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Paula DP, Camacho M, Barbosa O, Marques L, Harter Griep R, da Fonseca MJM, Barreto S, Lekadir K. Sex and population differences in the cardiometabolic continuum: a machine learning study using the UK Biobank and ELSA-Brasil cohorts. BMC Public Health 2024; 24:2131. [PMID: 39107721 PMCID: PMC11304673 DOI: 10.1186/s12889-024-19395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/08/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND The temporal relationships across cardiometabolic diseases (CMDs) were recently conceptualized as the cardiometabolic continuum (CMC), sequence of cardiovascular events that stem from gene-environmental interactions, unhealthy lifestyle influences, and metabolic diseases such as diabetes, and hypertension. While the physiological pathways linking metabolic and cardiovascular diseases have been investigated, the study of the sex and population differences in the CMC have still not been described. METHODS We present a machine learning approach to model the CMC and investigate sex and population differences in two distinct cohorts: the UK Biobank (17,700 participants) and the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) (7162 participants). We consider the following CMDs: hypertension (Hyp), diabetes (DM), heart diseases (HD: angina, myocardial infarction, or heart failure), and stroke (STK). For the identification of the CMC patterns, individual trajectories with the time of disease occurrence were clustered using k-means. Based on clinical, sociodemographic, and lifestyle characteristics, we built multiclass random forest classifiers and used the SHAP methodology to evaluate feature importance. RESULTS Five CMC patterns were identified across both sexes and cohorts: EarlyHyp, FirstDM, FirstHD, Healthy, and LateHyp, named according to prevalence and disease occurrence time that depicted around 95%, 78%, 75%, 88% and 99% of individuals, respectively. Within the UK Biobank, more women were classified in the Healthy cluster and more men in all others. In the EarlyHyp and LateHyp clusters, isolated hypertension occurred earlier among women. Smoking habits and education had high importance and clear directionality for both sexes. For ELSA-Brasil, more men were classified in the Healthy cluster and more women in the FirstDM. The diabetes occurrence time when followed by hypertension was lower among women. Education and ethnicity had high importance and clear directionality for women, while for men these features were smoking, alcohol, and coffee consumption. CONCLUSIONS There are clear sex differences in the CMC that varied across the UK and Brazilian cohorts. In particular, disadvantages regarding incidence and the time to onset of diseases were more pronounced in Brazil, against woman. The results show the need to strengthen public health policies to prevent and control the time course of CMD, with an emphasis on women.
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Affiliation(s)
- Daniela Polessa Paula
- National School of Statistical Sciences, Brazilian Institute of Geography and Statistics, Rio de Janeiro, Brazil.
- Institute of Mathematics and Statistics, University of the Rio de Janeiro State, Rio de Janeiro, Brazil.
| | - Marina Camacho
- Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain
| | - Odaleia Barbosa
- Institute of Nutrition, University of the Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Larissa Marques
- Coordination of Information and Communication (CINCO - PEIC), Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosane Harter Griep
- Health and Environmental Education Laboratory, Oswaldo Cruz Institute (IOC), Rio de Janeiro, RJ, Brazil
| | | | - Sandhi Barreto
- Postgraduate Program in Public Health, School of Medicine & Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Karim Lekadir
- Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain
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Hyun J, Lovasi GS, Katz MJ, Derby CA, Lipton RB, Sliwinski MJ. Perceived but not objective measures of neighborhood safety and food environments are associated with longitudinal changes in processing speed among urban older adults. BMC Geriatr 2024; 24:551. [PMID: 38918697 PMCID: PMC11197239 DOI: 10.1186/s12877-024-05068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/13/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Although a growing body of literature documents the importance of neighborhood effects on late-life cognition, little is known about the relative strength of objective and subjective neighborhood measures on late-life cognitive changes. This study examined effects of objective and subjective neighborhood measures in three neighborhood domains (neighborhood safety, physical disorder, food environments) on longitudinal changes in processing speed, an early marker of cognitive aging and impairment. METHODS The analysis sample included 306 community-dwelling older adults enrolled in the Einstein Aging Study (mean age = 77, age range = 70 to 91; female = 67.7%; non-Hispanic White: 45.1%, non-Hispanic Black: 40.9%). Objective and subjective measures of neighborhood included three neighborhood domains (i.e., neighborhood safety, physical disorder, food environments). Processing speed was assessed using a brief Symbol Match task (unit: second), administered on a smartphone device six times a day for 16 days and repeated annually for up to five years. Years from baseline was used as the within-person time index. RESULTS Results from mixed effects models showed that subjective neighborhood safety (β= -0.028) and subjective availability of healthy foods (β= -0.028) were significantly associated with less cognitive slowing over time. When objective and subjective neighborhood measures were simultaneously examined, subjective availability of healthy foods remained significant (β= -0.028) after controlling for objective availability of healthy foods. Associations of objective neighborhood crime and physical disorder with processing speed seemed to be confounded by individual-level race and socioeconomic status; after controlling for these confounders, none of objective neighborhood measures showed significant associations with processing speed. CONCLUSION Subjective neighborhood safety and subjective availability of healthy foods, rather than objective measures, were associated with less cognitive slowing over time over a five-year period. Perception of one's neighborhood may be a more proximal predictor of cognitive health outcomes as it may reflect one's experiences in the environment. It would be important to improve our understanding of both objective and subjective neighborhood factors to improve cognitive health among older adults.
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Affiliation(s)
- Jinshil Hyun
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Drexel University, 3215 Market Street, 2nd Floor, Philadelphia, PA, 19104, USA
| | - Mindy J Katz
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Carol A Derby
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Richard B Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Martin J Sliwinski
- Department of Human Development and Family Studies and Center for Healthy Aging, The Pennsylvania State University, 402 Biobehavioral Health Building, University Park, PA, 16802, USA
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Guimarães JMN, Jackson JW, Barber S, Griep RH, da Fonseca MDJM, Camelo LV, Barreto SM, Schmidt MI, Duncan BB, Cardoso LDO, Pereira AC, Chor D. Racial Inequities in the Control of Hypertension and the Explanatory Role of Residential Segregation: a Decomposition Analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Racial Ethn Health Disparities 2024; 11:1024-1032. [PMID: 37052798 DOI: 10.1007/s40615-023-01582-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/04/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023]
Abstract
The mechanisms underlying racial inequities in uncontrolled hypertension have been limited to individual factors. We investigated racial inequities in uncontrolled hypertension and the explanatory role of economic segregation in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). All 3897 baseline participants with hypertension (2008-2010) were included. Uncontrolled hypertension (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg), self-reported race (White/Brown/Black people), and neighborhood economic segregation (low/medium/high) were analyzed cross-sectionally. We used decomposition analysis, which describes how much a disparity would change (disparity reduction; explained portion) and remain (disparity residual; unexplained portion) upon removing racial differences in economic segregation (i.e., if Black people had the distribution of segregation of White people, how much we would expect uncontrolled hypertension to decrease among Black people). Age- and gender-adjusted prevalence of uncontrolled hypertension (39.0%, 52.6%, and 54.2% for White, Brown, and Black participants, respectively) remained higher for Black and Brown vs White participants, regardless of economic segregation. Uncontrolled hypertension showed a dose-response pattern with increasing segregation levels for White but not for Black and Brown participants. After adjusting for age, gender, education, and study center, unexplained portion (disparity residual) of race on uncontrolled hypertension was 18.2% (95% CI 13.4%; 22.9%) for Black vs White participants and 12.6% (8.2%; 17.1%) for Brown vs White participants. However, explained portion (disparity reduction) through economic segregation was - 2.1% (- 5.1%; 1.3%) for Black vs White and 0.5% (- 1.7%; 2.8%) for Brown vs White participants. Although uncontrolled hypertension was greater for Black and Brown vs White people, racial inequities in uncontrolled hypertension were not explained by economic segregation.
