The persistent burden of malnutrition, including undernutrition, micronutrient deficiencies, and overweight and obesity, disproportionately affects women and children in low- and middle-income countries. 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 examined the associations among cultivated, wild, built, and mixed FEs and diet and nutrition outcomes among women, children, and adolescents (<20 y) in low- and lower-middle-income countries. We searched 5 databases for studies published between 2000 and 2025, identifying 22,431 records. Eligible studies included women, children, and adolescents (<20 y); reported ≥1 FE exposure and assessed diet, nutrition, and/or food insecurity outcomes. FEs were classified using Downs et al. typology. A total of 155 studies met the 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 the 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, whereas 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 nondietary factors. Additionally, commonly used diet measures do not capture consumption of ultraprocessed 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 at PROSPERO as CRD42024497618.

Background Indigenous food systems of Indian tribal communities, hold potential to address the dual burden of malnutrition, and thus, comprehensive research on dynamics and complexity of food systems and their main drivers is critical to understand the root causes of poor nutrition in Indian tribes. Incorporating local food systems drivers into data-driven decision-making algorithms, can help improve food production, distribution, and consumption among Indian tribes through customized interventions to address malnutrition. The present study aims to assess indigenous food systems elements, their drivers and nutritional outcomes among diverse tribal communities of India and use novel data analytics to develop decision support algorithms for sustainable food systems solutions. Methods A prospective observational cohort study using mixed methods will be implemented across three tribal communities from three states of India: i) Gond tribal community of Mandla, Madhya Pradesh, ii) Garo tribal community of West Garo Hills, Meghalaya and iii) Pahari Korwa tribal community of Surguja, Chhattisgarh. Longitudinal data will be collected in all three tribal cohorts for a period of three years on food system elements (food supply chain and food environment), and different drivers like policy and governance, demographic, sociocultural, infrastructure and technology, biophysical and environment and economic drivers. Additionally, nutritional outcomes will be assessed as proximal outcomes (including household dietary patterns, nutritional intake, indigenous food consumption and dietary diversity in women and children under-five and the gut microbiota profile of women), and distal outcomes (including anthropometric indicators of women and children and nutritional and inflammatory biomarkers in women). The accumulated data from tribal cohorts will be used to formulate data-driven decision support tools using classical statistical procedures and machine learning informed optimization pathways to assess food system vulnerabilities and develop customized food systems interventions. Discussion The diverse data from several cross-sectoral domains, generated in the present study, will facilitate an objective assessment of the nuances of indigenous food systems. This will further guide the development of equity-focused, resource-optimized food systems interventions, which will be piloted for acceptability through inclusion of bottom-up voices from indigenous tribal communities as well as the stakeholders including policymakers and non-government organizations.

Background In Senegal, suboptimal infant and young child feeding (IYCF) practices contribute to persistent malnutrition. While community health workers are important, their reach in remote areas is often limited by geographic dispersion and high workloads. Mobile health (mHealth) offers a scalable approach to delivering evidence-based IYCF guidelines, yet evidence of its effectiveness in improving dietary outcomes remains limited. Objective This study evaluates a 16-week voice and text messaging intervention on minimum dietary diversity (MDD) and minimum meal frequency (MMF) among children aged 6–23 months. Study Design, Setting, Participants A cluster-randomized controlled trial was conducted across 3 regions of Senegal (Thiès, Diourbel, and Fatick). Villages were randomly assigned to intervention or control villages. Participants included caregivers of children aged 6–19 months at baseline who had access to a mobile phone. The intervention group received 16 weekly mobile voice and text messages in Wolof, consisting of 8 scripted and 8 unscripted messages from positive deviants grounded in the Theory of Planned Behavior. Measurable Outcome/Analysis Minimum dietary diversity (consuming 5 of 8 food groups) and MMF were assessed using 24-hour open dietary recall at baseline and endline. Data were analyzed using a difference-in-difference approach and generalized estimating equations to account for village-level clustering. Results In the unadjusted models, the interaction (treatment by time) was not significant for MDD (P = 0.25) or MMF (P = 0.80). Similarly, we observed the same trend after adjusting for covariates, MDD (adjusted odds ratio [aOR] = 1.33 [95% confidence interval (CI)], 0.75–2.35], P = 0.33) and MMF (aOR=1.06 [95% CI, 0.63–1.79], P = 0.83). However, both indicators improved significantly over time across both groups (P < 0.001). In addition, an increase in child age was significantly associated with MDD (aOR = 1.11 [95% CI, 1.07–1.16], P < 0.001). Conclusions We found that IYCF indicators improved significantly over time in both villages, but the intervention did not have a significant additional effect. This suggests that mHealth as a standalone approach may be insufficient for behavioral change. Future research should examine contextual and implementation factors that may influence the effectiveness of mHealth interventions. Funding National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (no. 1R21HD105067–01).

