The Relationship Among Food Environment Types, Diet, and Nutrition Outcomes in Women, Children, and Adolescents from Low- and Lower-Middle-Income countries: A Systematic Review.

Authors

Halimat O Oyeneye, Alhanouf A Alghamdi, Wiktoria Staromiejska, Shauna Downs

Published in

Advances in nutrition (Bethesda, Md.). Pages 100698. Jul 04, 2026. Epub Jul 04, 2026.

Abstract

The persistent burden of malnutrition, including undernutrition, micronutrient deficiencies, and overweight and obesity, disproportionately affects women and children in low-and middle-income countries (LMICs). Rapid urbanization and globalization are reshaping food environments (FEs), yet evidence on how different FE types influence diets and nutrition outcomes among these populations remains fragmented and largely concentrated in upper-middle and high-income settings. This systematic review examines the associations among cultivated, wild, built, and mixed FEs and diet and nutrition outcomes among women, children, and adolescents (<20 years) in low- and lower-middle-income countries (LLMICs). We searched five databases for studies published between 2000 and 2025, identifying 22,431 records. Eligible studies included women, children and adolescents (<20 years); reported at least one FE exposure, and assessed diet, nutrition, and/or food insecurity outcomes. FEs were classified using the Downs et al. typology. A total of 155 studies met inclusion criteria, spanning 17 low-income and 32 lower-middle-income countries. Most studies were conducted in rural settings (n = 114, 74%), and cultivated FEs were the most frequently examined (n = 82, 53%), highlighting underrepresentation of peri-urban and urban settings undergoing rapid food system transitions. Access to wild FEs was consistently linked to higher dietary diversity and micronutrient intake. Some school FEs were associated with obesogenic dietary patterns, while in mixed FE settings, households commonly relied on multiple food sources to meet dietary needs. Across FE types, associations with anthropometric outcomes were modest and variable, likely reflecting slow biological responsiveness of growth indicators and non-dietary factors. Additionally, commonly used diet measures do not capture consumption of ultra-processed foods, limiting the detection of unhealthy dietary shifts during nutrition transitions. This review highlights the need for expanded FE research in underrepresented settings and improved diet assessment tools to capture diverse dietary patterns and inform context-specific interventions. This study was registered in PROSPERO (CRD42024497618).

PMID:
42401252
Bibliographic data and abstract were imported from PubMed on 05 Jul 2026.

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