Although food environments have been highlighted as potentially effective targets to improve population diets, evidence on Mediterranean food environments is lacking. We examined differences in food availability and affordability in Madrid (Spain) by store type and area-level socio-economic status (SES).

Cross-sectional study. Trained researchers conducted food store audits using the validated Nutrition Environment Measures Survey in Stores for Mediterranean contexts (NEMS-S-MED) tool to measure the availability and price of twelve food groups (specific foods = 35). We computed NEMS-S-MED scores and summarised price data with a Relative Price Index (RPI, comparing prices across stores) and an Affordability Index (normalising prices by area-level income). We compared the availability and affordability of ‘healthier–less healthy’ food pairs, scores between food store types (supermarkets, specialised, convenience stores and others) and area-level SES using ANOVA and multi-level regression models.

City of Madrid. 2016 and 2019 to cover a representative sample.

Food stores within a socio-economically diverse sample of sixty-three census tracts (n 151).

Supermarkets had higher food availability (37·5/49 NEMS-S-MED points), compared to convenience stores (13·5/49) and specialised stores (8/49). Supermarkets offered lower prices (RPI: 0·83) than specialised stores (RPI: 0·97) and convenience stores (RPI: 2·06). Both ‘healthy’ and ‘less healthy’ items were more available in supermarkets. We found no differences in food availability or price by area-level SES, but affordability was higher in higher-income areas.

Supermarkets offered higher food availability and affordability for healthy and less healthy food items. Promoting healthy food availability through supermarkets and specialised stores and/or limiting access to convenience stores are promising policy options to achieve a healthier food environment.

To quantify the change in availability of hyper-palatable foods (HPF) in the US foods system over 30 years (1988–2018).

Three datasets considered representative of the US food system were used in analyses to represent years 1988, 2001 and 2018. A standardised definition from Fazzino et al. (2019) that specifies combinations of nutrients was used to identify HPF.

Analysis of food-item level data was conducted. Differences in the prevalence of HPF were characterised by Cochran’s Q and McNemar’s tests. Generalised linear mixed models with a fixed effect for time and random intercept for food item estimated change in the likelihood that a food was classified as hyper-palatable over time.

No participant data were used.

The prevalence of HPF increased 20 % from 1988 to 2018 (from 49 % to 69 %; P < 0·0001). The most prominent difference was in the availability of HPF high in fat and Na, which evidenced a 17 % higher prevalence in 2018 compared with 1988 (P < 0·0001). Compared with 1988, the same food items were >2 times more likely to be hyper-palatable in 2001, and the same food items were >4 times more likely to be classified as hyper-palatable in 2018 compared with 1988 (P values < 0·0001).

The availability of HPF in the US food system increased substantially over 30 years. Existing food products in the food system may have been reformulated over time to enhance their palatability.

To examine differences in the availability, variety and distribution of foods and beverages sold at street food stands (SFS) across neighbourhood income levels in Mexico City.

Cross-sectional.

Twenty neighbourhoods representing low-, middle- and high-income levels in Mexico City.

Direct observations of SFS (n 391).

The availability of healthy foods such as fruits/vegetables was high in middle- and high-income neighbourhoods, whereas the availability of unhealthy foods such as processed snacks was higher in low-income neighbourhoods. However, statistically significant differences in food availability across neighbourhoods were only observed for dairy and processed snack items (P < 0·05). Similarly, differences in variety were only observed for cereal and processed snacks (P < 0·05). No statistically significant differences were seen for variety of fruits/vegetable across neighbourhood income levels (P > 0·05). No statistically significant differences across neighbourhood income levels were observed for beverage availability and variety (P > 0·05). Although street foods and beverages were often distributed near homes, public transportation centres and worksites, no differences were observed across neighbourhood income levels (P > 0·05).

Findings suggest that SFS can be a source of both unhealthy foods and healthy foods for communities across neighbourhoods in Mexico City. Additional studies are needed to assess the relationship between street food and beverage availability, and consumption.

The aim of this study was to describe the results of food environment assessments completed after Hurricane Florence in North Carolina (2018) and Hurricane María in Puerto Rico (2017), and provide recommendations for assessing disaster food environments.