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Affiliation(s)
- Joanna M N Guimarães
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil.
| | - John W Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sharrelle Barber
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Maria de J M da Fonseca
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil
| | - Lidyane V Camelo
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Sandhi M Barreto
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, Hospital das Clínicas de Porto Alegre, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology, Hospital das Clínicas de Porto Alegre, Federal University of Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Leticia de O Cardoso
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo, São Paulo, SP, Brazil
| | - Dora Chor
- National School of Public Health, Oswaldo Cruz Foundation, R Leopoldo Bulhões 1480, Manguinhos, Rio de Janeiro, RJ, Cep 21041-210, Brazil
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Ygnatios NTM, Moreira BDS, Lima-Costa MF, Torres JL. Urban-rural differences in food consumption and environment and anthropometric parameters of older adults: results from ELSI-Brazil. CAD SAUDE PUBLICA 2023; 39:e00179222. [PMID: 37466554 PMCID: PMC10494684 DOI: 10.1590/0102-311xpt179222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 04/19/2023] [Indexed: 07/20/2023] Open
Abstract
This study aimed to identify dietary and anthropometric differences in older Brazilian adults (≥ 50 years old) living in urban-rural areas. This is a cross-sectional study with data from the second wave (9,949 participants) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) from 2019-2021. Weekly dietary intake of fruit/vegetables, beans, and fish; self-perception of salt consumption; food environment (availability of fruit/vegetables in the neighborhood and self-production of food); and objective anthropometric parameters (body mass index [BMI] and waist circumference [WC]) were evaluated. Analyses were adjusted for schooling level. Compared to urban areas, rural areas show lower consumption of fruit/vegetables five days or more per week (74.6% vs. 86.4%) and greater adequate salt intake (96.8% vs. 92.1%) - differences we observed for men and women. Rural areas showed lower high WC (61.9% vs. 68%), significant only for men. Considering food environment, rural areas had lower fruit and vegetable availability in the neighborhood (41.2% vs. 88.3%) and higher self-production of food (38.2% vs. 13.2%). We observed a lower consumption of fruit/vegetables five days or more per week in rural areas with fruit/vegetable availability in the neighborhood and no self-production of food. Urban and rural areas show food and nutritional diversity. Incentives for fruit or vegetable consumption among residents in urban areas should consider the greater availability of these foods in their neighborhood, whereas, in rural areas, self-production of food should be encouraged. Adequate salt intake and ideal WC maintenance should be reinforced in urban areas.
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Affiliation(s)
- Nair Tavares Milhem Ygnatios
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
- Centro Universitário Santa Rita, Conselheiro Lafaiete, Brasil
| | - Bruno de Souza Moreira
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Maria Fernanda Lima-Costa
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
- Instituto de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Juliana Lustosa Torres
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Polessa Paula D, Barbosa Aguiar O, Pruner Marques L, Bensenor I, Suemoto CK, Mendes da Fonseca MDJ, Griep RH. Comparing machine learning algorithms for multimorbidity prediction: An example from the Elsa-Brasil study. PLoS One 2022; 17:e0275619. [PMID: 36206287 PMCID: PMC9543987 DOI: 10.1371/journal.pone.0275619] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Multimorbidity is a worldwide concern related to greater disability, worse quality of life, and mortality. The early prediction is crucial for preventive strategies design and integrative medical practice. However, knowledge about how to predict multimorbidity is limited, possibly due to the complexity involved in predicting multiple chronic diseases. METHODS In this study, we present the use of a machine learning approach to build cost-effective multimorbidity prediction models. Based on predictors easily obtainable in clinical practice (sociodemographic, clinical, family disease history and lifestyle), we build and compared the performance of seven multilabel classifiers (multivariate random forest, and classifier chain, binary relevance and binary dependence, with random forest and support vector machine as base classifiers), using a sample of 15105 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We developed a web application for the building and use of prediction models. RESULTS Classifier chain with random forest as base classifier performed better (accuracy = 0.34, subset accuracy = 0.15, and Hamming Loss = 0.16). For different feature sets, random forest based classifiers outperformed those based on support vector machine. BMI, blood pressure, sex, and age were the features most relevant to multimorbidity prediction. CONCLUSIONS Our results support the choice of random forest based classifiers for multimorbidity prediction.
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Affiliation(s)
- Daniela Polessa Paula
- National School of Statistical Sciences, Brazilian Institute of Geography and Statistics, Rio de Janeiro, Brazil
- * E-mail: ,
| | | | - Larissa Pruner Marques
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabela Bensenor
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Claudia Kimie Suemoto
- Division of Geriatrics, Department of Clinical Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Rosane Härter Griep
- Health and Environmental Education Laboratory, Oswaldo Cruz Institute (IOC), Rio de Janeiro, Brazil
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Muzenda T, Dambisya PM, Kamkuemah M, Gausi B, Battersby J, Oni T. Mapping food and physical activity environments in low- and middle-income countries: A systematised review. Health Place 2022; 75:102809. [PMID: 35508088 DOI: 10.1016/j.healthplace.2022.102809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/06/2021] [Accepted: 04/15/2022] [Indexed: 12/27/2022]
Abstract
This systematised literature review synthesised evidence on approaches to mapping food and physical activity (PA) environments in low- and middle-income countries (LMICs). Of the 60 articles included, 25 and 35 mapped food and PA environments respectively. All studies were cross-sectional with researcher-led data collection. Three types of mapping tools were identified - maps (n = 18), GPS (n = 10), and GIS (n = 37). Our findings point to a paucity of research mapping food and PA environments, overall and particularly subjective domains. We highlight a need for future studies that utilise innovative, inexpensive and participatory research methods to understand dynamic exposures to obesogenic environment features in resource-constrained contexts undergoing rapid urbanisation.
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Affiliation(s)
- Trish Muzenda
- Research Initiative for Cities Health and Equity (RICHE), Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, 7925, South Africa; Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom.
| | - Philip Mbulalina Dambisya
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, 7925, South Africa
| | - Monika Kamkuemah
- Research Initiative for Cities Health and Equity (RICHE), Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, 7925, South Africa; Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, 7925, South Africa
| | - Blessings Gausi
- Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, 7925, South Africa
| | - Jane Battersby
- African Centre for Cities, University of Cape Town, Cape Town, 7945, South Africa
| | - Tolu Oni
- Research Initiative for Cities Health and Equity (RICHE), Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, 7925, South Africa; Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
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Liu J, Yang L, Xiao L, Tao Z. Perceived Neighborhood Environment Impacts on Health Behavior, Multi-Dimensional Health, and Life Satisfaction. Front Public Health 2022; 10:850923. [PMID: 35359780 PMCID: PMC8964045 DOI: 10.3389/fpubh.2022.850923] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/16/2022] [Indexed: 11/23/2022] Open
Abstract
The impacts of perceived neighborhood environment on adults' health and life satisfaction have drawn increasing academic attention. However, previous studies usually examine multi-dimensional (physical, mental, and perceived) health and life satisfaction separately, and few studies dealt with them simultaneously. Moreover, limited research revealed the mechanisms behind the effects of perceived neighborhood environment on health and life satisfaction, as well as how such effects are moderated by socio-demographics. Therefore, employing the 2016 China Family Panel Study Dataset and using structural equation modeling, this study delves into the complicated relationships among perceived neighborhood environment, health behavior, health outcomes (i.e., body mass index, self-rated health status, and depression), and life satisfaction. Notably, it considers mediation and moderation simultaneously. It finds: (1) Better perceived neighborhood environment significantly promotes physical activity and reduces sedentary behavior, smoking, and drinking; (2) Health behavior fully mediates the effects of perceived neighborhood environment on health; (3) Perceived neighborhood environment significantly affects life satisfaction both directly and indirectly (through health behavior and health outcomes); (4) Socio-demographics moderate the above relationships. This study disentangles the complicated impacts of perceived neighborhood environment on adults' multi-dimensional health and life satisfaction, thus providing policy makers and practitioners with nuanced knowledge for intervention.
