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

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