Fast-food restaurant, unhealthy eating, and childhood obesity: A systematic review and meta-analysis

The Association Between a Neighborhood Adverse Childhood Experiences Index and Body Mass Index Among New York City Youth

Background: The role of neighborhood factors in the association between adverse childhood experiences (ACEs) and body mass index (BMI) has not been widely studied. A neighborhood ACEs index (NAI) captures neighborhood environment factors associated with ACE exposure. This study examined associations between BMI and an NAI among New York City (NYC) youth. An exploratory objective examined the NAI geographic distribution across NYC neighborhoods. Methods: Data for students attending NYC public general education schools in kindergarten-12th grade from 2006-2017 (n = 1,753,867) were linked to 25 geospatial datasets capturing neighborhood characteristics for every census tract in NYC. Multivariable hierarchical linear regression tested associations between BMI and the NAI; analyses also were conducted by young (<8 years), school age (8-12 years), and adolescent (>12 years) subgroups. In addition, NAI was mapped by census tract, and local Moran's I identified clusters of high and low NAI neighborhoods. Results: Higher BMI was associated with higher NAI across all sex and age groups, with largest magnitude of associations for girls (medium NAI vs. low NAI: unstandardized β = 0.112 (SE 0.008), standardized β [effect size]=0.097, p < 0.001; high NAI vs. low NAI: unstandardized β = 0.195 (SE 0.008), standardized β = 0.178, p < 0.001) and adolescents (medium NAI vs. low NAI: unstandardized β = 0.189 (SE 0.014), standardized β = 0.161, p < 0.001, high NAI vs. low NAI: unstandardized β = 0.364 (SE 0.015), standardized β = 0.334, p < 0.001 for adolescent girls; medium NAI vs. low NAI: unstandardized β = 0.122 (SE 0.014), standardized β = 0.095, p < 0.001, high NAI vs. low NAI: unstandardized β = 0.217 (SE 0.015), standardized β = 0.187, p < 0.001 for adolescent boys). Each borough of NYC included clusters of neighborhoods with higher and lower NAI exposure, although clusters varied in size and patterns of geographic dispersion across boroughs. Conclusions: A spatial index capturing neighborhood environment factors associated with ACE exposure is associated with higher BMI among NYC youth. Findings complement prior literature about relationships between neighborhood environment and obesity risk, existing research documenting ACE-obesity associations, and the potential for neighborhood factors to be a source of adversity. Collectively, evidence suggests that trauma-informed place-based obesity reduction efforts merit further exploration as potential means to interrupt ACE-obesity associations.

Evaluation of the Consumption of Junk Food Products and Lifestyle among Teenagers and Young Population from Romania

BACKGROUND

The long-term consumption of junk food products can lead to nutritional and metabolic imbalances, especially when it is associated with a lack of physical activity and the consumption of alcohol or other high-calorie products.

METHODS

The evaluation of junk food consumption among teenagers and young people in Romania was carried out with the help of a cross-sectional study based on a questionnaire.

RESULTS

A total number of 1017 respondents participated in this study, comprising 470 males and 547 females aged between 16 and 25 years. Although the majority of young people fell into the normal-weight category (607 of them, p < 0.0001), some aspects can be noted that in the long term can produce a series of nutritional imbalances: an increased tendency toward sedentarism, with 553 (p = 0.613) of the respondents declaring that they performed sports rarely or not at all, and a tendency toward relatively high consumption of foods high in calories (fast food products and especially fried potatoes, hamburgers, shawarma, pastries, and snacks, along with sweetened drinks and even alcoholic beverages). The respondents participating in this study even indicated a perceived addiction to the consumption of certain products: coffee (50.48%), fried potatoes (38.9%), hamburgers (37.05%), shawarma (31.65%), and snacks (30.08%). Many of these products are rich in calories, saturated fat, and even trans fat.

CONCLUSIONS

This study highlights a series of aspects that can have long-term negative effects related to the excess weight associated with other imbalances: consumption preferences among young people for hypercaloric fast food products, sweetened drinks associated with reduced physical activity, and even the development of some forms of food addictions for a series of hypercaloric foods.

Exposome-Wide Association Study of Body Mass Index Using a Novel Meta-Analytical Approach for Random Forest Models

BACKGROUND

Overweight and obesity impose a considerable individual and social burden, and the urban environments might encompass factors that contribute to obesity. Nevertheless, there is a scarcity of research that takes into account the simultaneous interaction of multiple environmental factors.

OBJECTIVES

Our objective was to perform an exposome-wide association study of body mass index (BMI) in a multicohort setting of 15 studies.

METHODS

Studies were affiliated with the Dutch Geoscience and Health Cohort Consortium (GECCO), had different population sizes (688-141,825), and covered the entire Netherlands. Ten studies contained general population samples, others focused on specific populations including people with diabetes or impaired hearing. BMI was calculated from self-reported or measured height and weight. Associations with 69 residential neighborhood environmental factors (air pollution, noise, temperature, neighborhood socioeconomic and demographic factors, food environment, drivability, and walkability) were explored. Random forest (RF) regression addressed potential nonlinear and nonadditive associations. In the absence of formal methods for multimodel inference for RF, a rank aggregation-based meta-analytic strategy was used to summarize the results across the studies.

RESULTS

Six exposures were associated with BMI: five indicating neighborhood economic or social environments (average home values, percentage of high-income residents, average income, livability score, share of single residents) and one indicating the physical activity environment (walkability in 5 -km buffer area). Living in high-income neighborhoods and neighborhoods with higher livability scores was associated with lower BMI. Nonlinear associations were observed with neighborhood home values in all studies. Lower neighborhood home values were associated with higher BMI scores but only for values up to € 300,000 . The directions of associations were less consistent for walkability and share of single residents.

DISCUSSION

Rank aggregation made it possible to flexibly combine the results from various studies, although between-study heterogeneity could not be estimated quantitatively based on RF models. Neighborhood social, economic, and physical environments had the strongest associations with BMI. https://doi.org/10.1289/EHP13393.

Obesogens in Adolescence: Challenging Aspects and Prevention Strategies

Childhood obesity has become a global epidemic, with significant increases in prevalence over recent decades. While excessive calorie consumption and physical inactivity are known factors, emerging research highlights the role of endocrine-disrupting chemicals (EDCs), particularly obesogens, in obesity's pathogenesis. This review explores the historical context of the environmental obesogens hypothesis, their sources, mechanism of action, impact on prenatal and postnatal development, and epigenetics. Additionally, it discusses the long-term consequences of childhood obesity and proposes prevention strategies that will mitigate negative health effects. Obesogens were found to disrupt hormonal balance and metabolic processes through various mechanisms such as altering gene expression, hormonal interference, and inflammation. Especially significant was exposure during critical windows of development, which correlates with an increased risk of obesity in childhood or adolescence. Long-term effects of childhood obesity include chronic health conditions and psychosocial issues. A comprehensive approach is necessary to address childhood obesity encompassing genetic, environmental, and lifestyle factors. Prevention strategies should focus on reducing obesogen exposure, promoting healthy lifestyles, and implementing regulatory policies. Future research should investigate obesogens-diet interactions, microbiome impacts, and combined obesogens effects. Long-term human studies are also crucial for validating findings from animal models and allowing for informed decision-making to combat the obesity pandemic.

Scoping review of obesity interventions: Research frontiers and publication status

Obesity and overweight are significant global health issues, and numerous obesity intervention studies have been conducted. Summarizing current knowledge of interventions aims to inform researchers and policymakers to keep up-to-date with the latest scientific advancements and trends. In this review, we comprehensively retrieved and screened 4,541 studies on obesity intervention published between 2018 and 2022 in the Web of Science Core Collection, and objectively presented research frontiers using bibliometric analysis. The research frontiers of intervention are mainly focused on dietary, exercise, pharmacological interventions, bariatric surgery, environmental, and cognitive interventions. Time-restricted eating is the hottest research topic, followed by probiotics and Roux-en-Y gastric bypass. Gut microbiota is located in the "Basic and transversal themes" quadrant with a high centrality and low density, which has great development potentiality. Obesity intervention is becoming increasingly common,and we advocate for researchers to undertake more focused research endeavors that consider the specific characteristics of diverse populations or patients.