Objective: The objective of this study was to develop, implement and refine a food environment survey to capture people's perceptions of their food environments in low-and middle-income countries: the Food Environment Perceptions Survey (FEPS).Design: Identifying aspects of food environment to include drawing from existing survey instruments, a Delphi survey with food environment experts working globally, workshops with local experts in India and Cambodia, cognitive testing of the survey items and piloting the tools in diverse field settings in India and Cambodia.Setting: Rural, peri-urban and urban communities in India and Cambodia.Participants: Global food environment experts for the Delphi survey, food environment experts in India and Cambodia for workshops and a convenience sample of participants in India (n 44) and Cambodia (n 60) for FEPS piloting.Results: The FEPS underwent many iterations prior to piloting. The initial versions of the survey were long, leading us to remove questions and reconfigure the survey to streamline it. The workshop participants rated the revised survey versions relatively favourably. The final survey consists of 109 questions covering six sections: accessibility and availability (forty-eight questions); affordability (five questions), convenience (seventeen questions); quality and safety (three questions); information, promotion and labelling (sixteen questions); and an optional sustainability section (twenty questions). Based on pilot data, we found significant differences in how participants interacted with different food environment types across rural, peri-urban and urban transects.Conclusions: The finalised FEPS is a newly developed survey instrument that can be incorporated by other researchers to characterise diverse perceptions of food environments in low-and middle-income countries.

Food environments (the interfaces between consumers and the broader food system) shape dietary change and associated health outcomes. Characteristics of food environments (e.g., availability, accessibility, affordability, convenience, desirability) can influence consumer decision-making around food acquisition in different types of food environments (e.g., informal and formal markets, wild and cultivated natural environments). With the novel decision matrix approach presented in this paper, we aimed to develop a simple and rapid tool for collecting perceived evaluations and preferences of different types and characteristics of food environments. The decision matrix results were triangulated using a mixed methodology of geolocated participant observation, participatory mapping, market price comparisons and qualitative interviews. The decision matrix results were compared to the reported use of different food environment types in an Indigenous Pgaz K’Nyau community in Northern Thailand. Despite an ongoing food environment transition, participants preferred natural food environments and ranked market environments most poorly, largely reflecting actual food environment use. Interviewees stressed the importance of flavor and food safety, citing concerns over agrochemical contamination of market foods. The proposed decision matrix and mixed methods approach provides a rapid data collection method that can be used by food environment researchers and public health practitioners to assess food environment preferences and perceptions that influence decision-making in food environment transitions in low- and middle-income countries.

Diet is pivotal in preventing and managing cardiometabolic diseases. Our study aimed to describe the prevalence of poor diet quality and perceiving a poor diet as healthy and to determine individual-level factors associated with these groups. This cross-sectional study analyzed seven 2-year cycles of National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018, which included non-pregnant adults between 20 and 85 years old, who completed a one-day 24-h dietary recall and dietary interview. Diet quality was measured using the American Heart Association (AHA) primary diet score, and perceived diet quality was based on NHANES questionnaire response. Among 31,644 adults, the prevalence of poor diet quality was 47%. Male sex and smoking were associated with a higher risk of poor diet quality, while older age, higher levels of education, increased income, diabetes mellitus diagnosis, and increased vigorous activity levels were associated with a lower risk of poor diet quality. Among adults with poor diet quality (n = 14,952), 23% perceived their diet as healthy. In multivariable analysis, older age, higher education, and vigorous activity level were associated with a higher risk of perceiving a poor diet as healthy. Nearly half of US adults had poor diet quality based on AHA guidelines for cardiovascular health, yet nearly a quarter of them perceived their diet as healthy. This gap underscores the need for focused educational efforts and interventions in both healthcare and public health settings to dispel diet-related misperceptions and motivate the adoption of a healthier diet to address cardiometabolic health.

