ABSTRACT
Introduction ............................................................................................................ 114 Definitional Issues .................................................................................................. 114
Defining Food Insecurity ................................................................................... 114 Defining Poverty ............................................................................................... 115 Definition of NCDs of Poverty.......................................................................... 116
Food Insecurity as a Risk Factor for NCDs among the Poor: Traditional Hypotheses .......................................................................................... 117
Fetal Origins of Adult NCDs (The Barker Hypothesis) .................................... 118 Hypothesis on Food Insecurity and Obesity ..................................................... 119
Is the Double Burden of Obesity and Undernutrition among the (Extreme) Poor a Myth? .......................................................................................................... 119 Food Insecurity as a Risk Factor for Developing and Dying from NCDs among the Poorest .................................................................................................. 121
Uncertainty and Hunger Leading to Mental Illness .......................................... 121 Fetal Micronutrient Deficiencies Leading to Congenital Defects ..................... 121 Childhood Malnutrition Leading to Malnutrition-Related Atypical Diabetes Mellitus .............................................................................................. 123 Inadequate Food Processing Leading to Aflatoxin and Cyanogen Toxicity ............................................................................................ 123 Intermittent Undernutrition Leading to Medication Toxicity ...........................124 Adverse Changes in Healthcare-Related Behavior: Late Presentation and Poor Adherence to Therapy ........................................................................124 High-Risk Sexual Behavior Leading to HIV-Associated NCDs ....................... 125 Trade-Offs Leading to Increased Exposure to Other Risk Factors for NCDs .............................................................................................. 125
NCDs, Financial Risk, and Food Insecurity .......................................................... 125 Conclusions and Implications for Policy ............................................................... 125 References .............................................................................................................. 126
The literature on food insecurity, as it relates to noncommunicable diseases (NCDs), has focused primarily on drivers of overweight, obesity, and ultimately death from diabetes, hypertension, and vascular disease in middle and older ages. The perspective of this chapter is that, for the most part, this discussion has failed to adequately capture the specific issues around NCDs and food insecurity in the poorest populations in the world, where deaths due to NCDs are more concentrated at younger ages, and are often due to a different set of diseases and underlying risk factors than in low-and middle-income countries more generally. Those living in extreme poverty are more rarely overweight or obese. Food insecurity in these populations is pervasive and needs to be a major consideration in the programming of health interventions. The chapter will review the existing general literature on NCDs, food insecurity, and poverty. The chapter will then propose some directions for future research into the role of food insecurity as a risk factor for the high incidence and case fatality rates for NCDs in settings of extreme poverty. The chapter will also examine the likely role of NCDs as a driver of food insecurity. Finally, the chapter will discuss policy implications.
