The Association between Community Food Environments and Health Outcomes in High-Income Countries: A Systematic Literature Review

Abstract

PURPOSE OF THE REVIEW: Unhealthy diets are a major modifiable factor contributing to chronic noncommunicable diseases and are highly influenced by the surrounding community food environment. This review aimed to summarize and synthesize the existing published evidence on the relationship between the community food environment and health outcomes in high-income countries. RECENT FINDINGS: A systematic literature review using five databases was conducted and reported according to PRISMA guidelines (Registration number: CRD42023463886). Data were extracted from 55 studies and summarised using narrative synthesis due to heterogeneity. A harvest plot was used to depict the associations between the community food environment and health outcomes for various "healthy" and "unhealthy" food environment metrics. Among 55 included studies, the most researched health outcomes were diabetes (n = 31; 56.4%), cardiovascular diseases (n = 22; 40%) and chronic disease-associated mortality (n = 8; 14.6%). The density of fast-food outlets was predominantly positively associated with diabetes (n = 14/24 associations), cardiovascular diseases (n = 14/27), and chronic disease-associated mortality (n = 5/6). Similarly, the presence of fast-food outlets (n = 7/9), the density of convenience stores (n = 7/13), and the ratio/proportion of unhealthy food outlets (n = 4/4) were predominantly positively associated with diabetes. Conversely, the density of full-service restaurants (n = 8/12) was predominantly negatively associated with diabetes. Emerging evidence suggests an association between the community food environment and health outcomes, including diabetes, cardiovascular diseases, and chronic disease-associated mortality. A lack of consistency in metrics used to characterise the community food environment remains a significant challenge to informing evidence-based policies and programs to improve community health outcomes.