Factors That Most Influence the Choice for Fast Food in a Sample of Higher Education Students in Portugal

The frequency of fast food consumption among higher education students is high, causing worrying implications for public health. This study aims to relate the factors that influence the choice for fast food with social factors, nutritional status, and fast food consumption in a sample of higher education students in Portugal. An online questionnaire was developed and disseminated by social networks among students during the first half of 2023. Two hundred and thirty-seven students participated, mainly female (65.4%), who were attending public higher education institutions (59.1%), with a median of age of 20.0 (19.0; 22.0) years, and about 20% of the sample had overweight. Approximately 80% consumed fast food, and almost 40% consumed it more than once or twice a week. Predominantly (78.0%), they chose hamburger meals, spending EUR 8.0 per meal. The factors that most influenced the choice of fast food were ease or convenience of preparation (59.9%), price (48.5%), and flavor (28.3%). There were also differences between sexes and between those attending public and private higher education institutions regarding whether they usually consume fast food or not. The body mass index was positively associated with age (r: 0.142; p = 0.029) and with fast food spending (r: 0.146; p = 0.024). The results have implications for public health and clinical nutrition, and can support more effective strategies to improve food choices in higher education students.

Development and Validation of the Meiji Nutritional Profiling System (Meiji NPS) to Address Dietary Needs of Adults and Older Adults in Japan

This study introduces the Meiji Nutritional Profiling System (Meiji NPS), which was specifically designed to respond to age-related shifts in nutrient requirements among Japanese adults (<65 years old) and older adults (≥65 years old). Japan has one of the most aged societies in the world. The health issues of interest are malnutrition and lifestyle-related diseases among adults and frailty among older adults. Two versions of the NPS were developed based on nutrients to encourage (protein, dietary fibers, calcium, iron, and vitamin D), food groups to encourage (fruits, vegetables, nuts, legumes, and dairy), and nutrients to limit (energy, saturated fatty acids, sugars, and salt equivalents). The Meiji NPS for older adults did not include iron or saturated fatty acids. The algorithms were based on the Nutrient-Rich Foods Index (NRF). The convergent validity between the Meiji NPS and the existing NPSs for the same foods was confirmed using Spearman's correlation coefficients (NRF: r = 0.67 for adults and r = 0.60 for older adults; Health Star Rating: r = 0.64 for adults and r = 0.61 for older adults). The Meiji NPS may be useful for nutritional evaluation and reformulation of food products, tailored to adults and older adults to ameliorate health issues in Japan.

Fitness and fatness in children and adolescents: investigating their role in the association between physical activity and cardiometabolic health

To verify the role of the combination of fitness and fatness in the relationship between physical activity (PA) and cardiometabolic risk in children and adolescents. This is a cross-sectional study performed with 2786 children and adolescents (6 to 17 years). Fitness was determined by the cardiorespiratory fitness (CRF) six-minute walking and running test. Waist circumference (WC) was considered a fatness indicator. A selfreported questionnaire was used to determine PA practice, whereas the clustered cardiometabolic risk score (cMetS) was calculated by summing z-scores of triglycerides, total cholesterol/HDL-C ratio, systolic blood pressure, glucose, and WC. Considering the combination of CRF (fitness) and WC (fatness), the following phenotypes were created: Fit/Unfat, Fit/Fat, Unfit/Unfat and Unfit/Fat. Moderation analyses were tested using linear regression models. Significant interactions were found between PA and Unfit/Fat category (β = -0.001; p = 0.001) only for adolescents. The interaction observed in the Unfit/Fat phenotype indicated that adolescents who practise PA for 330 minutes per week presented lower cMetS compared to those who do not practise or practise for 60 minutes respectively. The combination of fitness and fatness moderates the relationship between PA and cardiometabolic risk, suggesting that adolescents, particularly those who are less fit and present high adiposity, should be encouraged to engage in regular PA to improve their metabolic health.

The Influence of the School Neighborhood Food Retail Environment on Unhealthy Food Purchasing Behaviors Among Adolescents: A Systematic Review

INTRODUCTION

Adolescents are often exposed to food retailers selling unhealthy food items during their lunch breaks and school commutes. This systematic review examines the influence of school neighborhood food retail environments on adolescent food purchasing.

METHODS

A systematic search of 6 databases. Observational studies published from January 2012 to December 2022 that measured food availability, accessibility, or exposure, measured food purchasing, and focused on adolescents (aged 10-19 years) were eligible for inclusion.

RESULTS

Twelve studies with 97 findings were included. Thirty-one findings indicated that a school neighborhood with a high density of unhealthy food retail, a school with unhealthy food retail nearby, or exposure to unhealthy food retail on the journey to/from school was associated with higher prevalence and frequency of unhealthy food purchases.

DISCUSSION

Adolescents' food purchasing behaviors may be meaningfully affected by their school neighborhood food retail environment; however, the included studies have many methodological shortcomings.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Results identify the need for new studies that measure food purchasing, use comprehensive definitions of food retail environments, and adopt more rigorous methods to approximate exposure to food retail. More robust evidence would strengthen the rationale for policy or program interventions and potentially indicate specific targets for intervention.

Temporal Patterns in Fruit and Vegetable Intake Among Racially and Ethnically Diverse Children and Adolescents in California

Introduction

Childhood dietary behaviors, including fruit and vegetable intake, are associated with adult health. Most children do not meet daily recommended servings of fruits and vegetables. Less is known about temporal patterns in fruit and vegetable consumption or if they vary by race and ethnicity. We investigated temporal patterns in fruit and vegetable intake among California school-age children and adolescents overall and by race and ethnicity.

Methods

We used 2-year cross-sectional datasets from the child and adolescent samples in the California Health Interview Surveys from 2011-2012 through 2019-2020 and modified Poisson regression models to estimate the likelihood of consuming 5 or more servings of fruits and vegetables in 2013-2016 and 2017-2020 compared with 2011-2012. Models controlled for age, race and ethnicity, gender, citizenship status, family income, and adult education and tested for differences by race and ethnicity. The samples included 16,125 children aged 5 to 11 years and 9,672 adolescents aged 12 to 17 years.

Results

Overall, 29.3% of children and 25.9% of adolescents reported intake of 5 or more fruits and vegetables per day. Among children, adjusted prevalence ratios (PR) of fruit and vegetable intake were higher in 2013-2016 (PR,1.25; 95% CI, 1.11-1.42) and 2017-2020 (PR,1.13; 95% CI, 0.99-1.30) compared with 2011-2012. Among adolescents, the adjusted prevalence did not differ significantly over time. We found no evidence of differential associations by race and ethnicity for children and adolescents.

Conclusion

We found favorable temporal changes in fruit and vegetable consumption among children, but not among adolescents. Monitoring temporal patterns in fruit and vegetable intake remains critical for planning population-level interventions to increase consumption.

Effects of rapeseed oil on body composition and glucolipid metabolism in people with obesity and overweight: a systematic review and meta-analysis

To investigate the effects of rapeseed oil on body composition, blood glucose and lipid metabolism in people with overweight and obesity compared to other cooking oils. We searched eight databases for randomized controlled studies (including randomized crossover trials). The risk of bias for the included studies was assessed using the Cochrane Risk of Bias 2.0 tool. The Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria were used to evaluate the quality of the outcomes. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. Sensitivity analysis was used to check the stability of the pooled results. Statistical analysis was carried out using Review Manager 5.3 software. As a result, fifteen randomized controlled studies (including six parallel studies and nine crossover studies) were included in this study. Compared to other edible oils, rapeseed oil significantly reduced low density lipoprotein cholesterol (LDL-C) (MD = -0.14 mmol/L, 95% CI: -0.21, -0.08, I2 = 0%, P < 0.0001), apolipoprotein B (ApoB) (MD = -0.03 g/L, 95% CI: -0.05, -0.01, I2 = 0%, P = 0.0003), ApoB/ApoA1 (MD = -0.02, 95% CI: -0.04, -0.00, I2 = 0%, P = 0.02) and insulin (MD = -12.45 pmol/L, 95% CI: -19.61, -5.29, I2 = 37%, P = 0.0007) levels, and increased fasting glucose (MD = 0.16 mmol/L, 95% CI: 0.05, 0.27, I2 = 27%, P = 0.003) levels. However, the differences in body weight and body composition between rapeseed oil and control oils were not significant. In a word, rapeseed oil is effective in reducing LDL-C, ApoB and ApoB/ApoA1 levels in people with overweight and obesity, which is helpful in preventing and reducing the risk of atherosclerosis. PROSPERO registration number: CRD42022333436.

