Structural constraints and psychosocial eating behaviours associated with dietary quality among reproductive-aged mothers in urban slums of Bangladesh

Dietary quality among women in urban slums may reflect structural constraints and eating behaviours, yet evidence examining both is limited. This cross-sectional study examined associations of food insecurity, work-time burden, and eating behaviours with dietary quality among 400 mothers aged 15–49 years in 20 urban slums of Dhaka, Bangladesh (two-stage stratified cluster sampling), and explored whether food insecurity moderated the emotional eating–dietary quality association. Dietary quality was assessed using the Bangladesh Healthy Eating Index (BD-HEI; 0–90) from a single 24-hour recall, and food insecurity using the Food Insecurity Experience Scale (FIES; 0–8). Multilevel models with slum random intercepts included linear and quadratic food insecurity terms (quadratic term improved fit, p < .001). Mean BD-HEI was 61.5 (SD 15.7), lowest for fruits and milk products. Predicted BD-HEI was 17.3 (95% CI: −24.2 to −10.5) and 18.6 points (−26.7 to −10.4) lower at FIES = 4 and 8, respectively, than at FIES = 0, mostly at low scores, with no statistically significant difference between FIES 6 and 8. Age (β = 0.375) was positively, and emotional eating (β = −0.872 per scale point; 95% CI: −1.696 to −0.048) negatively, associated with BD-HEI; work-time burden and residence duration were not significant after adjustment. The apparent food insecurity × emotional eating interaction was not supported with a quadratic term (joint test χ 2 (2) = 1.89, p = .389). Findings were similar including implausible energy reporters (n = 427); associations are cross-sectional and the nonlinear analyses data-driven.