Geographic disparities in Healthy Eating Index scores (HEI-2005 and 2010) by residential property values: Findings from Seattle Obesity Study (SOS)

Residential Density Is Associated With BMI Trajectories in Children and Adolescents: Findings From the Moving to Health Study

Introduction

This study investigates the associations between built environment features and 3-year BMI trajectories in children and adolescents.

Methods

This retrospective cohort study utilized electronic health records of individuals aged 5-18 years living in King County, Washington, from 2005 to 2017. Built environment features such as residential density; counts of supermarkets, fast-food restaurants, and parks; and park area were measured using SmartMaps at 1,600-meter buffers. Linear mixed-effects models performed in 2022 tested whether built environment variables at baseline were associated with BMI change within age cohorts (5, 9, and 13 years), adjusting for sex, age, race/ethnicity, Medicaid, BMI, and residential property values (SES measure).

Results

At 3-year follow-up, higher residential density was associated with lower BMI increase for girls across all age cohorts and for boys in age cohorts of 5 and 13 years but not for the age cohort of 9 years. Presence of fast food was associated with higher BMI increase for boys in the age cohort of 5 years and for girls in the age cohort of 9 years. There were no significant associations between BMI change and counts of parks, and park area was only significantly associated with BMI change among boys in the age cohort of 5 years.

Conclusions

Higher residential density was associated with lower BMI increase in children and adolescents. The effect was small but may accumulate over the life course. Built environment factors have limited independent impact on 3-year BMI trajectories in children and adolescents.

Longitudinal study of changes in greenness exposure, physical activity and sedentary behavior in the ORISCAV-LUX cohort study

BACKGROUND

Greenness exposure has been associated with many health benefits, for example through the pathway of providing opportunities for physical activity (PA). Beside the limited body of longitudinal research, most studies overlook to what extent different types of greenness exposures may be associated with varying levels of PA and sedentary behavior (SB). In this study, we investigated associations of greenness characterized by density, diversity and vegetation type with self-reported PA and SB over a 9-year period, using data from the ORISCAV-LUX study (2007-2017, n = 628).

METHODS

The International Physical Activity Questionnaire (IPAQ) short form was used to collect PA and SB outcomes. PA was expressed as MET-minutes/week and log-transformed, and SB was expressed as sitting time in minutes/day. Geographic Information Systems (ArcGIS Pro, ArcMap) were used to collect the following exposure variables: Tree Cover Density (TCD), Soil-adjusted Vegetation Index (SAVI), and Green Land Use Mix (GLUM). The exposure variables were derived from publicly available sources using remote sensing and cartographic resources. Greenness exposure was calculated within 1000m street network buffers around participants' exact residential address.

RESULTS

Using Random Effects Within-Between (REWB) models, we found evidence of negative within-individual associations of TCD with PA (β = - 2.60, 95% CI - 4.75; - 0.44), and negative between-individual associations of GLUM and PA (β = - 2.02, 95% CI - 3.73; - 0.32). There was no evidence for significant associations between greenness exposure and SB. Significant interaction effects by sex were present for the associations between TCD and both PA and SB. Neighborhood socioeconomic status (NSES) did not modify the effect of greenness exposure on PA and SB in the 1000 m buffer.

DISCUSSION

Our results showed that the relationship between greenness exposure and PA depended on the type of greenness measure used, which stresses the need for the use of more diverse and complementary greenness measures in future research. Tree vegetation and greenness diversity, and changes therein, appeared to relate to PA, with distinct effects among men and women. Replication studies are needed to confirm the relevance of using different greenness measures to understand its' different associations with PA and SB.

Multi-omics approach to socioeconomic disparity in metabolic syndrome reveals roles of diet and microbiome

The epidemy of metabolic syndrome (MetS) is typically preceded by adoption of a "risky" lifestyle (e.g., dietary habit) among populations. Evidence shows that those with low socioeconomic status (SES) are at an increased risk for MetS. To investigate this, we recruited 123 obese subjects (body mass index [BMI] ≥ 30) from Chicago. Multi-omic data were collected to interrogate fecal microbiota, systemic markers of inflammation and immune activation, plasma metabolites, and plasma glycans. Intestinal permeability was measured using the sugar permeability testing. Our results suggest a heterogenous metabolic dysregulation among obese populations who are at risk of MetS. Systemic inflammation, linked to poor diet, intestinal microbiome dysbiosis, and gut barrier dysfunction may explain the development of MetS in these individuals. Our analysis revealed 37 key features associated with increased numbers of MetS features. These features were used to construct a composite metabolic-inflammatory (MI) score that was able to predict progression of MetS among at-risk individuals. The MI score was correlated with several markers of poor diet quality as well as lower levels of gut microbial diversity and abnormalities in several species of bacteria. This study reveals novel targets to reduce the burden of MetS and suggests access to healthy food options as a practical intervention.

Urban densification over 9 years and change in the metabolic syndrome: A nationwide investigation from the ORISCAV-LUX cohort study

A growing body of evidence suggests that urban densification may be protective against obesity, type 2 diabetes, and cardiometabolic diseases, yet studies on how built environmental features relate to metabolic syndrome (MetS) and its components are scarce. This longitudinal study examines the associations of baseline urban density and densification over 9 years with MetS and MetS components, among 510 participants enrolled in both waves of the ORISCAV-LUX study (2007-2017) in Luxembourg. A continuous MetS score (siMS) was calculated for each participant. Six features of residential built environments were computed around participants' home address: street connectivity, population density, density of amenities, street network distance to the nearest bus station, density of public transport stations, and land use mix. A composite index of urban densification (UDI) was calculated by averaging the six standardized built environment variables. Using adjusted generalized estimating equation (GEE) models, one-SD increase in UDI was associated with a worsening of the siMS score (β = 0.07, 95% CI: 0.02, 0.13), higher triglyceride levels (β = 0.05, 95% CI: 0.02, 0.09), and lower HDL-c levels (β = -1.29, 95% CI: -2.20, -0.38). The detrimental effect of UDI on lipid levels was significant only for participants living in dense areas at baseline. Higher baseline UDI, as well as increased UDI over time among movers, were also associated with greater waist circumference. There were no associations between UDI, fasting plasma glucose and systolic blood pressure. Sex and neighborhood socio-economic status did not moderate the associations between UDI and the cardiometabolic outcomes. Overall, we found limited evidence for an effect of urban densification on MetS and its components. Understanding urban dynamics remains a challenge, and more research investigating the independent and joint health effect of built environment features is needed to support urban planning and design that promote cardiometabolic health.

Nine-year exposure to residential greenness and the risk of metabolic syndrome among Luxembourgish adults: A longitudinal analysis of the ORISCAV-Lux cohort study

Growing evidence shows a beneficial effect of exposure to greenspace on cardiometabolic health, although limited by the cross-sectional design of most studies. This study examined the long-term associations of residential greenness exposure with metabolic syndrome (MetS) and MetS components within the ORISCAV-LUX study (Wave 1: 2007-2009, Wave 2: 2016-2017, n = 395 adults). Objective exposure to residential greenness was measured in both waves by the Soil-Adjusted Vegetation Index (SAVI) and by Tree Cover Density (TCD). Linear mixed models were fitted to estimate the effect of baseline levels and change in residential greenness on MetS (continuous score: siMS score) and its components (waist circumference, triglycerides, HDL-cholesterol, fasting plasma glucose and systolic blood pressure), respectively. This study provides evidence that an increase in SAVI, but not TCD, may play a role in preventing MetS, as well as improving HDL-cholesterol and fasting plasma glucose levels. Greater baseline SAVI was also associated with lower fasting plasma glucose levels in women and participants living in municipalities with intermediate housing price, and greater baseline TCD was associated with larger waist circumference. Overall, findings suggest a mixed impact of increased greenness on cardiometabolic outcomes. Further longitudinal research is needed to better understand the potential effects of different types of greenness exposure on cardiometabolic outcomes.

Artificially sweetened beverages and urinary incontinence-a secondary analysis of the Women's Health Initiative Observational Study

OBJECTIVE

The aim of this study was to determine if higher artificially sweetened beverage intake is associated with higher prevalence of urinary incontinence symptoms.

