A systematic scoping review of urban food environment research, interventions, and measurement approaches in eight low- and middle-income countries.

Abstract

BACKGROUND: Food environments in low- and middle-income countries (LMICs) are undergoing rapid transformation, particularly in urban and peri-urban settings. These shifts—characterized by changes in food retail landscapes, consumer purchasing behaviors, and the availability and affordability of nutritious foods—have significant implications for nutrition. Yet, the key characteristics of these environments, such as food desirability, convenience, accessibility, and marketing influences, remain underexplored. This systematic scoping review synthesizes evidence published between 2001 and 2023 across eight LMICs (Bangladesh, Sri Lanka, Philippines, Kenya, Ghana, Ethiopia, Rwanda, Peru) to examine how urban and peri-urban food environments shape dietary behaviors and nutrition outcomes. METHODS: Guided by a conceptual framework encompassing nine key food environment dimensions—availability, prices, marketing and regulation, vendor and product properties, accessibility, affordability, desirability, convenience, and sustainability—we analyzed descriptive, associative, and intervention studies. We searched Scopus and Web of Science, identified 1,609 records, and included 251 studies in the review. RESULTS: As might be expected in a growing body of evidence, most research is descriptive, with limited causal or intervention-based evidence. Studies frequently focus on characteristics of informal vendors, sociocultural factors influencing shifts in dietary choice toward unhealthier options, and the proliferation of ultra-processed foods, especially near schools and in informal markets. Associations between food environment and nutrition outcomes, such as elevated BMI and overweight, are often linked to supermarket and fast-food access, though these relationships are frequently confounded by socioeconomic variables. Methodological inconsistencies in defining and measuring food environment dimensions limit cross-context comparability. Only seven intervention studies were identified, with few demonstrating significant improvements in diet or nutrition. CONCLUSIONS: This review highlights critical evidence gaps in urban food environments in LMICs and underscores the need for standardized measurement and robust evaluations of diet-related interventions. Strengthening this evidence base is essential to inform food policy, urban planning, and public health strategies that promote healthier diets for populations in rapidly urbanizing settings.