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.

Measurement Methods Used to Assess the School Food Environment: A Systematic Review

“…This was due to the diverse methodological approaches used to measure the school food environment and the differing jurisdictions where foods are provided to children as part of a school lunch program (e.g., the UK) or where foods are available for purchase at school canteens or tuck shops (e.g., Australia). The lack of standardized measurement methods identified in this review is broadly consistent with previous systematic reviews from high income [4,10,[86][87][88] and low-middle income countries [89] and with a review which quantified the methods used to measure the 'retail food environment' and associations with obesity [90]. The field therefore is in need of standardized methods and indicators to profile and monitor the school food environment across the diverse high and low to middle income settings and to provide robust assessments of the influence of the school food environment on nutrition and health.…”

Food Environment Typology: Advancing an Expanded Definition, Framework, and Methodological Approach for Improved Characterization of Wild, Cultivated, and Built Food Environments toward Sustainable Diets

“…For Objective 2, we developed the socio-ecological framework of the food environment within the food system through a literature review on socio-ecological models [57,[62][63][64][65] and interactions of food environments with diets, communities, cultures, markets, politics, governance, and ecosystems [66][67][68][69][70][71]. For Objective 3, we developed the food environment typology that includes both natural and built food environments through observations of diverse food environments at our study sites coupled with a literature review on food procurement [37,59,[72][73][74]. For Objective 4, we arrived at the multi-faceted methodological approach of measuring food environments with potential tools through a literature review on existing methods used for measuring built food environments [57,[75][76][77][78] along with potential tools we have used during field research measuring wild and cultivated food environments that draw from the fields of anthropology and ethnobiology [22,47,53].…”

“…To date, the food environment literature has largely focused on geographical analysis as the main mode of measurement including geospatial data of food outlets as well as checklists, interviews and questionnaires, economic appraisal, market baskets, and inventories [57,59,72,76,77]. These methodological approaches have been critiqued for being too narrow in scope and for inadequately measuring the way in which people are truly exposed to, and interact with, their food environments [104].…”

“…In Table 4, we draw from the food environment and sustainable diets literature [27,36,59,72,76,77,[105][106][107] as well as ecology, ethnobotany, environmental sciences, and other fields to provide an overview of potential methods for measuring the food environment. This overview includes objective and perceived availability, affordability, convenience, promotion and quality, and sustainability properties of foods and beverages in wild, cultivated, informal, and formal food environments [36].…”

“…Much of the food environment research to date has focused on describing the formal built food environment in high-income countries and its association with health outcomes [74]. More recently there has been an increase in the food environment research and literature in LMICs, yet these studies have still largely focused on the built environment [72]. This may be due in part to the differences between disciplines that are most often involved in the characterization of built food environments (e.g., nutritionists, public health researchers, etc.)…”