Adapted structured observation protocols were used to conduct rapid assessments of the availability, price, and quality of specific foods in retail markets.

In both settings, unhealthful food items (soda, chips, fruit-flavored drinks) and milk were widely available and at lower prices than domestic averages. The adapted instrument in Puerto Rico allowed for documentation of greater availability of canned items compared with fresh or frozen foods. In both settings, researchers noted the inability of the instrument to document items that are important to assess postdisaster: ready-to-heat and ready-to-eat foods; food preparation facilities and supplies; hygiene supplies; and empty shelf-space.

The instruments, despite their limitations, were able to capture food availability issues in postdisaster environments. Future instrument adaptation is necessary to capture availability of all major food groups, healthful and unhealthful options, shelf-stable, ready-to-eat, and ready-to-heat foods versus other formats (fresh, frozen), and cooking and hygiene supplies.

To investigate the perceived effects of the coronavirus disease (COVID-19) pandemic lockdown measures on food availability, accessibility, dietary practices and strategies used by participants to cope with these measures.

We conducted a cross-sectional multi-country online survey between May and July 2020. We used a study-specific questionnaire mainly based on the adaptation of questions to assess food security and coping strategies from the World Food Programme’s ‘Emergency Food Security Assessment’ and ‘The Coping Strategy Index’.

The questionnaire was hosted online using Google Forms and shared using social media platforms.

A total of 1075 adult participants from eighty-two countries completed the questionnaire.

As a prelude to COVID-19 lockdowns, 62·7 % of the participants reported to have stockpiled food, mainly cereals (59·5 % of the respondents) and legumes (48·8 %). An increase in the prices of staples, such as cereals and legumes, was widely reported. Price increases have been identified as an obstacle to food acquisition by 32·7 % of participants. Participants reported having lesser variety (50·4 %), quality (30·2 %) and quantity (39·2 %) of foods, with disparities across regions. Vulnerable groups were reported to be facing some struggle to acquire adequate food, especially people with chronic diseases (20·2 %), the elderly (17·3 %) and children (14·5 %). To cope with the situation, participants mostly relied on less preferred foods (49 %), reduced portion sizes (30 %) and/or reduced the number of meals (25·7 %).

The COVID-19 pandemic negatively impacted food accessibility and availability, altered dietary practices and worsened the food insecurity situation, particularly in the most fragile regions.

The present study aimed to examine the availability and price of healthier compared with less healthy foods by geography, store category and store type for convenience stores, and by store size for grocery stores in Nova Scotia.

A cross-sectional study that examined differences in the overall availability and price of healthier compared to less healthy foods in grocery and convenience stores in Nova Scotia. The Nova Scotia Consumer Food Environment project was part of a larger initiative of the Nova Scotia government (Department of Health and Wellness) to assess the food and beverage environment in Nova Scotia in 2015/16.

Four geographic zones (Nova Scotia Health Authority Management Zones) in Nova Scotia, Canada.

A sample of forty-seven grocery stores and fifty-nine convenience stores were selected from a list of 210 grocery stores and 758 convenience stores in Nova Scotia to ensure geographic and store type representation in our sample.

Findings indicate that rurality had a significant effect on food availability as measured by the Nutrition Environment Measures Surveys (NEMS) score (P < 0·01); there was a higher availability of healthy foods in rural compared to urban areas for convenience stores but not grocery stores. Healthier foods were also more available in chain stores compared to independent stores (P < 0·01) and in large stores compared to small and medium stores (P < 0·001 and P < 0·01, respectively).

The availability of and accessibility to less healthy foods in Nova Scotia food environment suggests that there is a need for government policy action to support a food environment that contributes to healthier diets.

To evaluate the relationship between fruits and vegetables (F&V) availability at home and young people’s F&V consumption behaviour, and how the theory of planned behaviour (TPB) constructs could potentially mediate the relationship.

Cross-sectional face-to-face survey questionnaire to assess the TPB constructs and home food availability assessed using open inventories method. F&V availability was categorised into low and high levels based on median split.

Singapore.

Two hundred and ten households (each consisting one parent–child pair) recruited via stratified cluster sampling with child participants ranging from 9 to 16 years of age.

