1
|
Sharifi Y, Sobhani S, Ramezanghorbani N, Payab M, Ghoreshi B, Djalalinia S, Nouri Ghonbalani Z, Ebrahimpur M, Eslami M, Qorbani M. Association of greenspaces exposure with cardiometabolic risk factors: a systematic review and meta-analysis. BMC Cardiovasc Disord 2024; 24:170. [PMID: 38509487 PMCID: PMC10953288 DOI: 10.1186/s12872-024-03830-1] [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: 12/15/2023] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Cardiometabolic conditions are major contributors to the global burden of disease. An emerging body of evidence has associated access to and surrounding public open spaces (POS) and greenspace with cardiometabolic risk factors, including obesity, body mass index (BMI), hypertension (HTN), blood glucose (BG), and lipid profiles. This systematic review aimed to synthesize this evidence. METHODS This systematic review was conducted based on the PRISMA guidelines. Four electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for eligible articles published until July 2023. All observational studies which assessed the association of greenspace and POS with cardiometabolic risk factors including obesity, BMI, HTN, BG, and lipid profiles were included and reviewed by two authors independently. Heterogeneity between studies was assessed using the I2 index and Cochrane's Q test. Random/fixed effect meta-analyses were used to combine the association between greenspace exposure with cardiometabolic risk factors. RESULTS Overall, 118 relevant articles were included in our review. The majority of the articles were conducted in North America or Europe. In qualitative synthesis, access or proximity to greenspaces or POS impacts BMI and blood pressure or HTN, BG, and lipid profiles via various mechanisms. According to the random effect meta-analysis, more access to greenspace was significantly associated with lower odds of HTN (odds ratio (OR): 0.81, 95% confidence intervals (CIs): 0.61-0.99), obesity (OR: 0.83, 95% CIs: 0.77-0.90), and diabetes (OR:0.79, 95% CI: 0.67,0.90). CONCLUSIONS Findings of this systematic review and meta-analysis suggested that greenspace accessibility is associated with some cardiometabolic risk factors. Improving greenspace accessibility could be considered as one of the main strategies to reduce cardiometabolic risk factors at population level.
Collapse
Affiliation(s)
- Yasaman Sharifi
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Sobhani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Nahid Ramezanghorbani
- Department of Development and Coordination Scientific Information and Publications, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Moloud Payab
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Ghoreshi
- Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Shirin Djalalinia
- Development of Research & Technology Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Zahra Nouri Ghonbalani
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahbube Ebrahimpur
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maysa Eslami
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
| |
Collapse
|
2
|
Quintana-Navarrete M. Extreme Violence and Weight-Related Outcomes in Mexican Adults. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:401-416. [PMID: 37052319 DOI: 10.1177/00221465231163906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Sociological research suggests that violent environments contribute to excess weight, a pressing health issue worldwide. However, this research has neglected extreme forms of violence, such as armed conflicts, a theoretically significant omission because armed conflict could reasonably lead to weight loss, not weight gain. I examine the weight-related, short-term consequences of the Mexican "War on Organized Crime." I combine body mass index (N = 3,341) and waist circumference (N = 3,509) measures from the Mexico Family Life Survey with a novel data set on aggressions, confrontations, and executions between 2009 and 2011 (CIDE-PPD database) and exploit variation in the timing of the outcome relative to violent events taking place in the same residential environment. I find a robust and large positive association between armed conflict events and weight gain in adults and suggestive evidence of the behavioral, emotional, and physiological/biochemical pathways connecting those variables.
Collapse
|
3
|
Oyedapo HA, Ayeni O, Afolabi NB, Akinyemi OJ. Quantile regression methods for determination of factors associated with nutritional status of women of reproductive age in Nigeria. SCIENTIFIC AFRICAN 2021. [DOI: 10.1016/j.sciaf.2021.e00988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
4
|
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:bmjgh-2021-006358. [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] [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.
Collapse
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
| | | |
Collapse
|
5
|
Social environment perception and associations with overweight in the city of Porto Alegre, Brazil. J Biosoc Sci 2021; 54:888-901. [PMID: 34353380 DOI: 10.1017/s0021932021000419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The prevalence of overweight in Brazilian adults has grown in recent years. There is evidence indicating that environmental factors, especially social characteristics, may be involved in the aetiology of overweight, but few studies have investigated this association adequately. The main objective of this study was to identify residents' perception of their social environment (social cohesion, security and violence) and assess its relationship with overweight in a central area of Porto Alegre, Brazil. The associations between socioeconomic characteristics and social environment perception were also explored. This cross-sectional study conducted in 2018-19 had 400 participants aged from 20 to 70 years living in low- and high-income areas of the city of Porto Alegre. Participants' perception of social cohesion, security and violence were evaluated using a validated questionnaire. Participants' body mass index (BMI) was measured, and those with a BMI ≥25 kg/m2 were considered to be overweight. Unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (95% CIs) were estimated through Poisson regression analysis; level of significance was 5%. The prevalence of overweight in the sample was 68.8% (95% CI 64.0-73.2). Individuals with a more positive social cohesion perception had a higher prevalence of overweight (PR 1.06; 95% CI: 1.00-1.12; p=0.02) than those with a less positive perception. Brown individuals also had a higher prevalence of overweight (PR: 1.08; 95% CI: 1.02-1.15; p=0.03) than those of other skin colour/race. No association was found between overweight and perception of security or violence. Therefore, social cohesion may be an important factor in overweight and the findings highlight the importance of considering social factors, and their perceptions, when planning actions for the prevention and control of overweight in a population.
