. 2015 ; Pradhan et al. 2019 ; Parks et al. 2015 ; Ayantunde et al. 2020 ; Khoza et al. 2019 ; Gathala et al. 2021 ; Montt and Luu 2020 ; Beuchelt and Badstue 2013 ; Halbrendt et al. 2014 ).

4.2.2 Food Environment

Several themes emerge from the evidence linking gender equality and women’s empowerment with improving the availability of and access to safe and nutritious food. First, the affordability of nutritious food is an important issue for accessing nutrient-rich foods to advance gender equality and women’s empowerment. Available evidence indicates that women are less likely than men to be able to afford a nutritious diet, as women often occupy lower-paying wage positions than men, earn and control smaller incomes than men, have less autonomy over household financial decisions, or have no income at all. For example, Raghunathan et al. ( 2021 ) estimated that, while nutritious diets have become substantially more affordable for both female and male wage workers in rural India, unskilled wage workers still cannot afford a nutritious diet; unskilled workers account for approximately 80–90% of female and 50–60% of male daily wage workers, and care for 63–76% of poor rural children.

Another important theme is ensuring equitable access to markets where nutritious foods can be purchased. Nutrient-dense foods, such as fruit, milk and vegetables, are difficult to transport and store, and therefore must be purchased locally, particularly in remote and rural areas (Hoddinott et al. 2015 ; Mulmi et al. 2016 ). Several articles linked women’s mobility and freedom of movement to market access, and thus to positive nutrition and food security outcomes. For example, Aryal et al. ( 2019 ) found that physical distance to markets impacted household food security outcomes for female-headed households more than for male-headed households in Bhutan. Shroff et al. ( 2011 ) found women’s low autonomy in mobility was positively associated with wasting in children in India. The evidence seems to associate women’s limited mobility with stricter social gender norms and religion.

4.2.3 Consumer Behavior

Agriculture can influence diets and dietary choices through the consumption of household-produced crops or increased purchasing power derived from the sale of agricultural products. Moore et al. ( 2021 ) found that, in research carried out since 2000, women’s roles in food systems have mostly been examined in terms of their role as consumers, such as household cooks, or as mothers who are breastfeeding or whose health affects that of their children. Other studies link gender norms, roles and responsibilities to women as food preparers and managers of the quality of household diets (Eissler et al. 2020a ; Sraboni and Quisumbing 2018 ). Komatsu et al. ( 2018 ) found a positive association between the amount of time women spent on food preparation and household dietary diversity, and Chaturvedi et al. ( 2016 ) found a positive association between the time mothers spent with their children and nutrition status.

There is evidence showing positive effects of nutrition counseling, nutrition education, and maternal education for nutrition, dietary diversity, and health outcomes for women and children (Choudhury et al. 2020 ; Akter et al. 2020 ; Kimambo et al. 2018 ; Reinbott and Jordan 2016 ; Reinbott et al. 2016 ; Rakotomanana et al. 2020 ; Ragasa et al. 2019 ). Interventions for sustainable and nutritious diets are found to be more effective when they include components on nutrition and communication about health behavior change, women’s empowerment, water, sanitation and hygiene (WASH), and micronutrient-fortified products (Ruel et al. 2018 ). Gelli et al. ( 2017 ) found preliminary evidence that WASH components of a nutrition-sensitive agriculture intervention in Burkina Faso may have mitigated the potential harm, such as the health risks, of introducing and enhancing small livestock production. However, more evidence is needed to understand the best practices for reducing potential harm of increased livestock production and management in nutrition-sensitive agricultural programs (Ruel et al. 2018 ).

4.3 Food System Outcomes

Recent research has examined the link between maternal mental health and psychosocial indicators and nutrition outcomes. There is mixed evidence regarding the link between maternal depression and mental health symptoms and child or household nutrition. Wemakor and Iddrisu ( 2018 ) found no association between maternal depression and child stunting in northern Ghana, whereas Wemakor and Mensah ( 2016 ) and Anato et al. ( 2020 ) found positive associations between women experiencing depressive symptoms and child undernutrition in Ghana and Ethiopia. Wemakor and Mensah ( 2016 ) observed that women experiencing the highest levels of depression were also those with the lowest incomes or from the lowest-income households. Cetrone et al. ( 2020 ) found that food security improvements resulting from participation in a nutrition-sensitive agriculture program mediated women’s depression symptoms in Tanzania. Such evidence, which is both mixed and limited, suggests that further studies are needed to understand the psychosocial impacts of women’s empowerment and mental health on household nutrition and health outcomes.

Evidence links access to resources and empowerment to outcomes in nutrition and children’s education. For example, evidence indicates that female livestock ownership or production diversity, combined with market access and women’s empowerment, are important drivers of diverse household consumption and nutritional status (Sibhatu et al. 2015 ; Mulmi et al. 2016 ; Hoddinott et al. 2015 ). Additionally, Malapit et al. ( 2019 ) found in Bangladesh that, while gaps in parental empowerment had only weak associations with children’s nutrition status, mother’s empowerment is positively associated with girls’ education and keeping older children in school in general.

A growing body of research has examined the pathways through which women’s empowerment is linked with household nutrition outcomes and access to nutritious foods (Alaofè et al. 2017 ; Reinbott and Jordan 2016 ; Bellows et al. 2020 ; Malapit and Quisumbing 2015 ; Heckert et al. 2019 ; Lentz et al. 2019 ). These pathways are contextual and vary across countries and regions (Na et al. 2015 ; Ruel et al. 2018 ; Quisumbing et al. 2021 ). Ruel et al. ( 2018 ) observe that, while the current evidence broadly associates women’s empowerment and nutrition outcomes, this evidence is generally context-specific, given that women’s empowerment and gender roles and norms are closely linked. As more evidence is generated from cross-context evaluations, future research can create typologies to better explain how gender roles more broadly interact with nutrition-sensitive agricultural interventions (Ruel et al. 2018 ).

Specific to equitable livelihood outcomes, evidence indicates that women face disproportionate barriers in accessing finance and credit options compared with men (Adegbite and Machethe 2020 ; Ghosh and Vinod 2017 ; Dawood et al. 2019 ; Kabir et al. 2019 ). For example, Kabir et al. ( 2019 ) found that in Bangladesh, a lack of access to credit is the most significant barrier women producers faced, followed by a lack of need-based training, high interest rates, insufficient land access, and a lack of quality seeds. Women’s ability to earn incomes and participate in income-generating activities is strongly mediated by restrictive gender norms, a lack of access to resources, and time burdens arising from normative roles and responsibilities. In a study of urban women vegetable traders in Viet Nam, Kawarazuka et al. ( 2017 ) found that women were able to work in less socially respected spaces, such as street trading, but still needed to negotiate their access to informal employment spaces with their husbands.

Supporting women’s entrepreneurship is suggested as an important pathway to advancing gender equality and women’s empowerment in food systems. Malapit et al. ( 2019 ) suggest that this is not necessarily the case if these businesses are small and home-based; such businesses typically make little profit and tend to add to women’s existing time burdens. And in a systematic literature review, Wolf and Frese ( 2018 ) emphasized the need to recognize that spousal support is a key factor for women’s entrepreneurship or engagement in income-generating activities.

5 Cross-Cutting Gender and Food System Issues

5.1 gendered social norms and expectations.

Social and cultural norms shape and reinforce the ways in which women and men can participate in, access, and benefit from opportunities and resources (Kristjanson et al. 2017 ; Meinzen-Dick et al. 2019a , b ; Rao et al. 2019 ; Moosa and Tuana 2014 ). This has important consequences across all aspects of advancing women’s empowerment and gender equality in food systems. For example, norms can hinder women’s ability to access or adopt new agricultural practices (Kiptot and Franzel 2012 ; Njuki et al. 2014 ). Importantly, gender norms vary within contexts, such as by religious identity or social class. Kruijssen et al. ( 2016 ) noted that different normative expectations of women in Hindu and Muslim communities in Bangladesh influenced the ways in which these women were constrained or enabled in participating in aquaculture value chains.

In general, women often experience restrictive social norms that hinder their empowerment and full participation in household or community activities and value chains (Huyer and Partey 2020 ; Kruijssen et al. 2018 ). In a review of evidence on gender issues in global aquaculture value chains, Kruijssen et al. ( 2018 ) found that contextual gender norms shape the ways in which women and men participate in aquaculture value chains around the world, often limiting women’s ability to participate in and benefit from aquaculture value chains equally.

Social gender norms are contextually and culturally specific and are strongly linked to women’s empowerment (Eissler et al. 2020a , b , 2021a ; Meinzen-Dick et al. 2019a , b ; Bryan and Garner 2020 ). Emic understandings of an empowered woman and an empowered man vary, but importantly inform the understanding of cultural nuances and expectations of the roles and responsibilities of women (Meinzen-Dick et al. 2019a , b ; Bryan and Garner 2020 ). Men are generally considered to be the household financial providers and decision-makers, whereas women are responsible for domestic chores, childcare, food preparation, and other unpaid care tasks. In rural agricultural settings, women may also provide household labor on their husbands’ agricultural plots in addition to their domestic work, yet are not remunerated for this labor (Picchioni et al. 2020 ; Nahusenay 2017 ; Ghosh and Chopra 2019 ). Recent evidence also suggests that patterns of male dominance in the household are linked to individuals’ gender norms, but are not necessarily correlated with intergenerational transfers of male dominance in intrahousehold decision-making (Leight 2021 ).

5.2 Gendered Access to and Control over Resources, Services and Technology

A large body of literature has examined differences in men’s and women’s access to, ownership of, and control over resources in the food system (Johnson et al. 2016 ; Uduji et al. 2019 ; Perez et al. 2015 ; Gebre et al. 2019 ; Fisher and Carr 2015 ; Lambrecht and Mahrt 2019 ). Evidence indicates that perceived or effective ownership of resources may be more important than actual ownership for women’s empowerment and nutrition outcomes (Eissler et al. 2020b ). Studies have found positive associations between women’s land ownership and their participation in community groups or co-operative networks, suggesting that access to important resources, such as land, facilitates access to other resources, such as increased bargaining power and pooled assets. Further evidence indicates that when women’s previously less lucrative or lower-valued activities begin to rise in value or earn higher incomes, control over the activity or resource may be transferred from women to men (Mwaseba and Kaarhus 2015 ).

