Global positioning system-based food environment exposures, diet-related, and cardiometabolic health outcomes: a systematic review and research agenda

BACKGROUND

Geographic access to food may affect dietary choices and health outcomes, but the strength and direction of associations may depend on the operationalization of exposure measures. We aimed to systematically review the literature on up-to-date evidence on the association between food environment exposures based on Global Positioning System (GPS) and diet-related and cardiometabolic health outcomes.

METHODS

The databases PubMed, Embase.com, APA PsycInfo (via Ebsco), Cinahl (via Ebsco), the Web of Science Core Collection, Scopus, and the International Bibliography of the Social Sciences (via ProQuest) were searched from inception to October 31, 2022. We included studies that measured the activity space through GPS tracking data to identify exposure to food outlets and assessed associations with either diet-related or cardiometabolic health outcomes. Quality assessment was evaluated using the criteria from a modified version of the Newcastle-Ottawa Scale (NOS) for cross-sectional studies. We additionally used four items from a quality assessment tool to specifically assess the quality of GPS measurements.

RESULTS

Of 2949 studies retrieved, 14 studies fulfilled our inclusion criteria. They were heterogeneous and represent inconsistent evidence. Yet, three studies found associations between food outlets and food purchases, for example, more exposure to junk food outlets was associated with higher odds of junk food purchases. Two studies found associations between greater exposure to fast food outlets and higher fast food consumption and out of three studies that investigated food environment in relation to metabolic outcomes, two studies found that higher exposure to an unhealthy food environment was associated with higher odds of being overweight.

CONCLUSIONS

The current and limited evidence base does not provide strong evidence for consistent associations of GPS-based exposures of the food environment with diet-related and cardiometabolic health outcomes.

The interaction between the community food environment and cooking skills in association with diet-related outcomes in Dutch adults

OBJECTIVE

We examined whether associations between the food environment, frequency of home cooking, diet quality and BMI were modified by the level of cooking skills.

DESIGN

Cross-sectional study using linear and modified Poisson regression models adjusted for age, sex, energy intake, education, income, household size and urbanisation. The frequency of home cooking was categorised into <6 and 6-7 d. Diet quality was based on a validated Dutch healthy diet index (0-150 points). Count of restaurants and food stores were determined by their count in a 1000m buffer around home and work. Cooking skills (score 1-5) were assessed using a validated questionnaire and added as interaction term.

SETTING

The Netherlands.

PARTICIPANTS

1461 adults aged 18-65 years.

RESULTS

Count of restaurants and food stores were not associated with the frequency of home cooking. A 10-unit higher count of food stores was associated with a higher diet quality (β: 0·58 (95 % CI (0·04, 1·12)), and a 10-unit higher count of restaurants was associated with a lower BMI kg/m2 (β: -0·02 (95 % CI (-0·04, -0·004)). Better cooking skills were associated with a higher likelihood of cooking 6-7 d compared with <6 d (risk ratio: 1·24 (95 % CI (1·16, 1·31)) and a higher diet quality (β: 4·45 (95 % CI (3·27, 5·63)) but not with BMI. We observed no interaction between the food environment and cooking skills (P-for-interaction > 0·1).

CONCLUSIONS

Exposure to food stores was associated with a higher diet quality and exposure to restaurants with a lower BMI. Better cooking skills were associated with a higher frequency of home cooking and better diet quality but did not modify associations with the food environment. Future studies should explore different approaches to understand how individuals interact with their food environment.

Abstract P420: The Interaction Between the Community Food Environment and Cooking Skills in Relation to Diet-Related Outcomes

Introduction: What people eat is dependent on their food environment. However, individuals with better cooking skills may be less dependent on what is available in their food environment.

Hypothesis: We assessed the hypothesis that the relation of the food environment around home and work with frequency of home cooking, diet quality, and body mass index (BMI) was modified by the level of cooking skills among Dutch adults.

Methods: Our study included 1461 Dutch adults aged 18-65 years, who participated in a cross-sectional survey. Availability of restaurants and food stores was determined by their count in a 1000m buffer around home and work. Frequency of home cooking was categorized into <6 days and 6-7 times a week. A validated Dutch healthy diet index (0-150 points) was used to determine dietary quality. BMI was based on self-reported height and weight. Cooking skills (score 1-5) were assessed using a validated questionnaire and added to the models as interaction term. Linear and logistic regression models were adjusted for age, sex, energy intake, education, income, household size, and urbanization.

