Urban Nutrition in the Global South: A Narrative Review of Current Research

Abstract

According to the Global Food Policy Report 2017, nearly 90% of the projected urban population increase by 2050 is going to be concentrated in Africa and Asia. Parallel evidence suggests that poverty and related challenges of food insecurity and undernutrition are also urbanizing. The dynamics underlying urban nutrition is different from rural ones but also arguably represents a more complex scenario. In this review, we synthesize available evidence on urban nutrition (in)security in the Global South. Although focused on nutrition-centric literature, our review also identifies and discusses studies in the contexts of the broader notion of urban food systems. Articles that analyzed any form of mal/nutrition were eligible for inclusion. One hundred sixty-nine articles were shortlisted based on a systematic search strategy, then expanded through a backward and forward literature survey. Our review identifies key emergent themes from a large body of research on urban food systems, noting that surprisingly few address nutrition directly. Rather, current literature on urban nutrition is scattered and skewed with an overt focus on urban agriculture. Our review reveals that the existing literature with direct nutrition relevance in an urban context can be systematically organized across three themes, i.e., urban agriculture, nutrition transition, and social protection. Noticeably, this literature also draws upon successful interventions having implications for urban nutrition. Finally, the review identifies a few research gaps that hinder a holistic view of urban nutrition. These gaps pertain to gender, equity, water (along with sanitation and hygiene), and local governance.

Introduction

Food and Agriculture Organization’s (FAO) [1] widely accepted definition of food security—“when all people, at all times, have physical and economic access to sufficient safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life”—captures many different concerns including not only the availability, access, quality, and nutritional value of food but also cultural preferences. What is evidently missing from this definition is a focus on the dynamics underlying nutrition security, such as the interactions with water and sanitation insecurity. Although the dimension of “utilization” in the FAO [1] definition gives space to some aspects of water and sanitation [2], it does so only partially. The 2012 report of the Committee for World Food Security broadened the benchmark for food security to “when all people, at all times, have physical, social and economic access to food which is safe and consumed in sufficient quantity and quality to meet their dietary needs and food preferences, and is supported by an environment of adequate sanitation, health services and care, allowing for a healthy and active life” [3]. This recasts the focus on food security to that of nutrition security as a marker of the state of health [4]; however, most literature does not yet adhere to this distinction, favors the earlier FAO’s definition [1], and uses the concepts of food and nutrition security somewhat interchangeably. Nevertheless, there is general recognition that, unlike as conceptualized under the Food Availability Discourse (FAD), food and nutrition outcomes are contingent upon a complex process of access and entitlement.

Access is a particularly important issue in the urban context [5], noting that this process of entitlement is likely significantly different in urban settings compared to rural ones [2]. In examining the four dimensions (i.e., availability, access, utilization, and stability of access) of nutrition security identified in the FAO definition, each suggests unique underlying pathways that may be particular to urban areas. For example, in rural areas, food may be consumed from one’s own production, but in urban areas, access to food almost entirely depends upon market purchases and cash economy [6]. Food affordability and utilization for individuals within urban areas in low- and middle-income countries (LMIC) depends upon urban space, among others [7]. With the increase of urbanization in LMIC, access to space is a challenge.

The Global Food Policy Report 2017 observes that nearly 90% of the projected urban population increase is concentrated in Africa and Asia—with China, India, and Nigeria alone expected to add 900 million urban residents by 2050 [8]. Given this, what invites multiple concerns is not only the magnitude of growth but also the nature of urbanization in the middle- and lower-income nations. For example, urbanization in developing countries is largely characterized by congestion, filth, and pollution [9]. In addition to dealing with the traditional urban challenges (e.g., housing, water, unemployment, crime, and pollution), city authorities now also need to tackle the challenges related to food security and nutrition amidst rapid urbanization—especially in low- and middle-income countries [10]. There is growing evidence that poverty, food insecurity, and malnutrition (rather than undernutrition) are moving to the cities as the world’s population becomes more urbanized [11, 12]. Also, the relationship between urbanization and child nutrition outcomes is non-linear, i.e., it varies across stages of urbanization [13, 14].

These trends together represent a complex scenario for nutrition security in urban areas, and thus, there is an urgent need to understand how current knowledge on urban scenario deals with this complexity and what are the key gaps that must be addressed. Therefore, in this review paper, we synthesize available evidence on urban nutrition security in the “Global South.” Our review is focused on nutrition-centric literature, but it includes an overview of studies on the broader notion of urban food systems. In discussing this literature, we also identify gaps in the available literature that indicate future research opportunities.

