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.

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.