Obesity, diet quality, physical activity, and the built environment: the need for behavioral pathways

Sibship Composition and BMI Z-Score Among Saudi Preschoolers: A Cross-Sectional Study

Background and objective The association between sibship composition and child body mass index (BMI) has not been investigated in any Arab/Middle Eastern populations. In light of this, this study aimed to examine the association of the number of siblings, number of older siblings, and number of younger siblings with child BMI z-score (BMIz) among preschoolers in the Kingdom of Saudi Arabia (KSA). Methods A total of 209 mothers and their children were recruited from preschools in Jeddah, KSA. Mothers reported their responses to the study questionnaire via telephone. Child anthropometry was objectively measured; BMIz was calculated based on age- and sex-specific World Health Organization (WHO) growth standards and reference data. We used hierarchical multiple linear regression to examine the association between sibship composition variables and child BMIz, independent of the effect of potential confounders, and to evaluate changes in model fit. Results The number of siblings was negatively associated with child BMIz [b = -0.18, 95% confidence interval (CI) = -0.35, -0.06, p<0.01, adjusted R2 = 0.16]. There was a negative association between the number of older siblings and child BMIz (b = -0.23, 95% CI = -0.38, -0.11, p<0.01, adjusted R2 = 0.21) as well as between the number of older sisters and child BMIz (b = -0.18, 95% CI = -0.52, -0.09, p<0.01, adjusted R2 = 0.19). However, there were no significant associations between the number of older brothers or the number of younger siblings and child BMIz. Conclusions Based on our findings, sibship composition was found to be associated with BMIz among a sample of preschoolers in KSA. More research is needed to further establish this association and to understand the underlying mechanism of the association of the greater number of older siblings and older sisters with lower BMIz.

The association between food environment, diet quality and malnutrition in low- and middle-income adult populations across the rural-Urban gradient in Vietnam

BACKGROUND

Economic reforms and trade liberalisation in Vietnam have transformed the food environment, influencing dietary patterns and malnutrition status. The present study focuses on the relationship between food environments (proximity and density of food outlets) and malnutrition (underweight, overweight, obesity) through diet quality in adult populations across urban, periurban and rural areas of Vietnam.

METHODS

We evaluated food environment by geospatial mapping of food outlets through a transect walk across the "food ecosystem" from rural to urban areas. Diet quality was assessed using the Diet Quality Index - Vietnamese (DQI-V) comprising Variety, Adequacy, Moderation and Balance components. Malnutrition status was determined using body mass index. We performed a mediation analysis utilising mixed effect models to control for neighbourhood clustering effects. Confounders included age, education, income and nutrition knowledge score.

RESULTS

Analysis of data from 595 adult participants (mean ± SD age: 31.2 ± 6.4 years; 50% female) found that longer distance to the nearest food outlet was associated with higher overall DQI-V (β = 2.0; 95% confidence interval = 0.2-3.8; p = 0.036) and the Moderation component (β = 2.6; 95% confidence interval = 1.2-4.0; p = 0.001). Outlet density shows a negative association with the odds of underweight among women (odds ratio = 0.62; 95% confidence interval = 0.37-0.96). However, we did not observe statistically significant relationships between diet quality and malnutrition. Education and nutrition knowledge scores were positively associated with diet diversity, while income was negatively associated with diet moderation.

CONCLUSIONS

The findings of the present study have important implications for nutrition and dietetics practice in Vietnam and globally. It emphasises the need to consider various dimensions of sustainable diets, including economic, health and socio-cultural/political factors. Longer distances to food outlets are associated with higher diet quality, whereas lower food outlet density increases the odds of underweight among women. This poses challenges in balancing modernisation and its adverse effects on sustainable food systems. Socio-economic status consistently correlated with diet quality and malnutrition, necessitating further research to promote healthy diets across socio-economic strata.

Change in the food environment and measured adiposity in adulthood in the Christchurch Health and development birth cohort, Aotearoa, New Zealand: A birth cohort study

This study investigated associations between change in the food environment and change in measured body mass index (BMI) and waist circumference (WC) in the Christchurch Health and Development Study (CHDS) birth cohort. Our findings suggest that cohort members who experienced the greatest proportional change towards better access to fast food outlets had the slightly larger increases in BMI and WC. Contrastingly, cohort members who experienced the greatest proportional change towards shorter distance and better access to supermarkets had slightly smaller increases in BMI and WC. Our findings may help explain the changes in BMI and WC at a population level.

