ISPUP and WHO project evaluates street food in Central Asia and Eastern Europe

The FEEDCities project, which results from a partnership between the Instituto de Saúde Pública da Universidade do Porto (ISPUP) and the World Health Organization (WHO) Europe, along with other units at the University of Porto, sought to study the urban street food environment in the cities of several countries in Central Asia and Eastern Europe.

What is street food?

According to the WHO definition, street food is characterised as “ready-to-eat foods and beverages prepared and/or sold by street vendors, especially in the streets and other similar places”. This type of food, sold beyond four walls, is particularly relevant in the countries that were analysed, which can be classified as low and middle income countries.

As Sofia Sousa, one of the ISPUP researchers involved in the project, explains, “street food is usually more prevalent and relevant in low and middle-income countries, where it holds not only a cultural and gastronomic importance but also an economic one for many families in those regions”.

Central Asian and Eastern European countries are currently experiencing a sharp rise in the number of chronic noncommunicable diseases, such as cardiovascular diseases and cancer. At the same time, due to increasing globalisation, these regions have also been going through a nutritional transition characterised by the gradual replacement of traditional food patterns with more globalised ones, through a decrease in the consumption of fruit, vegetables, legumes and whole grains and an increase in the consumption of animal-based and processed foods, which are more energy-dense and richer in fat, sugar and sodium.

Given the importance of diet in the onset and progression of noncommunicable diseases, it was important for the researchers to address the lack of information about the dietary and nutritional habits of these countries’ populations.

“We realized that in these regions there is a very large gap in regards to research on dietary intake and the nutritional composition of foods that are available to the population, so we thought it would be relevant to conduct this study,” says Sofia Sousa.

Seven cities assessed

The researchers studied the urban street food environment in seven cities in Central Asia and Eastern Europe: Dushanbe (Tajikistan), Bishkek (Kyrgyzstan), Chișin ău (Moldova), Sarajevo and Banja Luka (Bosnia and Herzegovina), Almaty (Kazakhstan) and Ashgabat (Turkmenistan). Project implementation is now beginning in Tbilisi (Georgia).

Specifically, they evaluated the locations and the ready-to-eat foods available in these urban centres, characterised the buyers and their purchases, and assessed the nutritional composition of the products sold, taking into account their energy and macronutrient content, the sodium and potassium amount, and the lipid profile of each food.

In order to conduct the project, ISPUP researchers relied on local surveyors, as well as the assistance of WHO agencies and Public Health Institutes in each country, several WHO consultants and other partners who were involved in the study.

The findings

Across all the cities that were studied, researchers found a wide diversity of food and beverages, and local products such as fermented drinks and traditional dishes coexisted with westernised products such as industrial biscuits and crisps. The high availability of soft drinks and the low availability of fruit and vegetables in these outlets was another result that proved common to all the cities assessed.

Regarding the nutritional profile of the available food, it was found that, generally, these foods had an unhealthy profile and a high fat content, especially of saturated and trans fat, and a high sodium content, as shown in two of the several studies published as part of the project: “The Sodium and Potassium Content of the Most Commonly Available Street Foods in Tajikistan and Kyrgyzstan in the Context of the FEEDCities Project” and “Street food in Eastern Europe: a perspective from an urban environment in Moldova.”

Of the foods selected for nutritional analysis, some industrial products, such as wafers and chocolate, were found to have high contents of saturated and trans fats. However, some traditional and homemade dishes, such as savoury pastries and baked goods, often had a high content of these fatty acids as well, which, according to the ISPUP researcher, “may be a reflection of the use of unhealthy cooking practices by the sellers, such as the frequent use of fat sources that are lower in nutritional quality in the confection of their foods, often associated with frying as a cooking method.”

Overall, the main sources of sodium were found in homemade foods, especially in meat-based dishes and in savoury pastries and snacks, which may indicate the excessive use of salt and/or sodium-rich ingredients.

More recently, two studies that characterised street food shoppers in these regions – A Cross-Sectional Study of the Street Foods Purchased by Customers in Urban Areas of Central Asia and Nutritional Content of Street Food and Takeaway Food Purchased in Urban Bosnia and Herzegovina -, showed that men and overweight or obese shoppers tended to buy items with a less favourable nutritional profile, generally with higher values of saturated and trans fats, as well as sodium.

Other research conducted under the project, entitled The Price of Homemade Street Food in Central Asia and Eastern Europe: Is There a Relation with Its Nutritional Value? showed that homemade street foods had a low cost: $1 (US dollar) per portion. Traditional, locally sourced foods were significantly cheaper than westernised foods. “The fact that local dishes have a lower cost is good news, since they play a very important role in gastronomic and cultural preservation. These results advocate the need to improve the nutritional quality of these foods, promoting them as cost effective food options for the population,” adds the ISPUP researcher.

An innovative project

Sofia Sousa highlights the innovative component of this project due to its focus on the nutritional quality of street food in low and middle income countries, something which is not regularly seen in the literature. “Until the implementation of this study, the scientific evidence available on street food was essentially related to hygiene and food safety in points of sale. The FEEDCities project innovated by studying the nutritional composition of food, its availability, consumption and price,” she says.

Concurrently, the methodology used in the study, based on systematised and standardised procedures, has allowed for the collection of data that can be comparable between different cities and countries. “This methodology, created especially for this project, also has the advantage of being adaptable to the specificities of each food environment”, she indicates.

It is expected that the knowledge generated in the context of FEEDCities will have the potential to set precedents for the advancement of new research efforts in the area of nutrition and public health in these countries.

Similarly, with the results achieved, the researchers aim for the creation of interventions tailored to the street food context of these cities, ensuring the design of policies aimed at improving the nutritional profile and cost of food sold.

“This data highlights a set of priorities for action that must be multisectoral and involve the main actors in these food environments, which in this case are the vendors and the consumers. The vendors, by encouraging the use of more nutritionally interesting ingredients, and raising awareness for healthier cooking practices. Consumers, by educating and empowering them to make better food choices.

 “It is also important to extend these measures to other actors in the food system who may influence the availability, cost and nutritional quality of the food sold in these places, such as the food industry, through the reformulation of industrial products to improve their nutritional profile, or through other multi-sectoral government actions involving the ministries of health, agriculture or economy.”

The ultimate goal? The prevention of diet-related chronic noncommunicable diseases and the improvement of the nutritional and health status of the population of these cities.

The protocol of the FEEDCities project: A comprehensive characterization of the street food environment in cities, is available here.

Researchers Nuno Lunet, Gabriela Albuquerque, Susana Casal, Patrícia Padrão and Pedro Moreira, from the Epidemiology Research Unit (EPIUnit) of ISPUP, also participated in the project, which had the collaboration of three other units from the University of Porto: The Faculdade de Medicina, the Faculdade de Ciências da Nutrição, and the Faculdade de Farmácia.

The FEEDCities project is funded by the World Health Organization (WHO registration 2015/591370-0 and 2017/698514) and the Ministry of Health of the Russian Federation.

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