Introduction
Household meals safety has been outlined as all members having enough entry to secure meals by way of socially acceptable means for lively and wholesome life (1). Limited or unsure sources of enough and secure dietary meals or the restricted or unsure skill to amass meals result in meals insecurity (FI). FI is a public well being problem world wide and hundreds of thousands of households are struggling to keep up or obtain meals safety, which incorporates availability, entry, utilization, and talent (2, 3). It is just not thought of a static state and is on a spectrum (3). According to the United Nations in 2021, there’s a increased prevalence of FI for the reason that starting of the COVID-19 pandemic in comparison with earlier than the pandemic (4). The prevalence of family FI in north Iran has been estimated to be ~50.8% in complete with 43.2% gentle FI, 6.5% reasonable FI, and 1.1% extreme FI (5), which can have elevated in recent times as a result of COVID-19 pandemic and different financial and social points.
Various strategies are used to guage FI, two of that are used essentially the most: (1) estimation of meals consumption and (2) estimation of the price of meals preparation (6). These strategies have limitations as a result of price, participant burden, and the necessity for an knowledgeable interviewer. Recently, “experiential” or “perception-based” strategies have been used to measure FI (7). Under these strategies, particular person expertise of FI (i.e., entry) is measured by way of a survey and summarized in a scale. The Household Food Security Survey Module (HFSSM) has been constantly validated as a dependable and important perception-based measure of FI within the United States (8). In Iran, FI is especially investigated by measuring the adequacy of power and vitamins utilizing meals questionnaires or by estimating the poverty line from earnings and expenditure surveys (6). FI is a menace to the well being and survival of people inside communities and may have each short- and long-term results (9). Several elements affect the prevalence of FI together with inhabitants progress, industrialization of communities, rising migration from rural to city areas, insufficient ranges of schooling, wars and financial sanctions by governments, pandemics or endemic ailments, and climate modifications (10–12). In addition, FI can embody a variety of health-related circumstances from undernutrition to overnutrition. Undernutrition consists of losing, underweight, stunting, anemia, and different ailments related to dietary deficiencies. Overnutrition can result in continual circumstances comparable to weight problems, diabetes, fatty liver, hypertension, poor psychological well being, and metabolic syndrome (13–17). As a end result, a big burden is confronted by the financial system and society (5).
Several research have been performed to analyze the prevalence, causes, and varieties of FI world wide and in Iran. According to a meta-analysis from West Africa, the prevalence of FI within the rural inhabitants was ~60.91% and the best prevalence was amongst giant households, female-headed households, and low-income households with low schooling ranges (10). Several systematic critiques and meta-analyses have been performed in Iran (6, 11, 12). In a meta-analysis from 2017, the prevalence of FI was 49.2% based mostly on research that evaluated FI utilizing questionnaires (12). Since the publication of the earlier meta-analysis, many research have been printed evaluating the standing of FI in Iran. Considering this, a brand new meta-analysis is warranted to supply up to date outcomes and summarize current findings. Therefore, the target of this systematic overview and meta-analysis is to replace the findings and conduct a extra complete overview of the prevalence of FI with the consideration of a number of subgroups and different elements.
Method
This systematic overview and meta-analysis had been performed based mostly on the Preferred Reporting Items for Systematic Review and Meta-Analysis assertion (PRISMA) guideline (18). The protocol of the current research was registered on the PROSPERO web site (www.crd.york.ac.uk/PROSPERO) (PROSPERO registration quantity = CRD42022328473).
Search technique and data sources
International scientific databases together with Web of Science, PubMed, Scopus, Google Scholar, and Iranian databases (HYPERLINKs: “https://www.sid.ir/fa/journal/,” “https://ganj.irandoc.ac.ir/,” “https://www.magiran.com/paperadvancedsearch,” “http://thesis.research.ac.ir/faces/home.jspx,” and “https://civilica.com/”) had been searched from 01 January 1990 to 01 February 2022 to determine related research. The detailed search technique is proven in Supplementary Table 1.