INTRODUCTION:Adolescents in informal urban communities, defined as settlements that fall outside of formal governmental planning and regulatory frameworks, are at increasing risk of poor-quality diets and malnutrition in all its forms. The food environment is the interface of adolescent food choice and the broader food system, and food environment interventions have the potential to improve adolescent diets and nutritional outcomes. METHODS AND ANALYSIS:We will conduct a mixed-methods study, integrating methods from participatory systems science and nutritional epidemiology to characterise linkages among adolescents' neighbourhood and home food environments, and their food choices, diets and nutritional outcomes. We will recruit adolescents, caregivers, school staff and food system actors from five communities along a gradient of urban informality in Nairobi, Kenya, to participate in cognitive mapping, group-based modelling and a cohort study over one academic year to evaluate dietary choices and nutritional outcomes. ETHICS AND DISSEMINATION:The study has been approved by the Research Ethics Committee of Rutgers University (Pro2024001981) and Amref Health Africa (P1831-2025). Adult participants will provide written informed consent, and adolescents will provide written informed assent to participate in the study. Findings will be disseminated through peer-reviewed journals, conference presentations and to participants through planned participatory interaction throughout the study.

Background The British Columbia Farmers ' Market Nutrition Coupon Program (BC FMNCP) provides households with low incomes with coupons to purchase healthy foods from farmers ' markets. Objective To examine the impact of the BC FMNCP on the short-term household food insecurity, malnutrition risk, mental well-being, sense of community (secondary outcomes), and subjective social status (exploratory outcome) of adults with low incomes post -intervention and 16 weeks post -intervention. Design Secondary analyses from a pragmatic randomized controlled trial conducted in 2019 that collected data at baseline, post -intervention, and 16 weeks post -intervention. Participants/setting Adults >= 18 years with low incomes were randomized to an FMNCP group (n = 143) or a no -intervention control group (n = 142). Intervention Participants in the FMNCP group received 16 coupon sheets valued at $21 Canadian dollars (CAD)/sheet over 10 to 15 weeks to purchase healthy foods from farmers ' markets and were eligible to participate in nutrition skill -building activities. Main outcome measures Outcomes included short-term household food insecurity (modi fied version of Health Canada 's 18 -item Household Food Security Survey Module), malnutrition risk (Malnutrition Universal Screening Tool), mental well-being (WarwickEdinburgh Mental Well -Being Scale), sense of community (Brief Sense of Community Scale), and subjective social status (MacArthur Scale of Subjective Social Status community scale). Statistical analysis Mixed -effects linear regression and multinomial logistic regression examined between -group differences in outcomes post -intervention and 16 weeks post -intervention. Results The risk of marginal and severe short-term household food insecurity was lower among those in the FMNCP group compared with those in the control group (relative risk ratio [RRR] 0.15, P = 0.01 and RRR 0.16, P = 0.02) post -intervention, with sustained reductions in severe household food insecurity 16 weeks post -intervention (RRR 0.11, P = 0.01). No statistically signi ficant differences were observed in malnutrition risk, mental well-being, sense of community, or subjective social status postintervention or 16 weeks post -intervention. Conclusions The BC FMNCP reduced short-term household food insecurity but was not found to improve malnutrition risk or psychosocial well-being among adults with low incomes compared with a no -intervention control group. J Acad Nutr Diet. 2024;124(4):466-480.

Background Food environments are rapidly changing in low- and middle-income countries (LMICs), leading to dietary shifts. Many gaps exist in the measurement of food environments in LMICs making it difficult to characterize the linkages between food environments and diets. Objective The objective of this study was to examine the feasibility of implementing USAID Advancing Nutrition's Market Food Environment Assessment (MFEA)—a suite of 7 non-resource intensive food environment assessments. Methods We implemented the MFEA package in 4 countries (Liberia, Honduras, Nigeria, and Timor-Leste) and assessed the feasibility of implementing the package by conducting a descriptive analysis, using both qualitative and quantitative data of enumerators’ feedback collected through training evaluations, feedback forms, detailed notes from meetings, and final reports from in-country partners. Results Overall, we found it feasible to implement the MFEA, some assessments being easier to implement and more practical than others. Several key themes related to the MFEA implementation were identified across the countries, including: the potential for vendors to be hesitant to engage in assessments; the importance of ascertaining buy-in from local officials; the need to shift toward electronic, rather than paper-based, data collection; difficulties in selecting markets; the time constraints of conducting some of the assessments; and the need for better alignment between the instructions, data collection, and data analysis sheets. Conclusions The package of food environment assessments, with minimal additional refinement, can be used to characterize market food environments in LMIC settings to inform context-specific interventions. Testing the feasibility of implementing a package of 7 assessments to measure factors influencing food access in low-resource settings

