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Cakmak S, Lukina A, Dales R. The association between neighbourhood walkability and blood lipids: a Canadian population study. Lipids Health Dis 2024; 23:298. [PMID: 39267049 PMCID: PMC11391640 DOI: 10.1186/s12944-024-02267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 08/19/2024] [Indexed: 09/14/2024] Open
Abstract
We examined the association between walkability and blood lipids in a nationally representative sample of 29,649 participants aged 3-79 years who participated in the Canadian Health Measures Survey (CHMS) cycles 1 to 6. We focused on seven lipid biomarkers: apolipoprotein A (Apo A), apolipoprotein B (Apo B), triglycerides (TG), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), total cholesterol (TC), and TC/HDL. Cross-sectional associations were analyzed using generalized linear mixed models incorporating survey-specific sampling weights. An increase in the Canadian Active Living Environments Index, a measure of neighborhood walkability, equivalent to the magnitude of its interquartile range (IQR) was associated with the following percentage (95% confidence intervals (CI)) changes in lipids: decreased TG, -2.85 (-4.77, -0.93) and TC/HDL, -1.68 (-2.80, -0.56), and increased HDL, 1.68 (0.93, 2.42). Significant effects were largely restricted to adults (aged 17 to 79). In the younger age group there were no significant associations between walkability and lipids in the fully adjusted model. Significant associations were more frequently seen in females than males. For females, fully adjusted significant inverse associations were observed for TG, LDL, and TC/HDL, and there were positive associations with HDL and Apo A. Canadians living in more walkable neighborhoods have more favorable lipid profiles, suggesting that the built environment has the potential to influence the risk profile for cardiovascular health, especially among adults and females.
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Affiliation(s)
- Sabit Cakmak
- Environmental Health Science and Research Bureau, Health Canada, 251 Sir Frederic Banting Driveway, Ottawa, ON, K1A 0K9, Canada
| | - Anna Lukina
- Environmental Health Science and Research Bureau, Health Canada, 251 Sir Frederic Banting Driveway, Ottawa, ON, K1A 0K9, Canada
| | - Robert Dales
- Environmental Health Science and Research Bureau, Health Canada, 251 Sir Frederic Banting Driveway, Ottawa, ON, K1A 0K9, Canada.
- University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada.
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Zhu W, Li Y, Zhao C, Howard VJ, Wadley VG, Judd SE, Colabianchi N, McClure LA, Hooker SP, Sun Y. Changes in Adiposity and Cognitive Function in Older Adults: The REGARDS Study. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbad184. [PMID: 38134240 PMCID: PMC10873843 DOI: 10.1093/geronb/gbad184] [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: 05/18/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Adiposity may have a role in the risk of dementia. Fewer studies have focused on the relationship between change in adiposity and cognitive decline. Our study aimed to explore the association between the change in adiposity and cognitive function in Black and White older adults. METHODS The participants were 12,204 older adults without cognitive impairment (62.8 ± 8.0 years) in the United States. The percent body mass index change (%BMI change) and percent waist circumference change (%WC change) were measured at 2 in-home visits (first: 2003-2007, second: 2013-2016). Cognitive status was assessed by the Six-Item Screener annually. Memory and executive function were measured by word list learning, MOCA recall and orientation, and letter and animal fluency every 2 years. Logistic regression or linear regression models were used to estimate the relationship between percent change in adiposity and cognitive function. RESULTS After 12.7 ± 1.7 years, a greater decrease in %BMI change or %WC change was significantly associated with a higher risk of cognitive impairment. Compared to older adults with -5% ≤ change ≤ 5% from baseline, a significantly higher risk of cognitive impairment and greater loss in memory and executive function were found among those who experienced more than a 10% decline in %BMI change or %WC change. Older adults who experienced a 5%-10% decrease in %BMI change had a higher risk of cognitive impairment and greater loss of memory compared to those with -5% ≤ change ≤ 5%. DISCUSSION A greater decrease in %BMI (>5%) and %WC (>10%) change was associated with greater cognitive loss observed over time.
