Abstract
Changes in lifestyle and food environment have created a heavy burden of obesity and chronic disease in China. However, measurements of the food environment have been rarely reported in China or other countries with similar food cultures; this measurement shortage is partially due to the lack of valid and reliable measurement tools. The aim of the present study was to adapt and validate a Chinese version of the Nutritional Environment Measurement Survey for Stores (C-NEMS-S). Categories and items of the NEMS-S were culturally adapted to fit the Chinese population and included grains, dry beans, starchy tubers, vegetables, fruits, seafood, meat and poultry, dietary oils, milk, bread, instant noodles, and beverages. A scoring sheet for each food category was created to measure availability, quality, and pricing. Then, the C-NEMS-S was validated in 10 large-sized supermarkets and 10 convenience stores in Shenyang, China. Two trained raters performed their evaluations separately at the same store. The intra-class correlation coefficient (ICC) of the availability composite score was 0.98. All food measures had a moderate or good ICC (0.41 to 1.00). The kappa for each food measure ranged from 0.52 to 1.00. C-NEMS-S was able to show the difference in healthy food availability between large-sized supermarkets and convenience stores, as well as the price differences between healthier options and regular options. Large-sized supermarkets had a significantly higher total score (p < 0.001) and healthier option availability for all food measures (all items were statistically significant (p < 0.05), except sugar-free beverages). Healthier options cost more than regular options for grains, milk, bread, and instant noodles (from 4% to 153%). The adapted C-NEMS-S can be used to measure the consumer food environment in stores in China.
Highlights
The food environment, which could be called a nutrition environment, refers to the physical presence of food that affects a person’s diet, a person’s proximity to food store locations, the distribution of food stores, food service, any physical entity by which food may be obtained, or a connected system that allows access to food [1]
Twelve measures were included in the C-Nutritional Environment Measurement Survey-Stores (NEMS-S)
The C-NEMS-S adapted in this study had high inter-rater reliability and was able to display the differences in healthy food availability between large-sized supermarkets and convenience stores, as well as the price differences between healthier options and regular options
Summary
The food environment, which could be called a nutrition environment, refers to the physical presence of food that affects a person’s diet, a person’s proximity to food store locations, the distribution of food stores, food service, any physical entity by which food may be obtained, or a connected system that allows access to food [1]. The food environment plays an important role in food choice, eating patterns, and energy intake [2]. It is widely reported that the food environment is associated with the increasing epidemic of childhood and adult obesity [3,4,5,6]. Res. Public Health 2019, 16, 782; doi:10.3390/ijerph16050782 www.mdpi.com/journal/ijerph
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: International journal of environmental research and public health
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
