key: cord-0777407-46vbra6q
authors: Huizar, Martha I.; Arena, Ross; Laddu, Deepika R.
title: The global food syndemic: The impact of food insecurity, Malnutrition and obesity on the healthspan amid the COVID-19 pandemic
date: 2020-07-10
journal: Prog Cardiovasc Dis
DOI: 10.1016/j.pcad.2020.07.002
sha: 7950b0618187164dbd53120818bc44c2cb764beb
doc_id: 777407
cord_uid: 46vbra6q

nan

J o u r n a l P r e -p r o o f and other stakeholders to address social and structural determinants of healthy eating as a treatment strategy to improve the healthspan of individuals.

Food insecurity, malnutrition and obesity, independently, represent three of the most complex conditions threatening the livelihoods of populations in nearly every country, making them leading causes of poor health, globally. 7 Food insecurity, defined as a limitation in the accessibility and/or the lack of resources (e.g., income, transportation, skills, etc.) for safe and nutritious food to support normal growth, affects more than a quarter (26.4%) of the world's population. 8 While estimates are lower in the United States (US) (11.1%), 9 nearly one-third of US families reportedly struggle to meet basic needs during situations that disrupt normalcy in the food system, which is certainly the case with the COVID-19 pandemic. 10 These statistics are presumably underestimated among disadvantaged populations 11 who are challenged by numerous health disparities associated with education, income, environmental and behavioral factors, all of which influence health inequities and commonly results in a poor health trajectory. Perhaps the most damaging impact of the complex food insecurity phenomenon on individual health is the increased likelihood of malnutrition. Malnutrition is most often associated with undernutrition (i.e., wasting, stunting, underweight); however, it has increasingly been recognized as a physiological consequence of overnutrition with evidence suggesting its role in both the development and progression of diet-related NCDs (e.g., obesity, cardiovascular disease, diabetes, certain types of cancers) and premature mortality. Most recently, malnutrition has been associated with a higher risk for SARS-CoV-2 infection and, when contracted, more severe cases (e.g., hospitalization, mechanical ventilation). 6, [12] [13] In particular, malnutrition is suggested to contribute to obesity just as obesity may contribute to malnutrition, and both are driven by J o u r n a l P r e -p r o o f unhealthy dietary behaviors, especially in the presence of food insecurity. 7 Likewise, the accumulation of psychosocial, behavioral and environmental/societal factors (e.g., transportation, food deserts, low literacy skills, poverty, etc.) that lend to the development of food insecurity, may further propagate downstream shifts in both the food environment and personal dietary behaviors that contribute to the development and the progression of malnutrition and obesity.

These various conditions may increase risk to adverse health outcomes, thereby setting the stage for a global food syndemic (Figure 1) . Thus, it is conceptually believed that the foundation of the global food syndemic is one that is dependent on the initial onset of food insecurity, its subsequent interplay with malnutrition and obesity, and the complex sequela that increases vulnerabilities to modifiable adverse health outcomes. 7

The outbreak of the COVID-19 pandemic has been a proximate cause of a transcontinental food emergency, with impending threats to the food environment and nutrition, which is expected to be severe in the most vulnerable populations. 5 World-wide mitigation strategies to reduce and control infection rates, particularly, have had a massive impact on economic markets (i.e. production, processing, transportation; trade/export restrictions, etc.), leading to significant disruptions in food availability and accessibility -the two pillars of a stable food security system. 5, 8 In the US alone, the rise in food insecurity prevalence has paralleled a 98% increase in the demand and reliance on receiving food from local food banks, 14 Perhaps a silver lining to the COVID-19 pandemic is the potential benefits of global and local mitigation efforts observed on changes in diet behaviors. Since the onset of this pandemic, local food markets have observed an increased demand for nutrient-dense versus low nutrientdense (highly processed) foods. Likewise, the limited take-out food options due to widespread J o u r n a l P r e -p r o o f restaurant closures may lend to greater opportunities for individuals and families to purchase, prepare and consume healthy foods with higher nutrient-densities at home. 11,23 Public and private health organizations have also leveraged social media as a strategy to increase health-promoting behaviors including diet-focused messages, recipes and recommendations to eat healthfully with limited resources. 1, [24] [25] Whether this increase in consumer spending of nutritious foods reciprocates into long-term improved dietary behaviors will be told in due time.

Beyond dispute, reversing the components of the global food syndemic (i.e., food insecurity, malnutrition and obesity) presents an immensely complex challenge; the COVID-19 pandemic has magnified its complexity and highlighted the fragility of the global food structure.

A system where all people are able and willing to access not just food, but healthy food that promotes the healthspan currently does not exist. While a host of governmental 9,18,26 and nonprofit 20,27 relief approaches have been implemented before and during the COVID-19 pandemic to help alleviate food insecurity, these strategies have served as temporary -band-aids‖ to attenuate rather than prevent or reverse the components of the global food syndemic.

Nonetheless, continuity and preservation of humanitarian food assistance programs combined with tailored efforts to ensure access to diverse, balanced and nutritious food to the underserved populations are paramount to alleviate food insecurity and the cascading effects leading to negative health outcomes. 5 That being said, the COVID-19 pandemic has presented numerous eye-opening opportunities to shift the current paradigm of unhealthy eating behaviors and substandard food environments to one that promotes healthier dietary choices and behaviors. In time, the effects of food insecurity and eating behaviors on health and overall risk of NCDs after Journal Pre-proof J o u r n a l P r e -p r o o f global reopening post the COVID-19 pandemic will eventually be known. Regardless of the resulting effects of the COVID-19 pandemic on the global food structure, a stronger response of health professionals to provide aggressive nutritional support, combined with greater collaboration from key stakeholders and policy makers to improve local food environments is an essential prescription to improving the healthspan in an equitable manner, especially in populations most vulnerable to the global food syndemic.

J o u r n a l P r e -p r o o f 

COVID-19) advice for the public

Centers for Disease Control and Prevention

Leading Causes of Death

The White House

The Impact of COVID-19 on Food Security and Nutrition

The Global Nutrition Report's Independent Expert Group

COVID-19 pandemic: The evolving impact on how people meet the food system

Obesity Is a Risk Factor for Greater COVID-19 Severity

Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 -COVID-NET, 14 States

Feeding America Network Faces Soaring Demand, Plummeting Supply Due to COVID-19 Crisis

Most States Are Using New Flexibility in SNAP to Respond to COVID-19 Challenges | Center on Budget and Policy Priorities

USDA Makes it Easier to Feed Kids and Those Who Need Food During the COVID-19 National Emergency

Pediatricians Insist USDA Immediately and Fully Extend COVID-Related Waivers through

The Impact of the Coronavirus on Food Insecurity | Hunger and Health

Nutrition amid the COVID-19 pandemic: a multi-level framework for action

Hunger in America

Self-Perceived Cooking Skills in Emerging Adulthood Predict Better Dietary Behaviors and Intake 10 Years Later : A Longitudinal Study

Start Simple with MyPlate: Food Planning During the Coronavirus Pandemic. (n.d.). ChooseMyPlate: U.S. Department of Agriculture

USDA to Purchase Up to $3 Billion in Agricultural Commodities, Issue Solicitations for Interested Participants

Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States