title: Interventions promoting healthy eating as a tool for reducing social inequalities in diet in low- and middle-income countries: a systematic review.
abstract: Diet is a major risk factor for non-communicable diseases (NCDs) and is also strongly patterned by socioeconomic factors. Whether interventions promoting healthy eating reduce social inequalities in diet in low- and middle-income countries (LMICs) remains uncertain. This paper aims to summarize current evidence on interventions promoting healthy eating in LMICs, and to establish whether they reduce social inequalities in diet.
  
  
  
  Systematic review of cross-sectional or quasi-experimental studies (pre- and post-assessment of interventions) in Pubmed, Scielo and Google Scholar databases, including adults in LMICs, assessing at least one outcome of healthy eating and showing results stratified by socioeconomic status.
  
  
  
  Seven intervention studies including healthy eating promotion, conducted in seven LMICs (Brazil, Chile, Colombia, Iran, Panama, Trinidad and Tobago, and Tunisia), met our inclusion criteria. To promote healthy eating, all interventions used nutrition education and three of them combined nutrition education with improved acces to foods or social support. Interventions targeted mostly women and varied widely regarding communication tools and duration of the nutrition education sessions. Most interventions used printed material, media use or face-to-face training and lasted from 6 weeks to 5 years. Four interventions targeted disadvantaged populations, and three targeted the entire population. In three out of four interventions targeting disadvantaged populations, healthy eating outcomes were improved suggesting they were likely to reduce social inequalities in diet. All interventions directed to the entire population showed improved healthy eating outcomes in all social strata, and were considered as having no impact on social inequalities in diet.
  
  
  
  In LMICs, agentic interventions promoting healthy eating reduced social inequalities in diet when specifically targeting disadvantaged populations. Further research should assess the impact on social inequalities in diet of a combination of agentic and structural approaches in interventions promoting healthy eating.
authors.affiliation: Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Bâtiment Biopôle 2, Route de la Corniche 10, 1010, Lausanne, Switzerland. Ana-Lucia.Mayen-Chacon@chuv.ch.
authors.forename: Ana-Lucia
authors.identifier: 0000-0001-9635-0416
authors.initials: AL
authors.lastname: Mayén
authors.affiliation: Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Bâtiment Biopôle 2, Route de la Corniche 10, 1010, Lausanne, Switzerland.
authors.forename: Carlos
authors.initials: C
authors.lastname: de Mestral
authors.affiliation: Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Zamora
authors.affiliation: Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Bâtiment Biopôle 2, Route de la Corniche 10, 1010, Lausanne, Switzerland.
authors.forename: Fred
authors.initials: F
authors.lastname: Paccaud
authors.affiliation: Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Pedro
authors.initials: P
authors.lastname: Marques-Vidal
authors.affiliation: Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Bâtiment Biopôle 2, Route de la Corniche 10, 1010, Lausanne, Switzerland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Bovet
authors.affiliation: Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Bâtiment Biopôle 2, Route de la Corniche 10, 1010, Lausanne, Switzerland.
authors.forename: Silvia
authors.initials: S
authors.lastname: Stringhini
mesh_terms: D000349:Africa; D000569:Americas; D003906:Developing Countries; D000072001:Diet, Healthy; D006266:Health Education; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007492:Iran; D011203:Poverty; D012923:Social Class
keywords: Diet; Education; Inequalities; Interventions; Low- and middle-income countries