Cited by 110Food Security and Health in Diverse PopulationsNutrition, Health and Food BehaviorUrban Transport and Accessibility

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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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Westbury, Susannah, Ghosh, Iman, Jones, Helen Margaret, Mensah, Daniel, Samuel, Folake, Irache, Ana, Azhar, Nida, Al-Khudairy, Lena, Iqbal, Romaina, Oyebode, Oyinlola·2021·BMJ Global Health

DOI 10.1136/bmjgh-2021-006358PMC PMC8506857

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Abstract

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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Figure 1 PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.CC BY-NC · PubMed Central

Figure 2 Map to show countries covered by observational studies included in our review.CC BY-NC · PubMed Central

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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: Westbury, Susannah
Ghosh, Iman
Jones, Helen Margaret
Mensah, Daniel
Samuel, Folake
Irache, Ana
Al-Khudairy, Lena
Iqbal, Romaina
Oyebode, Oyinlola
Venue: BMJ Global Health
Publisher: BMJ
Published: 2021-10
Volume: 6
Issue: 10
Pages: e006358
ISSN: 2059-7908 (ISSN-L)
DOI: 10.1136/bmjgh-2021-006358
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: cc-by-nc
creativecommons.org/licenses/by-nc/4.0/ (unspecified, 9 d)
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 › Medicine › Public Health, Environmental and Occupational Health › 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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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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