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Affiliation(s)
- Wenfei Zhu
- School of Physical Education, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Yanbing Li
- School of Physical Education, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Chenxi Zhao
- School of Physical Education, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Virginia G Wadley
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Leslie A McClure
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Steven P Hooker
- College of Health and Human Services, San Diego State University, San Diego, California, USA
| | - Yuliang Sun
- School of Physical Education, Shaanxi Normal University, Xi'an, Shaanxi, China
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Rundle AG, Neckerman KM, Judd SE, Colabianchi N, Moore KA, Quinn JW, Hirsch JA, Lovasi GS. Cumulative Experience of Neighborhood Walkability and Change in Weight and Waist Circumference in REGARDS. Am J Epidemiol 2023; 192:1960-1970. [PMID: 37312569 PMCID: PMC10691194 DOI: 10.1093/aje/kwad134] [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: 03/23/2022] [Revised: 04/24/2023] [Accepted: 06/04/2023] [Indexed: 06/15/2023] Open
Abstract
Neighborhood walkability-features of the built environment that promote pedestrian activity-has been associated with greater physical activity and lower body mass index (BMI; calculated as weight (kg)/height (m)2) among neighborhood residents. However, much of the literature has been cross-sectional and only a few cohort studies have assessed neighborhood features throughout follow-up. Using data from the Reasons for Geographic and Racial Differences in Stroke Study (2003-2016) and a neighborhood walkability index (NWI) measured annually during follow-up, we assessed whether the cumulative experience of neighborhood walkability (NWI-years) predicted BMI and waist circumference after approximately 10 years of follow-up, controlling for these anthropometric measures at enrollment. Analyses were adjusted for individual-level sociodemographic covariates and the cumulative experience of neighborhood poverty rate and neighborhood greenspace coverage. Almost a third (29%) of participants changed address at least once during follow-up. The first change of residence, on average, brought the participants to neighborhoods with higher home values and lower NWI scores than their originating neighborhoods. Compared with those having experienced the lowest quartile of cumulative NWI-years, those who experienced the highest quartile had 0.83 lower BMI (95% confidence interval, -1.5, -0.16) and 1.07-cm smaller waist circumference (95% confidence interval, -1.96, -0.19) at follow-up. These analyses provide additional longitudinal evidence that residential neighborhood features that support pedestrian activity are associated with lower adiposity.
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Affiliation(s)
- Andrew G Rundle
- Correspondence to Dr. Andrew Rundle, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032 (e-mail: )
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Rocke KD, Howitt C, Panter J, Tully M, Hambleton I. Neighbourhood Walkability and Its Influence on Physical Activity and Cardiometabolic Disease: A Cross-Sectional Study in a Caribbean Small Island Developing State. Cureus 2023; 15:e44060. [PMID: 37746352 PMCID: PMC10517735 DOI: 10.7759/cureus.44060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Cities and neighborhoods may provide opportunities for population-level environmental interventions to reduce physical inactivity and cardiometabolic risk. In this study, we describe the association between neighborhood walkability, physical activity (PA), and cardiometabolic outcomes, by linking data from a nationally representative survey of adults (25 years and older) collected in 2012-2013 with spatial data on built environment features in Barbados. Methods We estimated a walkability index for 45 neighborhoods using objectively measured built environment features (residential density, street connectivity, and land use mix). We used the Recent Physical Activity Questionnaire to capture time spent in outdoor walking, active commuting, moderate-to-vigorous PA (MVPA), and total PA. Our primary cardiometabolic outcome was a predicted 10-year cardiovascular risk (CVD) score, estimated using the American College of Cardiology/American Heart Association pooled cohort equation. Our secondary cardiometabolic outcomes were hypertension and diabetes. We explored the effect of neighborhood walkability on PA and cardiometabolic outcomes using several multivariable regression models (tobit and linear and logistic multi-level mixed effects), with the model choice depending on the structure of the outcome. Results The average time spent walking weekly for any purpose among participants was 75 minutes/week, time spent on active commuting was 15 minutes/week, and MVPA was 221 minutes/week. We estimated that the average 10-year CVD risk in the study population was 11.7% (95%CI 10.9-12.5). Our confounder-adjusted analyses showed positive linear relationships between neighborhood walkability and each PA outcome (p<0.05 in all cases), and a negative relationship between walkability and predicted 10-year CVD risk (p<0.001). Conclusion In our setting, adults residing in higher walkability neighborhoods spent more time engaged in PA, had a lower predicted 10-year CVD risk, and were less likely to have diabetes. Urban planners may consider shorter-term interventions, such as those on a microscale, which may provide additional ways to increase activity in a mostly fixed macroscale environment.
