S522 Food Insecurity and Digestive Diseases: A Systematic Review
Bibliographic record
Abstract
Introduction: Food insecurity (FI), the lack of consistent access to enough food for an active and healthy life, is widely prevalent globally and in the United States, and the incidence of FI has increased due to the COVID-19 pandemic. Previous studies have demonstrated the negative impact FI has on health outcomes, but few studies have examined the relationship between FI and gastrointestinal (GI) diseases. Therefore, we performed a systematic review to explore the relationship between FI and GI disorders worldwide. Methods: The Embase (via Elsevier), Web of Science (via Clarivate), and PubMed/MEDLINE electronic databases were searched from inception through February 2021 for studies examining a relationship between FI and non-hepatic GI diseases. Additional studies were identified through bibliography review (Figure 1). Non-English studies and those without a comparison group were excluded. Studies not using a validated FI measure and those published before 1995, when the Household Food Security Survey Module was developed, also were excluded. The Newcastle-Ottawa Scale was used to assess study quality. Results: The search strategy yielded 1931 studies and 12 (0.6%), of which 8 were from the US, were included in the systematic review (Table). Overall, the studies showed an association between FI and GI diseases. There were no clinical trials or studies that assessed a causative role of FI on GI diseases, though one longitudinal study showed an association between the presence of FI and heartburn (OR 4.56; 95% CI 1.45-14.3) among pregnant women. Six studies (3 cross-sectional, 2 cohort, and 1 case-control) demonstrated a relationship between FI and GI cancers, though causation could not be determined. The presence of FI was associated with an increase in the risk of diarrheal illnesses in children and FI was associated with an increased risk (OR 1.69; 95% 1.15, 2.49) of inflammatory bowel disease (IBD) as well as increased medication non-adherence compared to those without IBD. Conclusion: Despite the increasing incidence of FI and recognition of its impact on disease outcomes, we identified few studies that have examined the relationship between FI and GI diseases. Our systematic review reveals that while significant associations between FI and GI diseases exist, the apparent literature gap provides an opportunity for future work to investigate this problem further.Figure 1.: Reasons reported by those with bloating in the past seven days for having never sought healthcare for their symptoms (n=7,215). OTC, over-the-counter. Note: Sum percentage exceeds 100%, as survey respondents can choose more than one reason.Table 1.: Title: Table. Reliability Statistics for Categorical Questions Evaluating Bloating and Distension Symptoms Footnotes: ***, near perfect agreement (k ≥ 0.81); **, substantial agreement (0.61 ≤ k < 0.81); *, moderate agreement (0.41 ≤ k < 0.61); k, Cohen's kappa coefficient; CI, confidence interval; Sx, symptom; d, days; hrs, hoursTable 1Table 1
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.029 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.007 |
| Bibliometrics | 0.013 | 0.014 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".