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Affiliation(s)
- Jixiang Liu
- Department of Urban Planning, School of Architecture and Civil Engineering, Xiamen University, Xiamen, China
- Faculty of Architecture, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Linchuan Yang
- Department of Urban and Rural Planning, School of Architecture, Southwest Jiaotong University, Chengdu, China
| | - Longzhu Xiao
- Department of Urban Planning, School of Architecture and Civil Engineering, Xiamen University, Xiamen, China
- Department of Architecture and Civil Engineering, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Zhuolin Tao
- Faculty of Geographical Science, Beijing Normal University, Beijing, China
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Marchioni DM, Cacau LT, De Carli E, de Carvalho AM, Rulli MC. Low Adherence to the EAT-Lancet Sustainable Reference Diet in the Brazilian Population: Findings from the National Dietary Survey 2017-2018. Nutrients 2022; 14:1187. [PMID: 35334839 PMCID: PMC8956109 DOI: 10.3390/nu14061187] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
Diets are simultaneously connected with population health and environment. The EAT-Lancet Commission proposed a sustainable reference diet to improve population health and respect the planetary boundaries. Recently, the Planetary Health Diet Index (PHDI) has been developed to assess the adherence to this reference diet. In the present study, we aimed to evaluate the adherence to the EAT-Lancet diet through the PHDI in a nationwide population-based study carried out in Brazil. We used data from the National Dietary Survey conducted through the Household Budget Survey in 2017-2018, with 46,164 Brazilians aged over 10 years old. Food consumption was evaluated with a 24 h dietary recall. The average PHDI total score in the Brazilian population was 45.9 points (95% CI 45.6:46.1) on a total score that can range from 0 to 150 points. The adherence to EAT-Lancet diet was low among all Brazilian regions. Women, elderly, those overweighed/obese, with higher per capita income and living in the urban area had higher scores in the PHDI. In general, the Brazilian population presented low adherence to a healthy and sustainable dietary pattern and seems far from meeting the EAT-Lancet recommendations.
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Affiliation(s)
- Dirce Maria Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; (L.T.C.); (E.D.C.); (A.M.d.C.)
| | - Leandro Teixeira Cacau
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; (L.T.C.); (E.D.C.); (A.M.d.C.)
| | - Eduardo De Carli
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; (L.T.C.); (E.D.C.); (A.M.d.C.)
| | - Aline Martins de Carvalho
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; (L.T.C.); (E.D.C.); (A.M.d.C.)
| | - Maria Cristina Rulli
- Department of Civil and Environmental Engineering, Politecnico di Milano, 20133 Milan, Italy;
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Perceived neighbourhood food access is associated with consumption of animal-flesh food, fruits and vegetables among mothers and young children in peri-urban Cambodia. Public Health Nutr 2022; 25:717-728. [PMID: 34593072 PMCID: PMC9991642 DOI: 10.1017/s1368980021004122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine whether mothers' perceived neighbourhood food access is associated with their own and their young children's consumption of animal-flesh food, fruits and vegetables in peri-urban areas of Cambodia. DESIGN A cross-sectional survey measured food consumption frequency and perceived neighbourhood food access, the latter including six dimensions of food availability, affordability, convenience, quality, safety and desirability. Multivariate logistic regression was used to assess the association between perceived food access and food consumption. SETTING Peri-urban districts of Phnom Penh and Siem Reap, Cambodia. PARTICIPANTS 198 mothers of children between 6 and 24 months old. RESULTS Over 25 % of the mothers and 40 % of the children had low consumption (< once a day) of either animal-flesh food or fruits and vegetables. Compared with perceived high food access, perceived low food access was associated with an adjusted 5·6-fold and 4·3-fold greater odds of low animal-flesh food consumption among mothers (95 % CI 2·54, 12·46) and children (95 % CI 2·20, 8·60), respectively. Similarly, relative to perceived high food access, perceived low food access was associated with 7·6-times and 5·1-times higher adjusted odds of low fruits and vegetables consumption among mothers (95 % CI 3·22, 18·02) and children (95 % CI 2·69, 9·83), respectively. CONCLUSIONS Mothers' perceived neighbourhood food access was an important predictor of their own and their young children's nutrient-rich food consumption in peri-urban Cambodia. Future work is needed to confirm our findings in other urban settings and examine the role of neighbourhood food environment in the consumption of both nutrient-rich and nutrient-poor food.
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Gao X, Engeda J, Moore LV, Auchincloss AH, Moore K, Mujahid MS. Longitudinal associations between objective and perceived healthy food environment and diet: The Multi-Ethnic Study of Atherosclerosis. Soc Sci Med 2022; 292:114542. [PMID: 34802783 PMCID: PMC8748383 DOI: 10.1016/j.socscimed.2021.114542] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/18/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Research examining the influence of neighborhood healthy food environment on diet has been mostly cross-sectional and has lacked robust characterization of the food environment. We examined longitudinal associations between features of the local food environment and healthy diet, and whether associations were modified by race/ethnicity. METHODS Data on 3634 adults aged 45-84 followed for 10 years were obtained from the Multi-Ethnic Study of Atherosclerosis. Diet quality was assessed using the Alternative Healthy Eating Index at Exam 1 (2000-2002) and Exam 5 (2010-2012). We assessed four measures of the local food environment using survey-based measures (e.g. perceptions of healthier food availability) and geographic information system (GIS)-based measures (e.g. distance to and density of healthier food stores) at Exam 1 and Exam 5. Random effects models adjusted for age, sex, education, moving status, per capita adjusted income, and neighborhood socioeconomic status, and used interaction terms to assess effect measure modification by race/ethnicity. RESULTS Net of confounders, one standard z-score higher average composite local food environment was associated with higher average AHEI diet score (β=1.39, 95% CI: 1.05, 1.73) over the follow-up period from Exam 1 to 5. This pattern of association was consistent across both GIS-based and survey-based measures of local food environment and was more pronounced among minoritized racial/ethnic groups. There was no association between changes in neighborhood environment and change in AHEI score, or effect measure modification by race/ethnicity. CONCLUSION Our findings suggest that neighborhood-level food environment is associated with better diet quality, especially among racially/ethnically minoritized populations.
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Affiliation(s)
- Xing Gao
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
| | - Joseph Engeda
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA; Social & Scientific Systems, Durham, NC, USA
| | - Latetia V Moore
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy H Auchincloss
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
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11
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Gayman MD, Wilkin HA, Stover S, Vidmar CM, Edwards T, Gallashaw C. Perceived Built Environment and Physical Limitations: Race Contrasts in Historically Lower-Income African American Neighborhoods. FAMILY & COMMUNITY HEALTH 2021; 44:21-31. [PMID: 33055574 DOI: 10.1097/fch.0000000000000282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study uses primary data from a community-based random sample of adults in historically lower-income African American (or Black) neighborhoods in Atlanta, Georgia (N = 352). The aim was to investigate whether there are race differences in perceived neighborhood conditions/amenities, and the potential conditional effect of race on the relationship between the perceived built environment and physical limitations. Findings indicate significant race differences in the perceived built environment and that the relationship between the perceived built environment and physical limitations is conditioned by race, whereby Whites experience greater physical health benefits from more neighborhood conditions/amenities than African Americans.