Digital Marketing and Fast-Food Intake in the UAE: The Role of Firm-Generated Content among Adult Consumers

In the contemporary digital marketing context, this study aimed to investigate the influence of firm-generated content and social media advertising on fast-food consumption patterns among the adult population. Utilizing a questionnaire distributed to customers of a restaurant in Fujairah, United Arab Emirates, convenience sampling was employed. The findings underscored a significant positive relationship between firm-generated content and social media engagement, as well as between the latter and online shopping behavior. However, it was determined that word of mouth did not significantly moderate the relationship between attitudes towards social media advertisements and fast-food consumption patterns. From a theoretical perspective, these results enrich the understanding of how digital dynamics shape consumer behavior in specific contexts. Practically speaking, they prompt a critical reflection on the ethics of marketing in promoting products potentially detrimental to health, urging both companies and policymakers to reconsider their strategies and regulations, respectively.

Quantifying the Impact of Supermarket Distance on Childhood Obesity in Greater London, United Kingdom: Exploring Different Access Measures and Modification Effects of Transportation

Background: Healthy food access may be relevant for predicting trends in childhood obesity. The goal was to determine associations between childhood overweight (including obesity) and distance to three nearest supermarkets stratified by transportation modes (walking, cycling, driving). Methods: Bivariate and multivariate linear regressions examine the relationship with obesity, including interacting active and inactive modes. Results: Proximity to at least three supermarkets shows small but significant positive association with obesity. Walking mode showed higher obesity rates than driving, and distance was not related to the mode of travel. Conclusions: Disparities in healthy food access may not contribute meaningfully to childhood obesity, as other individual factors may be largely at play.

Linking the Urban Environment and Health: An Innovative Methodology for Measuring Individual-Level Environmental Exposures

Environmental exposures (EE) are increasingly recognised as important determinants of health and well-being. Understanding the influences of EE on health is critical for effective policymaking, but better-quality spatial data is needed. This article outlines the theoretical and technical foundations used for the construction of individual-level environmental exposure measurements for the population of a northern English city, Bradford. The work supports 'Connected Bradford', an entire population database linking health, education, social care, environmental and other local government data over a period of forty years. We argue that our current understanding of environmental effects on health outcomes is limited both by methodological shortcomings in the quantification of the environment and by a lack of consistency in the measurement of built environment features. To address these shortcomings, we measure the environmental exposure for a series of different domains including air quality, greenspace and greenness, public transport, walkability, traffic, buildings and the built form, street centrality, land-use intensity, and food environments as well as indoor dwelling qualities. We utilise general practitioners' historical patient information to identify the precise geolocation and duration of a person's residence. We model a person's local neighbourhood, and the probable routes to key urban functions aggregated across the city. We outline the specific geospatial procedure used to quantify the environmental exposure for each domain and use the example of exposure to fast-food outlets to illustrate the methodological challenges in the creation of city and nationwide environmental exposure databases. The proposed EE measures will enable critical research into the relationship and causal links between the built environment and health, informing planning and policy-making.

Relationships of Local Food and Physical Activity Environments With Overweight in 5- to 17-Year-Old Malaysian Children

Evidence on the associations between built environment and overweight in children outside developed countries is scarce. We examined associations between access to local food and physical activity environments and overweight in 5- to 17-year-old Malaysians in two states with differing overweight levels. Information on children was measured in the National Health and Morbidity Survey 2015 and combined with Geographic Information System-derived data on local food and physical activity environments. Access to the built environment was measured by presence and distance from child's residence. Complete data were available for 880 children. Access to local food outlets and parks was higher and associated with higher occurrence of overweight in children living in the state with higher overweight prevalence. When adjusted for sociodemographic factors, higher presence of and shorter distance to convenience stores and parks were associated with overweight. Both built environment and children's sociodemographic backgrounds should be considered when planning interventions to curb the overweight epidemic in Malaysia.

How to cope with emerging viral diseases: lessons from South Korea's strategy for COVID-19, and collateral damage to cardiometabolic health

South Korea is a unique country in many aspects in terms of its strategy against the COVID-19 pandemic. From February 2020, the South Korean government adopted active epidemiological investigations, strict isolation of affected patients, and extensive public lockdowns, which were helpful in controlling spread until the end of 2021. This stable situation in South Korea has changed dramatically since the Omicron variant-reportedly less severe but more infective than the original strain-became dominant from January 2022. From mid-February to mid-April 2022, daily cases of COVID-19 in South Korea increased steeply, reaching > 600,000 cases/day: the highest incidence rate in the world at that time. Despite this rapid increase, the South Korean government has eased its preventive strategies progressively, based on the belief in the efficacy of >80% of vaccine coverage in the population. Now, in June 2022, the COVID-19 situation in South Korea is improving. The mortality rate is 0·13%: the lowest among the 30 countries with the highest case counts. High vaccine coverage rate (87·7%), the efficient healthcare system, and active co-operation between private sectors and the central government seem to have contributed to this. However, it should also be noted that the COVID-19 pandemic and its preventive measures have had a negative influence on cardiometabolic profiles in the country. Considering the likelihood of another novel variant of SARS-CoV-2 or new infectious disease emerging in the future, understanding the situation in South Korea and the strategies flexibly adopted by its government could be beneficial for many countries.

A Review of the Effects of Puerarin on Glucose and Lipid Metabolism in Metabolic Syndrome: Mechanisms and Opportunities

Chronic diseases, including metabolic syndrome related to sugar and lipid metabolic disorders, are the leading causes of premature death around the world. Novel treatment strategies without undesirable effects are urgently needed. As a natural functional ingredient, puerarin is a promising alternative for the treatment of sugar and lipid metabolic disorders. However, the applications of puerarin are limited due to its poor solubility and short half-life. Various drug delivery systems have been investigated to improve the bioavailability of puerarin. This review summarizes the mechanisms involved in the beneficial action of puerarin: suppressing the release of glucose and FFA; regulating the transport of glucose and fatty acids; acting on the PI3K-Akt and AMPK signaling pathways to decrease the synthesis of glucose and fatty acids; acting on the PPAR signaling pathway to promote β-oxidation; and improving insulin secretion and sensitivity. In addition, the preparation technologies used to improve the bioavailability of puerarin are also summarized in this review, in the hope of helping to promote the application of puerarin.

Mediterranean Diet Adherence in Community-Dwelling Older Adults in Spain: Social Determinants Related to the Family

The Mediterranean diet (MD), a well-established quality diet model, and regular physical activity are associated with reducing the appearance or progression of several chronic diseases and reducing morbidity and mortality. However, reduction of these goals, adherence to the MD, and regular physical activity occur at all ages, including older individuals in Mediterranean countries such as Spain, where at least adherence to the MD is culturally rooted. Objective: To evaluate the degree of adherence to the MD and physical activity in older individuals. Methods: The sample comprises 679 older adults aged 60 and over who attended activities in municipal centers for older adults in Valencia. Adherence to the Mediterranean diet, frequency of physical activity, and anthropometric assessment were used. Results: High adherence (score ≥ 9) to MD was observed only in 23.7% of the study sample. Smoking habits or having meals in fast-food restaurants on a weekly basis were significantly (p < 0.05) associated with lower MD adherence. Age, BMI, marital status, and physical activity were not significantly associated with MD adherence. Physical activity was significantly (p < 0.05) lower in individuals who were divorced or widow/ers and in those taking care of their grandchildren several times a week. Conclusions: Adherence to the MD in a big Spanish city is low among older individuals. Socio-family factors seem to play a role. Public health and governmental strategies should reinforce adherence to the MD among older individuals as a gold standard for nutrition.

Residential urban food environment profiles and diet outcomes among adults in Brooklyn, New York: a cross-sectional study

OBJECTIVE

To assess the clustering properties of residential urban food environment indicators across neighbourhoods and to determine if clustering profiles are associated with diet outcomes among adults in Brooklyn, New York.