Review Methodology

This paper conducts a narrative review broadly following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [15].

Our strategy included a systematic search from the following databases: Elsevier (Scopus), Directory of Open Access Journals, PubMed, EBSCO Host, and Web of Science. Our search was conducted in two rounds with the initial focus being on urban food and nutrition security, urban hunger, and urban food systems. Based on major themes emerging from the first round of search and guided by the UNICEF [16] framework on child malnutrition, we conduct a second round of literature search.

In the second round of literature search, we adopted a sub-thematic focus, wherein six sets of coincident keywords/terms were used for the literature search: (1) urban agriculture, (2) urban diet (including diet quality and safety) and micronutrient deficiencies, (3) gender, care, and urban nutrition, (4) governance and urban nutrition, (5) social protection and urban nutrition, and (6) urban nutrition and water, sanitation, and hygiene (WASH). Articles that analyzed any form of mal/nutrition (e.g., undernutrition, overnutrition, micronutrient deficiency, and dietary diversity) were eligible for inclusion. Articles that focused on high-income countries, as per the latest World Bank definition [17], and those looking at rural food and nutrition security were excluded from our review. Our search was expanded through a backward and forward literature search with each identified relevant article. The review was not date-limited and was inclusive of both qualitative and quantitative studies situated in low-income, lower-middle-income, and upper-middle-income countries. The resulting selection was 169 papers (see Fig. 1).

Fig. 1.

PRISMA flow diagram on identification, screening, and selection of papers for review

Results

Our review finally included 169 papers. We structured our review summary on the issue of urban nutrition security to encompass four recognized dimensions—availability, access, utilization, and stability of access plus WASH; however, our review organizes the literature in terms of key strands of available knowledge. These 169 articles are classified in Table 1 according to the country covered, study types/designs, and themes captured.

Table 1.

Classification of reviewed papers

Countries	Study types/design	Themes
Nigeria (2), Ghana (3), Bangladesh (6), Bogota (1), Other (73), Kenya (13), India (16), Zambia (1), Burkina Faso (3), Vietnam (6), Philippines (1), Tanzania (2), Brazil (7), Egypt (1), Pakistan (1), Ecuador (2), South Africa (7), Ethiopia (5), Cambodia (1), Mozambique (1), Senegal (1), China (4), Peru (2), Sri Lanka (1), Uganda (1), Nepal (1), Indonesia (2), Malaysia (1), Cameroon (1), Zimbabwe (1), Mexico (2)	Quantitative (80), Qualitative (20), Mixed method (8), Theoretical (38), Reviews (23)	Overall urban food security and systems (18), urban agriculture and urban nutrition (49), nutrition transition and urban nutrition (30), social protection and urban nutrition (28), others/varied themes (44)

Locating Nutrition within Urban Food System: Current Knowledge

Although nutrition is a key component of urban food systems, our review revealed that literature on the latter seldom focuses on urban nutrition specifically. A scattered and small set of studies revolve around urban food systems—particularly production systems, supply chain, land use planning, rural–urban linkages, retail and food safety environment, food prices, and urban planning/governance [18–35]. Several studies dealt with the conceptualization and measurement of urban food security and systems and include both reviews and empirical papers [6, 10, 19, 36–38]. All these studies do not typically provide an explicit connection to urban nutrition, though they contain some critical pathways inevitably linked to nutrition outcomes in LMIC. For example, Toriro [22] addresses how appropriate urban land use planning should encourage urban agriculture, thus improving food availability and, possibly, nutrition. Solomon and Gross [36] discuss the likely changes in diet, lifestyle, and health that urbanization invokes and has more direct implications for urban nutrition. Bel-Serrat et al. [39] conduct a systematic review of vegetable intake in a low-income urban context with potential linkages with nutrition.

This set of identified literature also touches upon human-food relationships in an urbanized world—including the ways of producing, shopping, and consuming food, as well as ideas about sanitation and cleanliness surrounding food systems [40]. Most of the identified literature along this theme addresses one or more aspects of this dynamics. Urban agriculture, as linked to the production system in the context of urbanization, has fetched the most attention within the urban food system literature [41–44]. Urbanization and nutrition transition is the second most researched topic within urban food systems literature. Since access to food is a key issue in urban areas, the role of informal food vending and supermarkets (constituting the retail environment) has been explored in several studies [45, 46]. While supermarkets have been examined for their role in catalyzing the urban nutrition transition [47, 48], informal food vendors have also been highlighted as a nutritional cushion for the urban poor [46].

