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In Vietnam, lifestyles are changing as a result of industrialisation, globalisation, increasing disposable incomes and urbanisation(1–8). Combined, these factors are leading to changes in consumer demand for food products(8–15). Correspondingly, food retailing is transforming to meet the changing needs of consumers(10–20). For example, in urban Vietnam, traditional food markets and vendors (e.g. formal wet markets, informal street markets, street stalls and hawkers) now exist alongside modern food retailers (e.g. formal hypermarkets, supermarkets and convenience stores)(5,9–11,21) and ‘western-style’ food service establishments.
A variety of western-style food service establishments, including fast food chains (e.g. McDonalds, KFC), family-style restaurants (e.g. Pizza Hut) and coffee shops/cafés (e.g. Starbucks)(5,21), can now be found in most urban areas in Vietnam. For consumers, these western food establishments may be substitutes for traditional ‘street food’ vendors that have long been part of the local food culture in Vietnam, offering time-pressed urban consumers affordable, convenient, relatively nutritious food (e.g. pho, a popular street food, traditionally contains lean sources of protein and vegetables). However, consumers may be attracted to modern western food service establishments through advertising which promotes consumer benefits such as appealing food (tasty, more palatable), improved food safety, more sanitary facilities and even status(10–12).
There are concerns that changes in the food environment in urban Vietnam are contributing to an undesirable diet and nutrition transition, characterised by increasing consumption of energy-dense and highly processed western foods at the expense of nutrient-dense, lower energy traditional foods(1–3,18). Energy-dense diets have been shown to be associated with higher rates of diet-related non-communicable diseases, including obesity, type 2 diabetes and cardiovascular disease (CVD)(22–33). A number of studies in emerging Asian countries, including China(20), Indonesia(17,18), Malaysia(34) and Thailand(19), have examined the relationship between food market modernisation, diet quality, diet transition and non-communicable diseases, and the findings have been mixed.
Two relevant recent studies have examined the relationship between retail transformation and measures of diet quality in Vietnam. A study of 400 women of reproductive age in Hanoi used mixed methods, including household surveys and 24-h dietary recall, and found no significant association between food retail transformations and dietary quality(10). Another study found that food...