Mediation analyses were conducted using structural equation modelling. The relationship between home F&V availability and F&V consumption behaviour did not have a significant direct association, but there were significant indirect effects through the routes of perceived behavioural control (PBC) and intention as well as attitude and intention. Specifically, higher level of F&V availability at home was related to more positive PBC and attitude towards F&V, and subsequently greater intention to consume F&V and higher consumption of F&V.

Parents should make F&V more readily available at home as increased exposure to F&V could be related to enhanced liking, sense of control and intention to consume F&V and facilitate children’s healthy diet.

We evaluated the relationship between food availability, as the only dietary exposure data available across Africa, and age-standardised cancer incidence rates (ASR) in eighteen countries.

Ecological study.

Availability of food groups and dietary energy was considered for five hypothetical time points: years of collection of ASR (T0) and 5, 10, 15 and 20 preceding years (T–5, T–10, T–15, T–20). Ecological correlations adjusted for human development index, smoking and obesity rates were calculated to evaluate the relationship between food availability and ASR of breast, prostate, colorectal, oesophageal, pancreatic, stomach and thyroid cancer.

Red meat was positively correlated with pancreatic cancer in men (T–20: r–20 = 0·61, P < 0·05), stomach cancer in women (T0: r0 = 0·58, P < 0·05), and colorectal cancer in men (T0: r0 = 0·53, P < 0·05) and women (T–20: r–20 = 0·58, P < 0·05). Animal products including meat, animal fats and higher animal-sourced energy supply tended to be positively correlated with breast, colorectal, pancreatic, stomach and thyroid cancer. Alcoholic beverages were positively correlated to oesophageal cancer in men (r0 = 0·69, P < 0·001) and women (r–20 = 0·72, P < 0·001).

The present analysis provides initial insights into the impact of alcoholic beverages, and increasing use of animal over plant products, on the incidence of specific cancers in Africa. The findings support the need for epidemiological studies to investigate the role of diet in cancer development in Africa.

As numerous factors in the home environment have been related to children’s fruit and vegetable (F&V) consumption as a component of a healthy diet, the purpose of the present systematic review was to examine these factors specifically for children aged 6–12 years.

Relevant observational studies published in English between January 2007 and December 2015 were obtained through electronic database searches. Studies were included if the researchers reported on a potentially modifiable measure of the home physical, political and sociocultural environment related to child F&V consumption.

Of the thirty-three articles reviewed, overall methodological quality was poor with twenty studies rated as weak, mainly due to cross-sectional design (majority of studies), selection bias, convenience sampling and voluntary participation. Half of the studies had strong–moderate ratings for using valid and/or reliable tools while for the other half, psychometric properties were either not reported or weak. The most consistent evidence for children’s combined F&V consumption was found for availability and accessibility of F&V, parental role modelling of F&V and maternal intake of F&V.

A vast array of home environment components and their influence on children’s consumption of fruits and/or vegetables have been studied in recent years. Specific components of the home environment may have more influence than others, but more compelling evidence is needed to draw strong conclusions. Recommendations are made for future studies to be based upon conceptual/theoretical models to provide consistency in defining the home environment and investigation of potential moderators, such as personal or contextual factors.

The primary aim was to examine the association of socio-economic factors and diet with overweight (including obesity) among school-aged children in Haiti. The secondary aim was to describe food availability and the physical activity built environment in participating schools.

This cross-sectional study examined baseline data from the intervention Mamba study assessing the effectiveness of a fortified peanut butter paste in school-aged children. Logistic regression modelling was used to test hypothesized factors in association with overweight status.

Six primary schools in Cap-Haitien, the second largest city in Haiti.

Children (n 968) aged 3–13 years, in good health and enrolled in a participating school for the 2012/13 school year.

Child age (adjusted OR (AOR); 95 % CI=0·25; 0·12, 0·56), child age squared (1·08; 1·03, 1·13), always purchasing food at school (3·52; 1·12, 11·08), mother’s BMI (1·10; 1·04, 1·16) and household ownership of a bicycle (0·28; 0·11, 0·71) were significantly associated with overweight (likelihood ratio=36, P<0·0001). Consumption of fish was significantly lower in overweight children in the binary analysis (P=0·033) and improved the fit of the model. Schools had limited time and space for physical activity and foods sold by vendors were predominantly high in sugar or fat.