In addition, urban food systems have been analyzed, although less frequently, from the perspectives of gender, equity, sustainability, and climate change [49–54]. Most of this literature has been published in planning and policy realms (e.g., land use planning and regionalization) and does not address urban nutrition directly. A few studies focus on the performance of food and nutrition interventions and report mixed findings [55–57]. Sani et al. [58], using a generic conceptual framework, assess the relationship between water, energy, and food and also address the negative impact of water and energy crisis on food and nutrition outcomes. Very little literature explores gender inequality in nutrition by exploring food consumption differences within urban areas [59–61]. We identified only two studies [62, 63] linking sanitation (specifically WASH) to urban nutrition. Finally, an array of recent studies examine urban nutrition in the aftermath of COVID-19 in LMIC [64–66].

We also came across several systematic and scoping review papers, which are mostly focused on urban agriculture. In terms of the implication for urban nutrition, the literature mentioned above is scattered and touches upon a multitude of issues; however, if we examine urban nutrition exclusively, available literature can be understood through three themes: urban agriculture, nutrition transition, and social protection. This literature and its connection with specific dimension of urban nutrition are summarized in Fig. 2.

Fig. 2.

Thematic organization of urban nutrition literature and the dimensions of nutrition security they address

Theme A: Urban Agriculture and Urban Nutrition Security

Urban agriculture is the most dominant theme in the literature on urban food and nutrition security—particularly in the context of Africa [5, 37, 67–70], though there are studies based in Asia [71, 72] and Latin America [73] also. We found papers reviewing and synthesizing evidence on the importance of urban agriculture in providing food security [42, 74–79]. Part of this comes from a productionist perspective on urban hunger [38] and addresses the availability dimension of nutrition security directly. In fact, as Frayne et al. [80] observe in their bibliometric analysis of urban food security, the majority of research on this issue still remains productionist in nature with a focus on urban agriculture, community garden, etc.

But urban agriculture is recognized also for its multidimensional role, including in providing food access [81, 82]. As summarized in Zezza and Tasciotti [79], there are several ways through which urban agriculture may theoretically impact urban nutrition. At the household level, urban agriculture can be a source of income, can directly enhance availability and access to diversified nutritionally rich foods (vegetables, fruit, meat), can increase the stability in food consumption against seasonality or other temporary shortages, and can increase the time spent on child care, as opposed to non-agricultural activities that are more likely to be located further away from home.

“Urban agriculture” is defined as a large variety of activities [78, 83], including small-scale community gardens, which have been considered a sustainable alternative to traditional agricultural food supply to cities [43, 84–87]. Empirical studies using varied research strategies reveal positive impacts of urban agriculture on food and nutrition outcomes by improving dietary diversity, reducing food expenditure, and changing consumption behavior [13, 70, 73, 75, 85, 86, 88–96].

Notably, urban agriculture has been found to contribute to nutrition through both adaptation and coping. For example, Maxwell [97], in a quantitative study based in Kampala, Uganda, found that urban farming is largely a long-term adaptive strategy adopted by women to protect the food security of the persons for whom they are responsible—either through the direct provision of a supplemental source of food or a food reserve. In Nepal, Moucheraud et al. [98] found that participation in peri-urban agriculture is associated with improved dietary diversity for women and reduced child stunting. It was particularly notable that household production was found to lead to enhanced consumption of vegetables, leading to lower odds of stunting among children. An exploratory study carried out in Salvador found that community gardens enhance access to healthy food, despite a visible lack of policy support [99]. Maxwell et al. [100] note that not only is urban agriculture significantly correlated with higher child nutritional status, but it is probably the single most important determinant. Steenkamp et al. [83] underscore the multidimensional potential of urban agriculture not only in improving urban nutrition but also in addressing other urban risks such as unemployment, community decline, and food deserts.

Another aspect related to urban agriculture that emerged in the review is urban livestock management. Zezza and Tiacoiti [79] estimate that, although less common than cropping activities, livestock activities in some countries (e.g., Bangladesh, Nepal, Ecuador, and Nicaragua) are undertaken by about one in three urban households. Fishing, particularly, is an important activity contributing to the reduction of multiple forms of food and nutrition insecurity [101–106]. The consumption of wild-caught animals by urban poor household is widespread in Amazonia’s forested pre-frontier, which purportedly improved nutrition [106]. Even in urban settings, such “bushmeat” and fish can play an important role in increasing dietary diversity [107].