METHODS

We conducted a secondary analysis of data from the Women's Health Initiative Observational Study. Our analytic cohort included 80,388 women. Participants who answered questions about beverage consumption and urinary incontinence symptoms at a 3-year follow-up visit were included. Demographic characteristics were compared between three groups of beverage consumers: never to less than one serving per week, one to six servings per week, and greater than or equal to one serving per day. Multivariable logistic regression models were constructed to estimate odds and type of urinary incontinence and adjust for potential confounders.

RESULTS

Most participants (64%) were rare consumers of artificially sweetened beverages, with 13% ( n = 10,494) consuming greater than or equal to 1 serving per day. The unadjusted odds of reporting urinary incontinence were 10% to 12% higher in women consuming one to six servings per week (odds ratio [OR], 1.10; 95% CI, 1.06-1.14) or greater than or equal to one serving per day (OR, 1.12; 95% CI, 1.07-1.18) versus never to less than one serving per week. In multivariable analyses, women consuming greater than or equal to one serving per day (ref: never to <1 serving/wk) had 10% higher odds of reporting mixed urinary incontinence (OR, 1.10; 95% CI, 1.02-1.19). There were no significant differences for stress or urgency urinary incontinence symptoms between groups.

CONCLUSIONS

When compared to never to less than one serving per week, women consuming greater than or equal to one serving per day of artificially sweetened beverages had 10% greater odds of reporting mixed urinary incontinence after adjustments. Amount of artificially sweetened beverage consumption was not associated with stress or urgency urinary incontinence symptoms.

Association of Artificially Sweetened Beverage Consumption and Urinary Tract Cancers in the Women's Health Initiative Observational Study

Background

Insufficient data exist to conclude whether consumption of artificially sweetened beverages is associated with a higher risk of urinary tract cancers.

Objective

We sought to investigate whether urinary tract cancer incidence differed among women who consumed various amounts of artificially sweetened beverages.

Design setting and participants

This was a secondary analysis of data from the Women's Health Initiative Observational Study, a multicenter longitudinal prospective study of the health of 93 676 postmenopausal women with a mean follow-up time of 13.5 yr. Women were identified at 40 clinical centers across the USA and enrolled from 1993 to 1998. Women between the ages of 50 and 79 yr were enrolled. We included women who answered questions about artificially sweetened beverage consumption and reported no prior urinary tract cancer diagnoses. The frequency of artificially sweetened beverage consumption was categorized as follows: rare artificially sweetened beverage consumption (never to fewer than one serving per week), frequent consumption (one to six servings per week), and daily consumption (more than one servings per day).

Outcome measurements and statistical analysis

The incidence of urinary tract cancer reported during subsequent visits until February 28, 2020 was recorded. Demographic characteristics were compared between those with varying levels of artificially sweetened beverage consumption. Descriptive statistics were used to report the rates of urinary tract cancer diagnosis, and Cox regression models were constructed to determine hazard ratios and adjust for potential confounders.

Results and limitations

We identified 80 388 participants who met the inclusion criteria. Most participants (64%) were infrequent consumers of artificially sweetened beverages, with 13% (n = 10 494) consuming more than one servings per day. The incidence of urinary tract cancers was low, with only 804 cases identified. Cox regression models showed that frequent artificially sweetened beverage consumption was associated with a higher risk of kidney cancer (adjusted hazard ratio 1.34, 95% confidence interval 1.03-1.75). There was no significant association between artificially sweetened beverage intake and bladder cancer.

Conclusions

Frequent consumption of artificially sweetened beverages may be associated with a higher risk of kidney cancer among postmenopausal women.

Patient summary

A secondary analysis of the Women's Health Initiative Observational Study showed that higher consumption of artificially sweetened beverages was associated with a higher risk of kidney cancer.

Regional Difference in the Effect of Food Accessibility and Affordability on Vegetable and Fruit Acquisition and Healthy Eating Behaviors for Older Adults

The food environment has been determined to affect a range of healthy eating and health indicators, but the study on the regional difference of food environment effects on these outcomes is limited. This study aimed to examine whether food environment factors influence vegetable and fruit acquisition and healthy eating behaviors in urban and rural areas using a nationwide dataset. The study participants were community-dwelling older adults aged 65 years and older (n = 830) who participated in the 2019 Consumer Behavior Survey for Food provided by the Korea Rural Economic Institute. Food environment factors were assessed using questionnaires measuring perceived food accessibility and affordability. The negative perceptions of food environment were related to lower vegetable and fruit acquisitions and poor healthy eating behaviors. The higher risks of low vegetable and fruit acquisitions in older rural adults were related to a negative perception of food accessibility only (odds ratio [OR]: 2.34, 95% confidence interval [CI]: 1.27-4.32 for vegetable; OR: 1.96, 95% CI: 1.02-3.75 for fruit). For older urban adults, negative perceptions of both food accessibility and food affordability were related to the increased risk of low vegetable acquisition (OR: 2.03, 95% CI: 1.07-3.83 for food accessibility; OR: 2.52, 95% CI: 1.26-5.04 for food affordability). In terms of healthy eating behaviors, for those who perceived that either food accessibility or affordability was poor, older urban adults were less likely to have various and healthy food eating behaviors when they had a negative perception of affordability (OR: 0.47, 95% CI: 0.25-0.90 for variety; OR: 0.23, 95% CI: 0.11-0.46 for eating healthy foods); however, older rural adults were less likely to have the behaviors when they had a negative perception of accessibility (OR: 0.49, 95% CI: 0.21-0.97 for variety; OR: 0.28, 95% CI: 0.13-0.63 for eating healthy foods). In conclusion, the negative perceptions of food accessibility and affordability were related to low vegetable acquisition and poor healthy eating behaviors. The effects of food accessibility and affordability on vegetable and fruit acquisitions and healthy eating behaviors were different between urban and rural areas.

Associations between neighborhood built environment, residential property values, and adult BMI change: The Seattle Obesity Study III

Objective

To examine associations between neighborhood built environment (BE) variables, residential property values, and longitudinal 1- and 2-year changes in body mass index (BMI).

Methods

The Seattle Obesity Study III was a prospective cohort study of adults with geocoded residential addresses, conducted in King, Pierce, and Yakima Counties in Washington State. Measured heights and weights were obtained at baseline (n = 879), year 1 (n = 727), and year 2 (n = 679). Tax parcel residential property values served as proxies for individual socioeconomic status. Residential unit and road intersection density were captured using Euclidean-based SmartMaps at 800 m buffers. Counts of supermarket (0 versus. 1+) and fast-food restaurant availability (0, 1–3, 4+) were measured using network based SmartMaps at 1600 m buffers. Density measures and residential property values were categorized into tertiles. Linear mixed-effects models tested whether baseline BE variables and property values were associated with differential changes in BMI at year 1 or year 2, adjusting for age, gender, race/ethnicity, education, home ownership, and county of residence. These associations were then tested for potential disparities by age group, gender, race/ethnicity, and education.

Results

Road intersection density, access to food sources, and residential property values were inversely associated with BMI at baseline. At year 1, participants in the 3rd tertile of density metrics and with 4+ fast-food restaurants nearby showed less BMI gain compared to those in the 1st tertile or with 0 restaurants. At year 2, higher residential property values were predictive of lower BMI gain. There was evidence of differential associations by age group, gender, and education but not race/ethnicity.

Conclusion

Inverse associations between BE metrics and residential property values at baseline demonstrated mixed associations with 1- and 2-year BMI change. More work is needed to understand how individual-level sociodemographic factors moderate associations between the BE, property values, and BMI change.

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Strong, inverse cross-sectional relationships between the built environment, residential property values (a proxy for individual socioeconomic status), and measured BMI were observed.

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Measures of the built environment and residential property values showed modest and inconsistent associations with 1- and 2-year BMI change.

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There was suggestive evidence that age may moderate the association between urban density and 1- and 2-year BMI change while education may moderate the association between residential property values and 2-year BMI change.