DESIGN

Cross-sectional.

SETTING

Five neighbourhoods in Brooklyn, New York.

PARTICIPANTS

Survey data (n 1493) were collected among adults in Brooklyn, New York between April 2019 and September 2019. Data for food environment indicators (fast-food restaurants, bodegas, supermarkets, farmer's markets, community kitchens, Supplemental Nutrition Assistance Program application centres, food pantries) were drawn from New York databases. Latent profile analysis (LPA) was used to identify individuals' food access-related profiles, based on food environments measured by the availability of each outlet within each participant's 800-m buffer. Profile memberships were associated with dietary outcomes using mixed linear regression.

RESULTS

LPA identified four residential urban food environment profiles (with significant high clusters ranging from 17 to 57 across profiles): limited/low food access, (n 587), bodega-dense (n 140), food swamp (n 254) and high food access (n 512) profiles. Diet outcomes were not statistically different across identified profiles. Only participants in the limited/low food access profile were more likely to consume sugar-sweetened beverages (SSB) than those in the bodega-dense profile (b = 0·44, P < 0·05) in adjusted models.

CONCLUSIONS

Individuals in limited and low food access neighbourhoods are vulnerable to consuming significant amounts of SSB compared with those in bodega-dense communities. Further research is warranted to elucidate strategies to improve fruit and vegetable consumption while reducing SSB intake within residential urban food environments.

Neighborhood Food Environment and Children's BMI: A New Framework with Structural Equation Modeling

The relationship between neighborhood food environment and childhood obesity is complex and not yet well defined by current research in China, especially when considering the integrated effects with other relative factors. The main purpose of this article is to introduce a framework of children's weight status, based on their neighborhood food environment, and to identify the impact of food environment on the children's BMI and potential pathways. The participants of this cross-sectional study were students aged 8-16.5 years old and their parents. Two conceptual frameworks were tested using the structural equation modeling method, and two models were extracted. Model B added the neighborhood food environment based on model A. By comparing the two models, the neighborhood environment was potentially correlated with the children's BMI directly and may have a positive impact on unhealthy-food eating behaviors, which were positively associated with the children's BMI. The results suggest that the focus should be placed on the integrated effects of the potential risk factors of childhood obesity, based on considering the neighborhood food environment, which may relate to children's unhealthy-food eating behaviors and weight status.

Ambiente alimentar e excesso de peso em escolares: uma revisão sistemática sul-americana

Objetivo.

Identificar e compilar os achados de estudos observacionais que analisaram a relação de fatores do ambiente alimentar escolar e individuais de consumo na escola com excesso de peso em escolares da América do Sul no período de 2011 a 2021.

Métodos.

A pesquisa foi realizada em cinco bases de dados (PubMed, Web of Science, SciELO, Scopus e LILACS) e no Google Scholar, além de consulta a especialistas. Foram selecionados estudos observacionais com escolares de 5 a 19 anos, realizados na América do Sul, que usaram medidas objetivas para avaliar excesso de peso, como o índice de massa corporal (Organização Mundial da Saúde e/ou International Obesity Task Force), em associação a fatores do ambiente alimentar escolar e individuais de consumo na escola. O protocolo foi registrado na plataforma PROSPERO (CRD42020212383).

Resultados.

Dos 906 registros identificados, 13 estudos transversais (um da Argentina, um do Equador e 11 do Brasil) foram incluídos na revisão. As prevalências variaram de 7,5% a 32,5% para sobrepeso e 1,7% a 28,0% para obesidade. Fatores do ambiente alimentar escolar, dos domínios político e físico (como educação alimentar e nutricional insatisfatória e indisponibilidade de refeições preparadas na escola) se associaram com maiores prevalências de excesso de peso. Fatores individuais relacionados à adesão ao programa de alimentação escolar (como consumo da alimentação oferecida pela escola ao invés de lanche trazido de casa) se associaram a menores prevalências de excesso de peso.

Conclusões.

São escassos os estudos sul-americanos enfocando a associação entre fatores do ambiente alimentar escolar e/ou individuais e excesso de peso em escolares. As evidências restritas a contextos locais ou regionais incentivam novos estudos de abrangência nacional.

The perceived role of food and eating among turkish women with obesity: A qualitative analysis

The studies show the link between Body Mass Index (BMI) and higher food responsiveness despite negative physical, social, and psychological outcomes. The descriptive studies examining what makes individuals with higher BMI values more likely to respond to food are limited, while there is none in the Turkish sample. This study aims to understand the subjective relationship of women with obesity/overweight related to food in Turkish culture. Turkish adult women (aged 22-54) who have BMI higher than 25 (overweight/obesity) participated in semi-structured interviews focusing on how they relate to food and obesity. Participants were reached through Ankara Etlik Zübeyde Hanım Obstetrics and Gynecology Hospital Obesity outpatient service. Audio-recorded interviews were analyzed predominantly inductively by thematic analysis principles. Analysis of these interviews reflected three main themes: (1) the act of eating: "I don't know why I eat when I'm full", (2) being overweight: "I am the kind of person who constantly tries to lose weight", and (3) sources of distress. The results indicated the dynamic relationship between the desire to eat, chronic stress, perceived unavailability of close ones, and low sense of self-worth among adult women with obesity/overweight. The other indication is the effect of culture in shaping the relationship dynamics, the sources of distress, and the eating patterns in developing and maintaining obesity.

Exploring the associations between neighbourhood food environment, household food insecurity and child weight-related outcomes in socio-economically and racially/ethnically diverse families

OBJECTIVE

To examine associations among neighbourhood food environments (NFE), household food insecurity (HFI) and child's weight-related outcomes in a racially/ethnically diverse sample of US-born and immigrant/refugee families.

DESIGN

This cross-sectional, observational study involving individual and geographic-level data used multilevel models to estimate associations between neighbourhood food environment and child outcomes. Interactions between HFI and NFE were employed to determine whether HFI moderated the association between NFE and child outcomes and whether the associations differed for US-born v. immigrant/refugee groups.

SETTING

The sample resided in 367 census tracts in the Minneapolis/St. Paul, MN metropolitan area, and the data were collected in 2016-2019.

PARTICIPANTS

The sample was from the Family Matters study of families (n 1296) with children from six racial/ethnic and immigrant/refugee groups (African American, Latino, Hmong, Native American, Somali/Ethiopian and White).

RESULTS

Living in a neighbourhood with low perceived access to affordable fresh fruits and vegetables was found to be associated with lower food security (P < 0·01), poorer child diet quality (P < 0·01) and reduced availability of a variety of fruits (P < 0·01), vegetables (P < 0·05) and whole grains in the home (P < 0·01). Moreover, residing in a food desert was found to be associated with a higher child BMI percentile if the child's household was food insecure (P < 0·05). No differences in associations were found for immigrant/refugee groups.

CONCLUSIONS

Poor NFE were associated with worse weight-related outcomes for children; the association with weight was more pronounced among children with HFI. Interventions aiming to improve child weight-related outcomes should consider both NFE and HFI.

Who Likes Unhealthy Food with a Strong Flavour? Influence of Sex, Age, Body Mass Index, Smoking and Olfactory Efficiency on Junk Food Preferences

Background. Unhealthy food is an important element in the development of diseases of civilisation. The aim of this study was to determine how sex, age, body mass index, smoking and olfactory efficiency influence the consumption of such foods. Methods. A total of 283 people living in the Silesian Voivodeship in Poland took part in the study. They were aged 18−82. An interview and olfactory tests were conducted together with assessments of food preferences from 25 types of food products. The extent to which sex, age, body mass index, tobacco addiction and sense of smell influence unhealthy food consumption was assessed. Results. Using the VARIMAX factor analysis, a coherent group of ‘unhealthy food with a strong flavour’ products was selected: crisps, salty snacks, fast food, sugary carbonated drinks and sour products. Unhealthy food was liked more by people who were younger (B = −0.04; PU = −0.05, −0.03; t = −7.43, eta2 = 0.17; p < 0.001) and who had a higher BMI (B = 0.03; PU ≤ 0.01, 0.06; t = 1.92, eta2 = 0.01; p = 0.056). The efficiency of the sense of smell does not play a significant role in the preference for the ‘unhealthy food’ group as a whole. The analysis of each type of unhealthy food separately showed that young people liked crisps, salty snacks, fast food and sugary carbonated drinks more, men liked fast food and sugary carbonated drinks more than women, and people with a good sense of smell liked sour products. Conclusion. According to the food preferences stated, dietary education should be targeted at young people, especially young men, to prevent the development of overweight and obesity.

