Using a global food environment framework to understand relationships with food choice in diverse low- and middle-income countries

Abstract Objectives Food systems are increasingly recognized as critical to advancing better nutrition, with the food environment as the nexus between food systems and dietary consumption. Developing a robust measurement framework of the market food environment is a research priority particularly for low and middle income countries (LMIC), where market food environments are rapidly shifting, accompanied by shifts in diet patterns and nutrition outcomes. The objective of this work was to identify existing metrics of the food environment and develop a measurement framework that can be used to assess the outcomes of nutrition-sensitive, market-focused interventions in LMIC. Methods We conducted a narrative review of the food environment literature using targeted searches of peer-reviewed articles, agency websites, and bibliographies to identify measures of the food environment in current or recent use. First, we extracted 182 unique measures from and compiled them into a list. Second, a pile-sorting exercise was conducted online by 5 nutrition experts, selected for their expertise in food environment, ethnographic, food choice, and/or nutritious value chain research. Participants were asked to sort the measures into piles that belonged together and create a label for each pile. An in-depth debriefing was conducted with each sorter to obtain the reasoning for their sorts. We then categorized the results into emergent groups based on the percentage agreement of the assignment of individual items into the piles. Results Eight broad categories with at least 75% measure agreement emerged pertaining to both perceived and objective measures of the built/physical food environment. Etic measures included the availability of food stores, the availability and quality of foods within a store, food prices, and marketing. Emic (perception) measures included perceptions of access to food stores, perceptions of food availability and quality in stores, and affordability. Personal characteristics and values determining food choice also emerged; these are not measures of the food environment per se. Conclusions These results begin to outline a measurement framework for assessing the market food environment that can be adapted to LMIC. The next step will be to test the framework and evaluate its utility as a tool to further understanding around consumer food choices. Funding Sources GAIN.

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PROTOCOL: Impact of the food environment on diet‐related health outcomes in school‐age children and adolescents in low‐ and middle‐income countries: a systematic review

Campbell Systematic Reviews ◽

10.1002/cl2.198 ◽

2018 ◽

Vol 14 (1) ◽

pp. 1-55 ◽

Cited By ~ 3

Author(s):

Bianca Carducci ◽

Christina Oh ◽

Emily C Keats ◽

Michelle F Gaffey ◽

Daniel E Roth ◽

...

Keyword(s):

Systematic Review ◽

Health Outcomes ◽

Children And Adolescents ◽

Food Environment ◽

School Age Children ◽

School Age ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Effect of Food Environment Interventions on Anthropometric Outcomes in School-Aged Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Current Developments in Nutrition ◽

10.1093/cdn/nzaa098 ◽

2020 ◽

Vol 4 (7) ◽

Cited By ~ 1

Author(s):

Bianca Carducci ◽

Christina Oh ◽

Emily C Keats ◽

Daniel E Roth ◽

Zulfiqar A Bhutta

Keyword(s):

Health Outcomes ◽

Food Environment ◽

Cochrane Library ◽

Free Text ◽

Environmental Interventions ◽

Middle Income ◽

Middle Income Countries ◽

School Aged Children ◽

The Impact ◽

Low And Middle Income

ABSTRACT Food environments may promote access to unhealthy foods, contributing to noncommunicable diseases in low- and middle- income countries (LMICs). This review assessed published evidence on the effects of food environment interventions on anthropometric (BMI and weight status) outcomes in school-aged children (5–9 y) and adolescents (10–19 y) (SACA) in LMICs. We summarized randomized controlled trials (RCTs) and quasi-experimental studies (QES) published since 2000 to August 2019 in the peer-reviewed and gray literature that assessed the effects of food-related behavioral and environmental interventions on diet-related health outcomes in SACA in LMICs. Electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Library) were searched using appropriate keywords, Medical Subject Headings, and free text terms. Eleven RCTs and 6 QES met the inclusion criteria, testing multicomponent behavioral and environmental interventions in schools. Analysis of 6 RCTs (n = 17,054) suggested an overall effect on change in BMI [mean difference (MD): −0.11, 95% CI: −0.19 , −0.03], whereas there was no observed effect in 5 studies using endline BMI (n = 17,371) (MD: 0.05, 95% CI: −0.32, 0.21). There was no significant pooled effect among the 3 QES (n = 5,023) that reported differences in change in BMI or endline (MD: −0.37, 95% CI: −0.95, 0.22). There is limited evidence to support the modification of diet-related health outcomes through school-based food environment interventions in SACA in LMICs. Further studies are needed to understand the impact of school and community-based food environment interventions on nutritional status in this population.

