1. The association between food environment, diet quality and malnutrition in low‐ and middle‐income adult populations across the rural—Urban gradient in Vietnam.
- Author
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Vuong, Vy Thao, Fiorella, Kathryn J., Jones, Andrew D., Thi Trinh, Huong, Khoury, Colin K., Huynh, Tuyen Thi Thanh, Hoang, Ky The, and Nguyen, Kien Tri
- Subjects
OBESITY risk factors ,GEOGRAPHIC information systems ,CONFIDENCE intervals ,AGE distribution ,NUTRITION ,DIET ,FOOD supply ,RISK assessment ,INCOME ,HEALTH literacy ,SEX distribution ,MALNUTRITION ,QUESTIONNAIRES ,FACTOR analysis ,DESCRIPTIVE statistics ,RESEARCH funding ,FOOD quality ,BODY mass index ,RESIDENTIAL patterns ,ODDS ratio ,RURAL population ,EDUCATIONAL attainment ,DISEASE risk factors ,ADULTS - Abstract
Background: Economic reforms and trade liberalisation in Vietnam have transformed the food environment, influencing dietary patterns and malnutrition status. The present study focuses on the relationship between food environments (proximity and density of food outlets) and malnutrition (underweight, overweight, obesity) through diet quality in adult populations across urban, periurban and rural areas of Vietnam. Methods: We evaluated food environment by geospatial mapping of food outlets through a transect walk across the "food ecosystem" from rural to urban areas. Diet quality was assessed using the Diet Quality Index – Vietnamese (DQI‐V) comprising Variety, Adequacy, Moderation and Balance components. Malnutrition status was determined using body mass index. We performed a mediation analysis utilising mixed effect models to control for neighbourhood clustering effects. Confounders included age, education, income and nutrition knowledge score. Results: Analysis of data from 595 adult participants (mean ± SD age: 31.2 ± 6.4 years; 50% female) found that longer distance to the nearest food outlet was associated with higher overall DQI‐V (β = 2.0; 95% confidence interval = 0.2–3.8; p = 0.036) and the Moderation component (β = 2.6; 95% confidence interval = 1.2–4.0; p = 0.001). Outlet density shows a negative association with the odds of underweight among women (odds ratio = 0.62; 95% confidence interval = 0.37–0.96). However, we did not observe statistically significant relationships between diet quality and malnutrition. Education and nutrition knowledge scores were positively associated with diet diversity, while income was negatively associated with diet moderation. Conclusions: The findings of the present study have important implications for nutrition and dietetics practice in Vietnam and globally. It emphasises the need to consider various dimensions of sustainable diets, including economic, health and socio‐cultural/political factors. Longer distances to food outlets are associated with higher diet quality, whereas lower food outlet density increases the odds of underweight among women. This poses challenges in balancing modernisation and its adverse effects on sustainable food systems. Socio‐economic status consistently correlated with diet quality and malnutrition, necessitating further research to promote healthy diets across socio‐economic strata. Key points: Growing evidence supports the role of food environments in shaping diet quality and nutritional status based on body mass index, in both industrialised and industrialising countries.However, existing studies often focus on individual relationships between food environment and diet quality, diet quality and nutritional status, or food environment and nutritional status, leaving the full pathway from food environment to nutritional status via diet quality poorly understood, especially in industrialising countries.Although we did not have sufficient evidence to show the existence of a pathway from food environment to malnutrition through diet quality, we found intriguing associations:Longer distance to the nearest food outlet correlated with higher overall DQI‐V, particularly the Moderation component (control of unhealthy food consumption).Outlet density was inversely related to the odds of underweight among women.Education and nutrition knowledge scores positively influenced diet diversity, whereas income showed a negative association with diet moderation.The study underscores the significance of considering multiple dimensions of sustainable diets, such as economic, human health, and socio‐cultural/political aspects. This approach helps balance modernisation with healthy food environments, cultural preservation and social well‐being, both in Vietnam and globally.Industrialising countries' food environments differ significantly from industrialised countries, necessitating innovative approaches beyond proximity and density to understand their impact on food access, consumption patterns, and nutrition. This includes accounting for natural food environments, seasonal cycles, infrastructure disparities, small‐scale businesses, the informal sector, national culinary traditions and social fabric.Addressing the influence of socio‐economic factors on diet quality and malnutrition is crucial in developing effective strategies to combat malnutrition and promote better health outcomes, particularly among diverse socio‐economic groups. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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