Results: Neither the count of restaurants nor food stores was associated with the frequency of home cooking. A 10-unit higher count of food stores was associated with higher diet quality (β: 0.58 (95% CI: 0.04, 1.13)). This association was not found for count of restaurants (β: 0.04 (95% CI: -0.02, 0.11)). A 10-unit higher count of restaurants was associated with a lower BMI (β: -0.02 (95% CI: -0.04, -0.004) but not with frequency of home cooking (OR: 1.00 (95% CI: 0.99, 1.01) or diet quality (β: 0.04 (95% CI: -0.02, 0.11). Better cooking skills were associated with higher odds of home cooking 6-7 days a week compared to <6 days a week (OR: 1.81 (95% CI 1.55, 2.12) and higher diet quality (β: 4.31 (95% CI: 3.12, 5.49)), but not with BMI (β: 0.06 (95% CI: -0.25, 0.37)). No significant effect modification between the food environment and cooking skills in relation to any of the outcomes was observed (P-for-interaction >0.1).

Conclusions: In conclusion, being exposed to food stores was associated with a higher diet quality and being exposed to restaurants was associated with a lower BMI. Better cooking skills were associated with a higher frequency of home cooking and a better diet quality, but did not modify the observed associations with the food environment.

Environmental risk factors of type 2 diabetes-an exposome approach

Type 2 diabetes is one of the major chronic diseases accounting for a substantial proportion of disease burden in Western countries. The majority of the burden of type 2 diabetes is attributed to environmental risks and modifiable risk factors such as lifestyle. The environment we live in, and changes to it, can thus contribute substantially to the prevention of type 2 diabetes at a population level. The 'exposome' represents the (measurable) totality of environmental, i.e. nongenetic, drivers of health and disease. The external exposome comprises aspects of the built environment, the social environment, the physico-chemical environment and the lifestyle/food environment. The internal exposome comprises measurements at the epigenetic, transcript, proteome, microbiome or metabolome level to study either the exposures directly, the imprints these exposures leave in the biological system, the potential of the body to combat environmental insults and/or the biology itself. In this review, we describe the evidence for environmental risk factors of type 2 diabetes, focusing on both the general external exposome and imprints of this on the internal exposome. Studies provided established associations of air pollution, residential noise and area-level socioeconomic deprivation with an increased risk of type 2 diabetes, while neighbourhood walkability and green space are consistently associated with a reduced risk of type 2 diabetes. There is little or inconsistent evidence on the contribution of the food environment, other aspects of the social environment and outdoor temperature. These environmental factors are thought to affect type 2 diabetes risk mainly through mechanisms incorporating lifestyle factors such as physical activity or diet, the microbiome, inflammation or chronic stress. To further assess causality of these associations, future studies should focus on investigating the longitudinal effects of our environment (and changes to it) in relation to type 2 diabetes risk and whether these associations are explained by these proposed mechanisms.

Diet quality and cardiometabolic health in childhood: the Generation R Study

Purpose

Diet is an important determinant of cardiometabolic disease risk in adults. We aimed to study associations of diet quality with cardiometabolic health in school-age children.

Methods

This study was embedded in the Generation R Study a prospective population-based cohort in Rotterdam, the Netherlands and included 3991 children. Food intake was assessed with a Food-Frequency Questionnaire at age 8 years. A diet quality score (0–10) was calculated reflecting adherence to age-specific dietary guidelines. The following outcome variables were measured at age 10 years and used to create a continuous cardiometabolic risk factor score: body fat percentage, insulin, triglycerides, HDL cholesterol, and systolic and diastolic blood pressure. Outcomes were expressed in age- and sex-specific standard deviation scores (SDS). Multivariable linear regression models were used to assess associations between the diet quality score and the cardiometabolic risk factor score and with the individual cardiometabolic risk factors.

Results

In models adjusted for socioeconomic and lifestyle factors and BMI, a higher diet quality was associated with a lower cardiometabolic risk factor score [− 0.08 per point higher diet score, (95% CI − 0.15, − 0.001)]. This association was mainly driven by associations of higher diet quality with lower systolic [− 0.04 SD (95% CI − 0.06, − 0.01)] and diastolic blood pressure [− 0.05 SD, (95% CI − 0.07, − 0.02)]. No statistically significant associations were found for insulin, triglycerides, HDL cholesterol, or body fat percentage as individual factors.

Conclusions

We found an association between higher diet quality and better cardiometabolic health in childhood, mainly driven by a lower blood pressure. Further research is needed to explore associations of diet quality in childhood with long-term cardiometabolic health.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-021-02673-2.