The role of area-level socioeconomic disadvantage in racial disparities in cancer incidence in metropolitan Detroit

BACKGROUND

Neighborhood deprivation is associated with both race and cancer incidence, but there is a need to better understand the effect of structural inequities on racial cancer disparities. The goal of this analysis was to evaluate the relationship between a comprehensive measure of neighborhood-level social disadvantage and cancer incidence within the racially diverse population of metropolitan Detroit.

METHODS

We estimated breast, colorectal, lung, and prostate cancer incidence rates using Metropolitan Detroit Cancer Surveillance System and US decennial census data. Neighborhood socioeconomic disadvantage was measured by the Area Deprivation Index (ADI) using Census Bureau's American Community Survey data at the Public Use Microdata Areas (PUMA) level. Associations between ADI at time of diagnosis and cancer incidence were estimated using Poisson mixed-effects models adjusting for age and sex. Attenuation of race-incidence associations by ADI was quantified using the "mediation" package in R.

RESULTS

ADI was inversely associated with incidence of breast cancer for both non-Hispanic White (NHW) and non-Hispanic Black (NHB) women (NHW: per-quartile RR = 0.92, 95% CI 0.88-0.96; NHB: per-quartile RR = 0.94, 95% CI 0.91-0.98) and with prostate cancer incidence only for NHW men (per-quartile RR = 0.94, 95% CI 0.90-0.97). ADI was positively associated with incidence of lung cancer for NHWs and NHBs (NHW: per-quartile RR = 1.12, 95% CI 1.04-1.21; NHB: per-quartile RR = 1.37, 95% CI 1.25-1.51) and incidence of colorectal cancer (CRC) only among NHBs (per-quartile RR = 1.11, 95% CI 1.02-1.21). ADI significantly attenuated the relationship between race and hormone receptor positive, HER2-negative breast cancer (proportion attenuated = 8.5%, 95% CI 4.1-16.6%) and CRC cancer (proportion attenuated = 7.3%, 95% CI 3.7 to 12.8%), and there was a significant interaction between race and ADI for lung (interaction RR = 1.22, p < 0.0001) and prostate cancer (interaction RR = 1.09, p = 0.00092).

CONCLUSIONS

Area-level socioeconomic disadvantage is associated with risk of common cancers in a racially diverse population and plays a role in racial differences in cancer incidence.

Perceived urban environment attributes and obesity indices in adults: an 8-Nation study from Latin America

This study examines the associations between perceived urban environment attributes and obesity indices by country using data from an eight-nation study from Latin America. The data were collected from 8185 adults. The Neighbourhood Environment Walkability-abbreviated scale was used to assess perceived urban environment attributes. Obesity indices considered were body mass index, waist circumference, neck circumference, a body shape index and waist-to-height ratio. The perception of a more and better land use mix-diversity (β - 0.44; 95% CI - 0.59, - 0.28), traffic safety (- 0.39; - 0.66, - 0.12), and safety from crime (- 0.36; - 0.57, - 0.15) was associated with lower body mass index across the entire sample. Land use mix-diversity (- 1.21; - 1.60, - 0.82), street connectivity (- 0.26; - 0.37, - 0.15), and traffic safety (- 0.79; - 1.47, - 0.12) were negatively associated with waist circumference. Land use mix-diversity (- 0.11; - 0.20, - 0.03), land use mix-access (- 0.23; - 0.34, 0.12), walking/cycling facilities (- 0.22; - 0.37, - 0.08), and safety from crime (- 0.27; - 0.42, - 0.12) were negatively associated with neck circumference. No associations between perceived urban environment attributes and a body shape index were found. Land use mix-diversity (- 0.01; - 0.02, - 0.01), aesthetics (- 0.02; - 0.03, - 0.01), and safety from crime (- 0.02; - 0.04, - 0.01) were associated with waist-to-height ratio. Environmental interventions involving urban environment attributes are associated with obesity indices and, therefore, may help decrease the prevalence of overweight and obesity.