Inclusion and exclusion standards
Quality evaluation
The Joanna Briggs Institute (JBI) high quality evaluation guidelines was used to carry out the standard evaluation of the printed articles (19). Two impartial researchers (HA and PS) performed a high quality evaluation for every of the included research. Studies that acquired scores of ≥5 had been categorized as low threat or good high quality and research with scores of ≤4 had been categorized as excessive threat or poor high quality.
Study choice and information extraction
Two impartial reviewers (HA and PS) screened the research based mostly on the eligibility standards. The abstracts and titles of the research had been reviewed, and the included full-text research had been evaluated. Any disagreements had been addressed by a 3rd reviewer’s choice.
Data synthesis and statistical evaluation
Pooled estimates for the magnitude of family meals insecurity had been calculated utilizing a random results mannequin and metaprop module in Stata 14.2. The cause for utilizing a random results mannequin was to try to account for the methodological variations throughout the included articles. A binomial distribution formulation was used to estimate normal errors for every pattern (20). The Egger’s take a look at and Trim and Fill take a look at had been used to guage publication bias. A funnel plot of symmetry visualized publication bias graphically. Evidence of statistically important publication bias was thought of a p-value < 0.05. Sensitivity analyses had been carried out by eradicating the research that confirmed proof of potential publication bias (21). The heterogeneity between research was assessed utilizing the I2 take a look at (22). Subgroup analyses had been performed based mostly on geographic area, age teams, kind of questionnaire, high quality of research, location, and gender. Using meta-regression evaluation, we examined the presence of any linear relationship between noticed impact measurement and time. Evidence of a big distinction throughout the subgroups by the take a look at of group distinction was thought of P < 0.05.
Results
The traits of the included research are proven in Table 1. Since a few of the research reported FI in numerous areas or genders, we thought of them as separate research. Of the included research, 51 examined FI in city areas, 41 in rural areas, and 14 in each areas. Included research additionally investigated FI amongst women and men (n = 70), males (n= 20), and ladies (n= 35). In addition, research had been performed on completely different age teams, together with youngsters (n = 14), adolescents (n = 6), adults (n = 45), and older adults (n = 9). Studies had been performed in a number of completely different areas together with the central (n = 36), western (n = 34), southern (n = 16), northern (n = 7), and japanese (n = 11) components of the nation. Different questionnaires had been used to evaluate FI together with the United States Department of Agriculture 18-item Household Food Security Survey Module (USDA 18-item questionnaire) (n = 48), Household Food Insecurity Access Scale (HFIAS) (n = 32), US Department of Agriculture 6-item Household Food Security Survey Module (USDA 6-item) (n = 12), Radimer-Cornell (n = 6), Farsi Current Population Survey-Food Security Survey Module (FaCPS-FSSM) (n = 3), and the Coping Strategies Index (n = 3).
Table 1. Characteristics of the included research within the systematic overview and meta-analysis.
According to the meta-analysis, the full prevalence of FI in Iran was 55.9% (95% CI: 52.6–59.2%) (Figure 2). To decide heterogeneity, meta-regression and subgroup analyses had been performed.
Figure 2. Forest plot for the prevalence of meals insecurity in Iran.
Subgroups and meta-regression analyses
The prevalence of FI in rural areas was 66.1% (95% CI: 58.8–73.4%) which was increased than the prevalence of FI in city areas [47.1% (95% CI: 44.1–50.0%)] (Supplementary Figure 1). The prevalence of FI amongst girls was increased [51.3% (95% CI: 45.1–57.6%) than the prevalence among men (47.8% (95% CI: 41.8–53.8%)] (Supplementary Figure 2). Pooled prevalence of FI was 44.7% (95% CI: 35.5–53.9%) in youngsters, 40.6% (95% CI: 33.2–48.0%) in adolescents, 56.5% (95% CI: 51.7–61.2%) in adults, and 49.8 % (95% CI: 36.6–63.0%) in older adults.