Measuring Obesogenicity and Assessing Its Impact on Child Obesity: A Cross-Sectional Ecological Study for England Neighbourhoods

Both major influences on changing obesity levels (diet and physical activity) may be mediated by the environment, with environments that promote higher weight being denoted obesogenic. However, while many conceptual descriptions and definitions of obesogenic environments are available, relatively few attempts have been made to quantify obesogenic environments (obesogenicity). The current study is an ecological study (using area units as observations) which has as its main objective to propose a methodology for obtaining a numeric index of obesogenic neighbourhoods, and assess this methodology in an application to a major national dataset. One challenge in such a task is that obesogenicity is a latent aspect, proxied by observed environment features, such as poor access to healthy food and recreation, as well as socio-demographic neighbourhood characteristics. Another is that obesogenicity is potentially spatially clustered, and this feature should be included in the methodology. Two alternative forms of measurement model (i.e., models representing a latent quantity using observed indicators) are considered in developing the obesogenic environment index, and under both approaches we find that both food and activity indicators are pertinent to measuring obesogenic environments (though with varying relevance), and that obesogenic environments are spatially clustered. We then consider the role of the obesogenic environment index in explaining obesity and overweight rates for children at ages 10-11 in English neighbourhoods, along with area deprivation, population ethnicity, crime levels, and a measure of urban-rural status. We find the index of obesogenic environments to have a significant effect in elevating rates of child obesity and overweight. As a major conclusion, we establish that obesogenic environments can be measured using appropriate methods, and that they play a part in explaining variations in child weight indicators; in short, area context is relevant.

Thought on Food: A Systematic Review of Current Approaches and Challenges for Food Intake Detection

Nowadays, individuals have very stressful lifestyles, affecting their nutritional habits. In the early stages of life, teenagers begin to exhibit bad habits and inadequate nutrition. Likewise, other people with dementia, Alzheimer's disease, or other conditions may not take food or medicine regularly. Therefore, the ability to monitor could be beneficial for them and for the doctors that can analyze the patterns of eating habits and their correlation with overall health. Many sensors help accurately detect food intake episodes, including electrogastrography, cameras, microphones, and inertial sensors. Accurate detection may provide better control to enable healthy nutrition habits. This paper presents a systematic review of the use of technology for food intake detection, focusing on the different sensors and methodologies used. The search was performed with a Natural Language Processing (NLP) framework that helps screen irrelevant studies while following the PRISMA methodology. It automatically searched and filtered the research studies in different databases, including PubMed, Springer, ACM, IEEE Xplore, MDPI, and Elsevier. Then, the manual analysis selected 30 papers based on the results of the framework for further analysis, which support the interest in using sensors for food intake detection and nutrition assessment. The mainly used sensors are cameras, inertial, and acoustic sensors that handle the recognition of food intake episodes with artificial intelligence techniques. This research identifies the most used sensors and data processing methodologies to detect food intake.

Trans-Fatty Acids in Fast-Food and Intake Assessment for Yerevan’s Population, Armenia

There are stringent regulations applicable for trans-fatty acid (TFA) limitations from food supply across the world. However, in Armenia, there is a scarcity of data on TFA content in food products and their consumption levels. Considering that fast-food is among the major contributors to TFA intake, this study aims to assess the dietary exposure of TFAs through the consumption of fast-food in Yerevan, Armenia. Eleven types of fast-food were included in the study. The Food Frequency Questionnaire (FFQ) was used to evaluate daily fast-food consumption. TFA contents in samples were determined using gas chromatography-mass spectrometry. Mean daily fast-food consumption values ranged from 14.68 g/day to 76.09 g/day, with popcorn as the lowest and pastry as the highest consumed food. The study results indicate that the aggregate average daily intake (DI) of TFA is 0.303 g/day. Even though TFA DI values do not exceed the WHO limit of 1%, they substantially contribute to daily TFA intake and may exceed the limit when combined with other foods. Hence, it is recommended to carry out continuous monitoring of TFA content in the food supply to ensure consumer health protection.

Retrieval-induced forgetting in children and adolescents with and without obesity

BACKGROUND/OBJECTIVES

Previous research indicates that youth with obesity exhibit deficits in executive functioning (EF), which often take the form of impaired response inhibition. One aspect of EF not previously studied in obesity is the adaptive process known as retrieval-induced forgetting (RIF), the suppression/inhibition of intrusive or non-target items by the retrieval of specific items from memory. The present study investigated if child or adolescent obesity disrupts the ability to inhibit retrieval of intrusive memories.

SUBJECTS/METHODS

We compared the manifestation of RIF in children (ages 8-12) and adolescents (ages 13-18) as a function of their weight status and sex. We also evaluated the effects of these variables on simple recall of items from episodic memory under conditions where competition from intrusive items was reduced.

RESULTS

Children with obesity did not demonstrate significant RIF, whereas RIF was exhibited by preteens without obesity and by teenage participants with- and without obesity (Weight Status × Age Group interaction p = 0.028). This pattern of results did not differ as a function of sex for either age group. No differences in episodic memory were found. Additional analyses using Age as continuous covariate (and not as a nominal group) comparing participants who exhibited RIF with those who did not, found that the no RIF group consumed fast-food meals more frequently (p = 0.024) and had higher percentages of total body adiposity and android fat compared to the RIF group (p's < 0.05).

CONCLUSIONS

The findings expand what is known about the effects of childhood obesity on cognitive functioning, identify impaired RIF with specific behavioral and dietary factors and increased adiposity, and suggest the possibility that impairments in the ability to inhibit intrusive memories of food and eating may contribute to poor early-life weight control.

Health Economic Aspects of Childhood Excess Weight: A Structured Review

An economic perspective is crucial to understand the broad consequences of childhood excess weight (CEW). These can manifest in the form of elevated health care and societal costs, impaired health status, or inefficiencies in the allocation of resources targeted at its prevention, management, or treatment. Although existing systematic reviews provide summaries of distinct economic research strands covering CEW, they have a restricted focus that overlooks relevant evidence. The overarching aim of this structured review was to update and enhance recent key reviews of four strands of economic evidence in this area, namely, (1) economic costs associated with CEW, (2) health utilities associated with CEW, (3) economic evaluations of interventions targeting CEW, and (4) economic determinants and broader consequences of CEW. Our de novo searches identified six additional studies for the first research strand, five studies for the second, thirty-one for the third, and two for the fourth. Most studies were conducted in a small number of high-income countries. Our review highlights knowledge gaps across all the research strands. Evidence from this structured review can act as data input into future economic evaluations in this area and highlights areas where future economic research should be targeted.

The Negative Impact of Night Shifts on Diet in Emergency Healthcare Workers

Despite the consequences of night-shift work, the diet of night-shift workers has not been widely studied. To date, there are no studies related to food intake among emergency healthcare workers (HCWs). We performed a prospective observational study to assess the influence of night work on the diet of emergency HCWs. We monitored 24-h food intake during a day shift and the consecutive night, and during night work and the daytime beforehand. We analyzed 184 emergency HCWs' food intakes. Emergency HCWs had 14.7% lower (-206 kcal) of their 24-h energy intake during night shifts compared to their day-shift colleagues (1606.7 ± 748.2 vs. 1400.4 ± 708.3 kcal, p = 0.049) and a 16.7% decrease in water consumption (1451.4 ± 496.8 vs. 1208.3 ± 513.9 mL/day, p = 0.010). Compared to day shifts, night-shift had 8.7% lower carbohydrates, 17.6% proteins, and 18.7% lipids. During the night shift the proportion of emergency HCWs who did not drink for 4 h, 8 h and 12 h increased by 20.5%, 17.5%, and 9.1%, respectively. For those who did not eat for 4 h, 8 h and 12 h increased by 46.8%, 27.7%, and 17.7%, respectively. A night shift has a huge negative impact on both the amount and quality of nutrients consumed by emergency healthcare workers.

