Nutrition status among adults in the face of household food insecurity: a cross-sectional study in five different regions in senegal

Abstract Background Household food insecurity remains a critical public health issue in low- and middle-income countries, contributing to undernutrition and overweight. Senegal is undergoing a nutrition transition, with regions experiencing varying degrees of food insecurity and nutritional outcomes. This study examines the association between household food insecurity and adult nutritional status across five ecologically distinct regions of Senegal. Method A cross-sectional study was conducted from April to June 2024 involving 1,965 adults from 1,253 households in Boundou, Bedik/Bandafassi, Senegal River Valley, Lower Casamance, and Dakar regions. Household food insecurity was assessed using the validated Household Food Insecurity Access Scale, while body mass index (BMI) was calculated from measured weight and height. Associations between food insecurity, socioeconomic factors, and BMI categories were analyzed using multilevel ordinal logistic regression with region-stratified analyses conducted to evaluate context-specific relationships. Results Findings revealed significant geographic variation in food security and nutritional outcomes. Over 50% of households in Boundou and Bedik/Bandafassi were severely food insecure, while Lower Casamance had the highest food security levels. Underweight was most prevalent in food-insecure rural regions like Boundou, whereas overweight and obesity were concentrated in urban areas like Dakar and Lower Casamance. Food insecurity was significantly associated with higher BMI in Boundou and overweight in Dakar, supporting the food insecurity-obesity hypothesis. However, no significant association emerged between food insecurity and underweight in the overall model, suggesting that broader ecological and health-related factors may drive undernutrition. Conclusion The study highlighted the context-specific and regionally differentiated relationships between food insecurity and nutritional status in Senegal. These findings underscore the need for locally tailored, multisectoral interventions that address the dual burden of malnutrition by improving both food access and diet quality.