Subgroup analyses by area revealed that the best prevalence of FI was within the western a part of the nation [64.8% (95% CI: 57.7–72.0%)] and the bottom prevalence of FI was within the central a part of the nation [46.1% (95% CI: 43.1–49.2%)]. The prevalence of FI was additionally assessed in line with questionnaires used within the research. The prevalence of FI in research that used USDA 18-item was 54.8% (95% CI: 49.0–60.6%), the HFIAS was 58.4% (95% CI: 49.8–67.1%), and the USDA 6-item was 48.2% (95% CI: 44.3–52.0 %). The highest prevalence of FI was 77.8 % (95% CI: 69.1–93.8%) in research that used the Coping Strategies Index. Moreover, the prevalence was 53.4% (95% CI: 43.0–63.7%) in research that used FaCPS-FSSM and 63.2% (95% CI: 38.2–88.1%) in research that used Radimer-Cornell (Table 2). Meta-regression analyses utilizing random results fashions had been performed to research the change within the prevalence of FI over time; nonetheless, outcomes indicated that there have been no important modifications in FI over time (Figure 3).
Table 2. Food insecurity prevalence information by location, intercourse, area, age group, high quality of research, and evaluation instrument.
Figure 3. Association of the prevalence of meals insecurity in households with years of information assortment.
Quality evaluation
The Joanna Briggs Institute (JBI) high quality evaluation guidelines was used to evaluate the standard of the printed articles (19). According to the guidelines, 70 research had been categorized as top quality and 36 research had been categorized as low high quality (Supplementary Table 2). Subgroup evaluation revealed no proof of a statistical distinction between the 2 teams.
Publication bias
Despite looking a number of databases, looking grey literature, and never having language limitations, the outcomes of the funnel plot (Figure 4) and Egger’s take a look at (P < 0.000) revealed proof of publication bias. The trim and fill technique utilizing random results was used to regulate the pooled prevalence estimates for publication bias. After imputing 36 research under the imply, the end result indicated an adjusted prevalence of 74.6% (95% CI: 67.3–82.7%) amongst individuals (Figure 5). Furthermore, there was a big heterogeneity between subgroups based mostly on the area (P-value < 0.000), gender (P-value = 0.017), kind of FI questionnaire (P-value = 0.004), and site (P-value < 0.000).
Figure 4. Funnel plot of included research.
Figure 5. Funnel plot for publication bias with trim and fill technique.
Sensitivity evaluation
Sensitivity evaluation urged that there have been no modifications within the imply prevalence after the elimination of particular person research (Supplementary Figure 3).
Discussion
The current systematic overview and meta-analysis evaluated the prevalence of FI in Iran inspecting 106 articles and theses amongst 152,300 individuals from 2010 to 2021 with the consideration of gender, geographical areas, age teams, location, and sort of questionnaires. According to the United Nations International Children’s Emergency Fund (UNICEF), about 375.8 million folks in Asian nations together with Iran and the Pacific confronted starvation in 2020, which elevated by practically 54 million folks in comparison with 2019. Moreover, greater than 1.1 billion folks didn’t have entry to enough meals in 2020 (129). Based on the current meta-analysis, the full prevalence of FI in Iran was 55.9% (95% CI: 52.6–59.2%), which is taken into account excessive. A earlier meta-analysis evaluating FI in Iran additionally revealed a excessive prevalence of FI amongst completely different age classes (6, 11, 12). Differences in inclusion and exclusion standards may very well be thought of a possible cause for the contrasting findings. Additionally, this current research evaluated a better quantity of research over a number of databases utilizing a complete search technique.
In this research, subgroup analyses had been carried out based mostly on recognized elements to guage FI prevalence comprehensively. Subgroup analyses revealed that FI prevalence was considerably increased in Iranian girls in comparison with males (51.3 vs. 47.8%, p < 0.000). In line with our findings, Diab-El-Harake et al. discovered the next prevalence of FI in girls residing in Arab nations (130). In addition, a meta-analysis performed by Jung et al. discovered that female-headed households had been 75% (95 % CI: 49–96%) extra more likely to expertise FI in comparison with male-headed households (131). Another meta-analysis in Ethiopia additionally discovered the next FI prevalence in female-headed households (132). Furthermore, based mostly on the 2019 State of FI report, the prevalence of FI was increased amongst girls in comparison with males in each continent from 2016 to 2019 (133). Broussard (134) urged {that a} increased prevalence of FI could also be defined by variations in family earnings, social networks, and academic attainment. Furthermore, that gender variations in earnings accounted for greater than 70% of the gender hole in FI, and decrease instructional attainment accounted for five–45% of the hole. In addition, girls might categorical extra constructive feelings when they aren’t essentially experiencing favorable circumstances, suggesting that cultural elements might affect the standing of FI in girls (135).