Infancy Dietary Patterns, Development, and Health: An Extensive Narrative Review

Correct dietary patterns are important for a child’s health from birth to adulthood. Understanding a child’s health as a state of entire physical, mental, and social well-being is essential. However, reaching adulthood in a complete health proper state is determined by feeding and dietary habits during preconception, pregnancy, or children infancy. Different factors, such as the mother’s lifestyle, culture, or socioeconomic status, are crucial during all these phases. In this review, we aimed to assess the long-term associations between infancy dietary patterns and health and their influence on development and growth. To reach this objective, a consensus critical review was carried out using primary sources such as scientific articles, and secondary bibliographic indexes, databases, and web pages. PubMed, SciELO, and Google Scholar were the tools used to complete this research. We found that high-income countries promote high-calorie foods and, consequently, obesity problems among children are rising. However, undernutrition is a global health issue concerning children in low- and middle-income countries; thus, parental socioeconomic status in early life is essential to children’s health and development, showing that biological, social, and environmental influences are increased risk factors for chronic diseases. This narrative review is aimed to collect evidence for early nutritional intervention and future disease prevention.

Driving Distance and Food Accessibility: A Geospatial Analysis of the Food Environment in the Navajo Nation and Border Towns

The Navajo Nation, an area home to approximately 173,000 people in the southwest United States, experiences the highest rates of food insecurity in the United States and is classified as a food desert. The present study assessed the accessibility to food outlets (grocery stores, convenience stores, and restaurants) as measured by driving time on the Navajo Nation and in selected surrounding border towns. Food outlets located in neighboring border towns were examined using network analysis tools in ArcGIS Pro to calculate driving distance and examine the potential impact of driving time within the Navajo Nation on accessibility to nutritious foods. There were 14 grocery stores, 21 convenience stores, and 65 restaurants identified in the Navajo Nation using Mergent Intellect, a proprietary database, as compared to border towns which had a total of 542 grocery stores, 762 convenience stores, and 3,329 restaurants equaling a ratio of about 50:1 (grocery, 39:1; convenience, 36:1; restaurants, 51:1) when comparing food outlets nearby versus on the Navajo Nation. This ecological study presents a visual representation of driving time and food accessibility, revealing geographic areas within the Navajo Nation where access to border town food stores is sparse, and food insecurity may be elevated.

Quality of automatic geocoding tools: a study using addresses from hospital record files in Temuco, Chile

Abstract: Automatic geocoding methods have become popular in recent years, facilitating the study of the association between health outcomes and the place of living. However, rather few studies have evaluated geocoding quality, with most of them being performed in the US and Europe. This article aims to compare the quality of three automatic online geocoding tools against a reference method. A subsample of 300 handwritten addresses from hospital records was geocoded using Bing, Google Earth, and Google Maps. Match rates were higher (> 80%) for Google Maps and Google Earth compared with Bing. However, the accuracy of the addresses was better for Bing with a larger proportion (> 70%) of addresses with positional errors below 20m. Generally, performance did not vary for each method for different socioeconomic status. Overall, the methods showed an acceptable, but heterogeneous performance, which may be a warning against the use of automatic methods without assessing quality in other municipalities, particularly in Chile and Latin America.

Exploring the Geographic Variation in Fruit and Vegetable Purchasing Behaviour Using Supermarket Transaction Data

The existence of dietary inequalities is well-known. Dietary behaviours are impacted by the food environment and are thus likely to follow a spatial pattern. Using 12 months of transaction records for around 50,000 ‘primary’ supermarket loyalty card holders, this study explores fruit and vegetable purchasing at the neighbourhood level across the city of Leeds, England. Determinants of small-area-level fruit and vegetable purchasing were identified using multiple linear regression. Results show that fruit and vegetable purchasing is spatially clustered. Areas purchasing fewer fruit and vegetable portions typically had younger residents, were less affluent, and spent less per month with the retailer.

Characterising percentage energy from ultra-processed foods by participant demographics, diet quality and diet cost: findings from the Seattle Obesity Study (SOS) III

Higher consumption of 'ultra-processed' (UP) foods has been linked to adverse health outcomes. The present paper aims to characterise percentage energy from UP foods by participant socio-economic status (SES), diet quality, self-reported food expenditure and energy-adjusted diet cost. Participants in the population-based Seattle Obesity Study III (n 755) conducted in WA in 2016-2017 completed socio-demographic and food expenditure surveys and the FFQ. Education and residential property values were measures of SES. Retail prices of FFQ component foods (n 378) were used to estimate individual-level diet cost. Healthy Eating Index (HEI-2015) and Nutrient Rich Food Index 9.3 (NRF9.3) were measures of diet quality. UP foods were identified following NOVA classification. Multivariable linear regressions were used to test associations between UP foods energy, socio-demographics, two estimates of food spending and diet quality measures. Higher percentage energy from UP foods was associated with higher energy density, lower HEI-2015 and NRF9.3 scores. The bottom decile of diet cost ($216·4/month) was associated with 67·5 % energy from UP foods; the top decile ($369·9/month) was associated with only 48·7 % energy from UP foods. Percentage energy from UP foods was inversely linked to lower food expenditures and diet cost. In multivariate analysis, percentage energy from UP foods was predicted by lower food expenditures, diet cost and education, adjusting for covariates. Percentage energy from UP foods was linked to lower food spending and lower SES. Efforts to reduce UP foods consumption, an increasingly common policy measure, need to take affordability, food expenditures and diet costs into account.

Does the built environment have independent obesogenic power? Urban form and trajectories of weight gain

OBJECTIVE

To determine whether selected features of the built environment can predict weight gain in a large longitudinal cohort of adults.

METHODS

Weight trajectories over a 5-year period were obtained from electronic health records for 115,260 insured patients aged 18-64 years in the Kaiser Permanente Washington health care system. Home addresses were geocoded using ArcGIS. Built environment variables were population, residential unit, and road intersection densities captured using Euclidean-based SmartMaps at 800-m buffers. Counts of area supermarkets and fast food restaurants were obtained using network-based SmartMaps at 1600, and 5000-m buffers. Property values were a measure of socioeconomic status. Linear mixed effects models tested whether built environment variables at baseline were associated with long-term weight gain, adjusting for sex, age, race/ethnicity, Medicaid insurance, body weight, and residential property values.

RESULTS

Built environment variables at baseline were associated with differences in baseline obesity prevalence and body mass index but had limited impact on weight trajectories. Mean weight gain for the full cohort was 0.06 kg at 1 year (95% CI: 0.03, 0.10); 0.64 kg at 3 years (95% CI: 0.59, 0.68), and 0.95 kg at 5 years (95% CI: 0.90, 1.00). In adjusted regression models, the top tertile of density metrics and frequency counts were associated with lower weight gain at 5-years follow-up compared to the bottom tertiles, though the mean differences in weight change for each follow-up year (1, 3, and 5) did not exceed 0.5 kg.

CONCLUSIONS

Built environment variables that were associated with higher obesity prevalence at baseline had limited independent obesogenic power with respect to weight gain over time. Residential unit density had the strongest negative association with weight gain. Future work on the influence of built environment variables on health should also examine social context, including residential segregation and residential mobility.

Associations of Pre- and Postnatal Air Pollution Exposures with Child Blood Pressure and Modification by Maternal Nutrition: A Prospective Study in the CANDLE Cohort

BACKGROUND

Limited data suggest air pollution exposures may contribute to pediatric high blood pressure (HBP), a known predictor of adult cardiovascular diseases.

METHODS

We investigated this association in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study, a sociodemographically diverse pregnancy cohort in the southern United States with participants enrolled from 2006 to 2011. We included 822 mother-child dyads with available address histories and a valid child blood pressure measurement at 4-6 y. Systolic (SBP) and diastolic blood pressures (DBP) were converted to age-, sex-, and height-specific percentiles for normal-weight U.S. children. HBP was classified based on SBP or DBP ≥ 90 th percentile. Nitrogen dioxide (NO 2 ) and particulate matter ≤ 2.5 μ m in aerodynamic diameter (PM 2.5 ) estimates in both pre- and postnatal windows were obtained from annual national models and spatiotemporal models, respectively. We fit multivariate Linear and Poisson regressions and explored multiplicative joint effects with maternal nutrition, child sex, and maternal race using interaction terms.