Collapse
|
6
|
Why a New Research Agenda on Green Spaces and Health Is Needed in Latin America: Results of a Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115839. [PMID: 34072319 PMCID: PMC8198896 DOI: 10.3390/ijerph18115839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: Increasing and improving green spaces have been suggested to enhance health and well-being through different mechanisms. Latin America is experiencing fast population and urbanization growth; with rising demand for interventions to improve public health and mitigate climate change. (2) Aim: This study aimed to review the epidemiological evidence on green spaces and health outcomes in Latin America. (3) Methods: A systematic literature review of green spaces and health outcomes was carried out for studies published in Latin America before 28 September 2020. A search strategy was designed to identify studies published in Medline via PubMed and LILACS. The search strategy included terms related to green spaces combined with keywords related to health and geographical location. No time limit for the publication was chosen. The search was limited to English, Spanish, Portuguese, and French published articles and humans’ studies. (4) Findings: This systematic review found 19 epidemiological studies in Latin America related to green spaces and health outcomes. Nine studies were conducted in Brazil, six in Mexico, three in Colombia, and one in Chile. In terms of study design, 14 were cross-sectional studies, 3 ecological, and 2 cohort studies. The population included among the studies ranged from 120 persons to 103 million. The green space definition used among studies was green density or proximity (eight studies), green presence (five studies), green spaces index (four studies), and green space visit (two studies). The health outcomes included were mental health (six studies), overweight and obesity (three studies), quality of life (three studies), mortality (two studies), cardiorespiratory disease (one study), disability (one study), falls (one study), and life expectancy (one study). Eleven studies found a positive association between green spaces and health, and eight studies found no association. (5) Conclusion: This systematic review identified 19 epidemiological studies associating green spaces and health outcomes in Latin America. Most of the evidence suggests a positive association between green spaces and health in the region. However, most of the evidence was supported by cross-sectional studies. Prioritizing longitudinal studies with harmonized exposure and outcome definitions and including vulnerable and susceptible populations is needed in the region.
Collapse
|
7
|
Pérez-Ferrer C, Auchincloss AH, Barrientos-Gutierrez T, Colchero MA, de Oliveira Cardoso L, Carvalho de Menezes M, Bilal U. Longitudinal changes in the retail food environment in Mexico and their association with diabetes. Health Place 2020; 66:102461. [PMID: 33039800 PMCID: PMC7705211 DOI: 10.1016/j.healthplace.2020.102461] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/05/2020] [Accepted: 10/02/2020] [Indexed: 11/26/2022]
Abstract
The retail food environment is a potential population-level determinant of diet and nutrition-related chronic diseases, yet little is known about its composition and association with diabetes in low- and middle-income countries. Our objectives were: (1) to describe changes in the composition of the retail food environment in Mexican neighborhoods from 2010 to 2016 and (2) to examine the association between these changes and diabetes cases diagnosed over the same period. Individual level data came from the 2016 Mexican Health and Nutrition Survey (N = 2808 adults). Neighborhood level retail food environment data for 2010 and 2016 came from the National Directory of Economic Units of Mexico. Multilevel logistic regression was used to examine the adjusted association between changes in the neighborhood density per km2 of fruit and vegetable stores, chain convenience stores and supermarkets with diabetes. Small store formats still predominate in Mexico's food environment, however there is evidence of fast increase in chain convenience stores and supermarkets. Adults living in neighborhoods that saw a decline in fruit and vegetable store density and a simultaneous increase in chain convenience store density experienced higher odds of diabetes, compared to adults who lived in neighborhoods where fruit and vegetable and convenience stores did not change (OR 3.90, 95% CI 1.61, 9.48). Considering the complex interplay between store types, understanding the mechanisms and confirming the causal implications of these findings could inform policies that improve the quality of food environments in cities. We examined changes in the retail food environment in Mexican cities. We also examined whether those changes were associated with new diabetes cases. Small food stores still predominate but evidence of fast increase in chain convenience stores and supermarkets. Odds of diabetes were highest when fruit and vegetable stores declined and chain convenience stores increased. Changes in the density of supermarkets were not associated with diabetes.