Existing literature shows that women face social, cultural and institutional barriers to accessing and adopting agricultural technologies, information and services (Peterman et al. 2014 ; Peterman et al. 2011 ; Perez et al. 2015 ; Mudege et al. 2017 ; Ragasa et al. 2013 ; de Pinto et al. 2020 ; Raghunathan et al. 2019 ; Duffy et al. 2020 ). Men and women have different needs for and access to such information and technologies; gender analyses are therefore needed to tailor communication strategies so as to ensure that information and dissemination are adequately targeted towards men and women (Tall et al. 2014 ; Peterman et al. 2014 ; Diouf et al. 2019 ; Ragasa et al. 2013 ; Jost et al. 2016 ; Mudege et al. 2017 ; Duffy et al. 2020 ). Women have access to disproportionately less information than men overall, but they have access to more information regarding certain topics relevant to their gender-normative roles and responsibilities, such as post-harvest handling and small livestock production (Twyman et al. 2014 ).

Gender-sensitive program designs that aim to increase access to technologies have positive impacts on women’s nutrition and health outcomes (Kassie et al. 2020 ; Alaofè et al. 2016a , b , 2019 ). An evaluation of a gender-sensitive irrigation intervention in northern Benin found that women in the program had higher dietary diversity, increased intake of vegetables, reduced rates of anemia, higher body mass indexes (BMI), and improved household nutritional status through direct consumption as a result of women’s increased crop diversification and increased income that allowed them to make economic decisions (Alaofè et al. 2016a , b , 2019 ).

Interventions to benefit or empower women may overlook the time trade-offs required for women’s participation or for intended outcomes (Picchioni et al. 2020 ; Komatsu et al. 2018 ; van den Bold et al. 2021 ). Importantly, measuring time use itself does not address women’s agency over said time use or the intrahousehold decision-making surrounding how and on what activities women may spend their time (Eissler et al. 2021b ). There is little research to show how women can control their own time use or how interventions can support women in managing their own time to advance their strategic choices in food systems.

5.3 Women’s Agency: Decision-Making and Leadership

5.3.1 household level.

Evidence suggests that there are positive nutrition, livelihood, wellbeing, and resilience outcomes when women are more involved and have greater influence in household decision-making. Several studies find that when women own or have joint title to land, they are significantly more involved or have greater influence in household decision-making, particularly regarding agricultural or productive decisions (Wiig 2013 ; Mishra and Sam 2016 ). And while Fisher and Carr ( 2015 ) found that women farmers in Ghana and Malawi were less likely to adopt drought-tolerant maize varieties due to differences in resource access, women strongly influenced the adoption of drought-tolerant maize varieties on plots controlled by their husbands.

5.3.2 Community Level

Diiro et al. ( 2018 ) found evidence that increases in women’s empowerment, including women’s participation in community leadership, is associated with higher agricultural productivity; and women from more food-secure households are more likely to participate in community leadership roles. Niewoehner-Green et al. ( 2019 ) found that, for women in rural Honduras, social norms and structural biases hindered their participation in leadership positions in agricultural groups and limited their influence and voice in community decisions. There is some evidence to suggest that men and women value and participate in different types of community groups. For example, women place a higher value on savings and credit groups than men and may have greater access to hyper-local institutions, whereas men have greater access to institutions and services from outside of their immediate community (Cramer et al. 2016 ; Perez et al. 2015 ). Other evidence suggests that women may participate in fewer groups than men (Mwongera et al. 2014 ).

5.3.3 Food Systems Level

Increasing women’s voices and integrating their preferences into agricultural solutions, including technology design and implementation, is an under-researched pathway to empowerment and gender equality in food systems. For example, there is evidence that women may have different preferences than men with regard to crop varietals (Gilligan et al. 2020 ; Teeken et al. 2018 ), but there is limited evidence that breeders’ consider these preferences in varietal design and profiles (Tufan et al. 2018 ; Marimo et al. 2020 ).

5.4 Institutional Barriers, Policy, and Governance

The prevalence of gender-based violence (GBV) is a systemic barrier for women’s empowerment in food systems. There is extensive research in health literature on GBV; however, research on violence against women in the context of food systems is limited. Some studies find evidence that women’s asset ownership deters GBV, suggesting that when women own assets, their status may increase, making it easier for them to leave harmful relationships (Grabe 2010 ; Grabe et al. 2014 ). Buller et al. ( 2018 ) and Lees et al. ( 2021 ) found that cash transfer programs decrease the incidence of GBV. The new project-level Women’s Empowerment in Agriculture Index for Market Inclusion (pro-WEAI+MI) includes indicators on sexual harassment and violence against women in composite measurements of empowerment for women in agricultural value chains (Ragasa et al. 2021 ; Eissler et al. 2021a ), providing a tool to measure the incidence of GBV and its impact on women’s empowerment in food systems.

Institutions and policies that support gender equality and women’s empowerment in food systems are generally lacking in low-income countries (Meinzen-Dick et al. 2013 ). Bryan et al. ( 2018 ) observed that a lack of policies and institutional capacity hinders research and gender integration into climate change adaptation programs across a range of contexts, specifically noting a lack of staff capacity on gender, a lack of funding to support gender integration, and sociocultural constraints as key barriers to gender integration. Some evidence suggests a tension between formal legislation and practiced law. Pradhan et al. ( 2019 ) found that, in practice, women’s joint and personal property rights differ from legal definitions. Eissler et al. ( 2021a ) observed that, while Benin has formal gender equality and antidiscrimination laws, these are poorly enforced and do not align with social norms toward GBV or harassment. For example, women working in agricultural value chains often may not report incidents of sexual harassment in the workplace for fear of upsetting their husbands, suggesting that women may feel a sense of responsibility for inviting the harassment.

6 Conclusions

This scoping review aimed to elucidate evidence and identify evidence gaps for advancing gender equality and women’s empowerment in food systems. We see evidence that women have differing access to resources compared with men, such as essential services, knowledge and information, technology dissemination, land, credit options, time, and markets. This differing level of access is shaped and reinforced by contextual social gender norms. Existing evidence shows that context-specific pathways link women’s empowerment to important outcomes, such as household nutrition and dietary diversity, noting that these pathways may vary between and within contexts. Cross-contextual evidence exists of positive associations between maternal education (and specifically, access to nutrition education) and positive outcomes for child and household nutrition and diet quality.

While this review was not systematic, it appears that only limited studies address important areas of inquiry regarding gender equality and women’s empowerment in food systems. Specifically, only a few studies included in this review examined gender considerations in food systems for women in urban areas or aquaculture value chains. There have been few studies geared at understanding best practices and effective pathways for engaging men in the process of women’s empowerment in food systems, or addressing issues of migration, crises or indigenous food systems. Additionally, while there are gender-informed evaluation studies examining the effectiveness of gender- and nutrition-sensitive agricultural programs, there is limited evidence to indicate the long-term sustainability of such impacts.

In conclusion, this review suggests that there is substantial agreement about pathways to improve women’s empowerment and gender equality in food systems, but the actual evidence to support these pathways, specifically cross-contextual evidence, is limited. Existing evidence is extremely localized and context-specific, limiting its application beyond the focus area of the study. And finally, relatively few studies included a gender-informed design and conceptual framework to best understand mechanisms for promoting equality and empowerment. Moving forward, further research is required to produce stronger evidence on cross-contextual pathways to improve gender equality and women’s empowerment in food systems.

7 Recommendations for Investment

7.1 invest in maternal education, particularly nutrition-focused education and counseling.

Cross-contextual evidence indicates that maternal education and experiences with nutrition counseling are positively associated with improved diet quality and diversity, leading to better nutrition outcomes at the household level. For example, Choudhury et al. ( 2019 ) found a positive association of maternal education and maternal health, household dietary diversity, and nutrition and health outcomes for household members in 42 countries, suggesting that dietary diversity may be driven by preferences and knowledge. In Tanzania, Kimambo et al. ( 2018 ) found positive associations between women’s nutrition knowledge and consumption of African vegetables. Rakotomanana et al. ( 2020 ) found that, in Madagascar, children of mothers with knowledge and positive attitudes about complementary nutrient-rich foods had more nutrient-diverse diets, while those with mothers who had lower incomes and greater time burdens had less nutrient-diverse diets. Studies also found benefits from involving grandmothers in nutrition counseling, education and dialogues in Sierra Leone (Aidam et al. 2020 ; MacDonald et al. 2020 ) and Nepal (Karmacharya et al. 2017 ). Investments should focus on increasing women’s educational attainment, coupled with nutrition-focused counseling.

7.2 Invest in Programs/Interventions that Aim to Improve Women’s Influence and Role in Decision-Making and Leadership at All Levels of the Food System (Household, Community, and Systems)

Women’s influence and role in decision-making is associated positively with nutrition, women’s empowerment, and livelihood outcomes at all levels of food systems. At the household level, in northern Ghana, for example, women are less likely to have decision-making autonomy over productive decisions, purchasing, selling or transferring assets, and speaking in public (Ragsdale et al. 2018 ). In Bangladesh, de Pinto et al. ( 2020 ) found that households have higher levels of crop diversification when women have more influence in productive household decision-making, suggesting that an increase in women’s bargaining power can lead to more resilient agricultural livelihoods. At the community level, evidence indicates that women’s participation in community groups also enhances resilience, increases access to important resources such as land and labor, builds and facilitates social networks, and increases their influence and participation in community-level decision-making (Kumar et al. 2019 ; Aberman et al. 2020 ). For example, Kabeer ( 2017 ) found that women in Bangladesh who expand their active social networks through community groups have higher levels of empowerment. Raghunathan et al. ( 2019 ) found that Indian women’s participation in self-help groups was positively associated with increased levels of information and participation in some agricultural decisions, but did not affect agricultural production or outcomes, possibly because of women’s limited time, financial constraints, or restrictive social norms. At the systems level, there is limited evidence to suggest that technology development (including crop breeding, for example) incorporates women’s different preferences and needs into design (Tufan et al. 2018 ; Marimo et al. 2020 ). Investments should be made in interventions that address and facilitate improvements for women’s influence and participation in decision-making at all levels.

7.3 Invest in Interventions that Promote Positive and Equal Gender Norms at the Household, Community, and Systems Levels

Gender norms and associated expectations vary by context; however, restrictive gender norms shape and, in many ways, hinder women’s empowerment across contexts and limit their ability to participate in and act upon strategic decisions or activities to advance their own empowerment across all components of food systems. For example, a study in Egypt found that a woman’s normative role as an unpaid household caregiver limited her ability to sell fish compared with her husband, who did not face time burdens associated with caregiving and who maintained decision-making control over his and his wife’s activities (Kantor and Kruijssen 2014 ). In Papua New Guinea, Kosec et al. ( 2021 ) found that men are more likely to support women challenging normative gender roles in terms of their economic participation during periods of household economic stress because this can raise household income, not because they support transforming women’s role in society more generally. Contextual gender norms may also shape women’s food allocation preferences, which hold important implications for nutrition. In Ethiopia, for example, women may favor sons over daughters for more nutrient-dense foods (Coates et al. 2018 ). Sraboni and Quisumbing ( 2018 ) found that women’s preferences in allocating nutritious foods were influenced heavily by social norms in Bangladesh, where women favored sons over daughters because of male advantage in labor markets and property rights. Investments should be made to promote positive and equal gender norms for and with men and women across contexts and scales from the household to system levels.

