RT Journal Article SR Electronic T1 The influence of the urban food environment on diet, nutrition and health outcomes in low-income and middle-income countries: a systematic review JF BMJ Global Health JO BMJ Global Health FD BMJ Publishing Group Ltd SP e006358 DO 10.1136/bmjgh-2021-006358 VO 6 IS 10 A1 Susannah Westbury A1 Iman Ghosh A1 Helen Margaret Jones A1 Daniel Mensah A1 Folake Samuel A1 Ana Irache A1 Nida Azhar A1 Lena Al-Khudairy A1 Romaina Iqbal A1 Oyinlola Oyebode YR 2021 UL http://gh.bmj.com/content/6/10/e006358.abstract AB Introduction Diet and nutrition are leading causes of global morbidity and mortality. Our study aimed to identify and synthesise evidence on the association between food environment characteristics and diet, nutrition and health outcomes in low-income and middle-income countries (LMICs), relevant to urban settings, to support development and implementation of appropriate interventions.Methods We conducted a comprehensive search of 9 databases from 1 January 2000 to 16 September 2020 with no language restrictions. We included original peer-reviewed observational studies, intervention studies or natural experiments conducted in at least one urban LMIC setting and reporting a quantitative association between a characteristic of the food environment and a diet, nutrition or health outcome. Study selection was done independently in duplicate. Data extraction and quality appraisal using the National Heart Lung and Blood Institute checklists were completed based on published reports using a prepiloted form on Covidence. Data were synthesised narratively.Results 74 studies met eligibility criteria. Consistent evidence reported an association between availability characteristics in the neighbourhood food environment and dietary behaviour (14 studies, 10 rated as good quality), while the balance of evidence suggested an association with health or nutrition outcomes (17 of 24 relevant studies). We also found a balance of evidence that accessibility to food in the neighbourhood environment was associated with diet (10 of 11 studies) although evidence of an association with health outcomes was contradictory. Evidence on other neighbourhood food environment characteristics was sparse and mixed. Availability in the school food environment was also found to be associated with relevant outcomes. Studies investigating our other primary outcomes in observational studies of the school food environment were sparse, but most interventional studies were situated in schools. We found very little evidence on how workplace and home food environments are associated with relevant outcomes. This is a substantial evidence gap.Conclusion ‘Zoning’ or ‘healthy food cart’ interventions to alter food availability may be appropriate in urban LMIC.PROSPERO registration number CRD42020207475.Data sharing not applicable as no datasets generated and/or analysed for this study. This systematic review examines data that is available in the published literature.