Collapse
Affiliation(s)
- Carolina Pérez-Ferrer
- National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico; National Council for Science and Technology (CONACYT), Mexico
| | - Amy H Auchincloss
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - M Arantxa Colchero
- National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico
| | | | | | - Usama Bilal
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
8
|
Digital food environment of a Brazilian metropolis: food availability and marketing strategies used by delivery apps. Public Health Nutr 2020; 24:544-548. [PMID: 32900419 DOI: 10.1017/s1368980020003171] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Food delivery apps represent an important and emerging dimension of the digital food environment. This study aimed to examine food availability and the use of marketing strategies by two food delivery apps in a Brazilian metropolis. DESIGN An exploratory study was conducted in the city of Belo Horizonte, Minas Gerais. Food groups were identified and the use of price discounts and photos by the apps was observed. SETTING Eighteen neighbourhoods and the ten best rated restaurants in each app. PARTICIPANTS Three hundred sixty-two commercial food establishments. RESULTS The proportion of ultra-processed beverages on offer in the apps (78·45 %) was much higher in comparison with water (48·89 %), natural juices or smoothies (27·07 %). Ultra-processed ready-to-eat meals represented almost 70 % of the food offered in the establishments' menus, while traditional meals and vegetables represented just over 30 % of the offering. Ice cream, candies and salty packaged snacks were nine times more frequently presented than fruits. The use of photos and price discounts prevailed predominantly among ultra-processed beverages, sandwiches and ice cream, candies and salty packaged snacks. These marketing strategies were least used for promoting fruits and vegetables. CONCLUSIONS Restaurants registered on food delivery apps offered a significant amount of ultra-processed foods with price discounts and photos in comparison with unprocessed and minimally processed foods.
Collapse
|
9
|
Cunningham-Myrie CA, Younger NO, Theall KP, Greene LG, Lyew-Ayee P, Wilks R. Understanding neighbourhood retail food environmental mechanisms influencing BMI in the Caribbean: a multilevel analysis from the Jamaica Health and Lifestyle Survey: a cross-sectional study. BMJ Open 2020; 10:e033839. [PMID: 32830113 PMCID: PMC7445353 DOI: 10.1136/bmjopen-2019-033839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To derive estimates of the associations between measures of the retail food environments and mean body mass index (BMI) in Jamaica, a middle-income country with increasing prevalence of obesity. DESIGN Cross-sectional study. SETTING Data from the Jamaica Health and Lifestyle Survey 2008 (JHLS II), a nationally representative population-based survey that recruited persons at their homes over a 4-month period from all 14 parishes and 113 neighbourhoods defined as enumeration districts. PARTICIPANTS A subsample of 2529 participants aged 18-74 years from the JHLS II who completed interviewer-administered surveys, provided anthropometric measurements and whose addresses were geocoded. PRIMARY OUTCOME MEASURE Mean BMI, calculated as weight divided by height squared (kg/m2). RESULTS There was significant clustering across neighbourhoods for mean BMI (intraclass correlation coefficients=4.16%). Fully adjusted models revealed higher mean BMI among women, with further distance away from supermarkets (β=0.12; 95% CI 8.20×10-3, 0.24; p=0.036) and the absence of supermarkets within a 1 km buffer zone (β=1.36; 95% CI 0.20 to 2.52; p=0.022). A 10 km increase in the distance from a supermarket was associated with a 1.7 kg/m2 higher mean BMI (95% CI 0.03 to 0.32; p=0.020) in the middle class. No associations were detected with fast-food outlets or interaction by urbanicity. CONCLUSIONS Higher mean BMI in Jamaicans may be partially explained by the presence of supermarkets and markets and differ by sex and social class. National efforts to curtail obesity in middle-income countries should consider interventions focused at the neighbourhood level that target the location and density of supermarkets and markets and consider sex and social class-specific factors that may be influencing the associations.
Collapse
Affiliation(s)
| | - Novie O Younger
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - Katherine P Theall
- Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA
| | - Lisa-Gaye Greene
- Mona GeoInformatics Institute, University of the West Indies, Mona, Jamaica
| | - Parris Lyew-Ayee
- Mona GeoInformatics Institute, University of the West Indies, Mona, Jamaica
| | - Rainford Wilks
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| |
Collapse
|
10
|
Affiliation(s)
- Christopher Turner
- From the Natural Resources Institute, University of Greenwich, Food and Markets Department, Chatham Maritime, United Kingdom
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom
| |
Collapse
|
11
|
Oliveira DM, Marques ML, dos Santos D, Spexoto MCB, Togashi GB, Massini DA, Pessôa Filho DM. Spatial index relating urban environment to health lifestyle and obesity risk in men and women from different age groups. PLoS One 2020; 15:e0229961. [PMID: 32163459 PMCID: PMC7067401 DOI: 10.1371/journal.pone.0229961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/17/2020] [Indexed: 11/19/2022] Open
Abstract
The challenge in the search for relationships between urban space, physical mobility, and health status, is detecting indicators able to link the environment with healthy life habits. Therefore, the objective was to design an urban index for the identification of urban environment propensity for physical activity (PA) and to determine how it relates to lifestyle and anthropometric parametrization of obesity. Participants (N = 318–60.4% women and 39.6% men) were recruited from a mid-sized city with epidemiology and morbidity rates below the average for the mid-west region of Brazil. Body mass index (BMI) was measured and a questionnaire was applied to gather information about PA and life habits. The spatial urban health index (SUHI) was designed in a geographic information system using data from demographic, environmental and urban physical features. The relationship between BMI and PA was verified with multiple linear regression, controlled for SUHI levels. Regarding the BMI of the population, 69.5% were classified in the eutrophic or overweight ranges, with no effect of gender and age. The SUHI classified 63.7% of the urban area favorable to PA. The PA routine was adequate (≥3 sessions with ≥1 h each) for ~80% of the population, as well as healthy habits such as non smoking (~94%) and non alcohol abuse (~55%). The SUHI strengthens the relationships of BMI to weekly frequency (r = -0.68; t = -9.4; p<0.001) and session duration (r = -0.66; t = -2.8; p<0.001) for the whole group by improving the explanatory coefficient in ~25% (R2Adj = 0.61 to R2Adj = 0.85). The SUHI indicated that the urban environment is able to promote healthy life habits by diminishing the “obesogenic” features of the city when physical structures are planned to facilitate PA, whatever the gender and age group.