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Affiliation(s)
- Mathew D Gayman
- Departments of Sociology (Dr Gayman, Mss Stover and Edwards, and Mr Vidmar) and Communication (Dr Wilkin), Georgia State University, Atlanta. Ms Gallashaw is Research Team Community Member in Atlanta, Georgia
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12
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Westbury S, Ghosh I, Jones HM, Mensah D, Samuel F, Irache A, Azhar N, Al-Khudairy L, Iqbal R, Oyebode O. The influence of the urban food environment on diet, nutrition and health outcomes in low-income and middle-income countries: a systematic review. BMJ Glob Health 2021; 6:e006358. [PMID: 34635553 PMCID: PMC8506857 DOI: 10.1136/bmjgh-2021-006358] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Diet and nutrition are leading causes of global morbidity and mortality. Our study aimed to identify and synthesise evidence on the association between food environment characteristics and diet, nutrition and health outcomes in low-income and middle-income countries (LMICs), relevant to urban settings, to support development and implementation of appropriate interventions. METHODS We conducted a comprehensive search of 9 databases from 1 January 2000 to 16 September 2020 with no language restrictions. We included original peer-reviewed observational studies, intervention studies or natural experiments conducted in at least one urban LMIC setting and reporting a quantitative association between a characteristic of the food environment and a diet, nutrition or health outcome. Study selection was done independently in duplicate. Data extraction and quality appraisal using the National Heart Lung and Blood Institute checklists were completed based on published reports using a prepiloted form on Covidence. Data were synthesised narratively. RESULTS 74 studies met eligibility criteria. Consistent evidence reported an association between availability characteristics in the neighbourhood food environment and dietary behaviour (14 studies, 10 rated as good quality), while the balance of evidence suggested an association with health or nutrition outcomes (17 of 24 relevant studies). We also found a balance of evidence that accessibility to food in the neighbourhood environment was associated with diet (10 of 11 studies) although evidence of an association with health outcomes was contradictory. Evidence on other neighbourhood food environment characteristics was sparse and mixed. Availability in the school food environment was also found to be associated with relevant outcomes. Studies investigating our other primary outcomes in observational studies of the school food environment were sparse, but most interventional studies were situated in schools. We found very little evidence on how workplace and home food environments are associated with relevant outcomes. This is a substantial evidence gap. CONCLUSION 'Zoning' or 'healthy food cart' interventions to alter food availability may be appropriate in urban LMIC. PROSPERO REGISTRATION NUMBER CRD42020207475.
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Affiliation(s)
- Susannah Westbury
- School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - Iman Ghosh
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Daniel Mensah
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Folake Samuel
- Department of Human Nutrition and Dietetics, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Ana Irache
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Nida Azhar
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | | | - Romaina Iqbal
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
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13
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Albuquerque LDS, Griep RH, Aquino EML, Cardoso LDO, Chor D, Fonseca MDJMD. Factors associated with body image dissatisfaction in adults: a cross-sectional analysis of the ELSA-Brasil Study. CIENCIA & SAUDE COLETIVA 2021; 26:1941-1954. [PMID: 34076134 DOI: 10.1590/1413-81232021265.07152019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 07/26/2019] [Indexed: 11/22/2022] Open
Abstract
The aim of this article is to assess the association between body image dissatisfaction and sociodemographic and health behaviors, according to sex. Data were analyzed for 6,289 women and 5,188 men (35-59 years), participants in the baseline of the Longitudinal Study of Adult Health (ELSA-Brasil), using multinomial regression. The odds of dissatisfaction due to feeling underweight were higher among in women with low schooling and those who only consumed fruit weekly. Moderate physical activity reduced this type of dissatisfaction by 50%. Higher odds of dissatisfaction due to overweight were seen in married women, those who practiced light physical activity, and former smokers. Men with secondary schooling and excessive alcohol consumption showed 50% higher odds of dissatisfaction due to underweight, while light or moderate physical activity increased the odds by 75% and 94%, respectively. Among men, light and moderate physical activity were also associated with increased odds of dissatisfaction due to overweight. These findings corroborate that unhealthy habits and behaviors can influence body image dissatisfaction with different patterns between women and men.
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Affiliation(s)
- Liliane da Silva Albuquerque
- Secretaria Municipal de Educação da cidade do Rio de Janeiro. Escola Municipal Lino Martins da Silva. R. Teixeira Ribeiro 1000 bloco 1, Campus Maré Bonsucesso. 21044-251 Rio de Janeiro RJ Brasil.
| | - Rosane Harter Griep
- Laboratório de Educação em Ambiente e Saúde, Instituto Oswaldo cruz, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | - Letícia de Oliveira Cardoso
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rio de Janeiro RJ Brasil
| | - Dóra Chor
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rio de Janeiro RJ Brasil
| | - Maria de Jesus Mendes da Fonseca
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rio de Janeiro RJ Brasil
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The association of dimensions of fruit and vegetable access in the retail food environment with consumption; a systematic review. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2021; 29:100528. [PMID: 34164256 PMCID: PMC8202327 DOI: 10.1016/j.gfs.2021.100528] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/29/2021] [Accepted: 03/04/2021] [Indexed: 12/04/2022]
Abstract
The consumption of fruit and vegetables (F&V) is important for human health to protect against non-communicable disease and micronutrient deficiency. Increasing consumption of F&V may also benefit planetary health if these foods are substituted for foods with higher environmental footprints such as red meat or dairy. The retail food environment (RFE) is an influential junction between the food system and individual diets as it drives access to F&V through external (physical access) and personal (availability, affordability, acceptability) domains. We performed a systematic search of six literature databases (January 2021) for studies assessing access to F&V in the RFE and its association with F&V consumption in adults in high- and upper-middle income countries. 36 studies were identified and categorised by dimensions of food access – accessibility, affordability, acceptability, availability and accommodation. More than half of the studies (n = 20) were based in the USA. F&V accessibility was the most commonly reported dimension (n = 29); no study reported on accommodation. 6 studies were rated to be high quality. A positive association of increased availability of F&V options in the RFE with intake was identified in 9 of 15 studies. Associations in both acceptability and accessibility dimensions were inconsistent. No association was observed between F&V affordability and consumption although available data were limited. Many challenges exist to building a robust evidence base within food environment research including conceptual, definitional and methodological heterogeneity and measurement standardisation. Future food policies should consider multi-dimensional interventions to promote access to F&V in the RFE across all domains. First systematic review of dimensions of access in the retail food environment (RFE) and fruit and vegetable (F&V) intake. This review suggests potential importance of having access to available healthy options in the RFE for F&V intake. The absence of an association of F&V affordability with consumption is likely due to limited and mixed data availability. F&V accessibility and acceptability require development as dimensions of access for clearer links to be made. The retail food environment is complex but likely predictor of F&V consumption.