7.4 Invest in Interventions and Efforts that Improve Women’s Access to Important and Necessary Resources

The evidence overwhelmingly indicates that, across contexts, women have less access to important resources than men. These resources include, but are not limited to, land, agricultural inputs, financing options, financial services, technology, technical services, and time. Nuanced variations exist across and within contexts. For example, in sub-Saharan Africa, studies indicate that women may rely on informal sources of information, such as personal connections, whereas men rely on formal sources of information, such as extension or the private sector; however, in Colombia, men may have more access to information overall compared to women, but both rely on the same sources of information (Twyman et al. 2014 ; Mudege et al. 2017 ). With regard to time, Komatsu et al. ( 2018 ) found that women’s time allocation and household nutrition outcomes varied by local context, such that women’s time in domestic work was positively associated with diverse diets in Bangladesh, Cambodia, Ghana, Mozambique and Nepal, but in Mozambique, the relation between women’s time in agricultural work and children’s diet quality varied with women’s asset poverty. Picchioni et al. ( 2020 ) found that, in India and Nepal, women and men participate equally in productive work that requires high levels of energy, but women shoulder most of the reproductive work at the expense of leisure opportunities. Van den Bold et al. ( 2021 ) found that a nutrition-sensitive agricultural intervention in Burkina Faso significantly increased the time women spent on agriculture and led to improved maternal and child nutrition outcomes, and that women’s increased time spent on agriculture did not have deleterious effects on their own or their children’s nutrition. Investments should be made to target improving women’s access to and control and ownership over such resources so as to ensure that they are able to effectively benefit from these resources.

7.5 Target Research to Yield More Cross-Contextual Evidence for Advancing Gender Equality and Women’s Empowerment in Food Systems

Finally, the overall outcome of this review revealed that the current evidence on advancing women’s empowerment and gender equality in food systems is locally specific and linked to contextual gender norms. Developing cross-contextual typologies can support the development of evidence that has broader application. More targeted research is required to identify patterns of successful and effective interventions and pathways to advance women’s empowerment and gender equality in food systems with contextual norms. The outcome of such research would be clear typologies that link successful interventions and recommendations by gender norms.

See Johnson et al. ( 2018 ) for a discussion of the Reach-Benefit-Empowerment framework.

All articles reviewed for this paper are compiled in a separate Excel database, with the following metrics collected for each article: author(s) name, article title, year published, journal or organization of publication, national focus (if specified), regional focus, methods used, and main finding(s). Additional information on the search methods and articles selected are included in the full review paper (citation forthcoming).

The findings presented in this paper are high-level. A further, more nuanced explanation of the findings can be found in the full review paper (citation forthcoming).

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Njuki, J., Eissler, S., Malapit, H., Meinzen-Dick, R., Bryan, E., Quisumbing, A. (2023). A Review of Evidence on Gender Equality, Women’s Empowerment, and Food Systems. In: von Braun, J., Afsana, K., Fresco, L.O., Hassan, M.H.A. (eds) Science and Innovations for Food Systems Transformation. Springer, Cham. https://doi.org/10.1007/978-3-031-15703-5_9

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Food Research & Action Center Applauds Congress for Releasing FY 2024 Spending Bill to Fully Fund WIC, Rejecting Harmful SNAP Policy Rider

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Statement attributable to Luis Guardia, President, Food Research & Action Center (FRAC)

WASHINGTON, March 3, 2024  — At a crucial juncture, Congress today  released  a final fiscal year (FY) 2024 Agriculture Appropriations package, securing $7.030 billion in critical funding for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a lifeline for nearly 7 million pregnant and postpartum women and young children, including approximately half of all infants born in the U.S. By rejecting a substantial number of harmful policy riders, which included efforts to restrict SNAP benefits — a proposal which received widespread, bipartisan criticism, Congress has also shown a commitment to the health, well-being, and dignity of millions of families.

The journey to secure funding was not without challenges. For months, FRAC has been sounding the alarm about the potential threat facing WIC participants if adequate funding was not secured. Recognizing the benefits of WIC, along with rising caseloads coupled with higher food prices all putting a squeeze on WIC, the Biden administration, alongside U.S. Agriculture Secretary Tom Vilsack, called for an additional $1 billion in funding to fully support WIC in FY 2024.

The final package includes critical resources to address WIC’s budget shortfall, helping to avert a potential disruption of services and prevent long waiting lists that would have left more women, infants, and young children hungry and unable to access the essential WIC services they rely on.

FRAC commends the House and Senate leadership for passing a short-term continuing resolution on Friday that has kept government programs operating while appropriators hammered out the final details of the spending package. FRAC urges Congress to swiftly pass this desperately needed funding measure.

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WASHINGTON, March 3, 2024 — At a crucial juncture, Congress today released a final fiscal year (FY) 2024 Agriculture Appropriations package, securing $7.030 billion in critical funding for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a lifeline for nearly 7 million pregnant and postpartum women and young children, including approximately half of all infants born in the U.S.

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Consumer Research on Labeling, Nutrition, Diet, and Health

Below are research abstracts of consumer research studies conducted or supported by the Center for Food Safety and Applied Nutrition.

The Health and Diet Survey is a national consumer survey conducted by the Food and Drug Administration (FDA). The national single-stage random-digit-dialing telephone survey has been commissioned by CFSAN since early 1980’s. Respondents are randomly selected non-institutionalized adults in the 50 states and the District of Columbia. The latest iteration was conducted in 2008. The purpose of the survey is to track and gather information on consumer awareness, attitudes and practices related to health and diet issues. In particular, the survey focuses on foods and dietary supplements, two categories of the consumer products regulated by the FDA. On diet and health, the survey asks about (1) awareness of the relationship between diet and diseases (cancer, heart disease, high blood pressure), (2) knowledge of fats and cholesterol, (3) knowledge of dietary deficiencies, (4) dietary management practices, and (5) use and impact of food labels. On dietary supplements, the survey asks about (1) prevalence of use, (2) information sources and uses, (3) perceptions of dietary supplements and their labels, (4) substitution of dietary supplements for prescription or over-the-counter drugs, (5) adverse experiences with dietary supplements, and (6) children's and teenagers' use of dietary supplements. The available demographic information includes gender, age, education, race/ethnicity, household size, pregnancy/lactation status, health status, region, and household income. [Contact: Amy Lando ]

Nutrient Content Claims: How They Impact Perceived Healthfulness of Fortified Snack Foods and the Moderating Effects of Nutrition Facts Labels. 2017. Irina A. Iles, Xiaoli Nan and Linda Verrill. Health Communication.

Nutrient content claims (NCCs) may inflate perceived healthfulness of nutritionally poor foods. The aim of this study is to experimentally test the effects of NCCs on consumers’ perceptions of fortified snack foods in terms of the presence of both healthful and less healthful nutrients, as well as their intentions to consume such products. It also explores the potential moderating effects of reading Nutrition Facts Labels (NFL) on the influence of NCCs. Data for this study were collected through a web-based experiment (N = 5,076). Results indicated that the presence of an NCC on a fortified snack food product increased perceived healthfulness of that product, perceptions of the presence of healthful nutrients, and intentions to consume the product. The presence of NCCs also decreased perceptions of the presence of certain less healthful nutrients. Reading the NFL had mixed effects on the impact of NCCs. [Contact: Linda Verrill ]

Vitamin-Fortified Snack Food May Lead Consumers to Make Poor Dietary Decisions. 2016. Linda Verrill, Dallas Wood, Sheryl Cates, Amy Lando, and Yaunting Zhang. Journal of the Academy of Nutrition and Dietetics.

BACKGROUND: The US Food and Drug Administration’s fortification policy discourages the fortification of certain foods, including sugars and snack foods such as cookies, candies, cakes, chips, and carbonated beverages, yet manufacturers sometimes add vitamins and minerals to snack foods. OBJECTIVE: To assess whether vitamin-fortified snack foods affect consumers’ information-seeking, purchase decisions, and product-related health perceptions. DESIGN: For this experimental study, participants were randomly assigned to study conditions to compare products that varied in product type, nutrition profile, and fortification and nutrient claim status. Data were collected via an online consumer panel. PARTICIPANTS/SETTING: US adults aged 18 years and older were randomly selected from Research Now’s e-panel online household panel. Data were collected during fall 2014 (N=5,076). INTERVENTION: Participants were randomly assigned to one of 24 conditions: two products (vegetable chip/potato chip), two nutrition profiles (healthier/less healthy), two fortification scenarios (not fortified/fortified), and three nutrient claim conditions (two no claim/one with claim). The design was not balanced; claims were not shown on products that were not vitamin fortified. MAIN OUTCOME MEASURES: Outcome measures were information-seeking (viewed the Nutrition Facts label), purchase decisions, perception of product healthfulness, and correct selection of product with the healthier nutrient profile. STATISTICAL ANALYSIS PERFORMED: Logistic regression was used to test all models. Analyses was adjusted for general label use, consumes product, health status, age, sex, level of education, presence of children in the household, and race/ethnicity. RESULTS: When the snack food carried a nutrient claim for vitamin fortification, participants were 1) less likely to look for nutrition information on the Nutrition Facts label, 2) more likely to select the product for purchase, 3) more likely to perceive the product as healthier, and 4) less likely to correctly choose the healthier product. CONCLUSIONS: Snack foods that have been vitamin-fortified may cause consumers to make poor dietary decisions. [Contact: Linda Verrill ]

"As Much Calcium as a Glass of Milk!" Understanding American Consumers’ Preferences for Fortified Foods. 2016. Xiaoli Nan, Linda Verrill, and Irina Iles. Journal of Food Products Marketing.

This study examines predictors of American consumers’ preferences for fortified foods, focusing on sociodemographic as well as psychological correlates. Analysis of a probability-based survey (N = 6,728) revealed that females and the more educated tended to have greater preferences for fortified foods. Whites held the least favorable views on fortified foods when compared to Blacks and Hispanics. In terms of psychological predictors, people who were more health-conscious were more likely to prefer fortified foods. Perceived usefulness of nutrition labels and confusion about healthy food choices were both associated with stronger preferences for fortified foods. Both relationships appeared to be moderated by health consciousness. Communication and policy implications of these findings are discussed. [Contact: Linda Verrill ]

Prevalence of self-reported food allergy in U.S. adults: 2001, 2006, and 2010. 2015. Linda Verrill, Richard Bruns and Stefano Luccioli. Allergy and Asthma Proceedings 36:458–467.