This study aimed to examine the impact of climate change curriculum on 5th-grade students' food choice and sustainability considerations. Insight into the drivers of food choice and sustainability considerations that were most salient among 5th-grade students were gleaned through interviews to assist in designing and implementing a school curriculum entitled People, Plants, and the Planet

Convenience is a major driver of food choice throughout the world, yet it is often inconsistently conceptualised, defined and measured. This limits the scope for food systems policy and interventions to leverage convenience to improve diet and nutrition outcomes. We conducted a systematic literature review to determine how convenience is both defined and measured in food environment and nutrition research. Six databases were systematically searched and studies were screened by two independent reviewers based on pre-defined eligibility criteria, yielding 243 studies for inclusion in the final review. 77% of studies did not explicitly define convenience. Among those that did, the dimensions and components within definitions varied. 83% of studies used perceived measures of convenience rather than objective measures. Convenience was most commonly measured in high income countries (64%) and in relation to the home food environment (53%), followed by formal retail (40%). Very few studies measured convenience in relation to the informal retail or cultivated food environments, and no studies considered convenience in relation to wild food environments. The vast majority of studies did not consider the validity or reliability of the measures of convenience. Based on our findings we propose a definition of convenience as a characteristic that results in reduced requirement for resources including time, physical effort, mental effort and skills by the consumer in relation to the planning, acquisition, preparation, storage, transport, consumption or clean-up of food. This definition can be used to help guide the development of measurement tools that can be used to assess convenience across different dimensions and contexts in a more comprehensive way. We also propose a framework for considering convenience as an entry point in food systems to improve diets and nutrition outcomes.

The consumption of animal-source foods, and particularly red meat from ruminants, is a major contributor to greenhouse gas emissions, freshwater use, and loss of biodiversity. Reducing red meat consumption has been identified as a key strategy to mitigate climate change; however, little is known about how to effectively intervene to promote its reduction in the United States (US). This study aimed to examine meat (red, unprocessed, and poultry) and seafood consumption patterns, the factors influencing their consumption (including a reduction in their consumption over time), and how these differed based on socioeconomic variables. The study was conducted through an online survey with a representative sample of the US population (n=1224) in 2021 using KnowledgePanel®. Overall, we found that most participants reported consuming red meat (78%), processed meat (74%), or poultry (79%) 1-4 times per week, with several differences in consumption patterns based on socio-demographic characteristics. A substantial proportion of the population reported reducing their red (70%) and processed meat (64%) consumption over the previous year, which was much higher than those that reported reducing poultry (34%) or seafood (26%). Key factors influencing red meat reduction were health and price, while environmental sustainability and animal welfare were less important, particularly among certain socio-demographic groups. These findings can help provide insight into how best to frame messaging campaigns aimed at shifting red meat consumption in the US to support climate change mitigation. Focusing on the factors that resonate more with consumers is more likely to lead to shifts in consumption patterns.

Objectives: To examine the impact of a mobile voice and text messaging intervention aimed at improving infant and young child feeding (IYCF) practices among children 6-23 months in Senegal. Methods: A cluster randomized control trial was conducted with children (n=488) living in 102 villages in three regions of Senegal in May-December 2022. Mothers and fathers of children in the experimental group voice and text messages over the course of the 16-week intervention (1 voice and text message per week). Primary outcomes for the RCT included anemia based on hemoglobin measurement using Hemocue finger prick machines. Household surveys were conducted at baseline and endline with parents in the experimental and control groups. Separate regression models were fitted for each outcome [linear regression for hemoglobin and logistic regression for anemia] and adjusted for intervention, time, and intervention by time interaction (of primary importance). The data were analyzed at the individual level and accounted for clustering. Results: At baseline, most of the children (69.3%) had anemia. The only statistical differences in the experimental and control households at baseline were their religious and ethnic backgrounds. In adjusted models, the intervention by time interaction term was significant in the hemoglobin model (p=0.04) but not in the anemia (p=0.18) models. This indicates that the intervention increased hemoglobin levels over time in children in the intervention group whilst it decreased in children in the control group. Conclusions: We found a significant increase in hemoglobin levels within the experimental group over the intervention period, indicating that the intervention likely had beneficial impacts on children included in the experimental group. Future work should combine voice and text messaging with interventions that improve food access to generate larger impacts on child nutrition. Funding Sources: Research reported in this publication was supported by the Eunice Kennedy Shriver National Institutes of Child Health & Human Development (1R21HD105067-01).