According to Sinclair et al., rural girls had the next prevalence of FI, which is in accordance with our subgroup analyses based mostly on the area that indicated that the prevalence of FI was increased in rural areas [66.1% (95% CI: 58.8–73.4%)] in comparison with city areas [47.1% (95% CI: 58.8–73.4%)] (136). Another research performed by Sims et al. discovered that there was FI and malnutrition amongst Indian rural girls (137). In addition, Sansón-Rosas et al. discovered excessive charges of FI in Colombian rural households (138). It is accepted that poverty is considerably linked to FI (139) and it’s usually thought of the most typical determinant of FI throughout the globe (139). Economic constraints might clarify the next prevalence of FI in rural areas (140). Many people who find themselves from low-income households and are weak to FI reside in rural areas and rely on agricultural actions to provide meals; and in case of restricted entry to agricultural amenities and lands, they’ll face insufficient meals availability (141).
In the current research, the best prevalence of FI was amongst adults (56.5% [95% CI: 51.7–61.2%]) in comparison with completely different age teams. Sinclair et al. additionally discovered the next prevalence of FI amongst folks between the ages of 25–49 throughout the globe (136). A attainable clarification for these findings could also be that adults are sometimes the pinnacle of the family and within the case of insufficient entry to meals, they might prioritize different members of the family. It additionally ought to be thought of that fewer research have been performed amongst adolescents and older adults in comparison with these performed on the grownup inhabitants in Iran.
Subgroup analyses had been additionally performed based mostly on the kind of questionnaire used to guage FI. Despite the truth that the questionnaires utilized in all the research had been validated, there was proof of a statistically important distinction between subgroups (p-value for heterogeneity: 0.003). However, the outcomes for the prevalence of FI from the USDA 18-item (54.8% [95% CI: 49.0–60.6%]) and HFIAS (58.4% [95% CI: 49.8–67.1%]) had been comparatively related, which had been the questionnaires utilized in a lot of the research. Other questionnaires had been solely utilized in a small variety of included research, which can clarify the numerous variations that had been discovered on this research within the subgroup evaluation for the kind of questionnaire. Finally, the subgroup evaluation for the outcomes of the standard evaluation didn’t reveal any proof of a big distinction between high-quality and low-quality research.
Strengths and limitation
To one of the best of our data, the present meta-analysis included the best variety of research to guage the prevalence of FI in Iran. The earlier meta-analysis performed by Behzadifar et al. (129) included 31 research till 2015; subsequently, the prevalence estimates reported within the current research signify the present findings. In addition, we carried out subgroup analyses based mostly on beforehand recognized elements which will affect FI and located important associations between the named elements and the prevalence of FI, which offered a powerful complete overview of the relationships. However, this research had limitations price contemplating when evaluating the findings. There was proof of excessive heterogeneity between included research. Furthermore, we didn’t assess the completely different ranges of FI which will exist among the many individuals. Future research and critiques might take into account evaluating various ranges of FI as it could present extra details about FI standing.
Conclusion
The findings of this systematic overview and meta-analysis revealed that the prevalence of FI is excessive in Iran. The prevalence was increased amongst girls, adults (aged), in rural areas and the western a part of the nation. It is a crucial discovering that the prevalence of FI in Iran is influenced by age, gender, socioeconomic standing, and habitation.
Data availability assertion
Author contributions
Funding
This research was supported by the Tehran University of Medical Sciences (Grant Number: IR.TUMS.MEDICINE.REC.1400.1423).
Conflict of curiosity
Publisher’s observe
Supplementary materials
The Supplementary Material for this text could be discovered on-line at: https://www.frontiersin.org/articles/10.3389/fnut.2022.1006543/full#supplementary-material
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