Neighborhood environment is associated with unhealthy food intake in a Brazilian urban area

Unhealthy food intake is one of the main risk factors for morbidity and mortality for non-communicable diseases (NCDs), and is associated with multiple factors, including the neighborhood environment. The present study aimed to examine the association between the neighborhood context and unhealthy food intake in adults. This is a cross-sectional study, carried out in Belo Horizonte, Brazil. This study used the database of Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel), which was georeferenced and linked to a database with information on the physical and social realities of a neighborhood context. The administrative boundary of the basic health units (ABBHU) was used as a neighborhood unit. Unhealthy food intake was assessed by the regular consumption of meat with excess fat, soft drinks, and red meat, as well as the irregular consumption of fruits and vegetables. To characterize the physical and social realities of a neighborhood, this study used georeferenced data of establishments selling foods, population density, homicide rates, health vulnerability Index, and total income. For data analysis, multilevel logistic regression was used. The sample consisted of 5783 adults. It was observed that younger, males, people with a lower-level education, who were inactive during leisure time, who had abusive alcohol consumption, and who were current smokers, were associated with a greater chance of having an unhealthy food intake. After adjusting for individual characteristics, it was observed that living in ABBHU, with a low mean income and an extremely high vulnerability, increases the individual's chances of having an unhealthy food intake. An unhealthy food intake is partially explained by demographic characteristics and socioeconomic conditions in the neighborhood. The present study can contribute to improving the understanding of the importance of the urban environment in food choices.

Association Between Temporal Changes in Diet Quality and Concurrent Changes in Dietary Intake, Body Mass Index, and Physical Activity Among Japanese Adults: A Longitudinal Study

Background

Many cross-sectional studies have identified modifiable factors such as dietary intake, physique, and physical activity associated with diet quality but were unable to determine how a specific individual's diet quality changes with these factors. These relationships may vary depending on an individual's dietary intake. We aimed to determine the association between temporal changes in diet quality and concurrent changes in dietary intake, body mass index (BMI), and physical activity according to the diet quality trajectory pattern.

Methods

This longitudinal prospective study included 697 Japanese adults aged 26–85 years, at baseline, with available data from at least two dietary intake surveys (4,118 measurements). Dietary intake and physical activity were evaluated using validated dietary questionnaires and a triaxial accelerometer. Diet quality was calculated using the Nutrient-Rich Food Index 9.3 (NRF9.3), while physical activity was calculated based on the duration of activity performed at each level of intensity (sedentary, light, moderate, and vigorous). Body mass index was calculated from the measured height and weight. Statistical analyses involved latent class growth models (LCGM) and random-effect panel data analysis.

Results

During a mean follow-up period of 6.8 years, NRF9.3 scores were assessed, on average, 5.4 times in men and 6.1 times in women. Based on the NRF9.3 score, three separate trajectory groups—“low-increasing,” “medium-increasing,” and “high-stable”—among individuals aged 26–90 years were identified using LCGM. In the multivariate analysis, the NRF9.3 score trajectory was positively associated with intake of energy, protein, dietary fiber, vitamins A and C, magnesium, and food items, such as fruits and vegetables, and was negatively associated with BMI and the intake of added sugar, saturated fats, sodium, and food items, such as meat and sugar and confectioneries, even after adjusting for covariates. These relationships displayed heterogeneity across the identified NRF9.3 score trajectory groups. In the low-increasing group, an inverse relationship was observed between sedentary behavior and NRF9.3 score trajectory.

Conclusions

We identified modifiable factors associated with temporal changes in diet quality across a wide age range; however, these factors may vary according to the diet quality trajectories. Our findings may help develop effective strategies for improving diet quality, according to the trajectory of diet quality.

Differential associations of the built environment on weight gain by sex and race/ethnicity but not age

OBJECTIVE

To explore the built environment (BE) and weight change relationship by age, sex, and racial/ethnic subgroups in adults.

METHODS

Weight trajectories were estimated using electronic health records for 115,260 insured Kaiser Permanente Washington members age 18-64 years. Member home addresses were geocoded using ArcGIS. Population, residential, and road intersection densities and counts of area supermarkets and fast food restaurants were measured with SmartMaps (800 and 5000-meter buffers) and categorized into tertiles. Linear mixed-effect models tested whether associations between BE features and weight gain at 1, 3, and 5 years differed by age, sex, and race/ethnicity, adjusting for demographics, baseline weight, and residential property values.