Collapse
Affiliation(s)
| | - Mara Lucia Marques
- Pontificial Catholic University of Campinas (PUC-Campinas), CEATEC, Faculty of Geography, São Paulo, Brazil
| | - Daniel dos Santos
- Postgraduate Program in Health Promotion, University of Franca (UNIFRAN), Franca, São Paulo Brazil
| | | | | | - Danilo Alexandre Massini
- Postgraduate Program in Human Development and Technology, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, São Paulo, Brazil
- Department of Physical Education, College of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
| | - Dalton Müller Pessôa Filho
- Postgraduate Program in Human Development and Technology, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, São Paulo, Brazil
- Department of Physical Education, College of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
- * E-mail:
| |
Collapse
|
12
|
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: 85] [Impact Index Per Article: 21.3] [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.
Collapse
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
| |
Collapse
|
13
|
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: 51] [Impact Index Per Article: 10.2] [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.
Collapse
|
14
|
Abstract
Excessive intake of high-energy diets is an important cause of most obesity. The intervention of rats with high-fat diet can replicate the ideal animal model for studying the occurrence of human nutritional obesity. Proteomics and bioinformatics analyses can help us to systematically and comprehensively study the effect of high-fat diet on rat liver. In the present study, 4056 proteins were identified in rat liver by using tandem mass tag. A total of 198 proteins were significantly changed, of which 103 were significantly up-regulated and ninety-five were significantly down-regulated. These significant differentially expressed proteins are primarily involved in lipid metabolism and glucose metabolism processes. The intake of a high-fat diet forces the body to maintain physiological balance by regulating these key protein spots to inhibit fatty acid synthesis, promote fatty acid oxidation and accelerate fatty acid degradation. The present study enriches our understanding of metabolic disorders induced by high-fat diets at the protein level.
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Mendonça RDD, Lopes MS, Freitas PP, Campos SF, Menezes MCD, Lopes ACS. Monotony in the consumption of fruits and vegetables and food environment characteristics. Rev Saude Publica 2019; 53:63. [PMID: 31483005 PMCID: PMC6707622 DOI: 10.11606/s1518-8787.2019053000705] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/13/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the quantity and diversity in the consumption fruits and vegetables, as well as its relationship with the consumer's purchase characteristics and food environment. METHODS Baseline study stemming from a controlled and randomized community trial investigating a sample representative of Primary Health Care services (Health Academy Program) of Belo Horizonte, state of Minas Gerais. The intake of fruits and vegetables was analyzed in servings/day, whereas diversity was assessed by the Food Frequency Questionnaire. Users were also questioned on the frequency, purchase location and availability of these foods at their households. To assess the consumer's food environment, commercial establishments within a 1.6 km radius around the program unit sampled were audited. RESULTS 3,414 adults and older adults (88.1% women) were investigated, as well as 336 commercial establishments, in 18 units of the Health Academy Program. The average consumption of fruits and vegetables was adequate [5.4 (SD = 2.1) servings/day] but monotonous, with average daily intake of two different types. In the establishments audited, a good diversity (77.7% and 85.0%) and variety (74.5% and 81.4%) of fruits and vegetables was observed, although with lower quality of vegetables (60.4%). After adjusting for sociodemographic variables, we identified that knowledge on food crops (p = 0.006), increased monthly availability of fruits at households (p < 0.001), and greater variety of fruits (p = 0.03) and quality of vegetables (p = 0.05) in commercial establishments could improve the quantitative intake of fruits and vegetables, whereas a greater variety of fruits (p = 0.008) would increase consumption diversity. CONCLUSIONS The intake of fruits and vegetables was quantitatively adequate but monotonous, being influences by the consumer environment. Such results highlight the need for improving educational actions in health services and programs, in addition to acting on the consumer environment, aiming to promote and maintain the adequate and diversified consumption, as recommended by Brazilian guidelines for proper and healthy eating.
