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

Environmental Sustainability of Food Environments: Development and Application of a Framework in 4 cities in South Asia

Background

Food environments, where people directly engage with broader food systems, may be an important contributor to the environmental sustainability of food systems.

Objectives

The primary objectives of this study were to establish a new food environment framework that considers environmental indicators and to assess data availability and gaps using data previously collected as part of a food systems survey in 4 South Asian cities.

Methods

The framework was developed by conducting a structured literature review of previous food environment frameworks and in-depth interviews with content experts (n = 6). The framework and indicators were then mapped to data collected by consumer and vendor surveys using the Urban Food Systems Assessment Tool (UFSAT) in Ahmedabad (India), Pune (India), Kathmandu (Nepal), and Pokhara (Nepal).

Results

We have expanded the sustainability domain within food environments to include consumer travel to food vendors, the presence of food delivery services, policies related to sustainability, vendor food waste, vendor plastic use, vendor utility usage, vendor recycling and waste management practices, and food packaging. Mapping the framework to existing data from 4 cities in South Asia, we found variations in food environment sustainability indicators, particularly regarding consumer transportation to food vendors, the presence of delivery services, and food waste.

Conclusions

Although the majority of food environment research focuses on the availability and affordability of healthy foods, there is an urgent need to understand better how aspects of food environments contribute to environmental goals. When mapping the framework to existing food systems data, we found gaps in data on environmental sustainability in food environments and variation in indicators across settings.

Scientific research on food environments in Brazil: a scoping review

OBJECTIVE

To map the scientific research on food environments in Brazil, based on the following questions: How many studies have addressed food environments?; What study designs and methodological approaches were applied?; What is the geographic scope of the studies?; What scenarios and dimensions of food environments were studied?; Which population groups were studied?; How were food environments conceptualised?; What are the main limitations of the studies?

DESIGN

Scoping review conducted in four databases, from January 2005 to December 2022, using different food environment-related terms to cover the main types and dimensions proposed in the literature. The studies were independently selected by two authors. A narrative synthesis was used to summarise the findings.

SETTING

Brazil.

PARTICIPANTS

130 articles.

RESULTS

Scientific research on Brazilian food environments has been increasing. The analytical quantitative approach and the cross-sectional design were the most frequently used. Most articles were published in English. The majority of studies evaluated the community food environment, addressed aspects of the physical dimension, sampled the adult population, had food consumption as an outcome, used primary data, and were carried out in capital cities in the Southeast region. Furthermore, in most articles, no conceptual model was explicitly adopted.

CONCLUSIONS

Gaps in literature are related to the need for conducting studies in the Brazilian countryside, the support for the formulation of research questions based on conceptual models, the use of valid and reliable instruments to collect primary data, in addition to the need for a greater number of longitudinal, intervention and qualitative studies.

Riverine food environments and food security: a case study of the Mekong River, Cambodia

Rivers are critical, but often overlooked, parts of food systems. They have multiple functions that support the food security, nutrition, health and livelihoods of the communities surrounding them. However, given current unsustainable food system practices, damming and climate change, the majority of the world's largest rivers are increasingly susceptible to environmental degradation, with negative implications for the communities that rely on them. Here we describe the dynamism and multifaceted nature of rivers as food environments (i.e. the place within food systems where people obtain their food) and their role in securing food security including improved diets and overall health. We also provide a conceptual framework that explain rivers as food environments within the broader food system and describe approaches to characterizing these food environments to better inform our understanding of how they influence food security and nutrition outcomes. Applying this framework to the Mekong River in Cambodia, we describe rivers as multifaceted wild food environments embedded within ecosystems, sociocultural and political environments and sectors of influence. We also explain the ways in which individual factors might influence how communities interact with this food environment. Developing and articulating food-related, ecosystem-specific frameworks and their constructs can guide implementation of policies aimed to improve specific public health or environmental sustainability outcomes. Our conceptual framework incorporates the multiple dimensions of rivers, which will aid future work and public health policy framing to better describe, understand and intervene to ensure protection of rivers' biodiversity and ecosystems as well as food security, health and livelihoods.

The influence of food environments on dietary behaviour and nutrition in Southeast Asia: A systematic scoping review

Background: Food environments are crucial spaces within the food system for understanding and addressing many of the shared drivers of malnutrition. In recent years, food environment research has grown rapidly, however, definitions, measures, and methods remain highly inconsistent, leading to a body of literature that is notably heterogeneous and poorly understood, particularly within regions of the Asia-Pacific. Aim: This scoping review aims to synthesize the nature, extent, and range of published literature surrounding the role of the food environment on influencing dietary behaviour and nutrition in Southeast Asia. Methods: A systematic search of 5 databases was conducted following PRISMA guidelines for scoping reviews. Eligible studies included peer-reviewed research with adult participants living in Southeast Asia that examined the food environment as a determinant of dietary behaviour or nutrition. Results: A total of 45 articles were included. Overall, studies indicated that dietary behaviours in Southeast Asia were primarily driven by social, cultural, and economic factors rather than physical (e.g. geographical) features of food environments. Food price and affordability were most consistently identified as key barriers to achieving healthy diets. Conclusion: This work contributes to the establishment of more robust conceptualizations of food environments within diverse settings which may aid future policymakers and researchers identify and address the barriers or obstacles impacting nutrition and food security in their communities. Further research is needed to strengthen this knowledge, particularly research that explicitly explores the macro-level mechanisms and pathways that influence diet and nutrition outcomes.