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

Advances in Nutrition ◽

10.1093/advances/nmz031 ◽

2019 ◽

Cited By ~ 11

Author(s):

Christopher Turner ◽

Sofia Kalamatianou ◽

Adam Drewnowski ◽

Bharati Kulkarni ◽

Sanjay Kinra ◽

...

Keyword(s):

Scoping Review ◽

Food Environment ◽

Middle Income ◽

Middle Income Countries ◽

Environment Research ◽

Low And Middle Income

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An Emergent Framework of the Market Food Environment in Low- and Middle-Income Countries

Current Developments in Nutrition ◽

10.1093/cdn/nzab023 ◽

2021 ◽

Author(s):

Djeinam Toure ◽

Anna Herforth ◽

Gretel H Pelto ◽

Lynnette M Neufeld ◽

Mduduzi N N Mbuya

Keyword(s):

Food Environment ◽

Food Systems ◽

Personal Characteristics ◽

Future Research ◽

Product Characteristics ◽

Middle Income ◽

Middle Income Countries ◽

Research Priority ◽

Measurement Framework ◽

Low And Middle Income

Abstract Background Food systems are increasingly recognized as critical for advancing nutrition, and the food environment is viewed as the nexus between those systems and dietary consumption. Developing a measurement framework of the market food environment is a research priority, particularly for low- and middle-income countries (LMICs), which face rapid shifts in markets, dietary patterns, and nutrition outcomes. Objective In this study, we sought to assess current conceptions and measures of the market food environment that could be adapted for use in LMICs. Methods We conducted a narrative review of the literature to identify measures of the market food environment in recent use. First, we identified and reviewed frameworks of the food environment for LMICs with a specific focus on the market food environment. Second, we compiled 141 unique measures of the market food environment from 20 papers into a list that was pile-sorted by five nutrition experts into domains. We then categorized the measures based on percentage agreement across all sorts. Finally, we compared measured and conceptual domains of the market food environment to identify measurement gaps and needed adaptations. Results Conceptual frameworks provide differing definitions of the market food environment but conform in their definitions of food availability, price, marketing, and product characteristics. Greater clarity is needed in defining relevant vendor and product characteristics. Eight measured domains of the market food environment emerged from the literature review, with significant overlap among conceptual domains. Measurement gaps exist for food quality, safety, packaging, desirability and convenience. Personal characteristics also emerged as measured domains, although these are not of the food environment, per se. Conclusions These results are a step towards elucidating how, why and where we measure the market food environment in LMICs. Future research should focus on prioritizing the most meaningful methods and metrics, and developing new measures where gaps exist.

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Erratum to Turner et al. Food environment research in low- and middle-income countries: A systematic scoping review

Advances in Nutrition ◽

10.1093/advances/nmz060 ◽

2019 ◽

Vol 10 (4) ◽

pp. 730-730 ◽

Cited By ~ 2

Keyword(s):

Scoping Review ◽

Food Environment ◽

Middle Income ◽

Middle Income Countries ◽

Environment Research ◽

Low And Middle Income

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Food environment interactions after migration: A scoping review of low- and middle-income country immigrants in high-income countries

Public Health Nutrition ◽

10.1017/s1368980021003943 ◽

2021 ◽

pp. 1-67

Author(s):