RESULTS

Denser urban form and greater availability of supermarkets and fast food restaurants were associated with differential weight change across sex and race/ethnicity. At 5 years, the mean difference in weight change comparing the 3rd versus 1st tertile of residential density was significantly different between males (-0.49 kg, 95% CI: -0.68, -0.30) and females (-0.17 kg, 95% CI: -0.33, -0.01) (P-value for interaction = 0.011). Across race/ethnicity, the mean difference in weight change at 5 years for residential density was significantly different among non-Hispanic (NH) Whites (-0.47 kg, 95% CI: -0.61, -0.32), NH Blacks (-0.86 kg, 95% CI: -1.37, -0.36), Hispanics (0.10 kg, 95% CI: -0.46, 0.65), and NH Asians (0.44 kg, 95% CI: 0.10, 0.78) (P-value for interaction <0.001). These findings were consistent for other BE measures.

CONCLUSION

The relationship between the built environment and weight change differs across demographic groups. Careful consideration of demographic differences in associations of BE and weight trajectories is warranted for investigating etiological mechanisms and guiding intervention development.

Examining the consumer restaurant environment and dietary intake in children

Within the away-from-home food environment there is a need to account for individual exposure (e.g., frequency of visitation) to that environment. The present study examined the consumer environment in both proximal and visited restaurants and their association with childrens’ diet quality and anthropometrics. A cross-sectional analysis used baseline data from the Neighborhood Impact on Kids (NIK) study (2007–2009). Participants were 6–12-year-olds living in King County, WA and San Diego County, CA. This analysis (conducted 2019–2020) examined relationships between nearby restaurant count, Nutrition Environment Measures Survey in Restaurants (NEMS-R) within the child’s block group, and weighted NEMS-R scores based on the restaurant where the child ate most frequently in relation to child energy intake, Healthy Eating Index (HEI-2010) total score and anthropometrics. Children’s HEI-2010 scores were associated with NEMS-R scores within block groups, with children in the lowest NEMS-R tertile having significantly higher HEI scores than participants in the middle tertile. Weighted NEMS-R scores were significantly associated with waist circumference, with children in the highest NEMS-R tertile having a lower waist circumference than children in the lowest tertile. Nearby restaurant count was not associated with children’s diet quality or anthropometrics. Our findings suggest the relationship between nutrition environment and child diet and anthropometrics varied depending on how nutrition environment was defined. However, findings may be limited by the low frequency of eating out reported in this sample. Food environment measures that account for individual-level behavior are needed to better understand the influence of food environments on diet and anthropometrics

Biomarkers, disability and health care demand

Using longitudinal data from a representative UK panel, we focus on a group of apparently healthy individuals with no history of disability or major chronic health condition at baseline. A latent variable structural equation model is used to analyse the predictive role of latent baseline biological health, indicated by a rich set of biomarkers, and other personal characteristics, in determining the individual's disability state and health service utilisation five years later. We find that baseline biological health affects future health service utilisation very strongly, via progression to functional disability channel. We also find systematic income gradients in future disability risks, with those of higher income experiencing a lower progress to disability. Our model reveals that observed pro-rich inequity in health care utilisation, is driven by the fact that higher-income people tend to make greater use of health care treatment, for any given biological health and disability status; this is despite the lower average need for treatment shown by the negative association of income with both baseline ill biological health and disability progression risk. Factor loadings for latent baseline health show that a broader set of blood-based biomarkers, rather than the current focus mainly on blood pressure, cholesterol and adiposity, may need to be considered for public health screening programs.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Urban-regional patterns of food purchasing behaviour: a cross-sectional analysis of the 2015-2016 Australian Household Expenditure Survey

BACKGROUND/OBJECTIVES

In many high-income countries people living in regional (rural) areas have higher rates of chronic disease compared to people living in urban areas. Food purchasing behaviour provides a potential pathway linking residential location with dietary intake and health outcomes. This study examined the relationship between geographic location and food expenditure on a range of foods.

SUBJECTS/METHODS

Data from the 2015-2016 Australian Household Expenditure Survey (number of households = 9827) were used to examine weekly household food expenditure and proportion of total food expenditure on 14 categories of food items. Foods were classified using the Australian Guide to Healthy Eating. Two-part models and zero-one inflated beta regression models were used to assess the association between geographic area and food expenditure.

RESULTS

Average proportion of total food expenditure on fruit was estimated to be more for households located in major cities compared to households located in inner and outer regional areas. Households located in inner and outer regional areas allocated less to fresh fruit, fish and meals out compared to households in major cities. Households located in inner regional areas allocated a greater proportion of their food budget to sweet cakes, biscuits, puddings, desserts, chocolate and ice-cream compared to households in major cities and outer regional areas.

