The interplay between fast-food outlet exposure, household food insecurity, and diet quality in disadvantaged districts

Laura A van der Velde, Femke M P Zitman, Joreintje D Mackenbach, Mattijs E Numans, Jessica C Kiefte-de Jong

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)


OBJECTIVE: The current study aimed to explore the interplay between food insecurity, fast-food outlet exposure, and dietary quality in disadvantaged neighbourhoods.

DESIGN: In this cross-sectional study, main associations between fast-food outlet density and proximity, food insecurity status and dietary quality were assessed using Generalized Estimating Equation analyses. We assessed potential moderation by fast-food outlet exposure in the association between food insecurity status and dietary quality by testing for effect modification between food insecurity status and fast-food outlet density and proximity.

SETTING: A deprived urban area in the Netherlands.

PARTICIPANTS: We included 226 adult participants with at least one child below the age of 18 years living at home.

RESULTS: Fast-food outlet exposure was not associated with experiencing food insecurity (fast-food outlet density: b=-0.026, 95%CI=-0.076; 0.024; fast-food outlet proximity: b=-0.003, 95%CI=-0.033; 0.026). Experiencing food insecurity was associated with lower dietary quality (b=-0.48 per unit increase, 95%CI=-0.94; -0.012). This association was moderated by fast-food outlet proximity (p-interaction=0.008), and stratified results revealed that the adverse effect of food insecurity on dietary quality was more pronounced for those with the nearest fast-food outlet located closer to the home.

CONCLUSIONS: Food insecurity but not fast-food outlet density is associated with dietary quality. However, the association between food insecurity and dietary quality may be modified by the food environment. These findings could inform policy-makers to promote a healthier food environment including less fast-food outlets, with particular emphasis on areas with high percentages of food insecure households.

Original languageEnglish
Pages (from-to)1-20
Number of pages20
JournalPublic health nutrition
Publication statusE-pub ahead of print - 27 Oct 2020


  • Fast food
  • GIS
  • diet quality
  • food environment
  • food security
  • geographic information systems

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