RESULTS

Mean PM 2.5 and NO 2 in the prenatal period were 10.8 [standard deviation (SD): 0.9] μ g / m 3 and 10.0 (SD: 2.4) ppb, respectively, and 9.9 (SD: 0.6) μ g / m 3 and 8.8 (SD: 1.9) ppb from birth to the 4-y-old birthday. On average, SBP percentile increased by 14.6 (95% CI: 4.6, 24.6), and DBP percentile increased by 8.7 (95% CI: 1.4, 15.9) with each 2 - μ g / m 3 increase in second-trimester PM 2.5 . PM 2.5 averaged over the prenatal period was only significantly associated with higher DBP percentiles [β = 11.6 (95% CI: 2.9, 20.2)]. Positive associations of second-trimester PM 2.5 with SBP and DBP percentiles were stronger in children with maternal folate concentrations in the lowest quartile (p interaction = 0.05 and 0.07, respectively) and associations with DBP percentiles were stronger in female children (p interaction = 0.05). We did not detect significant association of NO 2 , road proximity, and postnatal PM 2.5 with any outcomes.

CONCLUSIONS

The findings suggest that higher prenatal PM 2.5 exposure, particularly in the second trimester, is associated with elevated early childhood blood pressure. This adverse association could be modified by pregnancy folate concentrations. https://doi.org/10.1289/EHP7486.

An assessment of nutrition information on front of pack labels and healthiness of foods in the United Kingdom retail market

Background

Front of pack nutrition labelling is part of United Kingdom government’s programme of activities aiming to tackle diet-related diseases. There are several front of pack labelling formats available and they differ in the information they deliver. This study assessed the frequency of usage of front of pack food labelling systems on food products in the United Kingdom grocery market. It also measured the healthiness of some foods in the online market by categorising them according to their nutrient contents.

Methods

Five hundred food products in five categories [(1) cereals and cereal products, (2) dairy products, (3) beverages, (4) packaged meats and meat products, and (5) pre-packaged fruits and vegetables] from three main United Kingdom retail websites were investigated. A simple random sampling method was used for product selection according to the categories on the retailers’ websites. The healthiness of foods was also assessed by categorising them into ‘healthier’, ‘moderately healthy’ and ‘least healthy’ based on fat, saturated fat, salt and sugar contents.

Results

The total number of label types assessed comprises 19.6% of Guideline Daily Amounts or Reference Intakes and 43.8% had a combination of Traffic Light and Reference Intakes (hybrid label). Slightly over a quarter (27.4%) of products included nutritional information in a grid or table, 3.4% of the foods had two of any of the following: Health Logo, Reference Intakes and Traffic Light labels, and 5.8% did not have any Reference Intakes, Traffic Light, Health Logo or Hybrid label. Most of the foods assessed were manufactured in the United Kingdom with only 30.8% imported from 32 countries across four continents.

Conclusions

Traffic Light and Guideline Daily Amounts were the most used front of pack labelling formats on the assessed food product. A higher number of assessed products belonged to the “moderately healthy” and “healthier” categories than the “least healthy”. The imported foods that were found in the United Kingdom retail market showed that food choices could be made from the diverse food types.

Inedible Food Waste Linked to Diet Quality and Food Spending in the Seattle Obesity Study SOS III

Americans waste about a pound of food per day. Some of this is represented by inedible food waste at the household level. Our objective was to estimate inedible food waste in relation to diet quality and participant socio-economic status (SES). Seattle Obesity Study III participants (n = 747) completed the Fred Hutch Food Frequency Questionnaire (FFQ) and socio-demographic and food expenditure surveys. Education and geo-coded tax-parcel residential property values were measures of SES. Inedible food waste was calculated from diet records. Retail prices of FFQ component foods (n = 378) were used to estimate individual-level diet costs. The NOVA classification was used to identify ultra-processed foods. Multivariable linear regressions tested associations between inedible food waste, SES, food spending, Nutrient Rich Food (NRF_9.3) and Healthy Eating Index (HEI-2015) scores. Inedible food waste was estimated at 78.7 g/d, mostly from unprocessed vegetables (32.8 g), fruit (30.5 g) and meat, poultry, and fish (15.4 g). Greater inedible food waste was associated with higher HEI-2015 and NRF_9.3 scores, higher food expenditures and lower percent energy from ultra-processed foods. In multivariable models, more inedible food waste was associated with higher food expenditures, education and residential property values. Higher consumption of unprocessed foods were associated with more inedible food waste and higher diet costs. Geo-located estimates of inedible food waste can provide a proxy index of neighborhood diet quality.

A cross-sectional analysis of physical activity and weight misreporting in diverse populations: The Seattle Obesity Study III

BACKGROUND

In-person assessments of physical activity (PA) and body weight can be burdensome for participants and cost prohibitive for researchers. This study examined self-reported PA and weight accuracy and identified patterns of misreporting in a diverse sample.

METHODS

King, Pierce and Yakima county residents, aged 21-59 years (n = 728), self-reported their moderate-to-vigorous PA (MVPA) and weight, in kilograms. Self-reports were compared with minutes of bout-level MVPA, from 3 days of accelerometer data, and measured weights. Regression models examined characteristics associated with underreporting and overreporting of MVPA and weight, the potential bias introduced using each measure and the relation between perceived and measured PA and weight.

RESULTS

MVPA underreporting was higher among males and college educated participants; however, there was no differential MVPA overreporting. Weight underreporting was higher among males, those age 40-49 years and persons with obesity. Weight overreporting was higher among Hispanic participants and those reporting stress, unhappiness and fair or poor health. The estimated PA-obesity relation was similar using measured and self-reported PA but not self-reported weight. Perceived PA and weight predicted measured values.

CONCLUSION

Self-reported PA and weight may be useful should objective measurement be infeasible; however, though population-specific adjustment for differential reporting should be considered.

Neighbourhood characteristics as a predictor of adherence to dietary recommendations: A population-based cohort study of Finnish adults

Aims: To investigate the association of six-year cumulative level of socioeconomic neighbourhood disadvantage and population density with subsequent adherence to dietary recommendations, controlling for preceding dietary adherence, in adults in Finland. Methods: Population-based Health and Social Support (HeSSup) study participants from four age groups (20–24, 30–34, 40–44 and 50–54 years at baseline in 1998). Data on diet and alcohol consumption were obtained from the 2003 and 2012 surveys and information on neighbourhoods from Statistics Finland Grid database (n = 10,414 men and women). Participants diet was measured as adherence to Nordic Nutrition recommendation (score range 0–100). Neighbourhood disadvantage was measured by median household income, proportion of those with primary education only and unemployment rate, and population density by the number of adult population between years 2007 and 2012. Linear models were used to assess the associations of neighbourhood characteristics with the score for adherence to dietary recommendations in 2012. Results: Cumulative neighbourhood socioeconomic disadvantage was associated with slightly weaker (1.49 (95% confidence interval (CI) −1.89 to −1.09) point decrease in dietary score) adherence while higher population density was associated with better (0.70 (95% CI 0.38−1.01) point increase in dietary score) adherence to dietary recommendations. These associations remained after controlling for prior dietary habits, sociodemographic, chronic cardio-metabolic diseases, and severe life events. Conclusions: These longitudinal findings support the hypothesis that neighbourhood characteristics affect dietary habits.

Small increments in diet cost can improve compliance with the Dietary Guidelines for Americans

Adherence to the Dietary Guidelines for Americans (DGA) may involve higher diet costs. This study assessed the relation between two measures of food spending and diet quality among adult participants (N = 768) in the Seattle Obesity Study (SOS III). All participants completed socio-demographic and food expenditure surveys and the Fred Hutch food frequency questionnaire. Dietary intakes were joined with local supermarket prices to estimate individual-level diet costs. Healthy Eating Index (HEI- 2015) scores measured compliance with DGA. Multiple linear regressions using Generalized Estimating Equations with robust standard errors showed that lower food spending was associated with younger age, Hispanic ethnicity, and lower socioeconomic status. Even though higher HEI-2015 scores were associated with higher diet costs per 2000 kcal, much individual variability was observed. A positive curvilinear relationship was observed in adjusted models. At lower cost diets, a $100/month increase in cost (from $150 to $250) was associated with a 20.6% increase in HEI-2015. For higher levels of diet cost (from $350 to $450) there were diminishing returns (2.8% increase in HEI- 2015). These findings indicate that increases in food spending at the lower end of the range have the most potential to improve diet quality.