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da Fonseca MDJM, Pimenta IT, Albuquerque LDS, Aquino EML, Cardoso LDO, Chor D, Griep RH. Factors Associated with Body Size Perception and Body Image (Dis)Satisfaction in the Elderly: Results of the ELSA-Brasil Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186632. [PMID: 32933014 PMCID: PMC7558384 DOI: 10.3390/ijerph17186632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 01/12/2023]
Abstract
The study aimed to assess the association between body image perception and (dis)satisfaction and sociodemographic and behavioral factors in the elderly, using multinomial logistic regression. Data were analyzed for 1686 women and 1499 men participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Men with less schooling and women with lower per capita income showed higher odds of underestimating their body size. Former smokers of both sexes showed higher odds of overestimating their body size; lower schooling and lower per capita income decreased these odds. Increasing age, lower per capita income, and smoking increased the odds of dissatisfaction due to thinness in men, and married marital status decreased these odds. In women, low per capita income, weekly consumption of vegetables, and smoking increased the odds of such dissatisfaction. Factors that increased the odds of dissatisfaction due to excess weight in both sexes were primary or secondary schooling and former smoking. In women, low per capita income, weak physical activity, weekly consumption of vegetables, and excessive alcohol intake also increased the odds of such dissatisfaction. The results suggest that improved living conditions and the adoption of healthy behaviors can help reduce misperceived negative body image among elderly.
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Affiliation(s)
- Maria de Jesus Mendes da Fonseca
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil; (I.T.P.); (L.d.O.C.); (D.C.)
- Correspondence:
| | - Isiyara Taverna Pimenta
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil; (I.T.P.); (L.d.O.C.); (D.C.)
| | | | - Estela M. L. Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador 40110-040, Brazil;
| | - Letícia de Oliveira Cardoso
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil; (I.T.P.); (L.d.O.C.); (D.C.)
| | - Dóra Chor
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil; (I.T.P.); (L.d.O.C.); (D.C.)
| | - Rosane Harter Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil;
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Longitudinal Study of Body Composition and Energy Expenditure in Overweight or Obese Young Adults. Sci Rep 2020; 10:5305. [PMID: 32210340 PMCID: PMC7093463 DOI: 10.1038/s41598-020-62249-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/09/2020] [Indexed: 12/29/2022] Open
Abstract
The aim of this study was to compare the effects of an aerobic training program with a strength training program on body composition and energy expenditure in overweight or obese (29.06 ± 3.49 kg/m2) young adults (21.96 ± 1.90 years). Subjects (N = 109) were randomly assigned to one of three groups: a control group (CG), an aerobic training (AT) group and a strength training (ST) group. Training took place over twelve weeks comprising three sessions per week with each session lasting 60 to 90 minutes. Before and after the program, weight, height, body mass index, lean mass percentage and fat mass percentage were evaluated. In addition, The International Physical Activity Questionnaire-Short Form (IPAQ-SF) was used to estimate energy expenditure. The results of both aerobic training and strength training produced statistically significant improvements in weight (AT-CG = −2.892 kg; ST-CG = −2.986 kg); BMI (AT-CG = −1.075 kg/m2; ST-CG = −1.118 kg/m2); total body fat (AT-CG = −1529.172 g; ST-CG = −763.815); and total body fat percentage (AT-CG = −1.421%; AT-ST = −0.855%). These two exercise prescription models were therefore useful in reducing overweight and obesity, which could have an impact on improving the health and quality of life of individuals with these characteristics.
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17
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Vegi ASF, Fernandes Filho EI, Pessoa MC, Ramos KL, Ribeiro AQ. [Walkability and healthy aging: an analytical proposal for small and medium-sized Brazilian cities]. CAD SAUDE PUBLICA 2020; 36:e00215218. [PMID: 32187294 DOI: 10.1590/0102-311x00215218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 09/03/2019] [Indexed: 11/21/2022] Open
Abstract
Evidence has shown that urban environments that discourage walking contribute to functional incapacity in the elderly. Various indices have been proposed to describe an area's walkability, combining different aspects of the built environment that promote (or inhibit) walking. However, due to problems with the quality and availability of data in Brazil, there is no walkability index to date applies to all cities of the country and that has been properly tested in the population. The current study aimed to propose a walkability index based on geographic information systems for a medium-sized city, with open-access data, and to test its association with functional incapacity in the elderly. The study used data from the urban area of a medium-sized Brazilian city to select a parsimonious set of variables through factor analysis. The resulting index was tested for its association with the capacity to perform activities of daily living that require more movement, in 499 elderly, using generalized estimating equations. The resulting walkability index consists of residential density, commercial density, street connectivity, presence of sidewalks, and public lighting. These variables comprised the first factor in the factor analysis, excluding only arborization which was retained in the second factor. The worst walkability score was associated with the highest functional incapacity score. Based on the results and their validation, the study suggests an easily applicable walkability index with great potential for use in action plans to adapt environments.
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Turner C, Kalamatianou S, Drewnowski A, Kulkarni B, Kinra S, Kadiyala S. Food Environment Research in Low- and Middle-Income Countries: A Systematic Scoping Review. Adv Nutr 2020; 11:387-397. [PMID: 31079142 PMCID: PMC7442349 DOI: 10.1093/advances/nmz031] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/22/2019] [Accepted: 03/07/2019] [Indexed: 11/13/2022] Open
Abstract
Food environment research is increasingly gaining prominence in low- and middle-income countries (LMICs). However, in the absence of a systematic review of the literature, little is known about the emerging body of evidence from these settings. This systematic scoping review aims to address this gap. A systematic search of 6 databases was conducted in December 2017 and retrieved 920 records. In total, 70 peer-reviewed articles met the eligibility criteria and were included. Collectively, articles spanned 22 LMICs, including upper-middle-income countries (n = 49, 70%) and lower-middle-income countries (n = 18, 26%). No articles included low-income countries. Articles featured quantitative (n = 45, 64%), qualitative (n = 17, 24%), and mixed-method designs (n = 11, 8%). Studies analyzed the food environment at national, community, school, and household scales. Twenty-three articles (55%) assessed associations between food environment exposures and outcomes of interest, including diets (n = 14), nutrition status (n = 13), and health (n = 1). Food availability was associated with dietary outcomes at the community and school scales across multiple LMICs, although associations varied by vendor type. Evidence regarding associations between the food environment and nutrition and health outcomes was inconclusive. The paucity of evidence from high-quality studies is a severe limitation, highlighting the critical need for improved study designs and standardized methods and metrics. Future food environment research must address low-income and lower-middle-income countries, and include the full spectrum of dietary, nutrition, and health outcomes. Improving the quality of food environment research will be critical to the design of feasible, appropriate, and effective interventions to improve public health nutrition in LMICs.