CONCLUSIONS

The geographic patterns in food purchasing suggest those in regional areas may be at risk of diets less aligned with healthy guidelines. Given the findings of this study suggesting geographic differences in food purchasing, further research is warranted to enhance contextual understanding of food purchasing behaviours in regional areas.

Association of Built Environment with Physical Activity and Physical Fitness in Men and Women Living inside the City Wall of Xi'an, China

This study was to investigate the association of built environment (BE) with physical activity (PA) and physical fitness of residents inside the city wall of Xi'an, one of the most historic cities in China. The cross-sectional study was conducted among 728 adults in this area. BE and PA were measured by Neighborhood Environment Walkability Scale and International Physical Activity Questionnaire, respectively. Body mass index (BMI), body fat percentage, blood pressure (BP), lung capacity, curl up, sit and reach, reaction time, balance, and grip strength were also measured. The results showed, for men, aesthetics was positively associated with total and leisure-time PA, and curl-up tests, respectively. Walking/cycling facilities were positively associated with leisure-time PA. Street connectivity was negatively associated with leisure-time PA and BMI. Residential density was positively correlated with BMI. Access to service was positively associated with lung capacity. Crime safety was negatively correlated with reaction time. For women, residential density was negatively associated with transportation PA and BP. Street connectivity was positively associated with curl-up test. The results suggest some BE attributes are positively related to PA and physical fitness in this population. Creating more PA-supportive BEs is recommended in this historic area along with urban conservation.

Are changes in depressive symptoms, general health and residential area socio-economic status associated with trajectories of waist circumference and body mass index?

Objective

This study sought to assess whether changes in depressive symptoms, general health, and area-level socio-economic status (SES) were associated to changes over time in waist circumference and body mass index (BMI).

Methods

A total of 2871 adults (18 years or older), living in Adelaide (South Australia), were observed across three waves of data collection spanning ten years, with clinical measures of waist circumference, height and weight. Participants completed the Centre for Epidemiologic Studies Depression (CES-D) and Short Form 36 health questionnaires (SF-36 general health domain). An area-level SES measure, relative location factor, was derived from hedonic regression models using residential property features but blind to location. Growth curve models with latent variables were fitted to data.

Results

Waist circumference, BMI and depressive symptoms increased over time. General health and relative location factor decreased. Worsening general health and depressive symptoms predicted worsening waist circumference and BMI trajectories in covariate-adjusted models. Diminishing relative location factor was negatively associated with waist circumference and BMI trajectories in unadjusted models only.

Conclusions

Worsening depressive symptoms and general health predict increasing adiposity and suggest the development of unhealthful adiposity might be prevented by attention to negative changes in mental health and overall general health.

Impact of Changes in the Food, Built, and Socioeconomic Environment on BMI in US Counties, BRFSS 2003-2012

OBJECTIVE

Researchers have linked geographic disparities in obesity to community-level characteristics, yet many prior observational studies have ignored temporality and potential for bias.

METHODS

Repeated cross-sectional data were used from the Behavioral Risk Factor Surveillance System (BRFSS) (2003-2012) to examine the influence of county-level characteristics (active commuting, unemployment, percentage of limited-service restaurants and convenience stores) on BMI. Each exposure was calculated using mean values over the 5-year period prior to BMI measurement; values were standardized; and then variables were decomposed into (1) county means from 2003 to 2012 and (2) county-mean-centered values for each year. Cross-sectional (between-county) and longitudinal (within-county) associations were estimated using a random-effects within-between model, adjusting for individual characteristics, survey method, and year, with nested random intercepts for county-years within counties within states.

RESULTS

A negative between-county association for active commuting (β = -0.19; 95% CI: -0.23 to -0.16) and positive associations for unemployment (β = 0.17; 95% CI: 0.14 to 0.19) and limited-service restaurants (β = 0.13; 95% CI: 0.11 to 0.14) were observed. An SD increase in active commuting within counties was associated with a 0.51-kg/m² (95% CI: -0.72 to -0.31) decrease in BMI over time.

CONCLUSIONS

These results suggest that community-level characteristics play an important role in shaping geographic disparities in BMI between and within communities over time.