Where Do Adolescents Eat Less-Healthy Foods? Correspondence Analysis and Logistic Regression Results from the UK National Diet and Nutrition Survey

This study investigates the relationship between the consumption of foods and eating locations (home, school/work and others) in British adolescents, using data from the UK National Diet and Nutrition Survey Rolling Program (2008-2012 and 2013-2016). A cross-sectional analysis of 62,523 food diary entries from this nationally representative sample was carried out for foods contributing up to 80% total energy to the daily adolescent's diet. Correspondence analysis (CA) was used to generate food-location relationship hypotheses followed by logistic regression (LR) to quantify the evidence in terms of odds ratios and formally test those hypotheses. The less-healthy foods that emerged from CA were chips, soft drinks, chocolate and meat pies. Adjusted odds ratios (99% CI) for consuming specific foods at a location "other" than home (H) or school/work (S) in the 2008-2012 survey sample were: for soft drinks, 2.8 (2.1 to 3.8) vs. H and 2.0 (1.4 to 2.8) vs. S; for chips, 2.8 (2.2 to 3.7) vs. H and 3.4 (2.1 to 5.5) vs. S; for chocolates, 2.6 (1.9 to 3.5) vs. H and 1.9 (1.2 to 2.9) vs. S; and for meat pies, 2.7 (1.5 to 5.1) vs. H and 1.3 (0.5 to 3.1) vs. S. These trends were confirmed in the 2013-2016 survey sample. Interactions between location and BMI were not significant in either sample. In conclusion, public health policies to discourage less-healthy food choices in locations away from home and school/work are warranted for adolescents, irrespective of their BMI.

Do Where The Elderly Live Matter? Factors Associated with Diet Quality among Korean Elderly Population Living in Urban Versus Rural Areas

This study aimed to examine whether there is an area difference on diet quality among the Korean elderly population. The effect of personal factors on diet quality is also estimated and compared between rural and urban areas. A cross-sectional data from the 2013-2015 Korea National Health and Nutrition Examination Survey (KNHANES) was used for this study. The participants were older adults aged ≥ 65 years (n = 3207) who participated in the KNHANES. Urban and rural areas classified the region and the Korean Healthy Eating Index (KHEI) assessed the diet quality. Personal factors that were related to diet quality included socio-demographic factors, health behaviors, and health conditions. This study found that the diet quality was different between urban and rural areas in the Korean elderly population, showing a higher mean of KHEI scores in urban areas than rural areas (67.3 for urban seniors, 63.6 for rural seniors, p < 0.001), and the regional difference was still significant, even after adjusting for the personal factors (p < 0.001). Different sets of personal factors were found to be significant that explain the diet quality of participants between areas, such as economic resources, walking exercise, and perceived oral health status in urban areas, and age and food insecurity in rural areas. In conclusions, this study found that there was a regional disparity in diet quality and some personal factors affecting diet quality were dependent on areas, which implied that regional environment with diverse contexts could influence diet quality. These findings emphasize the need to provide targeted intervention programs that take into account both the characteristics of individuals and local food environments in order to improve the overall diet quality in older adults.

Consumption of Fermented Foods Is Associated with Systematic Differences in the Gut Microbiome and Metabolome

Lifestyle factors, such as diet, strongly influence the structure, diversity, and composition of the microbiome. While we have witnessed over the last several years a resurgence of interest in fermented foods, no study has specifically explored the effects of their consumption on gut microbiota in large cohorts. To assess whether the consumption of fermented foods is associated with a systematic signal in the gut microbiome and metabolome, we used a multi-omic approach (16S rRNA amplicon sequencing, metagenomic sequencing, and untargeted mass spectrometry) to analyze stool samples from 6,811 individuals from the American Gut Project, including 115 individuals specifically recruited for their frequency of fermented food consumption for a targeted 4-week longitudinal study. We observed subtle but statistically significant differences between consumers and nonconsumers in beta diversity as well as differential taxa between the two groups. We found that the metabolome of fermented food consumers was enriched with conjugated linoleic acid (CLA), a putatively health-promoting molecule. Cross-omic analyses between metagenomic sequencing and mass spectrometry suggest that CLA may be driven by taxa associated with fermented food consumers. Collectively, we found modest yet persistent signatures associated with fermented food consumption that appear present in multiple -omic types which motivate further investigation of how different types of fermented food impact the gut microbiome and overall health.IMPORTANCE Public interest in the effects of fermented food on the human gut microbiome is high, but limited studies have explored the association between fermented food consumption and the gut microbiome in large cohorts. Here, we used a combination of omics-based analyses to study the relationship between the microbiome and fermented food consumption in thousands of people using both cross-sectional and longitudinal data. We found that fermented food consumers have subtle differences in their gut microbiota structure, which is enriched in conjugated linoleic acid, thought to be beneficial. The results suggest that further studies of specific kinds of fermented food and their impacts on the microbiome and health will be useful.

Community Socioeconomic Deprivation and Nonalcoholic Fatty Liver Disease Severity

BACKGROUND AND OBJECTIVES

Nonalcoholic fatty liver disease (NAFLD) is linked to obesity. Obesity is associated with lower socioeconomic status (SES). An independent link between pediatric NAFLD and SES has not been elucidated. The objective of this study was to evaluate the distribution of socioeconomic deprivation, measured using an area-level proxy, in pediatric patients with known NAFLD and to determine whether deprivation is associated with liver disease severity.

METHODS

Retrospective study of patients <21 years with NAFLD, followed from 2009 to 2018. The patients' addresses were mapped to census tracts, which were then linked to the community deprivation index (CDI; range 0--1, higher values indicating higher deprivation, calculated from six SES-related variables available publicly in US Census databases).

RESULTS

Two cohorts were evaluated; 1 with MRI (magnetic resonance imaging) and/or MRE (magnetic resonance elastography) findings indicative of NAFLD (n = 334), and another with biopsy-confirmed NAFLD (n = 245). In the MRI and histology cohorts, the majority were boys (66%), non-Hispanic (77%-78%), severely obese (79%-80%), and publicly insured (55%-56%, respectively). The median CDI for both groups was 0.36 (range 0.15-0.85). In both cohorts, patients living above the median CDI were more likely to be younger at initial presentation, time of MRI, and time of liver biopsy. MRI-measured fat fraction and liver stiffness, as well as histologic characteristics were not different between the high- and low-deprivation groups.

CONCLUSIONS

Children with NAFLD were found across the spectrum of deprivation. Although children from more deprived neighborhoods present at a younger age, they exhibit the same degree of NAFLD severity as their peers from less deprived areas.

Obesity and the Built Environment: A Reappraisal

The built environment (BE) has been viewed as an important determinant of health. Numerous studies have linked BE exposure, captured using a variety of methods, to diet quality and to area prevalence of obesity, diabetes, and cardiovascular disease. First-generation studies defined the neighborhood BE as the area around the home. Second-generation studies turned from home-centric to person-centric BE measures, capturing an individual's movements in space and time. Those studies made effective uses of global positioning system tracking devices and mobile phones, sometimes coupled with accelerometers and remote sensors. Activity space metrics explored travel paths, modes, and destinations to assess BE exposure that was both person and context specific. However, as measures of the contextual exposome have become ever more fine-grained and increasingly complex, connections to long-term chronic diseases with complex etiologies, such as obesity, are in danger of being lost. Furthermore, few studies on obesity and the BE have included intermediate energy balance behaviors, such as diet and physical activity, or explored the potential roles of social interactions or psychosocial pathways. Emerging survey-based applications that identify habitual destinations and associated travel patterns may become the third generation of tools to capture health-relevant BE exposures in the long term.

Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women's Health Initiative

Background and Purpose- We examine the association between self-reported consumption of artificially sweetened beverages (ASB) and stroke and its subtypes, coronary heart disease, and all-cause mortality in a cohort of postmenopausal US women. Methods- The analytic cohort included 81 714 women from the Women's Health Initiative Observational Study, a multicenter longitudinal study of the health of 93 676 postmenopausal women of ages 50 to 79 years at baseline who enrolled in 1993 to 1998. This prospective study had a mean follow-up time of 11.9 years (SD of 5.3 years.) Participants who completed a follow-up visit 3 years after baseline were included in the study. Results- Most participants (64.1%) were infrequent consumers (never or <1/week) of ASB, with only 5.1% consuming ≥2 ASBs/day. In multivariate analyses, those consuming the highest level of ASB compared to never or rarely (<1/wk) had significantly greater likelihood of all end points (except hemorrhagic stroke), after controlling for multiple covariates. Adjusted models indicated that hazard ratios and 95% confidence intervals were 1.23 (1.02-1.47) for all stroke; 1.31 (1.06-1.63) for ischemic stroke; 1.29 (1.11-1.51) for coronary heart disease; and 1.16 (1.07-1.26) for all-cause mortality. In women with no prior history of cardiovascular disease or diabetes mellitus, high consumption of ASB was associated with more than a 2-fold increased risk of small artery occlusion ischemic stroke hazard ratio =2.44 (95% confidence interval, 1.47-4.04.) High consumption of ASBs was associated with significantly increased risk of ischemic stroke in women with body mass index ≥30; hazard ratio =2.03 (95% confidence interval, 1.38-2.98). Conclusions- Higher intake of ASB was associated with increased risk of stroke, particularly small artery occlusion subtype, coronary heart disease, and all-cause mortality. Although requiring replication, these new findings add to the potentially harmful association of consuming high quantities of ASB with these health outcomes.

Neighborhood effect and obesity in adult survivors of pediatric cancer: A report from the St. Jude lifetime cohort study

Survivors of childhood cancer are at risk for obesity, a condition potentially modifiable if dietary intake and physical activity are optimized. These health behaviors are likely influenced by neighborhood of residence, a determinant of access to healthy, affordable food and safe and easy exercise opportunities. We examined associations between neighborhood level factors and obesity among survivors in the St. Jude Lifetime cohort and community comparison group members. Persons with residential addresses available for geocoding were eligible for analysis (n = 2,265, mean age 32.5 [SD 9.1] years, 46% female, 85% white). Survivors completed questionnaires regarding individual behaviors; percent body fat was assessed via dual X-ray absorptiometry (obesity: ≥25% males; ≥35% females); neighborhood effect was characterized using census tract of residence (e.g., neighborhood socioeconomic status [SES], rurality). Structural equation modeling was used to determine associations between neighborhood effect, physical activity, diet, smoking, treatment exposures and obesity. Obese survivors (n = 1,420, 62.7%) were more likely to live in neighborhoods with lower SES (RR: 1.23, 95% CI: 1.10-1.38) and rural areas (RR: 1.22, 95% CI: 1.07-1.39) compared to survivors with normal percent body fat. Resource-poor neighborhoods (standardized effect: 0.06, p < 0.001) and cranial radiation (0.16, p < 0.001) had direct effects on percent body fat. Associations between neighborhood of residence and percent body fat were increased (0.01, p = 0.04) among individuals with a poor diet. Neighborhoods where survivors reside as an adult is associated with obesity. Interventions targeting survivors should incorporate strategies that address environmental influences on obesity.

The Relationship Between Housing Instability and Poor Diet Quality Among Urban Families

OBJECTIVE

To examine associations between housing instability and poor diet quality in a sample of urban parents and children.

METHODS

Cross-sectional study of 340 parent/guardian-child dyads visiting a pediatric primary care center in Boston, Massachusetts. The parent/guardian (hereafter, parent) completed 2 Harvard Service Food Frequency Questionnaires, one regarding their own dietary intake and one regarding their child's intake, and an assessment of health-related social needs. Diet quality was measured using the Healthy Eating Index-2010 (HEI-2010; score range 0-100). Housing instability was defined as: 1) homeless or in sheltered housing, 2) doubled up with another family, 3) utilities threatened or shut off, or 4) concerned about eviction. Multivariable logistic regression was used to measure associations between unstable housing and lowest-quartile HEI-2010 scores, adjusting for parent age, race/ethnicity, education, income, and child age.

RESULTS

Median (interquartile range) parent and child HEI-2010 scores were 63.8 (56.3-70.8) and 59.0 (54.2-64.7), respectively. Housing instability was found in 136 dyads (40%). In multivariable analysis, it was associated with increased odds of lowest-quartile total parent HEI-2010 scores (adjusted odds ratio [aOR], 1.9; 95% confidence interval [95% CI], 1.1-3.5) but not child scores (aOR, 1.4; 95% CI, 0.8-2.5). It also was associated with increased odds of lowest-quartile parent HEI-2010 dietary component scores for Total vegetables and Greens and beans (aOR, 2.0; 95% CI, 1.1-3.7 and aOR, 2.5; 95% CI, 1.3-4.8, respectively).

CONCLUSIONS

In this urban primary care population, housing instability is associated with lower diet quality scores for parents but not children. Lower vegetable consumption appears to drive this association.

Plant- and animal-protein diets in relation to sociodemographic drivers, quality, and cost: findings from the Seattle Obesity Study

BACKGROUND

Promoting plant-based proteins is at the forefront of many initiatives in public health nutrition.

OBJECTIVES

The aim of this study was to characterize the sociodemographic drivers of plant-based protein diet consumption, and to study these in relation to diet quality and cost.

METHODS

The Seattle Obesity Study series (SOS I and II) yielded the study sample (n = 1636). Sociodemographic data were obtained by survey self-report. Diet quality and cost came from the Fred Hutchinson Cancer Research Center Food-Frequency Questionnaire linked to retail food prices. The Healthy Eating Index 2010 (HEI-2010) and mean adequacy ratio (MAR) served as measures of diet quality. Linear regressions with robust standard errors examined associations.

RESULTS

Total proteins contributed 16.8% of daily dietary energy. The breakdown by animal and plant proteins was 10.9% and 5.9%, respectively. The sociodemographic factors associated with plant-protein consumption were a positive attitude towards healthy eating and higher education but not income. Plant-protein diets were characterized by severalfold increases in nuts and seeds, soy and legumes, but much less meat, poultry, dairy, solid fats, and added sugars. Higher quartiles of plant-based diets were associated with significantly higher HEI-2010 (β: 13.0 from quartile 1 to quartile 4; 95% CI: 11.8, 14.3) and higher MAR (β: 6.0; 95% CI: 3.5, 8.5) with minimal impact on diet costs (β: 0.35; 95% CI: 0.04, 0.67). In contrast, higher quartiles of animal-protein diets were associated with higher diet costs (β: 1.07; 95% CI: 0.77, 1.36) but lower HEI-2010 (β: -3.2; 95% CI: -4.5, -1.9). Each additional 3% of energy from plant proteins was associated with an 8.4-unit increase in HEI-2010 (95% CI: 7.6, 9.1) and with a 4.1-unit increase in MAR (95% CI: 2.7, 5.5) with a minimal increase in diet cost (β: 0.28; 95% CI: 0.06, 0.50).

CONCLUSION

Plant-based protein diets may be a cost-effective way to improve diet quality at all levels of income. Future research needs to evaluate the quality of plant-based protein in relation to amino acids and health.