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Affiliation(s)
- Christopher Turner
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom
| | - Sofia Kalamatianou
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom
| | - Adam Drewnowski
- University of Washington, Department of Nutritional Sciences, Center for Public Health Nutrition, Seattle, WA
| | - Bharati Kulkarni
- National Institute of Nutrition, Tarnaka, Hyderabad, Telangana, India
| | - Sanjay Kinra
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Population Health, London, United Kingdom
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Association Between Perceived Neighborhood Characteristics and Carotid
Artery Intima-Media Thickness: Cross-Sectional Results From the ELSA-Brasil
Study. Glob Heart 2019; 14:379-385. [DOI: 10.1016/j.gheart.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/23/2019] [Accepted: 09/20/2019] [Indexed: 11/21/2022] Open
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The food environment in Latin America: a systematic review with a focus on environments relevant to obesity and related chronic diseases. Public Health Nutr 2019; 22:3447-3464. [PMID: 31666140 DOI: 10.1017/s1368980019002891] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Food environments may be contributing to the rapid increase in obesity occurring in most Latin American (LA) countries. The present study reviews literature from LA that (i) describes the food environment and policies targeting the food environment (FEP); and (ii) analytic studies that investigate associations between the FEP and dietary behaviours, overweight/obesity and obesity related chronic diseases. We focus on six dimensions of the FEP: food retail, provision, labelling, marketing, price and composition. DESIGN Systematic literature review. Three databases (Web of Science, SciELO, LILACS) were searched, from 1 January 1999 up to July 2017. Two authors independently selected the studies. A narrative synthesis was used to summarize, integrate and interpret findings. SETTING Studies conducted in LA countries. PARTICIPANTS The search yielded 2695 articles of which eighty-four met inclusion criteria. RESULTS Most studies were descriptive and came from Brazil (61 %), followed by Mexico (18 %) and Guatemala (6 %). Studies were focused primarily on retail/provision (n 27), marketing (n 16) and labelling (n 15). Consistent associations between availability of fruit and vegetable markets and higher consumption of fruits and vegetables were found in cross-sectional studies. Health claims in food packaging were prevalent and mostly misleading. There was widespread use of marketing strategies for unhealthy foods aimed at children. Food prices were lower for processed relative to fresh foods. Some studies documented high sodium in industrially processed foods. CONCLUSIONS Gaps in knowledge remain regarding policy evaluations, longitudinal food retail studies, impacts of food price on diet and effects of digital marketing on diet/health.
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Chaparro MP, Pina MF, de Oliveira Cardoso L, Santos SM, Barreto SM, Giatti Gonçalves L, Alvim de Matos SM, Mendes da Fonseca MDJ, Chor D, Griep RH. The association between the neighbourhood social environment and obesity in Brazil: a cross-sectional analysis of the ELSA-Brasil study. BMJ Open 2019; 9:e026800. [PMID: 31494597 PMCID: PMC6731797 DOI: 10.1136/bmjopen-2018-026800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the association between the neighbourhood social environment, including social cohesion, perceived neighbourhood safety, perceived neighbourhood violence, and obesity in Brazil. DESIGN Cross-sectional study. SETTING 6 state capitals in Brazil (Salvador, Vitoria, Belo Horizonte, Porto Alegre, Sao Paulo and Rio de Janeiro) PARTICIPANTS: Current or former employees of five federal universities and one research centre in each of the six Brazilian state capitals who were participants of the baseline wave (2008-2010) of the Brazilian Longitudinal Study of Adult Health (n=11 456; 56% women; 56% White, 28% Brown, and 16% Black). PRIMARY OUTCOME MEASURE Obesity, based on measured weight and height, and defined as having a body mass index ≥30 kg/m2. RESULTS No associations were found between the neighbourhood social environment and obesity among men. In multilevel logistic regression models adjusted for age, education, skin colour, state of residence, and individual-level social cohesion and perceived violence scores, respectively, women living in the least socially cohesive neighbourhoods and in those perceived as most violent had higher odds of obesity compared with their counterparts (OR=1.25, 95% CI=1.02-1.53; OR=1.28, 95% CI=1.04-1.56, respectively). When stratified by neighbourhood socioeconomic status (SES)-defined based on number of people per household, proportion of children 0-4 years, median income and per cent of white residents at the neighbourhood level-results for social cohesion and for violence remained only for women residing in high SES and low SES neighbourhoods, respectively. CONCLUSIONS In this civil-servant sample in six large cities in Brazil, the neighbourhood social environment was associated with obesity among women, but not men. Neighbourhood-level interventions to increase social cohesion and reduce violence may help in the prevention of obesity among women in Brazil.
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Affiliation(s)
- M Pia Chaparro
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Maria Fátima Pina
- Institute for Communication and Information on Health, Fundacao Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
- INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Letícia de Oliveira Cardoso
- Department of Epidemiology and Quantitative Methods, National School of Public Health Sergio Arouca, Fundacao Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Simone M Santos
- Department of Epidemiology and Quantitative Methods, National School of Public Health Sergio Arouca, Fundacao Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sandhi M Barreto
- School of Medicine & Clinical Hospital, Universidad Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luana Giatti Gonçalves
- School of Medicine & Clinical Hospital, Universidad Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Maria de Jesus Mendes da Fonseca
- Department of Epidemiology and Quantitative Methods, National School of Public Health Sergio Arouca, Fundacao Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dora Chor
- Department of Epidemiology and Quantitative Methods, National School of Public Health Sergio Arouca, Fundacao Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosane Haerter Griep
- Laboratory of Health and Environment Education, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
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How Does the Built Environment in Compact Metropolitan Cities Affect Health? A Systematic Review of Korean Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162921. [PMID: 31416292 PMCID: PMC6720808 DOI: 10.3390/ijerph16162921] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 12/15/2022]
Abstract
This systematic review aimed to examine the associations between health-related outcomes and the built environment (BE) characteristics of compact metropolitan cities in Korea using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Searching the three Korean academic databases and PubMed, two independent reviewers identified 27 empirical articles published between 2011 and 2016. Data extracted for review included the study characteristics, the variables and measurement methods related to the BE and health-related outcomes, and the findings on the associations between the BE characteristics and health-related outcomes. Vote counting was used to assess the consistency of associations and the direction of associations between the BE characteristics and health-related outcomes. All of the reviewed studies used cross-sectional designs. The objective BE qualities were commonly examined. The BE characteristics associated with health-related outcomes in the reviewed articles included land use, street environment, transportation infrastructure, green and open spaces, and neighborhood facilities. Street environment, transportation infrastructure, and green and open spaces had consistent positive associations with physical health. Mixed land use and neighborhood facilities, however, had inconsistent associations with physical health. Generally, insufficient findings were reported in the association between the BE characteristics and mental and social health. The accessibility of the BE in a compact urban environment was the prominent attribute related to health promotion, health challenges, and health equity. An international comparative analysis of compact cities with different urban contexts and scale is required. Interdisciplinary urban health strategies are recommended based on the associations between the BE characteristics and health-related outcomes.
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Breastfeeding duration is associated with offspring’s adherence to prudent dietary pattern in adulthood: results from the Nutritionist’s Health Study. J Dev Orig Health Dis 2019; 11:136-145. [DOI: 10.1017/s204017441900031x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractLittle is known about the long-term effect of breastfeeding on dietary habits. We examined the association between breastfeeding duration and adherence to current dietary patterns of young women. This was a cross-sectional analysis of 587 healthy women aged ≤45 years, undergraduates or nutrition graduates. Maternal characteristics and breastfeeding duration [<6; 6–<12; ≥12 months (reference)] were recalled. Diet was assessed using a food frequency questionnaire and patterns were identified using factor analysis by principal component. Adherence to patterns was categorized in tertiles; the first (T1 = reference) was compared to T2 + T3 (moderate-to-high adherence). Logistic regression was performed considering the minimal sufficient adjustment recommended by the directed acyclic graph. Median age was 22 (interquartile range (IQR) 20; 27) years and body mass index (BMI) 22.2 (IQR 20.4; 25.0) kg/m2. The four dietary patterns identified (Processed, Prudent, Brazilian and Lacto-vegetarian) explained 27% of diet variance. Women breastfed for <6 months showed lower chance of moderate-to-high adherence to the Prudent pattern (odds ratio (OR) = 0.53, p = 0.04). Breastfeeding was not associated with the other patterns. Maternal pre-pregnancy BMI was directly associated with moderate-to-high adherence to the Processed pattern (OR = 2.01, p = 0.03) and inversely to the Prudent pattern (OR = 0.52, p = 0.02). Higher adherence to the Brazilian pattern was associated with proxies of low socioeconomic status and the Lacto-vegetarian pattern with the opposite. Confirmation in prospective studies of the association found in this study between breastfeeding with the Prudent pattern in adult offspring could suggest that early feeding practices influence long-term dietary habits, which could then affect the risk of nutrition-related diseases.