Collapse
Affiliation(s)
- Raquel de Deus Mendonça
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Nutrição. Programa de Pós-Graduação em Enfermagem. Grupo de Pesquisas de Intervenções em Nutrição. Belo Horizonte, MG, Brasil
| | - Mariana Souza Lopes
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Medicina Preventiva e Social. Programa de Pós-Graduação em Saúde Pública. Grupo de Pesquisas de Intervenções em Nutrição. Belo Horizonte, MG, Brasil
| | - Patrícia Pinheiro Freitas
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Nutrição. Programa de Pós-Graduação em Enfermagem. Grupo de Pesquisas de Intervenções em Nutrição. Belo Horizonte, MG, Brasil
| | - Suellen Fabiane Campos
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Nutrição. Programa de Pós-Graduação em Enfermagem. Grupo de Pesquisas de Intervenções em Nutrição. Belo Horizonte, MG, Brasil
- Secretaria Municipal de Saúde. Núcleo de Apoio a Saúde da Família. Belo Horizonte, MG, Brasil
| | - Mariana Carvalho de Menezes
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Programa de Pós-Graduação de Epidemiologia em Saúde Pública. Grupo de Pesquisas de Intervenções em Nutrição. Rio de Janeiro, RJ, Brasil
| | - Aline Cristine Souza Lopes
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Nutrição. Programa de Pós-Graduação em Enfermagem. Grupo de Pesquisas de Intervenções em Nutrição. Belo Horizonte, MG, Brasil
| |
Collapse
|
17
|
Backes V, Bairros F, Cafruni CB, Cummins S, Shareck M, Mason K, Dias-da-Costa JS, Olinto MTA. Food environment, income and obesity: a multilevel analysis of a reality of women in Southern Brazil. CAD SAUDE PUBLICA 2019; 35:e00144618. [PMID: 31483048 DOI: 10.1590/0102-311x00144618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 04/02/2019] [Indexed: 11/22/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Vanessa Backes
- Universidade do Vale do Rio dos Sinos, São Leopoldo, Brasil.,Prefeitura Municipal de São Leopoldo, São Leopoldo, Brasil
| | | | | | - Steven Cummins
- London School of Hygiene & Tropical Medicine, London, U.K
| | | | - Kate Mason
- London School of Hygiene & Tropical Medicine, London, U.K
| | | | | |
Collapse
|
18
|
Paulo Dos Anjos Souza Barbosa J, Henrique Guerra P, de Oliveira Santos C, de Oliveira Barbosa Nunes AP, Turrell G, Antonio Florindo A. Walkability, Overweight, and Obesity in Adults: A Systematic Review of Observational Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173135. [PMID: 31466371 PMCID: PMC6747269 DOI: 10.3390/ijerph16173135] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/13/2019] [Accepted: 07/13/2019] [Indexed: 11/16/2022]
Abstract
We conducted a systematic review to describe and summarize possible associations between the walkability index, overweight, and obesity. Systematic searches using seven electronic databases and reference lists were conducted to identify papers published until December 2017. Observational studies, describing associations using regression-based statistical methods, published in English and Portuguese, reporting markers of overweight and obesity, and involving adults (≥18 years) were included. Of the 2469 references initially retrieved, ten were used for the descriptive synthesis. Seven studies showed significant inverse associations between walkability and overweight and obesity, however, all were cross-sectional studies. High risk of bias scores were observed in "selection bias" and "withdrawals and dropouts". All studies were published in high-income countries with sample sizes ranging among 75 to 649,513 participants. Weight and height as measures for determining BMI tended to be self-reported. Indicators of walkability, such as land-use mix, street connectivity and residential density were used as components of the indices. Based on this review, more studies should be conducted in low, middle, and middle-high income countries, using longitudinal designs that control neighborhood self-selection; other indicators of the neighborhood environment, such as food access, physical activity facilities, sidewalks, and safety and crime prevention should be considered.
Collapse
Affiliation(s)
- João Paulo Dos Anjos Souza Barbosa
- Nutrition Department, Graduate Program in Public Health Nutrition, School of Public Health, University of São Paulo, Sao Paulo City 01246-904, Brazil.
- Physical Activity Epidemiology Group, University of Sao Paulo, Sao Paulo City 03828-000, Brazil.