The Moving to Health (M2H) approach to natural experiment research: A paradigm shift for studies on built environment and health

Improving the built environment (BE) is viewed as one strategy to improve community diets and health. The present goal is to review the literature on the effects of BE on health, highlight its limitations, and explore the growing use of natural experiments in BE research, such as the advent of new supermarkets, revitalized parks, or new transportation systems. Based on recent studies on movers, a paradigm shift in built-environment health research may be imminent. Following the classic Moving to Opportunity study in the US, the present Moving to Health (M2H) strategy takes advantage of the fact that changing residential location can entail overnight changes in multiple BE variables. The necessary conditions for applying the M2H strategy to Geographic Information Systems (GIS) databases and to large longitudinal cohorts are outlined below. Also outlined are significant limitations of this approach, including the use of electronic medical records in lieu of survey data. The key research question is whether documented changes in BE exposure can be linked to changes in health outcomes in a causal manner. The use of geo-localized clinical information from regional health care systems should permit new insights into the social and environmental determinants of health.

Spatial Technologies in Obesity Research: Current Applications and Future Promise

Geographic Information Systems (GIS), Global Positioning Systems (GPS), and remote sensing (RS) are revolutionizing obesity-related research. The primary applications of GIS have included visualizing obesity outcomes and risk factors, constructing obesogenic environmental indicators, and detecting geographical patterns of obesity prevalence and obesogenic environmental features. GPS was mainly used to delineate individual activity space and combined with other devices to measure obesogenic behaviors. RS has been understated for its role as important sources of data about natural and built environments. These spatial technologies, collectively called the 3S technologies, will be useful in measuring more facets of obesogenic environments and individual environmental exposure at finer levels and studying obesity etiology and interventions.

Soda, salad, and socioeconomic status: Findings from the Seattle Obesity Study (SOS)

Background

Documenting geographic disparities in dietary behaviors can help inform public health interventions at the local level.

Objective

To study and visualize socioeconomic gradient in soda and salad consumption using a geo-localized measure of socioeconomic status in contrast to more traditional measures.

Methods

Geo-localized dietary intake data came from the Seattle Obesity Study I, a population-based sample of King County adults (n=1099). Socio-demographic data and soda and salad consumption frequencies (times/week) were obtained by 20-min telephone survey. Food frequency questionnaire (FFQ) data were used to construct Healthy Eating Index (HEI) scores. Individual residential property values obtained from the King County tax assessor. Multivariable linear regressions examined socioeconomic gradient in the frequency of soda and salad consumption by residential property values, the primary independent variable, in comparison to annual household incomes and educational attainment, with adjustment for age, gender, and race/ethnicity. Geographic disparities in soda and salad consumption by property value metric were illustrated at the census block level using modeled predicted marginal means.

Results

Among all three socioeconomic indicators (income, education and residential property values), residential property values captured strongest gradient in soda and salad consumption. Higher quintiles of residential property values were associated with lower soda and higher salad consumption. Respondents living in the highest quintile of property values −1.04 fewer sodas per week (95% CI= −1.87, −0.21) and 0.89 more salads per week (95% CI= 0.36, 1.42), adjusting for sociodemographic covariates. Residential property values illustrated geographic disparities in soda and salad consumption at the census-block level.

Conclusion

Geo-localized disparities in food consumption patterns by neighborhood can inform current discourse on the socioeconomic determinants of health, while providing a useful tool for targeted interventions at the local level.

•

Soda (inverse) and salad (positive) consumption show gradients with socioeconomic status (SES).

•

Place-based measures of SES and property values, allow for high resolution mapping of diet measures.

•

Provides new tools for spatial, nutritional epidemiology analyses.

Neighborhood socioeconomic status and adherence to dietary recommendations among Finnish adults: A retrospective follow-up study

Neighborhood socioeconomic status (SES) is associated with dietary habits among the residents, but few studies have examined this association separately among long-term residents and movers. We calculated cumulative neighborhood SES score weighted by residential time in each address over 6 years for non-movers (n = 7704) and movers (n = 8818) using national grid database. Increase in average neighborhood SES was associated with higher adherence to dietary recommendations in both groups. Among the movers, an upward trajectory from low to high neighborhood SES was also associated with better adherence. Our findings suggest high SES areas might offer healthier food environments than low SES areas.

The impact of a multilevel childhood obesity prevention intervention on healthful food acquisition, preparation, and fruit and vegetable consumption on African-American adult caregivers

OBJECTIVE

To evaluate the secondary impact of a multilevel, child-focused, obesity intervention on food-related behaviours (acquisition, preparation, fruit and vegetable (FV) consumption) on youths' primary caregivers.

DESIGN

B'More Healthy Communities for Kids (BHCK) group-randomized controlled trial promoted access to healthy foods and food-related behaviours through wholesaler and small store strategies, peer mentor-led nutrition education aimed at youths, and social media and text messaging targeting their adult caregivers. Measures included caregivers' (n 516) self-reported household food acquisition frequency for FV, snacks and grocery items over 30 d, and usual FV consumption in a sub-sample of 226 caregivers via the NCI FV Screener. Hierarchical models assessed average treatment effects (ATE). Treatment-on-the-treated-effect (TTE) analyses evaluated correlation between behavioural change and exposure to BHCK. Exposure scores at post-assessment were based on self-reported viewing of BHCK materials and participating in activities.

SETTING

Thirty Baltimore City low-income neighbourhoods, USA.ParticipantsAdult caregivers of youths aged 9-15 years.

RESULTS

Of caregivers, 90·89 % were female; mean age 39·31 (sd 9·31) years. Baseline mean (sd) intake (servings/d) was 1·30 (1·69) fruits and 1·35 (1·05) vegetables. In ATE, no significant intervention effect was found on caregivers' food-related behaviours. In TTE, each point increase in BHCK exposure score (range: 0-6·9) increased caregivers' daily fruit consumption by 0·2 servings (0·24 (se 0·11); 95 % CI 0·04, 0·47). Caregivers reporting greater social media exposure tripled their daily fruit intake (3·16 (se 0·92); 95 % CI 1·33, 4·99) and increased their frequency of unhealthy food purchasing v. baseline.

CONCLUSIONS

Child-focused community-based nutrition interventions may also benefit family members' fruit intake. Child-focused interventions should involve adult caregivers and intervention effects on family members should be assessed. Future multilevel studies should consider using social media to improve reach and engage caregiver participants.

Where do U.S. households purchase healthy foods? An analysis of food-at-home purchases across different types of retailers in a nationally representative dataset

Food shopping decisions are pathways between food environment, diet and health outcomes, including chronic diseases such as diabetes and obesity. The choices of where to shop and what to buy are interrelated, though a better understanding of this dynamic is needed. The U.S. Department of Agriculture's nationally representative Food Acquisitions and Purchase Survey food-at-home dataset was joined with other databases of retailer characteristics and Healthy Eating Index-2010 (HEI) of purchases. We used linear regression models with general estimating equations to assess relationships between trip, store, and shopper characteristics with trip HEI scores. We examined HEI component scores for conventional supermarkets and discount/limited assortment retailers with descriptive statistics. Overall, 4962 shoppers made 11,472 shopping trips over one-week periods, 2012-2013. Trips to conventional supermarkets were the most common (53.6%), followed by supercenters (18.6%). Compared to conventional supermarkets, purchases at natural/gourmet stores had significantly higher HEI scores (β = 6.48, 95% CI = [4.45, 8.51], while those from "other" retailers (including corner and convenience stores) were significantly lower (-3.89, [-5.87, -1.92]). Older participants (versus younger) and women (versus men) made significantly healthier purchases (1.19, [0.29, 2.10]). Shoppers with less than some college education made significantly less-healthy purchases, versus shoppers with more education, as did households participating in SNAP, versus those with incomes above 185% of the Federal Poverty Level. Individual, trip, and store characteristics influenced the healthfulness of foods purchased. Interventions to encourage healthy purchasing should reflect these dynamics in terms of how, where, and for whom they are implemented.

A new method to visualize obesity prevalence in Seattle-King County at the census block level

Objective

The aim of this study is to map obesity prevalence in Seattle King County at the census block level.

Methods

Data for 1,632 adult men and women came from the Seattle Obesity Study I. Demographic, socioeconomic and anthropometric data were collected via telephone survey. Home addresses were geocoded, and tax parcel residential property values were obtained from the King County tax assessor. Multiple logistic regression tested associations between house prices and obesity rates. House prices aggregated to census blocks and split into deciles were used to generate obesity heat maps.