BACKGROUND: Epidemiologic evidence indicates that food allergies are increasing in the population. Information on a change in self-reported food allergy (srFA) in adults over time is lacking. OBJECTIVE: To report the prevalence of srFA and compare differences at three time points over a decade. METHODS: We analyzed srFA and reported physician-diagnosed food allergy in 4000 U.S. adults who participated in the 2010 U.S. Food and Drug Administration Food Safety Survey. Information on causative food(s), reaction severity characteristics, and various diagnostic factors was also analyzed. We compared 2010 Food Safety Survey data with 2006 and 2001 data, and highlighted relevant differences. RESULTS: SrFA prevalence increased significantly, to 13% in 2010 and 14.9% in 2006 compared with 9.1% in 2001 (p<0.001). Physician diagnosed food allergy was 6.5% in 2010, which was not significantly different compared with 7.6% in 2006 and 5.3% in 2001. SrFA increased in both men and women, non-Hispanic white and black adults, 50–59 year olds, and in adults with a high school or lower education. In 2010, milk, shellfish, and fruits were the most commonly reported food allergens, similar to 2001. Also, in 2010, 15% of reactions reportedly required a hospital visit and 8.4% were treated with epinephrine. Minor differences in reaction severity characteristics were noted among the surveys. CONCLUSIONS: Analysis of survey results indicates that the prevalence of srFA increased among U.S. adults from 2001 to 2010 and that adults are increasingly self-reporting FAs without obtaining medical diagnosis. Improved education about food allergies is needed for this risk group. [Contact: Linda Verrill ]

Consumer Understanding of the Benefits and Risks of Fish Consumption During Pregnancy. 2014. Amy Lando and Serena Lo. American Journal of Lifestyle Medicine 8(2):88-92.

Fish consumption during pregnancy is one important area of dietary advice. There are potential benefits for pregnant women and their babies from a diet that contains sufficient amounts of fish. However, methylmercury, which is in most fish in at least trace amounts, can have adverse effects on the cognitive development of fetuses and can have neurological effects on children and adults in high amounts. The Federal government first issued national consumption advice in order to minimize the risk to the developing fetus from methylmercury in fish in the 1990s. This advice was updated in 2001 and again in 2004. Most recently, the US Dietary Guidelines for Americans, 2010 recommends a consumption target for pregnant and nursing women of 8 to 12 oz/wk of a variety of fish lower in methyl-mercury—to take advantage of the potential benefits that fish could provide to children’s development— while avoiding the 4 fish species highest in methylmercury that are named in joint 2004 Food and Drug Administration/Environmental Protection Agency advice (tilefish, shark, swordfish, and king mackerel). The challenge for policy makers, public health officials, and clinicians is to determine how best to communicate with pregnant women about both the benefits and risks associated with fish consumption. [Contact: Amy Lando ]

Consumer Research Needs from the Food and Drug Administration on Front-of-Package Nutritional Labeling. 2014. J. Craig Andrews, Jordan Lin, Alan S. Levy, and Serena Lo. Journal of Marketing and Public Policy 33(1):10-16.

Americans have increasingly busy lifestyles and desire quick and nutritious food choices. To provide consumers with at-a-glance nutrition information, many food manufacturers have introduced front-of-package (FOP) nutritional labeling systems. The purpose of this review is to reach out to the marketing and public policy discipline by identifying research needs on FOP systems not only to aid decision making for federal agencies, but also to help advance research on this important topic. We describe the many FOP systems, the FDA's regulatory background and approach to FOP systems, recent experimental research and gaps in knowledge, and research needs on FOP nutrition labeling. [Contact: Chung-Tung Lin ]

Simulating the Potential Effects of a Shelf-Tag Nutrition Information Program and Pricing on Diet Quality Associated with Ready-to-Eat Cereals. 2014. Biing-Hwan Lin, Joanne Guthrie, Ilya Rahkovsky, Chung-Tung J. Lin, and Jonq-Ying Lee. International Food and Agribusiness Management Review 17(Special Issue A):7-24.

Previous research has shown that the Guiding Stars Program TM (GSP), a shelf -tag nutrition information system used in some supermarkets in the United States (US), increases consumer demand for ready-to-eat (RTE) breakfast cereals that the program considers more nutritious. Further, consumer demand for cereals is found to respond to price. Here we simulate potential changes in RTE cereal consumption predicted by estimated demand if a GSP or a 10% price manipulation were in effect nationwide in the US, and measure the impact on intakes of whole grains, added sugars, sodium, and calories. We find small effects for the GSP and somewhat larger ones for a 10% price intervention. [Contact: Chung-Tung Lin ]

Food label usage and reported difficulty with following a gluten-free diet among individuals in the USA with coeliac disease and those with noncoeliac gluten sensitivity. 2013. Linda Verrill, Yuanting Zhang, and Rhonda Kane. Journal of Human Nutrition and Dietetics 26:479-487.

Individuals with coeliac disease (CD) and those with noncoeliac gluten sensitivity (GS) have reported difficulty following a gluten-free diet (GFD); however, few studies have explored the link between the food label, gluten-free (GF) claims and the difficulty associated with following a GFD. The present study surveyed adults with CD (n = 1,583) and adults with GS (n = 797) about their reported difficulty following a GFD, including assessing the role of food labels and GF claims, as well as other factors known to contribute to this difficulty. A two-sample t-test and chi squared tests for equality of means or proportions were used for the descriptive data and ordinal logistic regression (OLR) was used to model associations. On average, individuals with GS reported slightly more difficulty following the GFD than did participants with CD. According to the OLR results, reading the food label often was significantly associated with less reported difficulty following a GFD, whereas consuming packaged processed foods and looking for GF claims more often were significantly associated with more reported difficulty for both respondent groups. Individuals with GS may rely more heavily on the GF claim for information about a product’s gluten content. Individuals with CD, on the other hand, may be more experienced food label readers and may rely more on the ingredient list for finding GF foods. More studies are needed aiming to understand the role of the food label in facilitating consumers’ ability to follow a GFD. [Contact: Linda Verrill ]

Single-Larger-Portion-Size and Dual-Column Nutrition Labeling May Help Consumers Make More Healthful Choices. 2013. Amy Lando and Serena Lo. Journal of the Academy of Nutrition and Dietetics 113(2):241-250.

BACKGROUND: The Food and Drug Administration is considering changes to the Nutrition Facts label to help consumers make more healthful choices. OBJECTIVE:  To examine the effects of modifications to the Nutrition Facts label on foods that can be listed as having 1 or 2 servings per container, but are reasonably consumed at a single eating occasion. DESIGN: Participants were randomly assigned to study conditions that varied on label format, product, and nutrition profile. Data were collected via an online consumer panel. PARTICIPANTS/SETTING: Adults aged 18 years and older were recruited from Synovate's online household panel. Data were collected during August 2011. A total of 32,897 invitations were sent for a final sample of 9,493 interviews. INTERVENTION: Participants were randomly assigned to one of 10 label formats classified into three groups: listing 2 servings per container with a single column, listing 2 servings per container with a dual column, and listing a single serving per container. Within these groups there were versions that enlarged the font size for "calories," removed "calories from fat," and changed the wording for serving size declaration. MAIN OUTCOME MEASURES: The single product task measured product healthfulness, the amount of calories and various nutrients per serving and per container, and label perceptions. The product comparison task measured ability to identify the healthier product and the product with fewer calories per container and per serving. STATISTICAL ANALYSES PERFORMED: Analysis of covariance models with Tukey-Kramer tests were used. Covariates included general label use, age, sex, level of education, and race/ethnicity. RESULTS: Single-serving and dual-column formats performed better and scored higher on most outcome measures. CONCLUSIONS: For products that contain 2 servings but are customarily consumed at a single eating occasion, using a single-serving or dual-column labeling approach may help consumers make healthier food choices. [Contact: Amy Lando ]

Effects of the Guiding Stars Program on Purchases of Ready-To-Eat Cereals With Different Nutritional Attributes. 2013. Ilya Rahkovsky, Biing-Hwan Lin, Chung-Tung J. Lin, and Jonq-Ying Lee. Food Policy 43:100-107.

Over the past decade, the food industry has increased its use of front-of-package and shelf-tag nutrition labeling designed to present key nutritional aspects and characteristics of food products. One such system is the Guiding Stars Program™ (GSP), which uses an algorithm to score the nutritional values of food products from one to three stars, where more stars mean more nutritious. We studied how the introduction of the GSP in one supermarket chain affected the demand for ready-to-eat cereals. We estimated the demand for cereals and measured the effect using a treatment–control approach. We found that the GSP significantly increased the demand for cereals that GSP considers more nutritious at the expense of cereals that GSP considers less nutritious. [Contact: Chung-Tung Lin ]

Associations Between Self-Reported Weight Management Methods With Diet Quality as Measured by the Health Eating Index-2005. 2013. Chung-Tung J. Lin, Zhifeng Gao, and Jonq-Ying Lee. Preventive Medicine 57(3):238-243.

OBJECTIVE: We examine the relationship between weight management practices and diet quality. METHOD: Regressions were used to analyze the associations between self-reported weight management methods and diet quality, as measured by the Healthy Eating Index-2005 (HEI-2005), of 1,933 respondents who tried to lose or not gain weight in the 2003-2004 National Health and Nutrition Examination Survey (NHANES). The regressions controlled for sociodemographics, lifestyle behaviors, and other health-related behaviors and perceptions. RESULTS: Including both switching to foods with lower calories and exercise in weight management was associated with better diet quality, i.e., a higher total HEI-2005 score and higher scores in eight of the twelve HEI-2005 components than including neither method. The eight components included six components on fruit, vegetables and grains, milk, and calories from solid fat, alcohol beverages, and added sugars. Similar but smaller associations were also found among those who reported including either switching to foods with lower calories or exercise. CONCLUSIONS: Based on self-reported data, the findings suggest that including switching to lower calorie foods and exercise in weight management, as recommended by the Dietary Guidelines for Americans (DGA), is associated with diet quality that is more consistent with the key diet-related advice of the DGA. [Contact: Chung-Tung Lin ]

Sex-Based Differences in Food Consumption: Foodborne Disease Active Surveillance Network (FoodNet) Population Survey, 2006-2007. 2012. Beletshachew Shiferaw, Linda Verrill, Hillary Booth, Shelley Zansky, Dawn Norton, Stacy Crim, Olga Henao. Clinical Infectious Diseases 54:S453-S457.