Although urban agriculture is considered a crucial strategy for combating urban hunger, it has been found to be inaccessible by the urban poor, and it is the well-off—not the poor—who have been found to undertake urban agriculture [108]. Agroecological systems such as urban and peri-urban food forests tend to require significant capital in the initial stages [44]. In Malaysia, Rezai et al. [86] found that growing daily basic vegetable intake led to improving fresh food availability, accessibility, and nutritional intake status; however, households with higher income are more likely to witness the gain. Tevera [109], in their study conducted in Zimbabwe, Kenya, and Zambia, discovered that the real poor do not seem to benefit much from urban agriculture because their access to land is too circumscribed. Thus, urban agriculture has been found to support the poor, but not the poorest [110]. Although Zezza and Tacointti [79] confirmed in their analysis that urban agriculture was associated with greater dietary diversity and calorie availability, their analysis was done at a country level and could not account for intra-population disparities. There are also risks considered to be associated with both urban agriculture and livestock management. For example, waste water used in urban agriculture may contaminate produced food, or intensive irrigation may cause malaria and other waterborne diseases. Proximity to livestock amidst urban congestion can also create exposure to disease and infections [111]. There are also sustainability challenges associated with urban agriculture (e.g., decline in water table) [106, 112, 113]. Much needs to be understood in the context of these challenges; however, despite the growing volume of literature on urban agriculture, empirical evidence on its impact and scale remains limited [78].

Theme B: Nutrition Transition and Dietary Change

Nutrition transition due to changing dietary preferences pertains to both access and utilization dimensions of nutrition security. The process called “nutrition transition,” a term introduced by Barry Popkin in the 1990s, has come to dominate the urban populations of today’s developing nations in particular [114]. Also known as “diet globalization,” nutrition transition indicates a consumption shift to a diet high in fats and sweeteners promoted via the opening up of trade, foreign investment, shifts in global and local food industry production systems, and marketing, as well as changes in household lifestyles and choice [115, 116]. Urbanization-driven broad lifestyle changes associated with this nutrition transition are, in turn, leading to the double burden of malnutrition—wherein both under-nutrition and overnutrition co-exist in the same community, household, or individual [32, 117–124].

Several studies have considered how urbanization is causing shifts in consumption pattern with greater intake of non-traditional, ready-made, and processed foods [114, 124–130]. Reardon et al. [131] estimated that the share of processed food in urban food expenditure was 70% in Bangladesh, 72% in Indonesia, 64% in Nepal, and 87% in Vietnam. Brouzes et al. [132], in their study on urban Egyptian women, found that young cohorts had the highest proportion of being overweight. The dietary data revealed unbalanced nutrient intakes, with a high intake of total sugars, saturated fatty acids (SFAs), and sodium and an insufficient intake of vitamin D, folate, potassium, and iron. In urban areas, people get more of their dietary energy from easily accessible and affordable food high in fat, sugar, and salt, producing an obesogenic environment [133]. An ethnographic study on an indigenous community in Ecuador also found that urban residence was a key driver of nutrition transition [134]. Notably, the other two identified drivers—loss of cultural identity and household dietary patterns—are also influenced by urbanization. A study in urban Vietnam on more than 500 children aged 2–5 years found that one in every four children was clinically overweight, and this was associated with food consumption patterns [135]. The same emphasis on “unhealthy” food is also observed in school cafeterias (e.g., carbonated drinks) [136]. Cockx et al. [137], in a panel study in Tanzania, compared dietary patterns before and after the respondents migrated to urban areas with those staying back in rural areas. The decline in the consumption of traditional staples was significantly pronounced for those who moved to urban areas. Urban people in general spend more income on processed food and food away from home. This is due to an urban effect causing individuals to be away from home more that is independent of key socioeconomic and demographic variables [125, 138]. Urbanization is also found to be associated with a sedentary lifestyle, reduced physical activities, and a prevalence of clinically defined obesity and overweight via body measures. Urban areas in LMIC primarily depend upon the service sector, which does not involve physical labor as much as rural jobs [130].

Furthermore, often a lack of time due to work outside the home or increased female labor force participation is associated with the consumption of assorted fast food compared to a traditional staple-based meal [136]. Time scarcity has earlier been linked to an increase in the consumption of convenient and readymade food, which also increases the risk of non-communicable diseases such as diabetes [139]. Due to urbanization being associated with greater involvement in work outside the home and shifts in women’s role from reproductive to productive segment, time scarcity is inevitable. Hasan et al. [136], in their qualitative study situated in Dhaka city of Bangladesh, found that lack of time to prepare food for children was a common topic of discussion among mothers. In such a scenario, convenience becomes a key determinant of fast-food choices. In a qualitative study in South Africa, 59.1% of study participants stated that convenience is a key factor influencing their food choices [140].