Results

Deciles of property values for Seattle Obesity Study participants corresponded to county-wide deciles. Low residential property values were associated with high obesity rates (odds ratio, OR: 0.36; 95% confidence interval, CI [0.25, 0.51] in tertile 3 vs. tertile 1), adjusting for age, gender, race, home ownership, education, and incomes. Heat maps of obesity by census block captured differences by geographic area.

Conclusion

Residential property values, an objective measure of individual and area socioeconomic status, are a useful tool for visualizing socioeconomic disparities in diet quality and health.

Diet Quality and Satisfaction with Life, Family Life, and Food-Related Life across Families: A Cross-Sectional Pilot Study with Mother-Father-Adolescent Triads

Family is a major determinant of children's and adolescents' eating behavior. The objectives of the present study were to assess diet quality, eating habits, satisfaction with life, family life, and food-related life in mother-father-adolescent triads, and to identify profiles of families according to family members' diet quality. Questionnaires were administered to a sample of 300 two-parent families with one child over the age of 10 in the city of Temuco (Chile), including the Adapted Healthy Eating Index (AHEI), Satisfaction with Life Scale (SWLS), Satisfaction with Food-related Life (SWFoL) scale, Satisfaction with Family Life (SWFaL) scales, and questions relating to their eating habits. Positive relationships were found between the diet quality of the family members, particularly between mothers and adolescents. Three family profiles with different diet qualities were identified: "families with an unhealthy diet" (39.3%), "families in which mothers and adolescents have healthy diets, but the fathers' diets require changes" (14.3%), and "families that require changes in their diet" (46.4%). These findings stress the key role of mothers in determining family diet quality and suggest a positive relationship between diet quality and satisfaction with life.

The Impact of a City-Level Minimum-Wage Policy on Supermarket Food Prices in Seattle-King County

Background: Many states and localities throughout the U.S. have adopted higher minimum wages. Higher labor costs among low-wage food system workers could result in higher food prices. Methods: Using a market basket of 106 foods, food prices were collected at affected chain supermarket stores in Seattle and same-chain unaffected stores in King County (n = 12 total, six per location). Prices were collected at 1 month pre- (March 2015) and 1-month post-policy enactment (May 2015), then again 1-year post-policy enactment (May 2016). Unpaired t-tests were used to detect price differences by location at fixed time while paired t-tests were used to detect price difference across time with fixed store chain. A multi-level, linear differences-in-differences model, was used to detect the changes in the average market basket item food prices over time across regions, overall and by food group. Results: There were no significant differences in overall market basket or item-level costs at one-month (-$0.01, SE = 0.05, p = 0.884) or one-year post-policy enactment (-$0.02, SE = 0.08, p = 0.772). No significant increases were observed by food group. Conclusions: There is no evidence of change in supermarket food prices by market basket or increase in prices by food group in response to the implementation of Seattle's minimum wage ordinance.

Obesity Pathogenesis: An Endocrine Society Scientific Statement

Obesity is among the most common and costly chronic disorders worldwide. Estimates suggest that in the United States obesity affects one-third of adults, accounts for up to one-third of total mortality, is concentrated among lower income groups, and increasingly affects children as well as adults. A lack of effective options for long-term weight reduction magnifies the enormity of this problem; individuals who successfully complete behavioral and dietary weight-loss programs eventually regain most of the lost weight. We included evidence from basic science, clinical, and epidemiological literature to assess current knowledge regarding mechanisms underlying excess body-fat accumulation, the biological defense of excess fat mass, and the tendency for lost weight to be regained. A major area of emphasis is the science of energy homeostasis, the biological process that maintains weight stability by actively matching energy intake to energy expenditure over time. Growing evidence suggests that obesity is a disorder of the energy homeostasis system, rather than simply arising from the passive accumulation of excess weight. We need to elucidate the mechanisms underlying this "upward setting" or "resetting" of the defended level of body-fat mass, whether inherited or acquired. The ongoing study of how genetic, developmental, and environmental forces affect the energy homeostasis system will help us better understand these mechanisms and are therefore a major focus of this statement. The scientific goal is to elucidate obesity pathogenesis so as to better inform treatment, public policy, advocacy, and awareness of obesity in ways that ultimately diminish its public health and economic consequences.

Socioeconomic status and dietary patterns in children from around the world: different associations by levels of country human development?

Background

Although ‘unhealthy’ diet is a well-known risk factor for non-communicable diseases, its relationship with socio-economic status (SES) has not been fully investigated. Moreover, the available research has largely been conducted in countries at high levels of human development. This is the first study to examine relationships among dietary patterns and SES of children from countries spanning a wide range of human development.

Methods

This was a multinational cross-sectional study among 9–11 year-old children (n = 6808) from urban/peri-urban sites across 12 countries. Self-reported food frequency questionnaires were used to determine the children’s dietary patterns. Principal Components Analysis was employed to create two component scores representing ‘unhealthy’ and ‘healthy’ dietary patterns. Multilevel models accounting for clustering at the school and site level were used to examine the relationships among dietary patterns and SES.

Results

The mean age of participants in this study (53.7% girls) was 10.4 years. Largest proportions of total variance in dietary patterns occurred at the individual, site, and school levels (individual, school, site: 62.8%; 10.8%; 26.4% for unhealthy diet pattern (UDP) and 88.9%; 3.7%; 7.4%) for healthy diet pattern (HDP) respectively. There were significant negative ‘unhealthy’ diet-SES gradients in 7 countries and positive ‘healthy’ diet-SES gradients in 5. Within country diet-SES gradients did not significantly differ by HDI. Compared to participants in the highest SES groups, unhealthy diet pattern scores were significantly higher among those in the lowest within-country SES groups in 8 countries: odds ratios for Australia (2.69; 95% CI: 1.33–5.42), Canada (4.09; 95% CI: 2.02–8.27), Finland (2.82; 95% CI: 1.27–6.22), USA (4.31; 95% CI: 2.20–8.45), Portugal (2.09; 95% CI: 1.06–4.11), South Africa (2.77; 95% CI: 1.22–6.28), India (1.88; 95% CI: 1.12–3.15) and Kenya (3.35; 95% CI: 1.91–5.87).

Conclusions

This study provides evidence of diet-SES gradients across all levels of human development and that lower within-country SES is strongly related to unhealthy dietary patterns. Consistency in within-country diet-SES gradients suggest that interventions and public health strategies aimed at improving dietary patterns among children may be similarly employed globally. However, future studies should seek to replicate these findings in more representative samples extended to more rural representation.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4383-8) contains supplementary material, which is available to authorized users.

Description of the healthy eating indices-based diet quality in Turkish adults: a cross-sectional study

OBJECTIVES

This study aims to describe the dietary status of Turkish adults using two different versions of the Healthy Eating Index (HEI).

METHODS

In this cross sectional study, 494 healthy participants (311 females) with randomly selected and living in Ankara were included between September 2013 and March 2014. A questionnaire was completed and anthropometric measurements (weight and height) were performed. The 24-h dietary recall of individuals was collected. Diet quality was measured through HEI-2005 and HEI-2010 scores.

RESULTS

The mean age, body mass index (BMI), HEI-2005 and HEI-2010 scores of individuals were 32.9 ± 10.8 years; 25.0 ± 4.8 kg/m²; 56.1 ± 13.9 and 41.5 ± 13.7 points, respectively. Significant differences were found between mean HEI-2005 and HEI-2010 scores (p < 0.05). The individual's whose diet quality needs to be improved according to mean HEI-2005 score, had poorer diet based on mean HEI-2010 scores. The highest mean HEI-2005 and HEI-2010 scores were stated in female, in subjects had low education levels, aged 51 years or older and in overweight groups (p <0.05). Both versions of healthy eating indices were correlated positively with BMI and age CONCLUSION: Diet qualities of the individuals are associated with age, gender, education and BMI. Although the components and scores in HEI-2010 version were changed from the version of HEI-2005, the changes may encourage healthy choices of some food group. HEI-2010 gives more attention to food quality than HEI-2005. Thus, in the present study it was concluded that HEI-2010 provided more precise results about diet quality.