Obesity and the Built Environment: A Reappraisal

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

Spousal metabolic risk factors and incident hypertension: A longitudinal cohort study in Iran

We investigated the association between metabolic risk factors in one spouse with incident hypertension in the other. Study sample included 1528 men and 1649 women aged ≥20 years from the Tehran lipid and glucose study with information on body mass index (BMI), waist circumference (WC), hypertension, type 2 diabetes mellitus (DM), and dyslipidemia. The hazard ratio (HR) and 95% confidence interval (95% CI) were estimated for the association of spousal metabolic factors and incident hypertension among men and women separately. A total of 604 and 566 cases of incident hypertension were observed in men and women, respectively. Among men, spousal DM was associated with a 40% (CI: 1.07-1.83) excess risk of hypertension after adjusting for the men's own and their spouse's risk factors including BMI, DM, smoking, and physical activity level. Among women, spousal DM was associated with more than two times (2.11, 1.69-2.63) higher risk of hypertension. After further adjustment for the women's own and their spouse's risk factors, the association was attenuated and remained marginally significant (1.25, 0.99-1.58; P value = .053). Having a spouse with DM increases an individual's risk of hypertension, which raises the possibility of using preexisting information of one partner to guide the screening of the other partner.

Food environment, income and obesity: a multilevel analysis of a reality of women in Southern Brazil

The objective of this study was to explore relationships between the neighborhood food environment and obesity in urban women living in São Leopoldo, Rio Grande do Sul State, Brazil. A cross-sectional survey was carried out. This study was conducted with 1,096 women. Structured interviews were conducted using a standard pre-tested questionnaire. Obesity was defined as body mass index (BMI) ≥ 30kg/m2. Circular buffers of 400m in radius were created based on the centroid of the women's houses who participated, in the 45 census tracts inhabited by them. Neighborhood food establishments were identified through systematic survey of all streets in the study areas and geographical coordinates of shops were collected. Establishments were evaluated using the NEMS tool. The prevalence of obesity was 33% among the women participants. After adjusting for individual variables, supermarkets and healthy food establishments were positively associated with obesity, PR = 1.05 (95%CI: 1.01-1.10), PR = 1.02 (95%CI: 1.00-1.04), respectively, while mean buffer income was negatively associated, PR = 0.64 (95%CI: 0.49-0.83). Neighborhood food environment factors were associated with obesity even after controlled for individual variables, as socioeconomic variables, behavioral and food purchase.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Activity space metrics not associated with sociodemographic variables, diet or health outcomes in the Seattle Obesity Study II

BACKGROUND

Activity spaces (AS), captured using GPS tracking devices, are measures of dynamic exposure to the built environment (BE).

METHODS

Seven days of Global Positioning Systems (GPS) tracking data were obtained for 433 adult participants in the Seattle Obesity Study (SOS II). Heights and weights were measured. Dietary intakes from a food frequency questionnaire were used to calculate Healthy Eating Index (HEI 2010) scores. Linear regression analyses examined associations between AS measures: daily route length, convex hull, and radius of gyration, and diet quality and health outcomes, adjusting for covariates.

RESULTS

AS measures did not vary by age, gender, race/ethnicity, or socioeconomic status. AS measures were not associated with diet quality or with self-reported obesity or diabetes. One AS measure, route length (in miles), was associated with being employed, living in the suburbs, and with distance and time commuting to work.

CONCLUSION

Spatial mobility studies based on GPS tracking of environmental exposure need to demonstrate a link to relevant health outcomes.

Reconsidering the relationship between fast-food outlets, area-level deprivation, diet quality and body mass index: an exploratory structural equation modelling approach

BACKGROUND

Internationally, the prevalence of adults with obesity is a major public health concern. Few studies investigate the explanatory pathways between fast-food outlets and body mass index (BMI). We use structural equation modelling to explore an alternative hypothesis to existing research using area-level deprivation as the predictor of BMI and fast-food outlets and diet quality as mediators.

METHODS

Adults (n=7544) from wave II of the Yorkshire Health Study provided self-reported diet, height and weight (used to calculate BMI). Diet quality was based on sugary drinks, wholemeal (wholegrain) bread and portions of fruit and vegetables. Fast-food outlets were mapped using the Ordnance Survey Points of Interest within 2 km radial buffers around home postcode which were summed to indicate availability. Age (years), gender (female/male) and long-standing health conditions (yes/no) were included as covariates.