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Frank LD, Hong A, Ngo VD. Causal evaluation of urban greenway retrofit: A longitudinal study on physical activity and sedentary behavior. Prev Med 2019; 123:109-116. [PMID: 30731094 DOI: 10.1016/j.ypmed.2019.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 01/09/2019] [Accepted: 01/15/2019] [Indexed: 01/11/2023]
Abstract
Studies of the built environment and physical activity (PA) have primarily been cross-sectional. Evidence on the causal impacts of transportation improvements on PA and sedentary behavior (SB) is lacking. This study assessed the effect of retrofitting an urban greenway on PA and SB in Vancouver, Canada. A sample of 524 participants (median age of 44; 57% female) were divided into experimental and control groups, and the effect of exposure to the greenway was examined by using different distance thresholds. Self-report measures of moderate-to-vigorous PA (MVPA) and SB were collected using the International Physical Activity Questionnaire (IPAQ-SF) before (baseline; 2012-2013) and after (follow-up; 2014-2015) construction of the Comox-Helmcken Greenway in 2013. Mixed-effects models estimated the impacts of greenway on MVPA and SB. For participants living near the greenway (≤300 m), the odds of achieving an average of 20 min of daily MVPA doubled (OR = 2.00; 95% CI = 1.00, 3.98) after the greenway's opening. The odds of being sedentary for >9 h declined by 54% (OR = 0.46; 95% CI = 0.25, 0.85) after opening. PA benefits from the greenway declined with distance from 100 m to 500 m. Reduction in SB was lowest at 100 m and greatest at 300 m. Retrofitting an urban residential neighborhood through greenway interventions can be successful in promoting physical activity while reducing sedentary behavior. Recommendations for future longitudinal research include the use of objective PA measures, studying different neighborhood contexts, collecting more representative samples, and minimizing attrition.
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Affiliation(s)
- Lawrence D Frank
- University of British Columbia, School of Population and Public Health, School of Community and Regional Planning, Room 360B - 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Andy Hong
- University of Oxford, The George Institute for Global Health, Nuffield Department of Women's & Reproductive Health, Hayes House, 75 George Street, Oxford OX1 2BQ, United Kingdom.
| | - Victor Douglas Ngo
- University of British Columbia, School of Population and Public Health, School of Community and Regional Planning, Room 360B - 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
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Menezes MCD, Diez Roux AV, Souza Lopes AC. Fruit and vegetable intake: Influence of perceived food environment and self-efficacy. Appetite 2018; 127:249-256. [DOI: 10.1016/j.appet.2018.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 12/23/2022]
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Canella DS, Louzada MLDC, Claro RM, Costa JC, Bandoni DH, Levy RB, Martins APB. Consumption of vegetables and their relation with ultra-processed foods in Brazil. Rev Saude Publica 2018; 52:50. [PMID: 29791530 PMCID: PMC5953550 DOI: 10.11606/s1518-8787.2018052000111] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 09/27/2017] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To characterize the household purchase and the individual consumption of vegetables in Brazil and to analyze their relation with the consumption of ultra-processed foods. METHODS We have used data on the purchase of food for household consumption and individual consumption from the 2008-2009 Brazilian Household Budget Survey. The Brazilian Household Budget Survey studied the purchase of food of 55,970 households and the food consumption of 34,003 individuals aged 10 years and over. The foods of interest in this study were vegetables (excluding roots and tubers) and ultra-processed foods. We have described the amount of vegetables (grams) purchased and consumed by all Brazilians and according to the quintiles of caloric intake of ultra-processed food. To this end, we have calculated the crude and predicted values obtained by regression models adjusted for sociodemographic variables. We have analyzed the most commonly purchased types of vegetables (% in the total amount) and, in relation to individual food consumption, the variety of vegetables consumed (absolute number), the participation (%) of the types of culinary preparations based on vegetables, and the time of consumption. RESULTS The adjusted mean household purchase of vegetables was 42.9 g/per capita/day. The adjusted mean individual consumption was 46.1 g. There was an inverse relation between household purchase and individual consumption of vegetables and ultra-processed foods. Ten types of vegetables account for more than 80% of the total amount usually purchased. The variety consumed was, on average, 1.08 type/per capita/day. Approximately 60% of the vegetables were eaten raw, and the amount consumed at lunch was twice that consumed at dinner; individuals with higher consumption of ultra-processed foods tended to consume even less vegetables at dinner. CONCLUSIONS The consumption of vegetables in Brazil is insufficient, and this is worse among individuals with higher consumption of ultra-processed foods. The most frequent habit was to consume raw vegetables at lunch and with limited variety.
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Affiliation(s)
- Daniela Silva Canella
- Universidade do Estado do Rio de Janeiro. Instituto de Nutrição. Departamento de Nutrição Aplicada. Rio de Janeiro, RJ, Brasil
- Universidade de São Paulo. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil
| | - Maria Laura da Costa Louzada
- Universidade de São Paulo. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil
- Universidade Federal de São Paulo. Instituto de Saúde e Sociedade. Departamento de Políticas Públicas e Saúde Coletiva. Santos, SP, Brasil
| | - Rafael Moreira Claro
- Universidade de São Paulo. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Nutrição. Belo Horizonte, MG, Brasil
| | - Janaina Calu Costa
- Universidade Federal de Pelotas. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Daniel Henrique Bandoni
- Universidade Federal de São Paulo. Instituto de Saúde e Sociedade. Departamento de Saúde, Clínica e Instituições. Santos, SP, Brasil
| | - Renata Bertazzi Levy
- Universidade de São Paulo. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil
- Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, Brasil
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De Oliveira da Silva P, Miguez Nery Guimarães J, Härter Griep R, Caetano Prates Melo E, Maria Alvim Matos S, Del Carmem Molina M, Maria Barreto S, De Jesus Mendes da Fonseca M. Association between Body Image Dissatisfaction and Self-Rated Health, as Mediated by Physical Activity and Eating Habits: Structural Equation Modelling in ELSA-Brasil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040790. [PMID: 29670031 PMCID: PMC5923832 DOI: 10.3390/ijerph15040790] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/10/2018] [Accepted: 04/10/2018] [Indexed: 11/16/2022]
Abstract
This study investigated whether the association between body image dissatisfaction and poor self-rated health is mediated by insufficient physical activity and unhealthy eating habits. The participants were 6727 men and 8037 women from the baseline (2008–2010) of the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto, ELSA-Brasil). Structural equation modelling was used. Associations were found between body image dissatisfaction and poor self-rated health in both sexes. Insufficient physical activity was a mediator. However, unhealthy eating habits were found to exert a mediator effect only via insufficient physical activity. Body image dissatisfaction was found to associate, both directly and possibly indirectly, with poor self-rated health, mediated by insufficient physical activity and unhealthy eating habits. Accordingly, encouraging physical activity and healthy eating can contribute to reducing body image dissatisfaction and favour better self-rated health.
