Access to food outlets and children's nutritional intake in urban China: a difference-in-difference analysis

Background: In recent years supermarkets and fast food restaurants have been replacing those "wet markets" of independent vendors as the major food sources in urban China. Yet how these food outlets relate to children's nutritional intake remains largely unexplored. Method: Using a longitudinal survey of households and communities in China, this study examines the effect of the urban built food environment (density of wet markets, density of supermarkets, and density of fast food restaurants) on children's nutritional intake (daily caloric intake, daily carbohydrate intake, daily protein intake, and daily fat intake). Children aged 6-18 (n = 185) living in cities were followed from 2004 to 2006, and difference-in-difference models are used to address the potential issue of omitted variable bias. Results: Results suggest that the density of wet markets, rather than that of supermarkets, positively predicts children's four dimensions of nutritional intake. In the caloric intake model and the fat intake model, the positive effect of neighborhood wet market density on children's nutritional intake is stronger with children from households of lower income. Conclusion: With their cheaper prices and/or fresher food supply, wet markets are likely to contribute a substantial amount of nutritional intake for children living nearby, especially those in households with lower socioeconomic status. For health officials and urban planners, this study signals a sign of warning as wet markets are disappearing from urban China's food environment.