Another factor impacting urban nutrition transitions pertains to modern value chains that serve national and regional markets, particularly in urban areas, that now complement traditional markets [71, 141]. Proximity to these value chains has a direct impact on consumption pattern, dietary behavior, and nutrition outcomes [142, 143]. Easy access to supermarkets in urban areas is one of the factors considered to be responsible for the shift to processed food consumption [47, 144]. Demmler et al. [47], in their cross-sectional observational study conducted in Kenya, established that purchasing food in supermarkets run in urban areas is associated with the prevalence of overweight and obesity and other non-communicable diseases such as diabetes. This is proposed to be due to the increased consumption of processed food and mediated by factors such as the easy availability of processed food, special offers, and shopping environment. In parallel, supermarkets decrease the amounts of energy obtained from unprocessed food items such as fresh vegetables and grains [47].

Increased urban incomes are also linked with dietary changes—namely increased demand for animal-sourced food, fats, oils, refined grains, and fruits and vegetables [145]; however, the double burden of malnutrition among the urban poor also emerges from the relatively cheaper cost of unhealthy food in urban areas. Erzse et al. [146] conducted a qualitative study in a rapidly transitioning South African town. Study participants noted that their local food environment was unhealthy, particularly due to the high number of unhealthy food service outlets (e.g., food vendors) in the neighborhood. Moreover, urban food vendors and the informal food sector are important sources of food access to the urban poor with the advantages of proximity, low cost, and selling on credit [46, 147–149]. As such, urban poverty is also often posed as a driver of overweight and obesity [150].

One study situated in an urban neighborhood in Sri Lanka captured the impact of COVID-19 on the nutrition of women and children through a baseline and follow-up study [151]. An increase in the percentage of clinically overweight children was observed and explained through the increase in consumption of cheaper products and unhealthy food due to limited choices and increased sedentary behavior during lockdown periods. This study also observed an elevation in the double burden of malnutrition among children as the prevalence of wasting had increased. Auma et al. [152], in a primary study located in three Indonesian cities, found that after COVID-19, households in all cities substituted nutrient-dense (ND) foods with cheaper alternatives. Both women’s and children’s dietary diversity reduced during the post-pandemic period when compared with the pre-pandemic period.

Theme C: Social Protection and Urban Nutrition

Social protection is the third coherent theme emerging from our review, though it has received comparatively less attention in the literature than the other two themes. Studies on social protection are mostly effectiveness studies, including findings from nutrition trials. Social protection is recognized as an essential tool to address poverty and hunger [153] through increasing access to food; however, there is mixed evidence concerning urban nutrition. For example, using data collected through a primary survey, [55] assessed the impact of urban safety programs on food expenditure and intake capacity of urban poor in Ethiopia. This was a quasi-experimental study involving both beneficiary (treatment) and non-beneficiary (control group). Food purchasing power of beneficiary households was found to be significantly higher than that of non-beneficiaries. There was also a significant difference in daily food intake in the two groups, in favor of beneficiary households. Positive impacts have been reported for Mexico’s Prospera—a multi-faceted social support program—in both rural and urban areas [154]. In another study, Derso et al. [155] assessed the prevalence of food insecurity and associated factors among Urban Productive Safety Net Program beneficiary households in Ethiopia. This community-based cross-sectional study was conducted among 624 beneficiary households. Despite the safety programs, the authors found that 70.2% of households ate smaller amounts of meals than preferred. Three in four beneficiaries were assessed as food insecure. This is in line with what Vilar-Compte et al. [150] note: social safety programs are important but insufficient to mitigate the lack of access to food. In a theoretical paper, Sonnino et al. [56] considered the evolution of a school feeding program in Brazil. Through the lens of reflexive governance, they showed how the changing policy landscape surrounding the school feeding program incorporated values of decentralization and participation and created a marked dent in the prevalence of hunger and malnutrition in the country. Several studies have assessed the impact of the COVID-19 pandemic on food and nutrition outcomes in cities, including the role of social security. For example, Auma et al. [152], in their study across three Asian cities (Jakarta, Quezon City, Yangon) note that in Yangon, households that did not receive COVID relief payments were much less likely to consume fruits and vegetables when compared with households that received relief payments. Similarly, women in Jakarta, if their households received food subsidies, were four times more likely to attain minimum dietary diversity. In Quezon City, women in households receiving food subsidy were less likely to consume unhealthy food. This shows that cash assistance can have positive impacts on the diets of the poorest during a crisis [156].