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Affiliation(s)
- Patricia De Oliveira da Silva
- National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Manguinhos, 21041-210 Rio de Janeiro, RJ, Brazil.
| | - Joanna Miguez Nery Guimarães
- National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Manguinhos, 21041-210 Rio de Janeiro, RJ, Brazil.
| | - Rosane Härter Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Avenida Brasil, 4365, Manguinhos, 21040-360 Rio de Janeiro, RJ, Brazil.
| | - Enirtes Caetano Prates Melo
- National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Manguinhos, 21041-210 Rio de Janeiro, RJ, Brazil.
| | | | - Maria Del Carmem Molina
- Health Sciences Centre, Universidade Federal do Espírito Santo, 29043-900 Vitória, ES, Brazil.
| | - Sandhi Maria Barreto
- Faculty of Medicine, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil.
| | - Maria De Jesus Mendes da Fonseca
- National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Manguinhos, 21041-210 Rio de Janeiro, RJ, Brazil.
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Barber S, Diez Roux AV, Cardoso L, Santos S, Toste V, James S, Barreto S, Schmidt M, Giatti L, Chor D. At the intersection of place, race, and health in Brazil: Residential segregation and cardio-metabolic risk factors in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Soc Sci Med 2018; 199:67-76. [DOI: 10.1016/j.socscimed.2017.05.047] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 05/20/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
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de Matos SMA, Pitanga FJG, Almeida MDCC, Queiroz CO, dos Santos CA, de Almeida RT, da Silva ITM, Griep RH, Amorim LDAF, Patrão AL, Aquino EML. What Factors Explain Bicycling and Walking for Commuting by ELSA-Brasil Participants? Am J Health Promot 2017; 32:646-656. [DOI: 10.1177/0890117117738400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: To analyze the factors associated with commuting by bicycling and walking in adult participants from ELSA-Brasil (Longitudinal Study of Adult Health). Design: Cross-sectional. Setting: Six teaching/research institutions throughout Brazil. Participants: A total of 15 105 civil servants. Measures: Commuting by bicycling and walking was analyzed using the long-form International Physical Activity Questionnaire. Analysis: A hierarchical model containing possible factors associated with commuting by bicycling and walking was constructed. Crude and adjusted odds ratios were calculated using multinomial logistic regression. Results: Considering the 2 forms of commuting, 66% of the participants were being considered inactive or insufficiently active. In women, being “heavier,” feeling unsafe practicing physical activity, and being a former smoker were factors negatively associated with commuting by bicycling and walking. In men, active commuting was less common among those who were overweight or had abdominal obesity, those with a negative perception of safety, and those reporting that there was nowhere suitable in the neighborhood to practice physical activity. Conclusion: Obesity and negative perceptions in the neighborhood are associated with inactive or insufficiently active commuting. The relevance of this finding for public health is reinforce developing policies aimed at promoting health in Brazil and in other countries with similar characteristics.
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Affiliation(s)
| | | | | | | | - Clarice Alves dos Santos
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
- Department of Biological Sciences, State University of Southwestern Bahia (UESB), Jequié, Bahia, Brazil
| | - Rogerio Tosta de Almeida
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
- Department of Health, State University of Feira de Santana (UEFS), Feira de Santana, Bahia, Brazil
| | | | - Rosane Harter Griep
- Laboratory of Education in Environment and Health, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Ana Luísa Patrão
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Estela M. L. Aquino
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
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Pitanga FJG, Almeida MCC, Queiroz CO, Aquino EMLD, Matos SMA. Physical activity in Brazil: lessons from ELSA-Brasil. Narrative review. SAO PAULO MED J 2017; 135:391-395. [PMID: 28767993 PMCID: PMC10015998 DOI: 10.1590/1516-3180.2017.0023190317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/19/2017] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) was conducted among civil servants at six higher education institutions located in six Brazilian state capitals. The objective of this review was to identify the publications produced within the scope of ELSA-Brasil that analyzed the participants' physical activity. DESIGN AND SETTING: Review study using baseline data from ELSA-Brasil. METHODS: Narrative review of Brazilian studies on physical activity produced using data from ELSA-Brasil participants. RESULTS: The prevalence of leisure-time physical activity (LTPA) among ELSA-Brasil participants was low (44.1% among men and 33.8% among women). The main factors associated were social (higher schooling and family income), environmental (living in places with conditions and opportunities for physical activity) and individual (not being obese, being retired, not smoking and positive perception of body image). The perception of facilities for walking in the neighborhood was positively associated with both LTPA and commuting-related physical activity. An active lifestyle was a protective factor against several cardiometa-bolic variables (hypertension, diabetes, lipid abnormalities and cardiovascular risk over the next 10 years). Comparison between LTPA and commuting-related physical activity showed that only LTPA had a protective effect against arterial hypertension. CONCLUSIONS: The prevalence of physical activity among ELSA-Brasil participants was low. The main determinants were social, environmental and personal. LTPA had a greater protective efect on cardio-metabolic outcomes than did commuting-related physical activity.
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Affiliation(s)
- Francisco José Gondim Pitanga
- PhD. Associate Professor, Department of Physical Education, School of Education, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | | | - Ciro Oliveira Queiroz
- MSc. Assistant Professor, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador (BA), Brazil
| | - Estela Maria Leão de Aquino
- MD, PhD. Full Professor, Institute of Public Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Sheila Maria Alvim Matos
- PhD. Associate Professor, Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
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Affiliation(s)
- Paulo Andrade Lotufo
- MD, DrPH. Full Professor, Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brazil.
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Prescott SL, Logan AC. Transforming Life: A Broad View of the Developmental Origins of Health and Disease Concept from an Ecological Justice Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111075. [PMID: 27827896 PMCID: PMC5129285 DOI: 10.3390/ijerph13111075] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/21/2016] [Accepted: 10/28/2016] [Indexed: 12/20/2022]
Abstract
The influential scientist Rene J. Dubos (1901–1982) conducted groundbreaking studies concerning early-life environmental exposures (e.g., diet, social interactions, commensal microbiota, housing conditions) and adult disease. However, Dubos looked beyond the scientific focus on disease, arguing that “mere survival is not enough”. He defined mental health as fulfilling human potential, and expressed concerns about urbanization occurring in tandem with disappearing access to natural environments (and elements found within them); thus modernity could interfere with health via “missing exposures”. With the advantage of emerging research involving green space, the microbiome, biodiversity and positive psychology, we discuss ecological justice in the dysbiosphere and the forces—financial inequity, voids in public policy, marketing and otherwise—that interfere with the fundamental rights of children to thrive in a healthy urban ecosystem and learn respect for the natural environment. We emphasize health within the developmental origins of health and disease (DOHaD) rubric and suggest that greater focus on positive exposures might uncover mechanisms of resiliency that contribute to maximizing human potential. We will entrain our perspective to socioeconomic disadvantage in developed nations and what we have described as “grey space”; this is a mental as much as a physical environment, a space that serves to insidiously reinforce unhealthy behavior, compromise positive psychological outlook and, ultimately, trans-generational health. It is a dwelling place that cannot be fixed with encephalobiotics or the drug-class known as psychobiotics.
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Affiliation(s)
- Susan L Prescott
- International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN), 35 Stirling Hwy, Crawley 6009, Australia.
- School of Paediatrics and Child Health Research, University of Western Australia, P.O. Box D184, Princess Margaret Hospital, Perth 6001, Australia.
| | - Alan C Logan
- International Inflammation (in-FLAME) Network, Worldwide Universities Network (WUN), 35 Stirling Hwy, Crawley 6009, Australia.
- PathLight Synergy, 23679 Calabassas Road, Suite 542, Calabassas, CA 91302, USA.
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