目的：食物环境是儿童营养状况的主要决定因素。低收入和中等收入国家(LMICs)存在关于食物环境的缺乏证据。这项研究旨在通过记录大突尼斯市学校周围食物环境的嗜肥性来填补这一空白，突尼斯-中东和北非地区的LMIC，营养持续转型，儿童肥胖率不断上升。
方法：在这项横断面研究中，我们评估了大约50所小学的建成食物环境。在每所学校800米的道路网络缓冲区内进行了实地调查，以收集食品零售商和食品广告集的地理坐标和图片。根据基于NOVA的分类，零售商和广告集被归类为健康或不健康。使用多项回归模型探索了学校特征与零售商或广告集之间的关联。
方法：大突尼斯，突尼斯。
方法：随机抽取50所（35所私立和15所公立）小学。
结果：总体而言，绘制了3,621家食品零售商和2,098个广告集。大约三分之二的零售商和广告被标记为不健康。大多数零售商是传统的街角商店（22％），只有6％是水果和蔬菜市场。推广的主要食品类别是碳酸饮料和含糖饮料（22％）。不健康零售商的比例在最富有的人群中明显高于最贫穷的地区。
结论：学校附近的食物环境主要包括不健康的零售商和广告。LMIC食物环境的绘图对于记录营养转变对儿童营养状况的影响至关重要。这将为遏制儿童肥胖流行的政策和干预措施提供信息。
OBJECTIVE: Food environments are a major determinant of children\'s nutritional status. Scarce evidence on food environments exists in low- and middle-income countries (LMIC). This study aims to fill this gap by documenting the obesogenicity of food environments around schools in Greater Tunis, Tunisia - an LMIC of the Middle East and North Africa region with an ongoing nutrition transition and increasing rates of childhood obesity.
METHODS: In this cross-sectional study, we assessed built food environments around fifty primary schools. Ground-truthing was performed to collect geographic coordinates and pictures of food retailers and food advertisement sets within an 800-m road network buffer of each school. Retailers and advertisement sets were categorised as healthy or unhealthy according to a NOVA-based classification. Associations between school characteristics and retailers or advertisement sets were explored using multinomial regression models.
METHODS: Greater Tunis, Tunisia.
METHODS: Random sample of fifty (thirty-five public and fifteen private) primary schools.
RESULTS: Overall, 3621 food retailers and 2098 advertisement sets were mapped. About two-thirds of retailers and advertisement sets were labelled as unhealthy. Most retailers were traditional corner stores (22 %) and only 6 % were fruit and vegetable markets. The prevailing food group promoted was carbonated and sugar-sweetened beverages (22 %). The proportion of unhealthy retailers was significantly higher in the richest v. poorest areas.
CONCLUSIONS: School neighbourhood food environments included predominantly unhealthy retailers and advertisements. Mapping of LMIC food environments is crucial to document the impact of the nutrition transition on children\'s nutritional status. This will inform policies and interventions to curb the emergent childhood obesity epidemic.
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