| | - Paulo Henrique Guerra
- Physical Activity Epidemiology Group, University of Sao Paulo, Sao Paulo City 03828-000, Brazil
- Federal University of Fronteira Sul, Chapecó Campus, Chapecó 89815-899, Brazil
| | - Crislaine de Oliveira Santos
- Physical Activity Epidemiology Group, University of Sao Paulo, Sao Paulo City 03828-000, Brazil
- School of Arts, Sciences and Humanities, Graduate Program in Physical Activity Sciences, University of Sao Paulo, Sao Paulo City 03828-000, Brazil
| | | | - Gavin Turrell
- Centre for Urban Research, School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC 3000, Australia
| | - Alex Antonio Florindo
- Nutrition Department, Graduate Program in Public Health Nutrition, School of Public Health, University of São Paulo, Sao Paulo City 01246-904, Brazil
- Physical Activity Epidemiology Group, University of Sao Paulo, Sao Paulo City 03828-000, Brazil
- School of Arts, Sciences and Humanities, Graduate Program in Physical Activity Sciences, University of Sao Paulo, Sao Paulo City 03828-000, Brazil
| |
Collapse
|
19
|
Consuming school meals improves Brazilian children’s diets according to their social vulnerability risk. Public Health Nutr 2019; 22:2714-2719. [DOI: 10.1017/s1368980019001459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractObjective:To estimate usual diets among Brazilian children regarding the consumption of school meals and social vulnerability risks.Design:A cross-sectional study. School meal consumers were considered those children who reported consuming school meals ≥3 times/week. Social vulnerability risk was classified by an index. Dietary intake was evaluated by one 24 h dietary recall for the whole sample; a second 24 h dietary recall was administered in a sub-sample (38·6 %). The National Cancer Institute’s method was used to estimate children’s usual intake of nutrients and food groups.Setting:Municipal public schools from Belo Horizonte, Brazil.Participants:Children (n 1357) aged 8–12 years.Results:Half of the sample lived in low/medium social vulnerability risk areas and 27·9 % were school meal non-consumers. School meal consumers more frequently lived in high/very high social vulnerability risk areas (76·2 v. 68·7 %). Children with low/medium social vulnerability risk had a higher mean intake of thiamin (1·13 v. 1·04 mg) and a lower mean intake of candy (1·35 v. 1·42 g). Consumption of school meals among children under high/very high social vulnerability risk was associated with higher mean consumption of vitamin C (31·9 v. 24·1 mg), unprocessed/minimally processed foods (956·3 v. 851·9 g), fruits (128·5 v. 90·9 g) and vegetables (58·2 v. 47·1 g). Ultra-processed food product consumption was lower among school meal consumers (136·2 v. 187·7 g), especially ultra-processed beverages (252·5 v. 305·7 g).Conclusions:Consuming school meals was associated with a better usual diet quality, particularly among those with higher social vulnerability risk.
Collapse
|
20
|
Silva FMOD, Novaes TG, Ribeiro AQ, Longo GZ, Pessoa MC. [Environmental factors associated with obesity in the adult population in a medium-sized Brazilian city]. CAD SAUDE PUBLICA 2019; 35:e00119618. [PMID: 31141028 DOI: 10.1590/0102-311x00119618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 01/24/2019] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to estimate associations between environmental variables and obesity in the adult population in a medium-sized Brazilian city. This was a cross-sectional study with individual data from a population-based study and environmental data obtained by direct observation, later georeferenced by the addresses. The sample included 965 adults 20 to 59 years of age, and the study used anthropometric, socioeconomic, demographic, behavioral, and self-rated health data. The outcome variable was obesity, defined as body mass index (BMI) ≥ 30kg/m2. Retail food outlets were classified as: supermarkets and establishments with a predominance of healthy, unhealthy, and mixed foods. Settings for physical activity were categorized as public and private. Characterization of the social environment used the census tracts' per capita income in tertiles and the crime rate. Binary logistic regression analysis was performed according to the generalized estimating equations model. An inverse association was found between density of public and private locations for physical activity and obesity (OR = 0.95, 95%CI: 0.92-0.99; OR = 0.98, 95%CI: 0.97-0.99) in models adjusted by individual and environmental variables. In all the models, the highest per capita income tertile was inversely associated with obesity (p ≤ 0.05). The food environment and crime rates were not independently associated with obesity. These findings suggest that the census tract's income and its environment for physical activity can orient public policies to decrease obesity in this city.
Collapse
|
21
|
Tung EL, Wroblewski KE, Boyd K, Makelarski JA, Peek ME, Lindau ST. Police-Recorded Crime and Disparities in Obesity and Blood Pressure Status in Chicago. J Am Heart Assoc 2018; 7:e008030. [PMID: 29574461 PMCID: PMC5907588 DOI: 10.1161/jaha.117.008030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/22/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND The purpose of this study was to examine associations between several types of police-recorded crime (violent, nonviolent, and homicide) and cardiometabolic health (obesity and elevated blood pressure [BP]), and to determine if associations were modified by age and sex. METHODS AND RESULTS We analyzed cross-sectional data (N=14 799 patients) from 3 primary care clinics at an academic medical center in Chicago, IL. Patient-level health data were obtained from the electronic health record (June 1, 2014-May 31, 2015), including body mass index and BP, and linked to the City of Chicago Police Data Portal. Geocoded crime counts were aggregated to census tract and calculated as the annual crime rate per 1000 population. Generalized linear mixed models were used to assess obesity and BP status as a function of crime rate quartile, controlling for patient, clinic, and neighborhood characteristics. Median violent crime rates in each quartile ranged from 15 to 84 per 1000 population. Median age was 56 years (interquartile range, 38-72 years); 42% of patients were obese and 33% had elevated BP. Compared with patients living in the lowest quartile, patients living in the highest quartile for violent crime had 53% higher adjusted odds of obesity (95% confidence interval, 1.15-2.03) and 25% higher adjusted odds of elevated BP (95% confidence interval, 1.01-1.56). In subanalyses examining homicide, a relatively rare event, exposure was not associated with obesity and was inconsistently associated with elevated BP. CONCLUSIONS In a densely populated, high-poverty region in Chicago, recurrent exposure to high rates of violent crime was consistently associated with obesity and elevated BP, but rare exposure to homicide was not.