Prevalence of Overweight and Obesity and Associated Diet-Related Behaviours and Habits in a Representative Sample of Adolescents in Greece

Excessive body weight during adolescence represents a significant public health problem worldwide. Identifying factors associated with its development is crucial. We estimated the prevalence of overweight and obesity in a representative sample of 11, 13 and, 15-year-olds living in Greece and explored the association with diet-related behaviours and habits. Self-reported data on weight, height, diet-related behaviours and habits were used from 3816 students (1898 boys, 1918 girls) participants in the Greek arm of the international Health Behaviour in School-Aged Children (HBSC) study during 2018. Overweight and obesity were defined using the 2007 WHO growth charts classification. Prevalence of overweight was 19.4% in the total sample, 24.1% for boys and 14.7% for girls, and prevalence of obesity was 5.3% in the total sample, 7.3% for boys and 3.4% for girls, respectively. In the total sample, overweight (including obesity) was positively associated with male gender, low family affluence, skipping breakfast, and being on a diet, and inversely associated with age and being physically active. Eating rarely with the family was positively associated with overweight only among boys and eating snacks/meals in front of screens only among girls. No association was noted for eating in fast-food restaurants, consuming vegetables, fruits, sweets, and sugar-sweetened beverages.

Cooking at Home, Fast Food, Meat Consumption, and Dietary Carbon Footprint among US Adults

Shifting consumer behavior towards more sustainable diets can benefit environmental sustainability and human health. Although more frequent home cooking is associated with a better diet quality and fast-food consumption with worse diet quality, the environmental impact of diets based on frequency of cooking or eating fast food is not well understood. The objective of this study was to investigate whether the frequency of cooking dinner at home or eating fast food is associated with dietary greenhouse gas emissions (GHGE). We linked 24-h dietary recall data from adult respondents in the 2007-2010 National Health and Nutrition Examination Survey (NHANES) (N = 11,469) to a database of GHGE factors to obtain a measure of dietary GHGE (kgCO2-eq/2000 kcal) (the sum of emissions released in the production of food for an individual's diet), adjusted by energy intake (kgCO2-eq/2000 kcal). We examined associations between frequency of cooking dinner (the only meal for which cooking frequency was measured), frequency of eating fast food, and dietary GHGE and protein sources (beef, pork, poultry, other meat, and fish and seafood (g/2000 kcal)) using generalized linearized regression models that controlled for age, sex, and other socio-economic characteristics. Greater cooking frequency was associated with higher dietary GHGE. In fully adjusted models, cooking 5-6 times/week was associated with an additional 0.058 kgCO2-eq/2000 kcal (SE 0.033) and cooking 7 times/week was associated with an additional 0.057 kgCO2-eq/2000 kcal (SE 0.027) when compared to cooking 0-2 times/week. Individuals in households who cooked dinner more frequently consumed significantly more meat, poultry, and fish (cooking 7 times/week: 148.7 g/2000 kcal vs. cooking 0-2 times/week: 135.4 g/2000 kcal, p-trend = 0.005), which could explain the association with a higher carbon footprint diet. There were few associations of note between fast-food frequency and GHGE. Policies and interventions that reduce consumption of meat and increase consumption of plants when both cooking meals at home and eating meals out are needed to shift toward diets that will be beneficial for both human health and the health of the planet.

Serum Cystatin C Levels Are Associated With Obesity in Adolescents Aged 14-17 Years

BACKGROUND

The association between serum cystatin C levels and obesity has not been fully explored in adolescents. This study aimed to explore the association between serum cystatin C levels and obesity in adolescents of different sexes.

METHODS

We conducted a cross-sectional study including 481 adolescents aged 14-17 years. Cystatin C level was measured by immunoassay. Health examinations data, biochemical parameters, and questionnaire information were collected. The restricted cubic spline model analyzed the association between cystatin C levels and obesity in boys and girls.

RESULTS

Boys exhibited significantly higher cystatin C levels than girls, with a mean level of 0.97 ± 0.10 mg/L in boys and 0.86 ± 0.09 mg/L in girls (P < 0.001). The restricted cubic spline model suggested that low or high cystatin C levels were associated with an increased risk of obesity in boys, whereas only higher cystatin C levels were associated with an increased risk of obesity in girls.

CONCLUSIONS

A U-shaped correlation was observed between serum cystatin C levels and the risk of obesity in boys. However, in girls, the risk of obesity showed a trend of initially increase and then decrease with increasing cystatin C levels. Longitudinal studies should be conducted to further investigate the diagnostic potential of cystatin C in the progression of early obesity in adolescents of different sexes.

The Impact of Nutritional and Lifestyle Changes on Body Weight, Body Composition and Cardiometabolic Risk Factors in Children and Adolescents during the Pandemic of COVID-19: A Systematic Review

The coronavirus (COVID-19) pandemic and the measures taken by most countries to curb virus transmission, such as social distancing, distance learning, population, home confinement and disruption of all organized activities, has affected children and adolescents worldwide. The aim of this review was to assess the role of diet and lifestyle changes due to COVID-19 measures on body weight/composition and cardiometabolic risk factors in children and adolescents. An electronic search was conducted in PUBMED, COCHRANE, Google Scholar and SCOPUS databases up to 31 October 2021. 15 eligible studies were identified. According to the studies included in the analysis, COVID-19 measures seem to have had a negative impact on the diets and lifestyles of children and adolescents, with a consequent increase in body weight and central fat accumulation. On the other hand, the parental presence and control resulted in better glycaemic control in children with diabetes mellitus (DM) Type 1, but the effect of the pandemic in the glycaemic control of children with DM2 2 is controversial. Finally, diet and lifestyle changes had a differential impact on children’s hypertension prevalence. These findings point to the need for public policy measures to prevent obesity and its complications, to and improve diet and lifestyle during the continuing and yet unresolved COVID-19 epidemic.

Associations between State-Level Obesity Rates, Engagement with Food Brands on Social Media, and Hashtag Usage

Food advertisement exposure is associated with increased caloric intake, but little is known about food/beverage placements in the digital media environment. We aimed to examine the correlation between the number of people who follow food and beverage brand social media accounts (i.e., user engagement) and state-level obesity rates; quantify social media followers' use of "healthy" vs. "unhealthy" hashtags; and analyze the relationship between user engagement and hashtag usage. We identified the 26 fast-food and beverage brands with the highest advertising expenditures and used Demographics Pro to determine the characteristics of social media users amongst the 26 brands. A series of regression analyses were conducted that related the mean percentage of brand followers and state-level obesity rates. We then identified 733 hashtags on Instagram and 703 hashtags on Twitter, coding them as "healthy", "unhealthy", "neutral", or "unrelated to health". Intercoder reliability was established using ReCal2, which indicated a 90% agreement between coders. Finally, we conducted ANCOVA to examine the relationship between the mean percentage of brand followers and their hashtag usage. There was a significant, positive correlation between the state-level obesity rate and the mean percentage of followers of sugary drink or fast-food brands on Instagram and Twitter, but such a correlation between obesity and low-calorie drink brand followers was only found on Twitter. Our findings illustrate the relationship between the social media food environment and obesity rates in the United States. Given the high rates of engagement with food brands on social media, policies should limit digital advertisements featuring fast-food, sugary drink, and low-calorie drink brands.

Association of Neighborhood Food Environment and Physical Activity Environment With Obesity: A Large-Scale Cross-Sectional Study of Fifth- to Ninth-Grade Children in Japan

Objective: This study examined the relationship between neighborhood food and physical activity environment, and obesity among elementary and junior high school students in Japan. Methods: The participants were fifth- to ninth-grade children (n=7277), who were attending municipal schools in Japan. Percent overweight (POW) was calculated using their age, gender, height, and weight, which were collected through a questionnaire. A POW of < 20% was considered non-obese, while ≥ 20% was considered obese. Furthermore, using a geographic information system, we investigated the density of convenience stores, fast-food stores, casual restaurants, supermarkets and department stores, parks, sports facilities, stations, and intersections in the school district. Additionally, from the census, we obtained information regarding the population density of the municipality where the participants' schools were located. Multiple logistic regression analysis was used to examine the relationship between obesity and food environment (the food environment model), between obesity and physical activity environment (the physical activity environment model), and among obesity, food, and physical activity environment (the food and physical activity environment model). Results: In the food environment model and the food and physical activity environment model, the density of convenience stores showed a significant positive association. In the physical activity environment model, the density of stations showed a significant negative association. Conclusion: This study's findings can contribute to the development of appropriate community interventions for improving children's health in Japan and similar areas.