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Affiliation(s)
- Kern D Rocke
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
| | - Christina Howitt
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
| | - Jenna Panter
- Medical Research Council (MRC) Epidemiology Unit, Centre for Diet & Activity Research (CEDAR), University of Cambridge, Cambridge, GBR
| | - Mark Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, GBR
| | - Ian Hambleton
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
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Tharrey M, Malisoux L, Klein O, Bohn T, Perchoux C. Urban densification over 9 years and change in the metabolic syndrome: A nationwide investigation from the ORISCAV-LUX cohort study. Soc Sci Med 2023; 331:116002. [PMID: 37478660 DOI: 10.1016/j.socscimed.2023.116002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/02/2023] [Accepted: 05/30/2023] [Indexed: 07/23/2023]
Abstract
A growing body of evidence suggests that urban densification may be protective against obesity, type 2 diabetes, and cardiometabolic diseases, yet studies on how built environmental features relate to metabolic syndrome (MetS) and its components are scarce. This longitudinal study examines the associations of baseline urban density and densification over 9 years with MetS and MetS components, among 510 participants enrolled in both waves of the ORISCAV-LUX study (2007-2017) in Luxembourg. A continuous MetS score (siMS) was calculated for each participant. Six features of residential built environments were computed around participants' home address: street connectivity, population density, density of amenities, street network distance to the nearest bus station, density of public transport stations, and land use mix. A composite index of urban densification (UDI) was calculated by averaging the six standardized built environment variables. Using adjusted generalized estimating equation (GEE) models, one-SD increase in UDI was associated with a worsening of the siMS score (β = 0.07, 95% CI: 0.02, 0.13), higher triglyceride levels (β = 0.05, 95% CI: 0.02, 0.09), and lower HDL-c levels (β = -1.29, 95% CI: -2.20, -0.38). The detrimental effect of UDI on lipid levels was significant only for participants living in dense areas at baseline. Higher baseline UDI, as well as increased UDI over time among movers, were also associated with greater waist circumference. There were no associations between UDI, fasting plasma glucose and systolic blood pressure. Sex and neighborhood socio-economic status did not moderate the associations between UDI and the cardiometabolic outcomes. Overall, we found limited evidence for an effect of urban densification on MetS and its components. Understanding urban dynamics remains a challenge, and more research investigating the independent and joint health effect of built environment features is needed to support urban planning and design that promote cardiometabolic health.
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Affiliation(s)
- Marion Tharrey
- Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg; Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg.
| | - Laurent Malisoux
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Olivier Klein
- Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg
| | - Torsten Bohn
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Camille Perchoux
- Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg
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Jacobs MM, Ellis C. Stroke in women between 2006 and 2018: Demographic, socioeconomic, and age disparities. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231199061. [PMID: 37735849 PMCID: PMC10515531 DOI: 10.1177/17455057231199061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Black Americans have a higher prevalence of stroke and stroke-related deaths than any other racial group. Racial disparities in stroke outcomes are even wider among women than men. Conventional studies have cited differences in lifestyle (i.e. smoking, alcohol consumption, etc.) and vascular risk factors between races as the source of these disparities. However, these studies fail to account for the higher prevalence of minoritized populations at the lower end of the socioeconomic distribution. OBJECTIVES This study explores differences in stroke risk factors across age and socioeconomic cohorts to determine whether comorbidities can sufficiently explain disparities at all ages and income levels. DESIGN Using the 2006-2018 National Health Interview Survey data, statistical analysis evaluated differences in risk factors among a full sample cohort (aged 18-85 years; n = 131,091) and a "young" subsample cohort (aged 18-59 years; n = 6183) of women. METHODS Logistics and unconditional quantile regression models assessed the relationship between stroke and comorbid, demographic, and behavioral characteristics across socioeconomic classes. RESULTS Results suggest that Black women had a 1.415-fold (confidence interval = 1.259, 1.591) higher likelihood of stroke compared with White women after controlling for age, behavior, and comorbidities. Racial disparities were not statistically significant at the higher income ranges for either the full (odds ratio = 1.404, p = 0.3114) or young samples (odds ratio = 1.576, p = 0.7718). However, Blacks had significantly higher odds of stroke in the lower quartiles (lower odds ratio: 1.329, p = 0.0242; lower middle odds ratio: 1.233, p = 0.0486; and upper middle odds ratio: 1.994, p = 0.0005). Disparities were larger among young women (odds ratio = 1.449, confidence interval = 1.211, 1.734). CONCLUSION While comorbidities were highly associated with stroke prevalence in all socioeconomic cohorts, Blacks only had higher relative odds in the lower income classes. Lack of biological or behavioral explanations for these findings suggests that unobserved or uncontrolled factors such as systemic racism, prejudicial institutions, or differential treatment may contribute to this.
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Affiliation(s)
- Molly M Jacobs
- Department of Health Services Research, Management & Policy, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| | - Charles Ellis
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, USA
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