The influence of the urban food environment on diet, nutrition and health outcomes in low-income and middle-income countries: a systematic review
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INTRODUCTION: Diet and nutrition are leading causes of global morbidity and mortality. Our study aimed to identify and synthesise evidence on the association between food environment characteristics and diet, nutrition and health outcomes in low-income and middle-income countries (LMICs), relevant to urban settings, to support development and implementation of appropriate interventions. METHODS: We conducted a comprehensive search of 9 databases from 1 January 2000 to 16 September 2020 with no language restrictions. We included original peer-reviewed observational studies, intervention studies or natural experiments conducted in at least one urban LMIC setting and reporting a quantitative association between a characteristic of the food environment and a diet, nutrition or health outcome. Study selection was done independently in duplicate. Data extraction and quality appraisal using the National Heart Lung and Blood Institute checklists were completed based on published reports using a prepiloted form on Covidence. Data were synthesised narratively. RESULTS: 74 studies met eligibility criteria. Consistent evidence reported an association between availability characteristics in the neighbourhood food environment and dietary behaviour (14 studies, 10 rated as good quality), while the balance of evidence suggested an association with health or nutrition outcomes (17 of 24 relevant studies). We also found a balance of evidence that accessibility to food in the neighbourhood environment was associated with diet (10 of 11 studies) although evidence of an association with health outcomes was contradictory. Evidence on other neighbourhood food environment characteristics was sparse and mixed. Availability in the school food environment was also found to be associated with relevant outcomes. Studies investigating our other primary outcomes in observational studies of the school food environment were sparse, but most interventional studies were situated in schools. We found very little evidence on how workplace and home food environments are associated with relevant outcomes. This is a substantial evidence gap. CONCLUSION: 'Zoning' or 'healthy food cart' interventions to alter food availability may be appropriate in urban LMIC. PROSPERO REGISTRATION NUMBER: CRD42020207475.
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Public health studies have found that food environments matter for people's food choices to at least some extent, impacting the quality of their diets and health outcomes.
“Public health studies have found that food environments matter for people ' s food choices to at least some extent, impacting the quality of their diets and health outcomes (Westbury et al. 2021; Caspi et al. 2012).”
From Corporate concentration and power matter for agency in food systems (2025) · cites this paper as Westbury et al. 2021
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- Authors
- Westbury, S., Ghosh, I., Jones, H. M., Mensah, D., Samuel, F., Irache, A., Azhar, N., Al-Khudairy, L., Iqbal, R., & Oyebode, O.
- Affiliations
- Monash University (AU)
- University of Warwick (GB)
- Coventry University (GB)
- University of Ibadan (NG)
- Aga Khan University (PK)
- Corresponding author
- Oyebode, Oyinlola
- ORCID
- Venue
- BMJ Global Health
- Publisher
- BMJ
- Published
- 2021-10
- Volume
- 6
- Issue
- 10
- Pages
- e006358
- ISSN
- 2059-7908 (ISSN-L)
- PMC
- PMC8506857
- OpenAlex
- W3205366518
- Cited by
- 107
- References
- 114
- Citations by year
- 2026: 27 · 2025: 28 · 2024: 24 · 2023: 18 · 2022: 9 · 2021: 1
- FWCI
- 2.69
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Global Health (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- University of Birmingham Research Portal (University of Birmingham) (acceptedVersion, other-oa)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by-nc)
- eCommons - AKU (Aga Khan University) (submittedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Pure (Coventry University) (submittedVersion, cc-by-nc)
- University of Warwick (cc-by-nc)
- Funders
- NIHR (Global Health Research Unit on Improving Health in Slums)
- Topics
- Health Sciences › Health Professions › General Health Professions › Food Security and Health in Diverse Populations
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Transportation › Urban Transport and Accessibility
- Keywords
- urban food environment, food access, dietary behaviour, nutritional outcomes, health outcomes, low- and middle-income countries, school food environment, workplace food environment, home food environment
- MeSH terms
- Developing Countries, Diet, Humans, Poverty, Outcome Assessment, Health Care
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