This analysis used data from the most recent Foodborne Diseases Active Surveillance Network (FoodNet) Population Survey (May 2006 through April 2007) to examine differences in the consumption of various types of foods between men and women. Participants were surveyed by telephone and asked whether or not they had consumed certain foods in the past 7 days, including the following ‘‘high-risk’’ foods commonly associated with foodborne illness: pink hamburger, raw oysters, unpasteurized milk, cheese made from unpasteurized milk, runny eggs, and alfalfa sprouts. Data were weighted to adjust for survey design and to reflect the age and sex distribution of the population under FoodNet surveillance. A total of 14 878 persons $18 years were interviewed, of whom 5688 (38%) were men. A higher proportion of men reported eating meat and certain types of poultry than women, whereas a higher proportion of women ate fruits and vegetables. A higher proportion of men than women reported consuming runny eggs (12% versus 8%), pink hamburger (7% versus 4%), and raw oysters (2% versus 0.4%). A higher proportion of women than men ate alfalfa sprouts (3% versus 2%). No differences by sex were observed for consumption of unpasteurized milk or cheese. Data from the FoodNet Population Surveys can be useful in efforts to design targeted interventions regarding consumption of high-risk foods. Moreover, understanding the background rates of food consumption, stratified by sex, may help investigators identify the kinds of foods likely to be associated with outbreaks in which a preponderance of cases occur among members of one sex. [Contact: Linda Verrill ]

Changes in fat content of US snack foods in response to mandatory trans fat labelling. 2012. Debra Van Camp, Neal H. Hooker, and Chung-Tung J. Lin. Public Health Nutrition 15(6):1130-1137.

OBJECTIVE: Impact of mandatory trans fat labelling on US snack food introductions is examined. DESIGN: Using label information, lipid ingredients and fat profiles are compared pre- and post-labelling. SETTING: Key products in the US snack food industry contribute significant amounts of artificial trans fat. Industry efforts to reformulate products to lower trans fat may alter the overall fat profile, in particular saturates. SUBJECTS: Composition data for more than 5000 chip and cookie products introduced for sale between 2001 (pre-labelling) and 2009 (post-labelling) were analyzed. RESULTS: One-way ANOVA was used to test for significant changes in saturated fat content per serving and the ratio of saturated to total fat. The shares of chip and cookie introductions containing partially hydrogenated vegetable oil declined by 45 and 42 percentage points, respectively. In cookies, there was an increase of 0·49 (98 % CI 0·01, 0·98) g in the average saturated fat content per 30 g serving and an increase of 9 (98 % CI 3, 15) % in the average ratio of saturated to total fat. No statistically significant changes in fat content were observed in chips. CONCLUSIONS: This research suggests that, holding other factors constant, the policy has resulted in a decreased use of partially hydrogenated vegetable oil in chip products without a corresponding increase in saturated fat content, but led to significantly higher levels of saturated fat and ratio of saturated fat to total fat in cookie products. [Contact: Chung-Tung Lin ]

Knowledge of Dietary Fats among US Consumers. 2010. Chung-Tung J. Lin and Steven T. Yen. Journal of the American Dietetic Association 110(4):613-618.

Dietary advice emphasizes that some dietary fats increase the risk of heart disease, whereas other dietary fats decrease risk if they are substituted for more risk-increasing fats. Thus, it is important that consumers understand the differences between dietary fats. Existing evidence in the United States suggests troublesome consumer misunderstanding. As part of its continuing effort to promote public health, the US Food and Drug Administration measured consumer awareness and understanding of dietary fats in its Health and Diet Survey- 2004 Supplement. After cognitive interviews and pretests of the questionnaire, telephone interviews of randomly selected noninstitutionalized adults aged 18 years and older in the United States were conducted between October 12, 2004, and January 21, 2005. Using cross-sectional data collected from 1,798 respondents who completed the survey, this study estimated the prevalence of awareness and understanding of six dietary fats among US adults and identified the characteristics of adults with different levels of awareness and understanding. Descriptive analyses were used, along with logistic regression models, developed to accommodate the survey design and responses. There was a wide disparity among US consumers in their awareness and understanding. Saturated fat was most recognized and understood, whereas awareness of other fats was much lower. Most importantly, having heard of a fat did not necessarily mean understanding its relationship to heart disease. Only half of those who had heard of trans fat and n-3 fatty acids understood that the fats raise and lower the risk of heart disease, respectively. Only a minority of those who had heard of partially hydrogenated oil and polyunsaturated fat knew the fats raise and lower the risk of heart disease, respectively. Many admitted being uncertain about how a fat relates to the risk of heart disease. College or more-educated adults had better awareness and understanding. Nonwhite adults were less knowledgeable. Findings on the awareness and understanding and how they are related to individual characteristics can inform deliberations about educational messages, nutrition programs, and food labeling about dietary fats to promote public health. [Contact: Chung-Tung Lin ]

Effect of Low-carbohydrate Claims on Consumer Perceptions about Food Products' Healthfulness and Helpfulness for Weight Management. 2010. Judith Labiner-Wolfe, Chung-Tung Jordan Lin, and Linda Verrill. Journal of Nutrition Education and Behavior 42(5):315-320.

OBJECTIVE: Evaluate effect of low-carbohydrate claims on consumer perceptions about food products' healthfulness and helpfulness for weight management. DESIGN: Experiment in which participants were randomly assigned 1 of 12 front-of-package claim conditions on bread or a frozen dinner. Seven of the 12 conditions also included Nutrition Facts (NF) information. SETTING: Internet. PARTICIPANTS: 4,320 members of a national on-line consumer panel. INTERVENTION: Exposure to images of a food package. MAIN OUTCOME MEASURES: Ratings on Likert scales about perceived healthfulness, helpfulness for weight management, and caloric content. ANALYSIS: Mean ratings by outcome measure, condition, and product were calculated. Ratings were also used as the dependent measure in analysis of variance models. RESULTS: Participants who saw front-of-package-only conditions rated products bearing low-carbohydrate claims as more helpful for weight management and lower in calories than the same products without a claim. Those who saw the bread with low-carbohydrate claims also rated it as more healthful than those who saw no claim. When the NF label was available and products had the same nutrition profile, participants rated products with low-carbohydrate claims the same as those with no claim. CONCLUSIONS AND IMPLICATIONS: Consumers who do not use the NF panel may interpret low-carbohydrate claims to have meaning beyond the scope of the claim itself. [Contact: Chung-Tung Lin ]

Are Food Allergen Advisory Statements Really Warnings? Variation in Consumer Preferences and Consumption Decisions. 2009. Linda A. Verrill and Conrad J. Choiniere. Journal of Food Products Marketing 15:139-151.

The authors surveyed consumers for preferences on allergen advisory statements on food labels (N = 1,243). They also conducted an experiment to assess how consumers use advisory statements (N = 4,049) to make food consumption decisions. Results show that food allergic individuals, including caregivers to food allergic individuals, and a control group of nonallergic people preferred “Allergen Information: May Contain . . .” over three other statements tested. The experiment revealed measurable differences among the statements in how they are used to make food consumption decisions. Statements rated as more believable and more helpful also received higher ratings on a “likelihood of eating/ serving” measure. [Contact: Linda Verrill ]

Helping Consumers Make More Healthful Food Choices: Consumer Views on Modifying Food Labels and Providing Point-of-purchase Nutrition Information at Quick-service Restaurants. 2007. Amy M. Lando and Judith Labiner-Wolfe. Journal of Nutrition Education & Behavior 39(3):157-163.

OBJECTIVES: To understand consumer (1) interest in nutrition information on food labels and quick-service restaurant menu boards and (2) reactions to modifying this information to help highlight calories and more healthful choices. DESIGN: Eight consumer focus groups, using a guide and stimuli. SETTING: Focus group discussions in 4 US cities. PARTICIPANTS: A total of 68 consumers, with 7 to 10 per focus group. ANALYSIS: Authors prepared detailed summaries of discussions based on observation. Video recordings and transcripts were used to cross-check summaries. Data were systematically reviewed, synthesized, and analyzed. PHENOMENON OF INTEREST: Consumer views on alternative presentations of nutrition information on packaged food items and quick-service restaurant menu boards. RESULTS: Participants (1) were interested in having nutrition information available, but would not use it at every eating occasion; (2) thought that food products typically consumed at 1 eating occasion should be labeled as a single serving; and (3) indicated that an icon on labels and menu boards that signaled more healthful options could be helpful. CONCLUSIONS AND IMPLICATIONS: Findings provide a basis for the development of more systematic studies to better understand whether alternative presentations of nutrition information would help consumers. [Contact: Amy Lando ]

Who Uses Food Label Information: A Case Study of Dietary Fat. 2004. Chung-Tung Jordan Lin and Jonq-Ying Lee. Journal of Food Products Marketing 10(4):17-37.

Consumer psychology suggests that fat intake and search for fat information on food labels may be mutually dependent. This study extends previous research by using a simultaneous-equation model to measure the relationship between fat intake and label use. Using the 1994-6 USDA CSII and DHKS data, our results suggest individuals who consume a higher percentage of calories from fat are less likely to report searching for fat information on food labels. We also identified the roles played by several psychological variables on information search and fat intake. These findings have important implications on nutrition education and effectiveness of food labels. [Contact: Chung-Tung Lin ]

Do Dietary Intakes Affect Search for Nutrient Information on Food Labels? 2004. Chung-Tung Jordan Lin, Jonq-Ying Lee, and Steven T. Yen. Social Science and Medicine 59(9):1955-1967.

Nutrition labels on food packages are designed to promote and protect public health by providing nutrition information so that consumers can make informed dietary choices. High levels of total fat, saturated fat and cholesterol in diets are linked to increased blood cholesterol levels and a greater risk of heart disease. Therefore, an understanding of consumer use of total fat, saturated fat, and cholesterol information on food labels has important implications for public health and nutrition education. This study explores the association between dietary intakes of these three nutrients and psychological or demographic factors and the search for total fat, saturated fat, and cholesterol information on food labels. Psychology literature suggests a negative association between intakes of these nutrients and probability of search for their information on food labels. Health behavior theories also suggest perceived benefits and costs of using labels and perceived capability of using labels are associated with the search behavior. We estimate the relationship between label information search and its predictors using logistic regressions. Our samples came from the 1994-1996 Continuing Survey of Food Intakes by Individuals and Diet and Health Knowledge Survey conducted by the United States Department of Agriculture. Results suggest that search for total fat, saturated fat, and cholesterol information on food labels is less likely among individuals who consume more of the three nutrients, respectively. The search is also related to perceived benefits and costs of using the label, perceived capability of using the label, knowledge of nutrition and fats, perceived efficacy of diets in reducing the risk of illnesses, perceived importance of nutrition in food shopping, perceived importance of a healthy diet, and awareness of linkage between excessive consumption of the nutrients and health problems. These findings suggest encouraging search of food label information among consumers with unhealthy dietary habits would need innovative approaches. Yet, nutrition education can be instrumental in encouraging this search by stimulating motivation and providing technical help. [Contact: Chung-Tung Lin ]

Measuring the Welfare Effects of Nutrition Information. 2001. Mario F. Teisl, Nancy E. Bockstael, and Alan S. Levy. American Journal of Agricultural Economics 83(1):133-149.

