From pantry to physiology: A narrative review linking food insecurity to biological dysfunction.

Abstract

Food insecurity is an escalating public health and social equity challenge with measurable biological consequences. Defined as limited or uncertain access to nutritionally adequate and safe foods, it affects millions of households in the United States and is increasingly recognized as a driver of chronic disease. While research on food insecurity has expanded across public health, nutrition, and social science, understanding of its biological mechanisms remains fragmented. Using the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines, this narrative review synthesizes interdisciplinary evidence connecting food insecurity to physiological dysfunction, integrating findings from epidemiologic, clinical, and mechanistic studies. It explores the following: (1) general health and life expectancy; (2) cardiovascular disease; (3) diabetes; (4) nutrition, weight, and metabolic health; (5) mental health and sleep; and (6) immune function. Across these domains, chronic nutritional instability and psychosocial stress are linked to hormonal and inflammatory dysregulation, metabolic disturbance, and increased allostatic load. These mechanisms demonstrate that food insecurity operates not only as a social condition but as a biologically embedded stressor. Further coordination is needed to address both biological and structural drivers of disease. Food insecurity should be recognized as a modifiable determinant of physiological health and health equity. These findings align with global health priorities, including SDG 2 (Zero Hunger), SDG 3 (Good Health and Well-Being), and SDG 10 (Reduced Inequalities), highlighting food insecurity as a key driver of health disparities. Integrating insights from nutrition science, medicine, and social policy is essential to develop effective, multisector interventions. This review underscores the need for cross-sector collaboration to bridge nutrition science, medicine, and social policy, reframing food insecurity as a modifiable determinant of physiological health and health equity.