RESULTS

There was little evidence linking fast-food outlets to diet or BMI. An independent association between fast-food outlet availability and BMI operated counterintuitively and was small in effect. There was also little evidence of mediation between fast-food outlet availability and BMI. However, there was more evidence that area-level deprivation was associated with increased BMI, both as an independent effect and through poorer diet quality.

CONCLUSION

This exploratory study offers a first step for considering complexity and pathways linking fast-food outlets, area-level deprivation, diet quality and BMI. Research should respond to and build on the hypothesised pathways and our simple framework presented within our study.

Neighborhood Social Environment and Cardiovascular Disease Risk

Purpose of review

Limited physical activity (PA) and obesity are two primary risk factors for cardiovascular disease (CVD). Within a socio-ecological framework, neighborhood social environment may play a key role in influencing PA and obesity. However, the mechanisms underlying this relationship remain ambiguous. Our goals in this review are: (1) to summarize findings from the recent studies on neighborhood social environment in relation to PA and obesity as CVD risk factors, and (2) to briefly describe several innovative approaches to assessing neighborhood social environment.

Recent findings

Almost all recent studies assessed neighborhood social environment around residential areas. There were consistent associations between neighborhood social environment and PA and obesity, with some exceptions (indicating null associations or paradoxical associations). However, a focus on residential social environment may limit results because these studies did not account for any exposures occurring away from individuals' homes. Additionally, the majority of studies utilized a cross-sectional design, which limits our ability to make inferences regarding the causality of the association between social environment and PA or obesity as CV risk factors.

Summary

The majority of the studies on neighborhood social environment characterized factors around residential areas and assessed participant activity via self-reported surveys. Future research should leverage tools to account for the spatial mismatch between environmental exposures and outcomes by using global positioning systems, ecological momentary assessments, virtual neighborhood audits, and simulation modeling. These approaches can overcome major limitations by tracking individuals' daily activity and real-time perceptions of neighborhood social environments linked to CVD events.

Fast-food outlet availability and obesity: Considering variation by age and methodological diversity in 22,889 Yorkshire Health Study participants

This study investigated if the relationship between residential fast-food outlet availability and obesity varied due to methodological diversity or by age. Cross-sectional data (n = 22,889) from the Yorkshire Health Study, England were used. Obesity was defined using self-reported height and weight (BMI ≥ 30). Food outlets ("fast-food", "large supermarkets", and "convenience or other food retail outlets") were mapped using Ordnance Survey Points of Interest (PoI) database. Logistic regression was used for all analyses. Methodological diversity included adjustment for other food outlets as covariates and continuous count vs. quartile. The association between residential fast-food outlets and obesity was inconsistent and effects remained substantively the same when considering methodological diversity. This study contributes to evidence by proposing the use of a more comprehensive conceptual model adjusting for wider markers of the food environment. This study offers tentative evidence that the association between fast-food outlets and obesity varies by age.

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

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

Stress experiences in neighborhood and social environments (SENSE): a pilot study to integrate the quantified self with citizen science to improve the built environment and health

BACKGROUND

Identifying elements of one's environment-observable and unobservable-that contribute to chronic stress including the perception of comfort and discomfort associated with different settings, presents many methodological and analytical challenges. However, it also presents an opportunity to engage the public in collecting and analyzing their own geospatial and biometric data to increase community member understanding of their local environments and activate potential environmental improvements. In this first-generation project, we developed a methodology to integrate geospatial technology with biometric sensing within a previously developed, evidence-based "citizen science" protocol, called "Our Voice." Participants used a smartphone/tablet-based application, called the Discovery Tool (DT), to collect photos and audio narratives about elements of the built environment that contributed to or detracted from their well-being. A wrist-worn sensor (Empatica E4) was used to collect time-stamped data, including 3-axis accelerometry, skin temperature, blood volume pressure, heart rate, heartbeat inter-beat interval, and electrodermal activity (EDA). Open-source R packages were employed to automatically organize, clean, geocode, and visualize the biometric data.

RESULTS

In total, 14 adults (8 women, 6 men) were successfully recruited to participate in the investigation. Participants recorded 174 images and 124 audio files with the DT. Among captured images with a participant-determined positive or negative rating (n = 131), over half were positive (58.8%, n = 77). Within-participant positive/negative rating ratios were similar, with most participants rating 53.0% of their images as positive (SD 21.4%). Significant spatial clusters of positive and negative photos were identified using the Getis-Ord Gi* local statistic, and significant associations between participant EDA and distance to DT photos, and street and land use characteristics were also observed with linear mixed models. Interactive data maps allowed participants to (1) reflect on data collected during the neighborhood walk, (2) see how EDA levels changed over the course of the walk in relation to objective neighborhood features (using basemap and DT app photos), and (3) compare their data to other participants along the same route.