Collapse
Affiliation(s)
- Elizabeth L Tung
- Section of General Internal Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, IL
| | | | - Kelly Boyd
- Department of Obstetrics and Gynecology, University of Chicago, IL
| | | | - Monica E Peek
- Section of General Internal Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, IL
- MacLean Center for Clinical Medical Ethics, University of Chicago, IL
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, IL
- Department of Medicine-Geriatrics, MacLean Center on Clinical Medical Ethics and Comprehensive Cancer Center, University of Chicago, IL
| |
Collapse
|
22
|
Maia EG, Mendes LL, Pimenta AM, Levy RB, Claro RM. Cluster of risk and protective factors for obesity among Brazilian adolescents. Int J Public Health 2017; 63:481-490. [PMID: 29143071 DOI: 10.1007/s00038-017-1053-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/17/2017] [Accepted: 11/06/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study aims to identify and analyze clusters formed by risk and protective factors for obesity among Brazilian adolescents. METHODS Cross-sectional data collected in a national representative sample of adolescents by the Brazilian National School Health Survey of 2012 were used (n = 109,104). Cluster analysis was applied to identify clusters involving dietary intake, eating behavior, physical activity and sedentary behaviors. Logistic regression was employed to contextualize the clusters according to students' sociodemographics and schools' characteristics. RESULTS Two clusters were identified. Cluster 1 was predominantly characterized by the low frequency of both risk and protective factors for obesity; Cluster 2 was characterized by high frequency of both of these factors. None was essentially healthy or unhealthy. Adolescents from less developed regions and with mothers with lower education level were associated to Cluster 1. CONCLUSIONS The identification of two mixed clusters indicate wide spread obesity risk among scholars in the country. The association between the clusters and sociodemographic characteristics of the population allows a greater refinement of health promotion and obesity prevention and combat actions in Brazil.
Collapse
Affiliation(s)
- Emanuella Gomes Maia
- Graduate Program in Nursing, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Larissa Loures Mendes
- Nutrition Department, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Adriano Marçal Pimenta
- Department of Maternal Child Nursing and Public Health, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Renata Bertazzi Levy
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Rafael Moreira Claro
- Nutrition Department, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| |
Collapse
|
23
|
Mondal N, Sen J, Bose K, Timungpi R, Kathar M, Hanse S. Neck circumference as a screening measure of overweight/obesity among Indian adults. ANTHROPOLOGICAL REVIEW 2016. [DOI: 10.1515/anre-2016-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Neck circumference (NC) is an anthropometric measurement of differentiating body fat distributions and a marker of upper subcutaneous adiposity. The present study highlights the association and importance of NC as a suitable proxy screening measure of overweight/obesity as compared to the conventional anthropometric variables used among Indian adults. The present community based cross-sectional study was undertaken among 1169 Karbi adults (males: 625; females: 544) residing in Karbi Anglong district of Assam, Northeast India, who were selected through a multistage stratified random sampling method. Height, weight, waist circumference (WC), hip circumference (HC) and NC were recorded using standard procedures. The body mass index (BMI) was calculated and prevalence of overweight/obesity was assessed using standard cut-offs. The prevalence of obesity using BMI (≥25.00 kg m-2) was 15.52% and 15.26% among males and females, respectively (p≥0.05).The prevalence of obesity using NC was observed to be significantly higher among males (48.80%) than females (19.12%) (p<0.01). The binary logistic regression analysis showed that NC predicted obesity over the conventional anthropometric variables with reasonable accuracy (p<0.01). The ROC-AUC analysis showed a relatively greater significant association between BMI, WC and HC and NC for obesity (p<0.01). Thus, NC appears to be a potentially simple, easyto- use screening measure for predicting obesity among adults. Further studies are required to validate its use for screening of obesity among other ethnic populations in India.