Aravinda Berggreen-Clausen ◽

Sai Hseing Pha ◽

Helle Mölsted Alvesson ◽

Agneta Andersson ◽

Meena Daivadanam

Keyword(s):

Scoping Review ◽

Food Environment ◽

High Income ◽

Traditional Foods ◽

Middle Income ◽

Middle Income Countries ◽

Immigrant Populations ◽

Low Incomes ◽

The Usa ◽

Low And Middle Income

Abstract Objective: To map and characterize the interactions between the food environment and immigrant populations from low- and middle-income countries living in high-income countries. Design: A scoping review was carried out following the framework outlined by Arksey and O’Malley, as well as Levac et al. Peer-reviewed studies in English published between 2007 to 2021 were included. Two reviewers screened and selected the papers according to predefined inclusion criteria and reporting of results follows the PRISMA-ScR guidelines. A ‘Best fit’ framework synthesis was carried out using the ANGELO framework. Setting: High-income countries. Subjects: Immigrants from low- and middle-income countries. Results: A total of 68 articles were included, primarily based in the USA, as well as Canada, Australia and Europe, with immigrants originating from five regions of the globe. The analysis identified three overarching themes that interconnected different aspects of the food environment in addition to the four themes of the ANGELO framework. They demonstrate that in valuing fresh, healthy and traditional foods, immigrants were compelled to surpass barriers in order to acquire these, though children’s demands, low incomes, time scarcity and mobility influenced the healthiness of the foods acquired. Conclusion: This study brought together evidence on interactions between immigrant populations and the food environment. Immigrants attempted to access fresh, traditional, healthier food, though they faced structural and family-level barriers that impacted the healthiness of the food they acquired. Understanding the food environment and interactions therein is key to proposing interventions and policies that can potentially impact the most vulnerable.

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Reverse thinking: taking a healthy diet perspective towards food systems transformations

Food Security ◽

10.1007/s12571-021-01204-5 ◽

2021 ◽

Author(s):

I. D. Brouwer ◽

M. J. van Liere ◽

A. de Brauw ◽

P. Dominguez-Salas ◽

A. Herforth ◽

...

Keyword(s):

Food Environment ◽

Food Systems ◽

Food System ◽

Unintended Consequences ◽

Healthy Diet ◽

Middle Income ◽

Middle Income Countries ◽

Conflicting Objectives ◽

Healthy Diets ◽

Low And Middle Income

AbstractFood systems that deliver healthy diets without exceeding the planet’s resources are essential to achieve the worlds’ ambitious development goals. Healthy diets need to be safe, accessible, and affordable for all, including for disadvantaged and nutritionally vulnerable groups such as of smallholder producers, traders, and consumers in low- and middle-income countries. Globally, food systems are experiencing rapid and drastic changes and are failing to fulfil these multiple duties simultaneously. The international community therefore calls for rigorous food systems transformations and policy solutions to support the achievement of healthy diets for all. Most strategies, however, are essentially supply- and market-oriented. Incorporation of a healthy diet perspective in food system transformation is essential to enable food systems to deliver not only on supplying nutritious foods but also on ensuring that consumers have access can afford and desire healthy, sustainable, and culturally acceptable diets. This paper argues that this should be guided by information on diets, dietary trends, consumer motives, and food environment characteristics. Transformational approaches and policies should also take into account the stage of food system development requiring different strategies to ensure healthier diets for consumers. We review current knowledge on drivers of consumer choices at the individual and food environment level with special emphasis on low- and middle income countries, discuss the converging and conflicting objectives that exist among multiple food-system actors, and argue that failure to strengthen synergies and resolve trade-offs may lead to missed opportunities and benefits, or negative unintended consequences in food system outcomes. The paper proposes a menu of promising consumer- and food-environment- oriented policy options to include in the food systems transformation agenda in order to shift LMIC consumer demand towards healthier diets in low- and middle income countries.

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