Contrary to the above, however, several studies on social protection and nutrition conducted programmatic assessment of nutrition support programs. For example, Shah et al. [57] evaluated the impact of a school-based health and nutritional education program on the knowledge and behavior of schoolchildren in three cities of India. The survey also included parents and school teachers. A marked gap was observed in nutrition knowledge, as defined clinically among the respondents; however, significant improvement was reported in re-assessment post intervention. An exploratory qualitative study was done by Ramani et al. [157] in informal settlements in the city of Mumbai in India. This study looked at the perspective of frontline nutrition program workers on working in convergence with the public health sector. Cross-sector convergence was limited due to technical unfamiliarity with “health-sector” issues on the frontline, discomfort with data sharing, and a lack of meaningful incentives. There were also marked structural gaps in the setup of the urban nutrition program. In a cross-sectional study conducted in Dhaka, Bangladesh, quality assessment of nutrition services was done in terms of structural readiness, process, and client satisfaction. Nutrition training of health workers was found to be low. Participants attending public facilities had significantly lower satisfaction compared to those attending private and NGO health facilities.

Research Gaps

In this section, we move from reviewing literature to considering obvious gaps or inconsistencies that require resolution and the new research directions they suggest. We have selected four main themes that we consider especially fertile spaces for expanding our understanding of urban nutrition in LMIC.

Gender and Urban Nutrition

Despite the recognition of the gendered nature of hunger and nutrition insecurity, the gender-relevant discourse in the current reviewed literature primarily focuses on closing the gender gap in agriculture [158] and rural food security; however, there are numerous ways besides food production through which urban nutrition can have gendered dynamics. Urbanization has been found to alter women’s labor force participation with greater segregation between the reproductive and productive spaces [159]. Urbanization leads to shifts in gender roles which then can lead to changes in women’s relationships with food and food security management [160]. These changes have direct and indirect effects on dietary and nutrition outcomes [161]. Current urban nutrition literature acknowledges these changing relationships, but only a few attempt a thorough analysis [60, 61].

Water Security (Sanitation and Hygiene) and Urban Nutrition

WASH interventions in recent times have been found to produce inconsistent impact on child stunting outcomes, which is intriguing. Three randomized controlled trials (RCTs)—WASH Benefits in Kenya and Bangladesh and the SHINE trial in Zimbabwe—were deployed to provide causal evidence in testing the effects of WASH on a child’s growth and anemia. All three RCTs reported no effect of their respective WASH intervention on child stunting [162–164]. Newer pathways linking water and nutrition need to be identified. A few studies have attempted to unfold these pathways [165]. But these require further investigation.

Notably, the relationship between WASH and urban nutrition is important also from the perspective of climate change. In an urban context, climate change impact translates into shocks to food prices and other supply chain disruptions that make the urban poor particularly vulnerable [166]. Climate extremities, through their effect on water (along with sanitation and hygiene), can also impinge upon urban nutrition. However, our review could not find many papers in this area.

Equity in Urban Nutrition

Urban food and nutrition system is relatively more complex with a simultaneous interface between multiple actors, processes, identities, and agencies. Thus, both absolute poverty and inequality are likely drivers of urban malnutrition in the Global South [167–169]. Only a few studies acknowledge the need to account for power imbalances within urban food systems while addressing the concerns of the underprivileged [170–172]. The issue of intersectionality and entitlement becomes pertinent in the urban context but remains under-researched vis-à-vis urban nutrition.

Role of Local Government in Urban Nutrition

Finally, the role of local government in shaping urban nutrition in the Global South is yet another area that suffers from a gap in research. Current understanding of local government and urban nutrition is dominated by experience from the North [145, 173]. The hunger challenges faced by cities in developing countries are entirely different from those encountered in developed countries. Whether, and how, local government in the Global South mediates urban nutrition outcomes through its interference with the entitlement structure of the poor is an under-researched dimension.

Conclusion

This paper has identified and reviewed major strands of urban food system research with a particular focus on those directly connected to nutritional quality and adequacy. Given the unique contexts and implications of urban nutrition insecurity compared to rural areas, both research and policy require more theory-situated tools and detailed case studies from urban areas to build an adequate evidence base. That is, there is an array of studies that analyze some dimensions of urban food systems; however, very few of these consider nutrition directly. Several research gaps have been identified that represent fertile ground for future research.