Characterizing Retail Food Environments in Peri-Urban Pakistan during the COVID-19 Pandemic

(1) Background: To date, there are limited data in low- and middle-income countries (LMICs) that collect, monitor, and evaluate food environments in standardized ways. The development of a pilot survey tool, tailored to LMICs and focused on retail food environments, is necessary for improving public health nutrition. (2) Methods: A novel survey tool was developed and piloted in a sample of village retail food environments (n = 224) in Matiari, Pakistan between October 2020 to April 2021. Villages were randomly selected, and food outlets were surveyed within a 500-m radius from each village center. Descriptive statistics (counts and percentages) were used to describe the characteristics of food outlets and the availability of food. To test whether there was a difference in characteristics or in the mean of number of healthy, unhealthy, and total food items available by village size, a χ2 test or one-way ANOVA was conducted, respectively. (3) Results: In total, 1484 food outlets were surveyed for food accessibility, availability, and promotion across small (n = 54), medium (n = 112), and large villages (n = 58). In small and medium-sized villages, mobile food vendors were the predominant food outlet type (47.8% and 45.1%, respectively), whereas in large villages, corner stores (36%) were more prominent. The mean number of total food items (p < 0.006) and unhealthy food items (p < 0.001) available in food outlets differed by village size. The proportion of food outlets with available fruits, meat and poultry, water, and sugar-sweetened beverages also differed by village size (p < 0.001). (4) Conclusions: This study informs the global evidence gap in the current understanding of food environments in various ethnically diverse and dynamic LMICs, and the developed methodology will be useful to other LMICs for measuring and monitoring the food environment, especially among vulnerable population groups. This work complements current national and provincial survey efforts in Pakistan.

Valuing the Diversity of Research Methods to Advance Nutrition Science

The ASN Board of Directors appointed the Nutrition Research Task Force to develop a report on scientific methods used in nutrition science to advance discovery, interpretation, and application of knowledge in the field. The genesis of this report was growing concern about the tone of discourse among nutrition professionals and the implications of acrimony on the productive study and translation of nutrition science. Too often, honest differences of opinion are cast as conflicts instead of areas of needed collaboration. Recognition of the value (and limitations) of contributions from well-executed nutrition science derived from the various approaches used in the discipline, as well as appreciation of how their layering will yield the strongest evidence base, will provide a basis for greater productivity and impact. Greater collaborative efforts within the field of nutrition science will require an understanding that each method or approach has a place and function that should be valued and used together to create the nutrition evidence base. Precision nutrition was identified as an important emerging nutrition topic by the preponderance of task force members, and this theme was adopted for the report because it lent itself to integration of many approaches in nutrition science. Although the primary audience for this report is nutrition researchers and other nutrition professionals, a secondary aim is to develop a document useful for the various audiences that translate nutrition research, including journalists, clinicians, and policymakers. The intent is to promote accurate, transparent, verifiable evidence-based communication about nutrition science. This will facilitate reasoned interpretation and application of emerging findings and, thereby, improve understanding and trust in nutrition science and appropriate characterization, development, and adoption of recommendations.

An Indicator Measuring the Influence of the Online Public Food Environment: An Analytical Framework and Case Study

The online public food environment (OPFE) has had a considerable impact on people's lifestyles over the past decade; however, research on its exposure is sparse. The results of the existing research on the impact of the food environment on human health are inconsistent. In response to the lack of food elements in the definition of the food environment and the lack of a clear method to assess the health attributes and the impact degree of the food environment, we proposed a new analytical framework based on the latest disease burden research, combining the characteristics of China's current food environment, from the perspective of environmental science. We redefined the food environment and proposed that food and its physical space are two core elements of the food environment. Accordingly, we extracted four domains of characteristics to describe the basic components of the food environment. Using the sales records, we designed an approach by referring to the standard process of environmental health indicators, including the health attributes and the impact degree of the food environment, to measure the OPFE of takeaway food outlets. Further, we conducted a case study and extracted three domains of characteristics for more than 18,000 effective takeaway meals from 812 takeaway food outlets located in 10 administrative subdivisions in the Haidian District and Xicheng District of Beijing Municipality. The results showed that more than 60% of single meals sold by takeaway food outlets were considered as healthy, and only 15% of takeaway food outlets sold healthy meals exclusively. Additionally, there were significant differences in health effects among different types of food environments, and high-risk areas of different types of food environments can be spatially identified. Compared with the counting method in the availability of food environment, the proposed new approach can depict food environment characteristics not only in the macro-scale like the counting method but also in the meal-scale. The indicators could be useful for large-scale and long-term monitoring of food environmental changes due to their simple calculation and design depending on the food delivery platform.

Suitability of Data-Collection Methods, Tools, and Metrics for Evaluating Market Food Environments in Low- and Middle-Income Countries

Globalization is transforming food environments in low- and middle-income countries (LMICs) with implications for diets and nutrition. However, most food-environment assessments were developed for use in high-income countries. We evaluated the suitability of 113 data-collection assessments (i.e., methods, tools, and metrics) for eight dimensions of informal and formal market food environments for diverse contexts of LMICs. We used a scoring exercise and a survey of experts (n = 27). According to the scoring exercise, 10 assessments (8 methods, 1 tool, and 1 metric) were suitable without modification for informal markets. Suitability for formal markets was markedly higher, with 41 assessments (21 methods, 14 tools, and 6 metrics) found suitable without modification. Experts considered availability, accessibility, price, and affordability the most important dimensions of market food environments to evaluate in LMICs. Market-basket analysis and vendor audits (which include inventories) were ranked as the most suitable methods to assess multiple dimensions of market food environments, including availability, price, affordability, vendor and product characteristics, marketing, and regulation. Gaps in relevant assessments were found for convenience and desirability. Results demonstrate the need for the development, adaptation, and validation of assessments relevant for informal markets in a diverse range of LMIC contexts to support diets, nutrition, and health globally.