Food Environment Research in Low- and Middle-Income Countries: A Systematic Scoping Review

Abstract

Food environment research is increasingly gaining prominence in low- and middle-income countries (LMICs). However, in the absence of a systematic review of the literature, little is known about the emerging body of evidence from these settings. This systematic scoping review aims to address this gap. A systematic search of 6 databases was conducted in December 2017 and retrieved 920 records. In total, 70 peer-reviewed articles met the eligibility criteria and were included. Collectively, articles spanned 22 LMICs, including upper-middle-income countries (n = 49, 70%) and lower-middle-income countries (n = 18, 26%). No articles included low-income countries. Articles featured quantitative (n = 45, 64%), qualitative (n = 17, 24%), and mixed-method designs (n = 11, 8%). Studies analyzed the food environment at national, community, school, and household scales. Twenty-three articles (55%) assessed associations between food environment exposures and outcomes of interest, including diets (n = 14), nutrition status (n = 13), and health (n = 1). Food availability was associated with dietary outcomes at the community and school scales across multiple LMICs, although associations varied by vendor type. Evidence regarding associations between the food environment and nutrition and health outcomes was inconclusive. The paucity of evidence from high-quality studies is a severe limitation, highlighting the critical need for improved study designs and standardized methods and metrics. Future food environment research must address low-income and lower-middle-income countries, and include the full spectrum of dietary, nutrition, and health outcomes. Improving the quality of food environment research will be critical to the design of feasible, appropriate, and effective interventions to improve public health nutrition in LMICs.

Keywords: diets; double burden of malnutrition; food and nutrition security; food desert; food environment; health; low- and middle-income countries; nutrition; nutrition environment; obesogenic environment.

FIGURE 1

Conceptual framework. The conceptual framework depicts the food environment as the interface within the wider food system where people interact with food sources to acquire and consume foods. The external domain features exogenous dimensions such as food availability, prices, vendor and product properties, and marketing, and regulation, whereas the personal domain consists of dimensions relative to individuals, including food accessibility, affordability, convenience, and desirability. Complex interactions between these domains and dimensions shape food acquisition and consumption. (Reproduced from reference (5) with permission from Elsevier.)

FIGURE 2

Search tree.

FIGURE 3

Publication year of included articles.

FIGURE 4

The geographic distribution of included articles across LMICs.