The role of the food environment as a driver of diet quality in children and adolescents

Abstract

The food environment, typically considered the place where individuals interface with food supply, is increasingly discussed for its role and opportunity to influence diet quality of individuals. Available studies suggest that the food environment plays a role for diet quality, but the pathway behind this remains unclear. It is also not well understood to what degree the role of the food environment is mitigated by individual factors, such as wealth, education or sex. Additionally, detailed analysis on the role of the food environment for specific age group (children and adolescents) is lacking. Lastly, a better understanding of how food environments differ from each other is needed to inform targeted, effective policies to improve diet quality.<br/> Consequently, the aim of this research was to investigate if, and to what degree, the food environment is associated with the diet quality of children and adolescents. More specifically, we analysed the relationship between food environment indicators and diet quality of young children in 20 LMICs (<strong>study I</strong>) and identified the variation of diet intake among individuals aged 6-18 years within Dortmund, Germany (<strong>study II</strong>). Additionally, individual-level factors that influence diet intake among adolescents (<strong>study III</strong>) and the association between food environment indicators and diet quality around schools in Accra, Ghana (<strong>study IV</strong>) were investigated.<br/> Results from <strong>study I</strong> show that diet intake and quality vary across geographical settings. This study (n = 247 subnational areas, 6-23 months) highlights that high variation of food environment indicators (e.g. food price and availability) exists across LMICs. It also shows a superordinate association between food environment indicators and diet quality at the subnational level. <strong>study II</strong> (n = 360, 6-18 years) captures variation at the city level, using data from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study and shows that, in comparison to the North of Dortmund, students in the South have lower BMI, lower intake of sugar-sweetened Beverages and higher intake of vegetables.<br/> Results from <strong>study III</strong> suggest that individual level factors create dependency of adolescents (n = 409, 12-15 years) on the food environment. We report that daily food budget is negatively associated with overall diet quality and positively with food group diversity. Food environment indicators are also associated with diet quality after controlling for individual factors (<strong>study IV</strong>). Research conducted in Accra documents that pricing of foods from vendors (n = 1,340) in and around schools (n = 12) are associated with diet intake of students (n = 409, 12-15 years) in the same location. This association persists even after controlling for individual factors, indicating that some drivers of dietary quality are outside the control of the individual.<br/> In conclusion, the food environment is an important factor in understanding the variation in diet quality for children and adolescents. This result was confirmed by data from observational studies carried out in subnational areas in 20 LMICs, Dortmund, Germany and Accra, Ghana. The consistent association of financial indicators (both prices and budget) with diet quality suggests that affordability should be a key consideration for policies aiming to ensure access to a healthy, nutritious diet within the food environment.