London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom.
University of Washington, Department of Nutritional Sciences, Center for Public Health Nutrition, Seattle, WA.
Adv Nutr. 2020 Mar 1;11(2):387-397. doi: 10.1093/advances/nmz031.
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.
食品环境研究在中低收入国家（LMICs）日益受到重视。然而，由于缺乏对文献的系统综述，人们对这些环境中涌现的新证据知之甚少。本系统范围综述旨在解决这一差距。我们于 2017 年 12 月对 6 个数据库进行了系统检索，共检索到 920 条记录。共有 70 篇同行评审文章符合纳入标准，并被纳入本研究。这些文章涵盖了 22 个 LMICs，包括中上收入国家（n=49，70%）和中下收入国家（n=18，26%）。没有文章包括低收入国家。文章采用了定量（n=45，64%）、定性（n=17，24%）和混合方法设计（n=11，8%）。研究分析了国家、社区、学校和家庭层面的食品环境。23 篇文章（55%）评估了食品环境暴露与感兴趣的结果之间的关联，包括饮食（n=14）、营养状况（n=13）和健康（n=1）。在多个 LMICs 中，社区和学校层面的食品供应与饮食结果有关，尽管关联因供应商类型而异。关于食品环境与营养和健康结果之间关联的证据尚无定论。高质量研究证据的缺乏是一个严重的限制，这突出表明需要改进研究设计以及标准化方法和指标。未来的食品环境研究必须涵盖低收入和中下收入国家，并包括饮食、营养和健康结果的全部范围。提高食品环境研究的质量对于设计可行、适当和有效的干预措施以改善 LMIC 公共卫生营养至关重要。