Associations between Fast-Food Restaurants Surrounding Kindergartens and Childhood Obesity: Evidence from China

The prevalence of obesity among preschool children has risen dramatically due to the influx of Western fast food in China. In this study, we aimed to provide clear evidence on the associations between fast-food restaurants and childhood obesity. We collected and combined three unique cross-sectional datasets: physical fitness data, geographic information, and the financial data of each kindergarten. The two-stage least squares were used for empirical analyses. The final data including 75,730 children were from 785 kindergartens in 82 cities and 23 provinces in China in 2018. The mean age of participants was 4.94 ± 0.87; 34,249 (45.2%) females and 41,481 (54.8%) males. The number of fast-food restaurants within 1, 2, and 3 km radii had a significant and positive correlation with obesity, and this correlation decreased as the radius increased. Furthermore, the distance to the nearest fast-food restaurant had a significant and negative correlation with obesity. Western fast-food restaurants contributed more to obesity than the broader definition of fast-food restaurants. There was marked heterogeneity between urban and rural areas. Our findings documented that fast-food restaurants had a significant and positive association with childhood obesity, thus the restriction of fast-food restaurants surrounding kindergartens might be considered.

Race, Ethnicity, and Neighborhood Food Environment Are Associated with Adolescent Sugary Drink Consumption During a 5-Year Community Campaign

Background

A multi-level county-wide campaign to reduce sugary drink consumption was associated with significant decreases in retail sales of soda and fruit drinks. The aim of the current study was to examine changes in adolescent beverage consumption during the campaign by race/ethnicity and neighborhood food environment.

Methods

Beverage consumption among adolescents was evaluated at four time points in a repeated cross-sectional survey of a racially and ethnically diverse sample of sixth graders (N = 13,129) from public middle schools in the county. Each school’s surrounding attendance zone (i.e., neighborhoods where students live) was characterized as providing high or low exposure to unhealthy food retail (e.g., convenience stores, fast-food restaurants). Logistic and multiple linear regression models were used to evaluate changes in beverage consumption over time by student race/ethnicity and high versus low unhealthy food exposure.

Results

Over the 5 years, there were significant declines in the overall share of students who reported daily sugary drink consumption (49.4 to 36.9%) and their reported daily calories from these products (220 to 158 calories). However, disparities were observed, with higher levels of consumption among Black and Hispanic youth and among youth living in neighborhoods with more unhealthy food retail. Notably, Black students living in healthier neighborhood food environments reported significant decreases in daily consumption and calories after 5 years, while Black students living in neighborhoods with more convenience stores and fast-food outlets did not.

Conclusion

These findings suggest that both race/ethnicity and neighborhood food environments are important considerations when designing interventions to reduce sugary drink consumption among adolescents.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40615-021-01074-9.

Anthropometric Development in Children: Possible Changes in Body Mass, Basal Metabolic Rate and Inflammatory Status

(1) Background: Worldwide, public health policies focus on studying dietary patterns and the related anthropometric changes in children. Their aim is to improve the measures meant to reduce global malnutrition rates. Our goal was to study the main changes in the inflammatory status related to anthropometric changes and total daily energy intake. (2) Methods: We tested the study hypothesis by analyzing serum IL-6 and IL-8 levels, cholesterol and triglycerides values, as well as total proteins and creatinine levels, RMR, and food journals in a sample of 160 healthy subjects aged between 6 and 12 years old. (3) Results: IL-6 was correlated with the skinfold values. Changes in the skinfolds were significantly correlated with total proteins and triglycerides. Both weight for age and height for age were related to the skinfold values. Through the BMR measurements, peak carbohydrate metabolism changed significantly based upon IL-6 values, which were significantly correlated with the respiratory coefficient values. Based on the basal metabolic rate, an increased IL-8 ratio was related to the RQ value. (4) Conclusions: Skinfolds have been significantly correlated with IL-6 and IL-8 levels. With changes in body weight, we encountered differences in both serum cholesterol and serum triglycerides values, unlike total proteins and creatinine, which failed to change.

The good, the bad, and the environment: developing an area-based measure of access to health-promoting and health-constraining environments in New Zealand

Background

Accounting for the co-occurrence of multiple environmental influences is a more accurate reflection of population exposure than considering isolated influences, aiding in understanding the complex interactions between environments, behaviour and health. This study examines how environmental ‘goods’ such as green spaces and environmental ‘bads’ such as alcohol outlets co-occur to develop a nationwide area-level healthy location index (HLI) for New Zealand.

Methods

Nationwide data were collected, processed, and geocoded on a comprehensive range of environmental exposures. Health-constraining ‘bads’ were represented by: (i) fast-food outlets, (ii) takeaway outlets, (iii) dairy outlets and convenience stores, (iv) alcohol outlets, (v) and gaming venues. Health-promoting ‘goods’ were represented by: (i) green spaces, (ii) blue spaces, (iii) physical activity facilities, (iv) fruit and vegetable outlets, and (v) supermarkets. The HLI was developed based on ranked access to environmental domains. The HLI was then used to investigate socio-spatial patterning by area-level deprivation and rural/urban classification.

Results

Results showed environmental ‘goods’ and ‘bads’ co-occurred together and were patterned by area-level deprivation. The novel HLI shows that the most deprived areas of New Zealand often have the most environmental ‘bads’ and less access to environmental ‘goods’.

Conclusions

The index, that is now publicly available, is able to capture both inter-regional and local variations in accessibility to health-promoting and health-constraining environments and their combination. Results in this study further reinforce the need to embrace the multidimensional nature of neighbourhood and place not only when designing health-promoting places, but also when studying the effect of existing built environments on population health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12942-021-00269-x.

Urban sprawl and childhood obesity

Urban sprawl is thought to be a risk factor for childhood obesity primarily because the physical environment it creates discourages children's physical activity while encouraging their sedentary behavior. However, there has not been any review on the association between urban sprawl and childhood obesity. This study filled this research gap by comprehensively reviewing literature focusing on associations between urban sprawl and weight-related behaviors and outcomes among children and adolescents. Only two longitudinal and three cross-sectional studies conducted in two countries were identified. Sample sizes ranged from 2324 to 129 781. Four studies used weight status, and only one study used both behaviors and weight status as outcome variables. All positive, negative, and non-significant associations were reported. This review could not identify a clear association between urban sprawl and childhood obesity. More longitudinal studies are needed for in-depth analyses on this important topic in more regions, which would be important not only for public health guidelines but also for research, practice, and policies in urban planning.

Walkability indices and childhood obesity: A review of epidemiologic evidence

The lack of an active neighbourhood living environment can impact community health to a great extent. One such impact manifests in walkability, a measure of urban design in connecting places and facilitating physical activity. Although a low level of walkability is generally considered to be a risk factor for childhood obesity, this association has not been established in obesity research. To further examine this association, we conducted a literature search on PubMed, Web of Science and Scopus for articles published until 31 December 2018. The included literature examined the association between measures of walkability (e.g., walkability score and walkability index) and weight-related behaviours and/or outcomes among children aged under 18 years. A total of 13 studies conducted in seven countries were identified, including 12 cross-sectional studies and one longitudinal study. The sample size ranged from 98 to 37 460, with a mean of 4971 ± 10 618, and the age of samples ranged from 2 to 18. Eight studies reported that a higher level of walkability was associated with active lifestyles and healthy weight status, which was not supported by five studies. In addition to reviewing the state-of-the-art of applications of walkability indices in childhood obesity studies, this study also provides guidance on when and how to use walkability indices in future obesity-related research.

