Associations between the residential food environment and diet: The Generation R Study

The neighbourhood food environment is a potentially modifiable determinant of children's diets, yet evidence for associations with dietary outcomes remains mixed. This study examined cross-sectional associations between residential food environment characteristics and dietary outcomes among 8-year-old Dutch children, and whether maternal education (indicating household socioeconomic status) moderated these associations. Data were drawn from (n = 3739) children in the Generation R Study, a population-based birth cohort in Rotterdam, the Netherlands. Residential food environment exposure was assessed using Geographic Information System-based measures of absolute and relative fast-food outlet density and an overall neighbourhood food environment healthiness score within 400m from children's residences. Dietary outcomes were derived from a parent-reported Food Frequency Questionnaire, and included a validated overall diet quality score (out of 10), and non-core food and drink intake (g/day). Associations were examined using generalized linear models, adjusting for potential confounders. Findings revealed limited and unexpected associations. A healthier food environment score was associated with children's poorer diet quality, and no interaction with maternal education was found. Greater absolute fast-food outlet exposure was associated with better diet quality, but only among children with higher-educated mothers (+0.021 point/outlet, 95% CI: 0.008, 0.034). No associations were found between relative fast-food outlet density and any dietary outcomes. No consistent associations were found for food environment exposure and non-core food and drink intake. In the urban Dutch context, neighbourhood food environments showed weak and inconsistent associations with child diet, with some evidence of potential moderation by household socioeconomic status. These findings highlight the need for multidimensional research and intervention strategies that consider family resources and cultural context to effectively support healthy eating among children.