Cost/benefit analysis justifies regulations altering the amount of health-related information presented to consumers. The current method of benefit analysis, the cost of avoided illness, is limited; it assumes the benefits of health-related information are adequately represented by changes in illnesses. The manuscript develops a benefit estimation method to measure the welfare impacts of providing nutrient information. Nutrient labeling significantly affects purchase behavior but may not lead to increased consumption of healthy foods. Nutrient labeling may increase welfare without any change in health risk. Thus, the cost of avoided illness approach can underestimate the social benefits of providing nutrient information. [Contact: Sherry Liu ]

Food Sources of Added Sweeteners in the Diets of Americans. 2000. Joanne F. Guthrie, and Joan F. Morton. Journal of the American Dietetic Association 100(1):43-51.

OBJECTIVE: To identify food sources of added sweeteners in the US diet. DESIGN: A descriptive study using data from the US Department of Agriculture (USDA) 1994-1996 Continuing Survey of Food Intakes by Individuals. Each subject provided one 24-hour dietary recall. Intake of added sweeteners was calculated using the USDA Food Guide Pyramid servings database. SUBJECTS/SETTING: A national sample of noninstitutionalized persons aged 2 years and older (N = 15,010). STATISTICAL ANALYSES: Mean intakes of added sweeteners from all food sources and from specific food categories; percentage contribution of added sweeteners to total energy intake; and percentage contribution of each food category to total intake of added sweeteners. All analyses were conducted for the total sample and for 12 age-gender groups. RESULTS: During 1994 to 1996, Americans aged 2 years and older consumed the equivalent of 82 g carbohydrate per day from added sweeteners, which accounted for 16% of total energy intake. In absolute terms, adolescent males consumed the most; as a percentage of energy, male and female adolescents had the highest intakes (averaging 20% of total energy from added sweeteners). The largest source of added sweeteners was regular soft drinks, which accounted for one third of intake. Other sources were table sugars, syrups, and sweets; sweetened grains; regular fruitades/drinks; and milk products. APPLICATIONS/CONCLUSIONS: Intakes of added sweeteners exceed levels compatible with meeting current dietary recommendations. Knowing food sources of added sweeteners for the overall population and for specific age-gender groups can help dietitians provide appropriate nutrition education. [Contact: Sherry Liu ]

The Effects of Education and Information Source on Consumer Awareness of Diet-Disease Relationships. 1999. Mario F. Teisl, Alan S. Levy, and Brenda M. Derby. Journal of Public Policy and Marketing 18(2):197-207.

Information about diet--disease relationships provided by the news media is associated with increases in consumer awareness of these relationships. However, consumer awareness levels have declined during time periods when nutrient information increasingly was provided in food advertising. People with higher (lower) education levels were more (less) aware of diet--disease relationships. In general, the authors do not find strong evidence that media- or firm-provided information decreases the difference in awareness between more and less educated persons. [Contact: Sherry Liu ]

The Impact of Health Claims on Consumer Search and Product Evaluation Outcomes: Results from FDA Experimental Data. 1999. Brian E. Roe, Alan S. Levy, and Brenda M. Derby. Journal of Public Policy and Marketing 18(1):89-105.

The authors report results of a mall-intercept study regarding the effects of health claims on consumer information search and processing behavior. Results suggest that the presence of health and nutrient-content claims on food packages induces respondents to truncate information search to the front panel of packages. Respondents who either truncate information search or view claims provide more positive summary judgments of products and give greater weight to the information mentioned in claims than to the information available in the Nutrition Facts panel. The presence of a claim also is associated with a halo effect (rating the product higher on other health attributes not mentioned in the claim) and, for one of the three products tested, a magic-bullet effect (attributing inappropriate health benefits to the product). The authors discuss the policy implications of these results for Food and Drug Administration health claim regulations. [Contact: Sherry Liu ]

Consumers' Ability to Perform Tasks Using Nutrition Labels. 1998. Alan S. Levy, and Sara B. Fein. Journal of Nutrition Education 30(4):210-217.

Consumers' ability to perform common nutritional label use task components, which revealed the effect of prior knowledge, were analyzed for relationships with demographic characteristics, label reading, and health status. Data were from a mall intercept experimental study. Most consumers (78%) accurately compared two products, 58% accurately evaluated nutrient level claims, 45% comprehensively balanced nutrients over a daily diet, and 20% accurately calculated the contribution of a single food to a daily diet, a task that required complex math. The subjects who performed significantly poorer were over 55 years of age, nonwhite, and less educated than those who performed best. Not reading food labels and having a diet-related health condition were also related to poorer performance. Task component analysis showed that all types of subjects shared the same response tendencies when making nutrition judgments. The findings suggest that dietary guidance for consumers will be more effective if it does not require quantitative tasks but relies instead on tasks that are easier for consumers. [Contact: Sherry Liu ]

The Economics of Labeling: An Overview of Issues for Health and Environmental Disclosure. 1998. Mario F. Teisl, and Brian Roe. Agricultural and Resource Economics Review 27(2):140-50.

During the last two decades, product labeling has become an increasingly used policy tool, particularly with respect to the provision of health and environmental information. Theory holds that the flow of information among market participants plays a critical role in the efficient operation of markets. This paper explores the role of product labeling policy in ameliorating two potential market deficiencies: asymmetric information and costly search behavior. Practical considerations for the design and implementation of labeling policy and of labeling research are explored. [Contact: Sherry Liu ]

Changes in Consumers' Knowledge of Food Guide Recommendations, 1990-91 Versus 1994-95. 1998. Joanne F. Guthrie, and Brenda M. Derby. Family Economics and Nutrition Review 11(4):42-48.

This study assessed the awareness of people in the United States about the specific food group recommendations of the Food Guide Pyramid between 1990-1991 and 1994-1995. [Contact: Sherry Liu ]

Changes in Children's Total Fat Intakes and Their Food Group Sources of Fat, 1989-91 Versus 1994-95: Implications for Diet Quality. 1998. Joan F. Morton and Joanne F. Guthrie. Family Economics and Nutrition Review 11(3):44-57.

The 1995 Dietary Guidelines for Americans recommends that children 2 through 5 years old should gradually adopt a diet that contains no more than 30 percent of calories from fat and continue this diet throughout life. This study compares total fat intakes of children 2 to 17 years old in 1989-91 to intakes in 1994-95 to determine if improvement took place. The U.S. Department of Agriculture's 1989-91 and 1994-95 Continuing Survey of Food Intakes by Individuals was used. Overall nutrient intake and food group consumption patterns were also compared. Although grams of fat consumed increased over the periods, percentage of calories from fat declined due to increased caloric intake, particularly from carbohydrates. Children consumed less dairy products overall but more low-fat milks. Grain consumption rose, but the grain products consumed were not any lower in fat over the years studied. Beverage consumption, particularly soft drinks, rose, especially for adolescent males and contributed importantly to an increase in carbohydrate consumption. When assessing progress in meeting fat recommendations, professionals need to consider overall diet quality. [Contact: Sherry Liu ]

A Proposed Model of the Use of Package Claims and Nutrition Labels. 1997. Lisa R. Szykman, P.N. Bloom, and Alan S. Levy. Journal of Public Policy and Marketing 16(2):228-241.

The authors propose a conceptual model of the use of nutrition labels and on-package claims. Knowledge, perceived diet effectiveness, health status, and skepticism toward claims are all hypothesized to be significant in explaining the use of package claims and nutrition labels. Results from a preliminary investigation of the relationships among these constructs show that a person’s perception of how effective diet is in the fight against disease is related positively to the use of nutrition panel information and package claims. In addition, diet-disease knowledge is related positively to the use of package nutrition information in the forms of both package claims and panel information. Finally, being at risk for a diet-related disease is related positively to knowledge about the dietary links to the disease. The authors discuss policy implications of these findings. [Contact: Sherry Liu ]

Does Nutrition Labeling Lead to Healthier Eating? 1997. Mario F. Teisl and Alan S. Levy. Journal of Food Distribution Research 3(28):19-26.

Nutrient labeling is found to significantly affect consumer purchase behavior; some evidence that consumers may act as if they hold nutrient (or health risk) budgets is found. Providing nutrient information may allow consumers to more easily switch consumption away from 'unhealthy' products in those food categories where differences in other quality characteristics (e.g., taste) are relatively small between the more and less 'healthy' products, toward 'unhealthy' products in categories where differences may be relatively large (i.e., a 'substitution effect'). If this substitution effect is large, nutrient labeling may not change the overall consumption of 'unhealthy' nutrients and thus may not lead to significant changes in health risk. [Contact: Sherry Liu ]

Performance Characteristics of Seven Nutrition Label Formats. 1996. Alan S. Levy, Sara B. Fein, and Raymond E. Schucker. Journal of Public Policy and Marketing 15(1):1-15.

The authors evaluate seven nutrition label formats to determine consumer comprehension and acceptance of displayed information. They test comprehension of five tasks: comparing two products, judging healthfulness, verifying claims, estimating servings needed to meet the daily requirements for a nutrient, and balancing nutrients in a daily diet. Performance scores were higher on some tasks--particularly dietary management ones--for formats that displayed nutrient amounts in percentages than for those that displayed nutrient amounts in metric units, even when interpretational aids were included on the metric formats. The two most preferred formats were metric formats with an interpretational aid. The findings have an important impact on decisions about the final nutrition label format required by the Food and Drug Administration. [Contact: Sherry Liu ]

Women Dieters of Normal Weight: Their Motives, Goals, and Risks. 1995. Lois Biener and Alan W. Heaton. American Journal of Public Health 85(5):714-717.

Using data from a national survey of weight loss practices, this study examined those dieters who were of normal weight. Forty-seven percent of White women, 25% of Black women, and 16% of men currently trying to lose weight had a body mass index under 25. Women's primary motive was health improvement. Among normal-weight female dieters, 12% of Whites and 27% of Blacks were using risky strategies. Dieters were less likely than nondieters to smoke and reported better nutritional practices; however, they were not more likely to exercise, and their maximum weight fluctuation was 50% greater. Additional research on the consequences of dieting among normal-weight individuals is of high priority. [Contact: Sherry Liu ]

Information Sources of U.S. Adults Trying to Lose Weight. 1995. Alan S. Levy, and Alan W. Heaton. Journal of Nutrition Education 27(4):182-190.