To our knowledge the present study is the first to examine the covariates of childhood overweight or describe school food availability and physical activity built environments in Haiti. Further research is necessary to identify intervention targets and feasible, cost-effective approaches for prevention of obesity in Haiti children.

To describe the methods, strengths and limitations of available data sources for estimating US meat and protein consumption in order to facilitate accurate interpretations and applications.

We examined agricultural supply and dietary intake databases from the US Department of Agriculture (USDA), the US Department of Health and Human Services and the FAO to describe their methodology and to report the most recent estimates for meat and protein consumption.

Together, loss-adjusted agricultural supply data and dietary recall data provide the best available estimates of US consumption; the most recent sources indicated that US citizens (ages 2 years and over) consume 4·4–5·9 oz (125·9–166·5 g) of total meat and 6·2–7·4 oz-eq (175·2–209·4 g-eq) from the USDA Protein Foods Group per day. Meat constitutes the majority of intake within the Protein Foods Group, and red meat and processed meat constitute the majority of total meat intake. Nutrient supply data indicate that total meat represents an estimated 43·1 % of the total protein available in the US food supply, but without any loss-adjusted nutrient data, per capita protein intake is best estimated by dietary recall data to be 79·9 g/d.

In order to address public health concerns related to excess meat and/or protein consumption, practitioners, educators and researchers must appropriately use available data sources in order to accurately report consumption at the population level. Implications for comparing these estimates with various recommended intakes are discussed.

Household food access remains a concern among primarily agricultural households in lower- and middle-income countries. We examined the associations among domains representing livelihood assets (human capital, social capital, natural capital, physical capital and financial capital) and household food access.

Cross-sectional survey (two questionnaires) on livelihood assets.

Metropolitan Pillaro, Ecuador; Cochabamba, Bolivia; and Huancayo, Peru.

Households (n 570) involved in small-scale agricultural production in 2008.

Food access, defined as the number of months of adequate food provisioning in the previous year, was relatively good; 41 % of the respondents indicated to have had no difficulty in obtaining food for their household in the past year. Using bivariate analysis, key livelihood assets indicators associated with better household food access were identified as: age of household survey respondent (P = 0·05), participation in agricultural associations (P = 0·09), church membership (P = 0·08), area of irrigated land (P = 0·08), housing material (P = 0·06), space within the household residence (P = 0·02) and satisfaction with health status (P = 0·02). In path models both direct and indirect effects were observed, underscoring the complexity of the relationships between livelihood assets and household food access. Paths significantly associated with better household food access included: better housing conditions (P = 0·01), more space within the household residence (P = 0·001) and greater satisfaction with health status (P = 0·001).

Multiple factors were associated with household food access in these peri-urban agricultural households. Food security intervention programmes focusing on food access need to deal with both agricultural factors and determinants of health to bolster household food security in challenging lower- and middle-income country contexts.

Middle Eastern and North African countries are undergoing nutrition transition, a transition which is associated with an increased burden of non-communicable diseases. This necessitates the evaluation of dietary patterns in these regions. The present study aimed to assess changes in dietary patterns in Middle Eastern and North African countries between 1961 and 2007.

Availability of energy and fifteen main food items during 1961–2007 was examined using FAO food balance sheets from the FAOSTAT database.

Fifteen countries including nine in the Middle East and six in North Africa were selected and the average availability of total energy and different food items in these regions were compared.

Over the 47 years studied, energy and food availability (apart from animal fats and alcoholic beverages) has increased in the Middle East and North Africa. In both regions the proportion of energy derived from meat and vegetable oils has increased significantly while that from cereals decreased significantly. In addition, the proportion of energy from milk and dairy products and vegetables has shown an ascending trend in North Africa while the proportion of energy from fruits has shown a descending trend in the Middle East.

The study results reveal an unfavourable trend towards a Westernized diet in the Middle East and, to a certain extent, in North Africa. Tailored nutritional education encouraging healthy eating for prevention of the burden of chronic diseases in these countries seems essential.