CONCLUSIONS

Participants identified a variety of social and environmental features that contributed to or detracted from their well-being. This initial investigation sets the stage for further research combining qualitative and quantitative data capture and interpretation to identify objective and perceived elements of the built environment influence our embodied experience in different settings. It provides a systematic process for simultaneously collecting multiple kinds of data, and lays a foundation for future statistical and spatial analyses in addition to more in-depth interpretation of how these responses vary within and between individuals.

Environmental Risk Factors for Developing Type 2 Diabetes Mellitus: A Systematic Review

Different elements of the environment have been posited to influence type 2 diabetes mellitus (T2DM). This systematic review summarizes evidence on the environmental determinants of T2DM identified in four databases. It proposes a theoretical framework illustrating the link between environment and T2DM, and briefly discusses some methodological challenges and potential solutions, and opportunities for future research. Walkability, air pollution, food and physical activity environment and roadways proximity were the most common environmental characteristics studied. Of the more than 200 reported and extracted relationships assessed in 60 studies, 82 showed significant association in the expected direction. In general, higher levels of walkability and green space were associated with lower T2DM risk, while increased levels of noise and air pollution were associated with greater risk. Current evidence is limited in terms of volume and study quality prohibiting causal inferences. However, the evidence suggests that environmental characteristics may influence T2DM prevention, and also provides a reasonable basis for further investigation with better quality data and longitudinal studies with policy-relevant environmental measures. This pursuit of better evidence is critical to support health-orientated urban design and city planning.

Mango Supplementation Has No Effects on Inflammatory Mediators in Obese Adults

This pilot study examined the effects of freeze-dried mango (Mangifera indica L.) supplementation on anthropometric measurements, lipid parameters, and inflammatory mediators in obese individuals. A total of 20 obese (body mass index [BMI]: 30-35 kg/m2) adults (11 men and 9 women), aged 20 to 50 years, received 10 g/d of ground freeze-dried mango pulp for 12 weeks. Anthropometrics, lipids, and inflammatory mediators were assessed at baseline and after 12 weeks of mango supplementation. There were no differences between baseline and final visits in inflammatory mediators, lipids, diet, physical activity, and anthropometrics. Relationships were present at baseline and final visits between adiponectin and high-density lipoprotein cholesterol and between leptin and fat mass. Correlations were found after 12 weeks of mango supplementation between leptin and the following variables: waist-to-height ratio, BMI, percent fat, and fat mass. Our findings demonstrate that 12-week consumption of freeze-dried mango by obese individuals has no impact on obesity-related inflammation.

Supermarket access, transport mode and BMI: the potential for urban design and planning policy across socio-economic areas

OBJECTIVE

To investigate dietary intake, BMI and supermarket access at varying geographic scales and transport modes across areas of socio-economic disadvantage, and to evaluate the implementation of an urban planning policy that provides guidance on spatial access to supermarkets.

DESIGN

Cross-sectional study used generalised estimating equations to investigate associations between supermarket density and proximity, vegetable and fruit intake and BMI at five geographic scales representing distances people travel to purchase food by varying transport modes. A stratified analysis by area-level disadvantage was conducted to detect optimal distances to supermarkets across socio-economic areas. Spatial distribution of supermarket and transport access was analysed using a geographic information system.

SETTING

Melbourne, Australia.

SUBJECTS

Adults (n 3128) from twelve local government areas (LGA) across Melbourne.

RESULTS

Supermarket access was protective of BMI for participants in high disadvantaged areas within 800 m (P=0·040) and 1000 m (P=0·032) road network buffers around the household but not for participants in less disadvantaged areas. In urban growth area LGA, only 26 % of dwellings were within 1 km of a supermarket, far less than 80-90 % of dwellings suggested in the local urban planning policy. Low public transport access compounded disadvantage.

CONCLUSIONS

Rapid urbanisation is a global health challenge linked to increases in dietary risk factors and BMI. Our findings highlight the importance of identifying the most appropriate geographic scale to inform urban planning policy for optimal health outcomes across socio-economic strata. Urban planning policy implementation in disadvantaged areas within cities has potential for reducing health inequities.