This study attempted to determine whether dieters differ from nondieters in how and where they obtain nutrition and health information and whether choice of weight-loss practices is related to use of different information sources. A national telephone survey of a probability sample of 1649 adults provided detailed information on the weight-loss practices of 1431 dieters and comparable background information on 218 nondieters. Dieters were more active readers of nutrition information than were nondieters. However, their choices about type of regimen and about specific products and services were more heavily dependent on word of mouth, commercial sources, and physicians than on written information. Dieters relying on written materials were more likely to engage in healthy weight-loss regimens and less likely to engage in questionable weight-loss practices than were those relying on other sources. The pattern of information-seeking behavior observed for dieters, which indicated greater motivation to seek out written information but reliance on oral sources to inform them of specific weight-loss practices, suggests that if authoritative written information about specific weight-loss practices was available, it would be used and would likely be effective. [Contact: Sherry Liu ]

Nutrition Knowledge Levels About Dietary Fats and Cholesterol:1983-1988. 1993. Alan S. Levy, Sara B. Fein and Marilyn Stephenson. Journal of Nutrition Education 25(2):60-66.

Consumer knowledge of dietary fats and cholesterol was analyzed for trends over time and for relationships with demographic characteristics and health and dieting behaviors. The data were obtained from three approximately biennial Health and Diet Surveys conducted by the Food and Drug Administration and the National Heart, Lung and Blood Institute between 1983 and 1988. Statistical methods included regression analysis and factor analysis. The results indicate that consumer knowledge about dietary fats and cholesterol is poor. Respondents with greater knowledge in 1988 were those who were more educated, middle-aged, or white, and those who were on a cholesterol-lowering diet. The regression analysis of 1988 scores indicated that education was the most important predictor of knowledge scores. Being on a self-prescribed cholesterol-lowering diet was related to higher knowledge, but being on a physician-recommended diet was related to higher knowledge scores only for younger respondents. None of the health behaviors, except engaging in regular exercise, was associated with higher knowledge levels. [Contact: Sherry Liu ]

More Effective Nutrition Label Formats Are Not Necessarily Preferred. 1992. Alan S. Levy, Sara B. Fein and Raymond E. Schucker. Journal of the American Dietetic Association 92(10):1230-1234.

An experimental design was used to compare performance and preference for five nutrition label formats. Four performance measures--accuracy and false-positives in identifying nutrient differences, time required, and correctness in judging which product was more nutritious-- were derived from a product-comparison task. A sample of 1,460 food shoppers over 18 years old was recruited by a shopping mall-intercept method. Results of the study demonstrated that preferences and performance do not necessarily agree. The Control format, which had no nutrition profile information, performed the best but was liked the least. The Adjectival format, which provided nutrition profile information in the form of descriptive adjectives, was the most preferred. Results also showed that listing Daily Reference Values or nutrition profile aids increased preference but either did not affect performance or decreased it, depending on the specific aid and performance measure. Formats that some subjects liked for having adequate information others disliked for being hard to use. Formats that some subjects liked for being easy to use others disliked for having inadequate information. Age, education, and race were related to all of the performance measures except judgment of relative nutrition. Only gender was related to preference. Results of the study are useful as guidance for the development of consumer education materials. [Contact: Sherry Liu ]

Focus Group Sessions on Formats on Nutrition Labels. 1992. Christine J. Lewis, Elizabeth A. Yetley. Journal of the American Dietetic Association 92(1):62-66.

Four consumer focus group sessions, with a total of 40 participants, were conducted to gather information on the utility and appropriateness of selected components of nutrition label formats.. The formats reviewed were bar graphs, pie charts, numeric listings, and adjectival descriptors such as high and low. Participants were asked to compare food labels using various format types and to discuss the utility and interpretability of the formats. The outcomes suggested that these consumers did not find pie charts useful. They considered bar graphs confusing or unnecessary when numeric values were provided. Participants expressed concern that adjectival descriptors could be misleading. The numeric listing format they considered the most useful consisted of two columns of numbers: one listing the amounts of food components present in a serving of the food, and a second listing either the percentage of the label reference value (e.g., the US Recommended Daily Allowance) or the quantity established as the label reference value. Participants repeatedly stressed their interest in a simple label. The results form one component of the Food and Drug Administration's efforts to evaluate nutrition label formats and will be used in conjunction with ongoing experimental and quantitative research studies. [Contact: Sherry Liu ]

Trends in Prevalence and Magnitude of Vitamin and Mineral Supplement Usage and Correlation with Health Status. 1992. Mary M. Bender, Alan S. Levy, Raymond E. Schucker, and E.A. Yetley. Journal of the American Dietetic Association 92(9):1096-1101. ]

The 1980 Food and Drug Administration Vitamin and Mineral Supplement Use Survey and the 1986 National Health Interview Survey used similar questions and procedures to estimate and identify trends in the prevalence and magnitude of supplement usage in the United States. A comparison of the two surveys reveals that prevalence of supplement use among adults decreased slightly, from 42% in 1980 to 38% in 1986. The magnitude of supplement use has also decreased; users reported taking a mean of 2.15 supplements in 1980 compared with a mean of 1.77 in 1986. The prevalence of supplement users identified as light users increased from 42% in 1980 to 57% in 1986. Supplement usage was more likely and more intense among individuals who had one or more health problems and among individuals who perceived their health as very good or excellent. The findings indicate that supplement usage remains a widespread behavior linked to popular conceptions of good health and well-being but one that is susceptible to change. [Contact: Sherry Liu ]

Prevalence of Reading Nutrition and Ingredient Information on Food Labels Among Adult Americans: 1982-1988. 1992. Mary Bender and Brenda M. Derby. Journal of Nutrition Education 24(6):292-297. ]

Comparisons of five Food and Drug Administration Health and Diet Surveys conducted in the 1980s provide estimates of the numbers of consumers who report that they pay attention to ingredient lists and nutrition labels and identify trends based on replicated measures. Recent estimates indicate that more than four out of five U.S. consumers report that they pay attention to one or both types of label information, with just under three-fourths reporting use of each individual information source. There was no net increase in consumer use of the food label ingredient list from 1982 to 1986, but use of the nutrition label increased significantly. Consumers who use both types of labels are more likely to be young (25–34), white, female, better educated, and to follow a self-initiated or doctor-prescribed low-sodium or low-cholesterol diet. Educators now face a challenge—to address remaining knowledge gaps, particularly among population groups who are less likely to use labels, and to develop practical strategies to help all consumers make more effective use of food label information in dietary management. [Contact: Sherry Liu ]

Nutrition Shelf-Labeling and Consumer Purchase Behavior. 1992. Raymond E. Schucker, Alan S. Levy, Janet Tenney and Odonna Mathews. Journal of Nutrition Education 24(2):75-81. ]

A nutrition information program, consisting of brand-specific nutrition shelf-tags and a supplementary explanatory booklet, was tested for two years in Baltimore stores of the Giant Food chain, replicating a previous successful trial of the program in Washington, DC. Over the two-year evaluation period, market shares of shelf-tagged products increased 12% on average in Baltimore stores in 8 of 16 product categories that had been included in the original program trial. The largest market share increases occurred for products with the most flagged nutrients. Products with fewer flagged nutrients actually lost market share, suggesting that shopper purchases tended to be influenced by the number of featured nutrients as well as by the nature of the nutrients themselves. Responses to a shopper survey as well as the sales data converged to indicate that shopper concerns about nutrition and health status of family members are more highly correlated with program use than are education, income, and age. [Contact: Sherry Liu ]

Weight Loss Attempts in Adults: Goals, Duration, and Rate of Weight Loss. 1992. David F. Williamson, M.K. Serdula, R.F. Anda, Alan S. Levy, and T. Byers. American Journal of Public Health 82(9):1251-1257. ]

OBJECTIVES: Although attempted weight loss is common, little is known about the goals and durations of weight loss attempts and the rates of achieved weight loss in the general population. METHODS. Data were collected by telephone in 1989 from adults aged 18 years and older in 39 states and the District of Columbia. Analyses were carried out separately for the 6758 men and 14,915 women who reported currently trying to lose weight. RESULTS. Approximately 25% of the men respondents and 40% of the women respondents reported that they were currently trying to lose weight. Among men, a higher percentage of Hispanics (31%) than of Whites (25%) or Blacks (23%) reported trying to lose weight. Among women, however, there were no ethnic differences in prevalence. The average man wanted to lose 30 pounds and to weigh 178 pounds; the average woman wanted to lose 31 pounds and to weigh 133 pounds. Black women wanted to lose an average of 8 pounds more than did White women, but Black women's goal weight was 10 pounds heavier. The average rate of achieved weight loss was 1.4 pounds per week for men and 1.1 pounds per week for women; these averages, however, may reflect only the experience of those most successful at losing weight. CONCLUSIONS. Attempted weight loss is a common behavior, regardless of age, gender, or ethnicity, and weight loss goals are substantial; however, obesity remains a major public health problem in the United States. [Contact: Sherry Liu ]

Change in Cholesterol Awareness and Action: Results from National Physician and Public Surveys. 1991. Raymond E. Schucker. Archives of Internal Medicine 151(4):666-673.

The National Heart, Lung, and Blood Institute, Bethesda, Md, sponsored national telephone surveys of practicing physicians and the adult public in 1983, 1986, and 1990 to assess attitudes and practices regarding high serum cholesterol levels. Each time, approximately 1600 physicians and 4000 adults were interviewed. Trends show continuing change in medical practice and public health behavior relating to serum cholesterol. In 1990, physicians reported treating serum cholesterol at considerably lower levels than in 1986 and 1983. The median range of serum cholesterol at which diet therapy was initiated was 5.17 to 5.66 mmol/L (200 to 219 mg/dL) in 1990, down from 6.21 to 6.70 mmol/L (240 to 259 mg/dL) in 1986 and 6.72 to 7.21 mmol/L (260 to 279 mg/dL) in 1983. The median ranges for initiating drug therapy were 6.21 to 6.70 mmol/L (240 to 259 mg/dL) in 1990, 7.76 to 8.25 mmol/L (300 to 319 mg/dL) in 1986, and 8.79 to 9.28 mmol/L (340 to 359 mg/dL) in 1983. The number of adults who reported having had their cholesterol level checked rose from 35% to 46% to 65% in 1983, 1986, and 1990, respectively. Between 1983 and 1990, the number of adults reporting a physician diagnosis of high serum cholesterol increased from 7% to 16%; the number reporting a prescribed cholesterol-lowering diet increased from 3% to 9%. Reports of self-initiated diet efforts reached a high of 19% in 1986 and decreased to 15% in 1990 compared with 1% in earlier years. In 1990, over 90% of physicians reported awareness and use of the recommendations from the Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, and the public reported marked increases in awareness of dietary methods to lower serum cholesterol. These changes suggest educational gains; the data also suggest areas for continued cholesterol educational initiatives. [Contact: Sherry Liu ]

Nutrition Labeling Formats: Performance and Preference. 1991. Alan S. Levy, Sara B. Fein, and Raymond E. Schucker. Food Technology 45(7):116-121.]