The Mediterranean dietary pattern (MDP) and Japanese dietary pattern (JDP) have received increasing attention from the scientific community and media, predominantly due to their association with increased longevity and health. Although similarities between the two dietary patterns are evident, a detailed comparison between them is still relatively unexplored. This narrative review aimed to explore the similarities and differences between the MDP and JDP in terms of longevity while also reflecting on the adoption of these diets by other populations outside their regions of origin. Both dietary patterns are plant-based, minimally processed, and sustainable for their respective regions and have been shown to significantly prolong life expectancy in different populations. Nevertheless, these dietary patterns also differ in terms of macronutrient ratios, food preparation and consumption and individual cultural characteristics of each population. Additionally, both dietary patterns are part of broader lifestyle patterns, which include other behaviors, such as abstaining from smoking, engaging in regular physical activity, having low stress levels and a sense of community, spirituality/religiousness and purpose. The promotion of these two dietary patterns should be implemented in other regions after considering cultural and socio-economical characteristics.

Food environments, or interfaces between consumers and their food systems, are a useful lens for assessing global dietary change. Growing inclusivity of nature-dependent societies in lower-and middle-income countries is driving recent developments in food environment frameworks. Downs et al. (2020) propose a food environment typology that includes: wild, cultivated, informal and formal market environments, where wild and cultivated are “natural food environments.” Drawing from transdisciplinary perspectives, this paper argues that wild and cultivated food environments are not dichotomous, but rather exist across diverse landscapes under varying levels of human management and alteration. The adapted typology is applied to a case study of Indigenous Pgaz K’Nyau food environments in San Din Daeng village, Thailand, using the Gallup Poll’s Thailand-adapted Diet Quality Questionnaire with additional food source questions. Wild-cultivated food environments, as classified by local participants, were the source of more food items than any other type of food environment (37% of reported food items). The case of Indigenous Pgaz K’Nyau food environments demonstrates the importance of understanding natural food environments along a continuum from wild to cultivated.

We critically reviewed the motivations, processes, and implementation methods underlying a faculty-driven diversity, equity, and inclusion (DEI) curriculum self-reflection project in the Rutgers School of Public Health. This case study offers guidance on a curriculum self-reflection tool that was developed through the school's Curriculum Committee to promote DEI throughout the school's curricula. We review the key steps in this process and the unique aspects of developing and implementing such evaluations within higher education. The study draws on faculty experience, was informed by students and staff within the Curriculum Committee, and builds on existing knowledge and tools. A flexible 6-step framework-including guiding principles and strategic approaches to planning, developing, and implementing a DEI curriculum self-assessment-is provided to assist instructors, curriculum committees, DEI groups, and academic leaders at schools of public health interested in refining their courses and curricula. Academic units experience contextual challenges, and while each is at a different stage in curriculum reform, our findings provide lessons about integrating the assessment of DEI in school curriculum in a systematic and iterative way. Our approach can be applied to diverse academic settings, including those experiencing similar implementation challenges.

Food environments are a critical place within the food system to implement interventions aimed at enabling sustainable diets. In this perspective article, we argue for the need for food environment research to more comprehensively examine the different types of food environments that people access within their communities to ensure that interventions and programs are better aligned with people’s lived experiences. We highlight the potential ways in which participatory mapping (PM) can be leveraged to better design food environment research by: (1) identifying the different food environment types that are accessed within a given community; (2) providing insight into the timing for data collection; (3) informing the prioritization of where to conduct food environment assessments; and (4) highlighting the dynamism of food environments over time (e.g., across a given day or across seasons). We provide a case study example of the application of PM and the lessons learned from it in Cambodia. By conceptualizing food environments in a more comprehensive way, from the perspective of the people living within a given community, we will be able to measure food environments in a way that more closely aligns with people’s lived experiences.