Neighbourhood speed limit and childhood obesity

As an important factor for neighbourhood walkability, the speed limit in the neighbourhood may influence children's physical activity (PA) outdoors, especially active transport, and further their weight status. This review aimed to systematically evaluate the association between neighbourhood speed limit and obesity-related behaviours and outcomes among children and adolescents. PubMed, Embase and Web of Science were systematically searched for relevant studies published from the inception of the database to 1 January 2019. Sixteen studies were included, with 13 cross-sectional studies and three longitudinal studies. Speed limit was measured as the percentage/number of high-speed roads, perception of safe driving speed, perception of speeding and use of traffic-calming tools in the neighbourhood. Eleven studies measured the use of active transport as the outcome of interest, and seven studies measured PA directly. Eleven studies revealed an association between a lower speed limit and increased PA, whereas one study showed a negative association, and three studies reported non-significant associations. Only one study associated speed limit with weight status, which reported a non-significant association. This review generally supported a negative association between speed limit and PA among children and adolescents. More studies are needed to examine their causality, as well as the association between speed limit and weight status, in order to increase the impact of this research area on public health policy making.

Association between neighborhood aesthetics and childhood obesity

The lack of neighbourhood aesthetics (e.g. public art and well-maintained properties) may reduce walkability in the neighbourhood and increase the risk of childhood obesity. In this study, a literature search was conducted in the Cochrane Library, PubMed and Web of Science for articles published before January 1, 2019 to analyse the associations between neighbourhood aesthetics and weight-related behaviours and outcomes among children and adolescents aged <18. One cohort study and 24 cross-sectional studies, conducted in 10 countries with a median sample size of 1124 were identified. Neighbourhood aesthetics was more commonly assessed by self-reported or parent-reported perceptions than objective measurements. Eighteen of the 25 included studies analysed physical activity (PA) as the outcome of interests, eight studies analysed active transport to school (ATS), and eight studies analysed weight status, including body mass index and overweight/obesity status. About two-thirds of studies reported non-significant associations when using PA and weight status as outcomes, and half of studies showed that neighbourhood aesthetics is associated with increased use of ATS. The rest of the studies reported mixed findings with slightly more studies showing neighbourhood aesthetics may promote PA or reduce weight. Better designed studies are necessary to achieve a robust understanding of this epidemiological relationship in the future.

Access to fruit and vegetable markets and childhood obesity: A systematic review

The lack of access to fruit/vegetable markets (FVMs) is thought to be a risk factor for childhood obesity by discouraging healthy dietary behaviours while encouraging access to venues that offer more unhealthy food (and thus the compensatory intake of those options). However, findings remain mixed, and there has not been a review of the association between FVM access and childhood obesity. A comprehensive and systematic understanding of this epidemiologic relationship is important to the design and implementation of relevant public health policies. In this study, a literature search was conducted in the Cochrane Library, PubMed, and Web of Science for articles published before 1 January 2019 that focused on the association between neighbourhood FVM access and weight-related behaviours and outcomes among children and adolescents. Eight cross-sectional studies, two longitudinal studies, and one ecological study conducted in five countries were identified. The median sample size was 2142 ± 1371. Weight-related behaviours and outcomes were used as the outcome variable in two and eight studies, respectively, with one study using both weight-related behaviours and outcomes as outcome variables. We still found a negative association between access to FVMs in children's residential and school neighbourhoods and weight-related behaviours and an inconclusive association between FVM access and overweight or obesity. This conclusion should be regarded as provisional because of a limited amount of relevant evidence and may not be a strong guide for policymaking. Nonetheless, it points to an important research gap that needs to be filled if successful public health interventions are to be undertaken.

Fast-food restaurant, unhealthy eating, and childhood obesity: A systematic review and meta-analysis

Excessive access to fast-food restaurants (FFRs) in the neighbourhood is thought to be a risk factor for childhood obesity by discouraging healthful dietary behaviours while encouraging the exposure to unhealthful food venues and hence the compensatory intake of unhealthy food option. A literature search was conducted in the PubMed, Web of Science, and Embase for articles published until 1 January 2019 that analysed the association between access to FFRs and weight-related behaviours and outcomes among children aged younger than 18. Sixteen cohort studies and 71 cross-sectional studies conducted in 14 countries were identified. While higher FFR access was not associated with weight-related behaviours (eg, dietary quality score and frequency of food consumption) in most studies, it was commonly associated with more fast-food consumption. Despite that, insignificant results were observed for all meta-analyses conducted by different measures of FFR access in the neighbourhood and weight-related outcomes, although 17 of 39 studies reported positive associations when using overweight/obesity as the outcome. This systematic review and meta-analysis revealed a rather mixed relationship between FFR access and weight-related behaviours/outcomes among children and adolescents.

Association between access to full-service restaurants and childhood obesity

The lack of access to full-service restaurants (FSRs) is generally thought to be a risk factor for childhood obesity, as it could discourage healthful eating-out behaviours while increasing the exposure to unhealthful food venues as "compensatory" options. However, the association between FSR access and childhood obesity has not been comprehensively reviewed previously. A literature search was conducted on PubMed and Web of Science for articles published before 1 January 2019 that examined the association between FSR access and weight-related behaviours and outcomes among children and adolescents. Eighteen studies conducted in three countries were identified, published from 2006 to 2018 with a median sample size of 2352 (ranging from 323 to 529 367). Findings were mixed among these 18 studies that reported on the association between access to FSRs and weight-related outcomes. Our meta-analyses showed that there were no significant associations of FSR access with the level of body mass index (BMI) and the BMI z-score among children. Also, there was no apparent evidence on the association between FSR access and the risk of overweight/obesity. Our results need to be interpreted with caution, considering the menu quality of FSRs and heterogeneity of eligible studies in this meta-analysis. Well-designed epidemiologic studies are warranted to further elaborate on the potential association between FSR access and children's weight status.

Traffic-related environmental factors and childhood obesity: A systematic review and meta-analysis

A growing body of research links traffic-related environmental factors to childhood obesity; however, the evidence is still inconclusive. This review aims to fill this important research gap by systematically reviewing existing research on the relationship between traffic-related environmental factors and childhood obesity. Based on the inclusion criteria, 39 studies are selected with environmental factors of interest, including traffic flow, traffic pollution, traffic noise, and traffic safety. Weight-related behaviours include active travel/transport, physical activity (PA), and intake of a high trans-fat diet or stress symptoms; weight-related outcomes are mainly body mass index (BMI) or BMI z-scores and overweight/obesity. Of 16 studies of weight-related behaviours, significant associations are reported in 11 out of 12 studies on traffic flow (two positively and nine negatively associated with PA), five out of six studies on traffic safety (four positively and one negatively associated with PA), one study on traffic pollution (positively with unhealthy food consumption), and one study on traffic noise (negatively associated with PA). Among 23 studies of weight-related outcomes, significant associations are reported in six out of 14 studies on traffic flow (five positively and one negatively associated with obesity outcome), seven out of 10 studies on traffic pollution (all positively associated with obesity outcome), and two out of five on traffic noise (all positively associated with obesity outcome). Our findings show that long-term traffic pollution is weakly positively associated with children's BMI growth, and traffic flow, pollution, and noise could affect weight-related behaviours. Associations between traffic density and noise and weight status are rather inconclusive.

Natural environment and childhood obesity: A systematic review

The associations between built and food environments and childhood obesity have been studied extensively. However, the association between the natural environment and childhood obesity has received too little scholarly attention. This study reviewed the literature published before 1 January 2019, which described associations between a full range of natural environmental factors (e.g., rainfall, temperature, sunlight, natural disasters, flood and drought) and weight-related behaviours and childhood obesity. Five cross-sectional studies and one longitudinal study were identified. Measures of natural environmental factors varied across six included studies, falling into five broad categories: weather conditions, altitude, natural disaster risk, air quality and day length. It was found that temperature was a significant weather indicator in most included studies and was associated with a reduction of daily physical activity. Children living in high-altitude areas were more likely to be shorter and heavier than their counterparts in low-altitude areas. Findings of this study will contribute to helping multiple stakeholders, including policy makers and urban planners, and formulate health policies and interventions to mitigate the detrimental impact of the natural environment on childhood obesity. More longitudinal studies should be designed to confirm these effects and explore the potential health effects of more natural environmental factors.