The Nutrition Labeling and Education Act of 1990 requires almost all food products to bear nutrition labeling. To obtain consumer input into any revisions in the nutrition labeling format, the Food and Drug Administration has conducted a consumer study of five possible formats. This article describes a consumer study conducted as one component of FDA's information-gathering activities on nutrition labeling formats. The study was a controlled experimental evaluation of five formats. The experimental design used enables researchers to compare format performance characteristics and expressed preferences for the formats in a realistic label-use situation. [Contact: Sherry Liu ]

Declared Serving Sizes of Packaged Foods, 1977-86. 1990. J.T. Heimbach, Alan S. Levy, and Raymond E. Schucker. Food Technology 44(6):82-90.

FDA surveys of nutrition-labeled foods indicate that food manufacturers have occasionally reduced the serving size to be able to make low-sodium and similar claims. To answer the question of whether declared serving sizes have been reduced, the study obtained a sample of nutrition-labeled food products from a large collection of packaged processed food products that have been collected by FDA in biennial surveys since 1977. The goal was to identify product classes and individual products for which the declared serving sizes either did not change over time or exhibited significant increases or decreases. [Contact: Sherry Liu ]

The Impact of a Nutrition Information Program on Food Purchases. 1985. Alan S. Levy, Odonna Mathews, Marilyn Stephenson, Janet E. Tenney, and Raymond E. Schucker. Journal of Public Policy and Marketing 4(1):1-13.

A quasi-experimental repeated measures design using a matched set of 20 test and comparison supermarkets in the Washington, D.C. and Baltimore, Md., metropolitan areas was used to evaluate a nutrition information program called "Special Diet Alert" (SDA) introduced by Giant Food, Inc. into Washington, D.C. stores in March 1981. The objective of the SDA program was to help supermarket shoppers find products for special diet needs by providing brand-specific (i.e., individual product level) shelf markers that identified products considered low or reduced in sodium, calories, cholesterol, and fat, supplemented by take-away information booklets available from a rack in the store which listed SDA brand names and specific nutrient values. Market shares of these products were tracked over the two-year evaluation period in Washington, D.C. and Baltimore stores. The pattern of differential sales trends across 16 individual food categories was complicated, but sales of shelf-marked products increased on the average 4 to 8 percent more over the two-year evaluation period in Washington, D.C. than in Baltimore, Md. stores. The average magnitude of effect attributable to SDA was modest in comparison with other factors influencing consumer purchases, highlighting the need for powerful evaluation designs to assess the effectiveness of information programs that operate in the context of many other more powerful influences. Further research is needed to determine which aspects of the SDA program were critical to its success, but one obvious difference between SDA and other in-store nutrition information programs that have been reported in the literature was the use of individual brand-specific shelf markers to deliver nutrition information to shoppers rather than prominently displayed sectional posters and detailed educational pamphlets. [Contact: Sherry Liu ]

Evaluating the Life Cycle of a Product Warning: Saccharin and Diet Soft Drinks. 1984. Robert G. Orwin, Raymond E. Schucker, and Raymond C. Stokes. Journal of Evaluation Review 8(6):801-822.

The effect of the saccharin warning label on sales of diet soft drinks was modeled with an autoregressive integrated moving average (ARIMA) process. Retail price trends and attendant publicity were modeled concurrently to separate these effects from those due to the warning. Results indicated that the label produced a small yet statistically significant reduction in sales, with an abrupt onset and, thus far, permanent duration. Reasons for the absence of decay effects, limitations of interpretability, and ideas for improving future evaluations of warning labels are discussed. [Contact: Sherry Liu ]

Nutrition Labeling and Public Health: Survey of American Institute of Nutrition Members, Food Industry, and Consumers. 1982. James T. Heimbach and Raymond C. Stokes. American Journal of Clinical Nutrition 36:700-708.

Five hundred thirty-one members of the American Institute of Nutrition, 177 persons from the food industry, and 107 consumers from a Food and Drug Administration mailing list responded to a survey dealing with nutrition labeling of foods. They identified obesity and heart disease as the major diet-related national health problems and chose information about calories, sodium, fat, protein, iron, calcium, and carbohydrates as most useful to the public. [Contact: Sherry Liu ]

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A Regional Commitment Is Underway For Food Security and a Sustainable Future

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Mario Lubetkin is FAO Assistant Director-General and FAO Regional Representative for Latin America and the Caribbean for Latin America and the Caribbean

Official photograph captured during the proceedings of the 8th Summit of the Community of Latin American and Caribbean States (CELAC) convened in Saint Vincent and the Grenadines. Credit: CELAC

Official photograph captured during the proceedings of the 8th Summit of the Community of Latin American and Caribbean States (CELAC) convened in Saint Vincent and the Grenadines. Credit: CELAC

SANTIAGO, Mar 5 2024 (IPS) - The regional commitment to fight hunger and malnutrition in Latin America and the Caribbean has made significant progress thanks to the update of the Food Security, Nutrition and Hunger Eradication Plan of the Community of Latin American and Caribbean States (CELAC) for the period 2024-2030, known as the CELAC FNS Plan.

This update was approved and ratified during the VIII Summit of Heads of State and Government of CELAC, held on March 1 in Saint Vincent and the Grenadines.

This commitment evidence Latin America and the Caribbean’s significant contribution to accelerating the fulfillment of the Sustainable Development Goals, aimed at achieving societies free of hunger, poverty, and inequality in the region.

Our latest estimates show that, in 2022, 6.5 percent of the population of Latin America and the Caribbean suffered from hunger; this represented 2.4 million fewer people than in 2021. But the situation remains critical; hunger continues to affect 43.2 million people in the region Our latest estimates show that, in 2022, 6.5 percent of the population of Latin America and the Caribbean suffered from hunger; this represented 2.4 million fewer people than in 2021. But the situation remains critical; hunger continues to affect 43.2 million people in the region.

Likewise, limited access to resources and services, poverty, the aftermath of the pandemic, and conflicts as well as climate-related disasters, among other factors, are affecting the ecosystems on which food production and the livelihoods of farming communities depend and threaten efforts to ensure food security, nutrition and the sustainability of agrifood systems.

In this scenario, the CELAC FNS Plan 2024-2030 is a concrete initiative, reflected in a unanimous response from more than thirty countries, which, at a ministerial level, agreed to update this document to address the challenge of hunger and food insecurity in the region.

The new plan -developed in coordination with the Pro-Tempore Presidency, currently led by Saint Vincent and the Grenadines and the thirty-three CELAC countries, included broad participation and analysis with technical assistance from FAO, ECLAC, IICA, and ALADI- has become a benchmark for other regions of the world. Its implementation represents a milestone example of the consensus and political commitment of Latin America and the Caribbean.

This plan, structured into four pillars, includes a conceptual basis to guide the countries concerning legal frameworks, sustainable production, access to healthy diets, and agrifood systems resilient to climate change.

2024 could represent a decisive year for Latin America and the Caribbean to make progress in combating hunger and malnutrition and achieving more resilient and sustainable production systems. During 2023, we have consolidated a deep process of alliances, consensus, and dialogue that will soon be part of the FAO Regional Conference.

We are in the final stretch of preparation for our Regional Conference to be held in March in Georgetown, Guyana, where we will facilitate exchanges and discussions that will be essential to guide FAO’s technical cooperation in the design and implementation of plans and projects tailored to the needs of the countries, and in line with the priorities defined by governments at the highest political level.

In this regard, the reflections and resolutions arising from the updating and subsequent approval of the new CELAC FNS Plan also represent a significant contribution to the FAO Regional Conference.

The preparation of the Regional Conference includes an extensive consultation process involving different stakeholders, such as the private sector, academia, civil society, and parliamentary groups; and of course, the participation of government officials from the thirty-three FAO Member Countries; as well as the presence of Heads of State and Ministers of Agriculture and other sectors committed to the search for more efficient, inclusive, resilient and sustainable agrifood systems.

We hope that the results of the Conference, translated into FAO’s mandate, will be consolidated as a tangible response. The success of these efforts will depend on the collaboration of all to make the hope of a world without hunger a reality.

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Seaweed farming using the off-bottom seaweed farming approach—tying algal fonds or seaweed seeds to ropes attached between wooden pegs driven into the ocean sediment. Credit: Joyce Chimbi/IPS

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National Nutrition Month

March, National Nutrition Month, invites everyone to learn about making informed food choices and developing nutritious eating habits. Consider implementing the following steps to prioritize your health:

  • Use MyPlate.gov to create healthy meals that cover all five food groups. MyPlate offers over 1,000 healthy, budget-friendly, and tasty recipes to help you develop an eating style that meets your individual needs and can improve your health.
  • Plan weekly meals ahead of time by writing out the ingredients you will need for each meal. This practice will help you incorporate all five food groups and can double as a grocery list for easy shopping.
  • Find out your calorie needs to manage your daily food and beverage choices. Your calorie needs vary based on your age, gender, and physical activity level. To find out your specific calorie needs, use the U.S. Food and Drug Administration’s (FDA) Estimated Daily Calorie Needs table .
  • Read the FDA’s Nutrition Facts label when grocery shopping to compare ingredients in different food items. Select items that have higher amounts of vitamins, minerals, and dietary fiber and lower amounts of sodium, saturated fat, and added sugars.
  • Explore other FDA resources to simplify good nutrition and makes suggestions to make informed choices.

Always consult your physician before starting any diet plan. If you have questions, contact [email protected] .

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    According to the United Nations Food Systems Summit that was held in 2021, many of the world's food systems are fragile and not fulfilling the right to adequate food for all. Hunger and malnutrition are on the rise again. According to FAO's "The State of Food Security and Nutrition in the World 2023", between 691 and 783 million people faced hunger in 2022.

  30. National Nutrition Month

    March, National Nutrition Month, invites everyone to learn about making informed food choices and developing nutritious eating habits. Consider implementing the following steps to prioritize your health: Use MyPlate.gov to create healthy meals that cover all five food groups. MyPlate offers over 1,000 healthy, budget-friendly, and tasty recipes ...