Understanding differences in the local food environment across countries: A case study in Madrid (Spain) and Baltimore (USA)

• In Madrid, 40 food stores vs. 14 in Baltimore were located in average neighborhoods.
• There were no specialty stores carrying fresh foods in Baltimore vs. 12 in Madrid.
• In Madrid, 77% of the residents vs. 1% in Baltimore can access healthy foods within 200 m.
• Interventions might promote small-sized food stores and more walkable neighborhoods.

Places where we buy food influence dietary patterns, making local food environments a good example of a mass influence on population diets. Cross-cultural studies, using reliable methods, may help understanding the relationship between food environments and diet-related health outcomes. We aimed to understand cross-national differences in the local food environment between Madrid and Baltimore by comparing an average neighborhood in each city in terms of food store types, healthy food availability, and residents' pedestrian access.During 2012–2013, we assessed one neighborhood (~ 15,000 residents) in each city selecting median areas in terms of socio-demographic characteristics (segregation, education, aging, and population density). We collected on-field data on (a) number and types of all food stores, (b) overall healthy food availability and (c) specific availability of fruits & vegetables. Throughout a street network analysis (200 m, 400 m and 800 m) of food stores with high healthy food availability, we estimated residents' pedestrian accessibility.We found 40 stores in Madrid and 14 in Baltimore. Small food stores carrying fresh foods in Madrid contrasted with the high presence of corner and chain convenience stores in Baltimore. In Madrid, 77% of the residents lived within less than 200 m from a food store with high healthy food availability. In contrast, 95% of Baltimore's residents lived further than 400 m from these stores.Our results may help promoting interventions from local city agencies to allocate resources to existing small-sized food stores, and to improve walkable urban environments. These actions may influence food choices, especially for those residents lacking access to private vehicles.