Collapse
|
24
|
Todendi PF, Possuelo LG, Klinger EI, Reuter CP, Burgos MS, Moura DJ, Fiegenbaum M, Valim ARDM. Low-grade inflammation markers in children and adolescents: Influence of anthropometric characteristics and CRP and IL6 polymorphisms. Cytokine 2016; 88:177-183. [PMID: 27643980 DOI: 10.1016/j.cyto.2016.09.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 08/31/2016] [Accepted: 09/13/2016] [Indexed: 12/29/2022]
Abstract
Overweight and obesity are associated with chronic and subclinical inflammation due to an imbalance of inflammatory mediators. However, the association with gene polymorphism has been rarely studied in children. The aim of this study was to determine if serum concentrations of C-reactive protein (CRP) and interleukin-6 (IL-6) are related to the IL6 rs1800795, IL6 rs2069845 and CRP rs1205 polymorphisms (SNPs) according to body mass index (BMI) in a sample of children and adolescents. A cross-sectional study in 470 students between 7 and 17yearsof age of anthropometric characteristics, high sensitivity-CRP (Hs-CRP) and IL-6 levels and three SNPs genotyped. The prevalence ratio of hs-CRP>3mg/L in obese individuals was 4.15 (CI 2.43-7.06; p=0.01), and it was 1.91 (CI 1.03-3.55; p=0.03) in overweight individuals and 1.74 (CI 1.05-2.88 p=0.03) in females. Individuals with waist circumference (WC) and body fat percentage (BF%) alterations showed elevated levels of hs-CRP (p=4.3×10-5 and p=5.3×10-6). The combination of any two anthropometric measurement increases CRP levels, especially combinations with obesity body mass index (BMI): BMI+WC and BMI+BF%. Among the overweight/obesity group, T allele carriers of CRP rs1205 showed lower levels of hs-CRP (0.5, IQR=0.3-1.8mg/L) than CC homozygotes (1.5, IQR=0.4-3.4mg/L, p=0.018). Additionally, considering subjects with two or three anthropometric alterations for CRP rs1205: rs1205 T allele carriers had lower levels of hs-CRP (0.7, IQR=0.3-2.7mg/L) than CC homozygotes (1.2, IQR=0.5-3.5mg/L, p=0.02). In conclusion, carriers of the rs1205/T allele with higher BMIs had lower levels of hs-CRP. Schoolchildren who were overweight/obese had higher levels of CRP and IL-6, whereas individuals with WC and BF% alterations had higher levels of CRP.
Collapse
Affiliation(s)
- P F Todendi
- Post-Graduation Program in Health Promotion, University of Santa Cruz do Sul - UNISC, Santa Cruz do Sul, RS, Brazil.
| | - L G Possuelo
- Department of Biology and Pharmaceutical Sciences and the Post-Graduation Program in Health Promotion, University of Santa Cruz do Sul - UNISC, Santa Cruz do Sul, RS, Brazil.
| | - E I Klinger
- Post-Graduation Program in Health Promotion, University of Santa Cruz do Sul - UNISC, Santa Cruz do Sul, RS, Brazil.
| | - C P Reuter
- Department of Physical Education and Health and the Post-Graduation Program in Health Promotion, University of Santa Cruz do Sul - UNISC, Santa Cruz do Sul, RS, Brazil.
| | - M S Burgos
- Department of Physical Education and Health and the Post-Graduation Program in Health Promotion, University of Santa Cruz do Sul - UNISC, Santa Cruz do Sul, RS, Brazil.
| | - D J Moura
- Laboratory of Genetic Toxicology, Federal University of Health Sciences of Porto Alegre - UFCSPA, Porto Alegre, RS, Brazil.
| | - M Fiegenbaum
- Department of Basic Health Sciences, Federal University of Health Sciences of Porto Alegre - UFCSPA, Porto Alegre, RS, Brazil.
| | - Andréia Rosane de Moura Valim
- Department of Biology and Pharmaceutical Sciences and the Post-Graduation Program in Health Promotion, University of Santa Cruz do Sul - UNISC, Santa Cruz do Sul, RS, Brazil.
| |
Collapse
|
25
|
Juvanhol LL, Lana RM, Cabrelli R, Bastos LS, Nobre AA, Rotenberg L, Griep RH. Factors associated with overweight: are the conclusions influenced by choice of the regression method? BMC Public Health 2016; 16:642. [PMID: 27461119 PMCID: PMC4962412 DOI: 10.1186/s12889-016-3340-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background Different analytical techniques have been used to study the determinants of overweight. However, certain commonly used techniques may be limited by the continuous nature and skewed distribution of body mass index (BMI) data. In this article, different regression models are compared to identify the best approach for analysing predictors of BMI. Methods Data collected on 2270 nurses at 18 public hospitals in Rio de Janeiro, RJ (2010–2011) were analysed (80.6 % of the respondents). The explanatory variables considered were age, marital status, race/colour, mother’s schooling, domestic overload, years worked at night, consumption of fried food, physical inactivity, self-rated health and BMI at age 20 years. In addition to gamma regression, regarded as the reference method for selecting the set of explanatory variables described here, other modelling strategies – including linear, quantile (for the 0.25, 0.50 and 0.75 quantiles), binary and multinomial logistic regression – were compared in terms of final results and measures of fit. Results The variables age, marital status, race/colour, domestic overload, self-rated health, physical inactivity and BMI at age 20 years were significantly associated with BMI, independently of the method used. In the same way, consumption of fried food was significant in all the models, but a dose–response pattern was identified only in the gamma and normal models and the quantile model for the 0.75 quantile. Years worked at night was also associated with BMI in these three models only. The variable mother’s schooling returned significant results only for the category 12 or more years of schooling, except for overweight in the multinomial model and for the 0.50 quantile in the quantile model, in which the two categories were not significant. The results of the quantile regression showed that, generally, the effects of the variables investigated were greater in the upper quantiles of the BMI distribution. Of the models using BMI in its continuous form, the gamma model showed best fit, followed by the quantile models (0.25 and 0.5 quantiles). Conclusions The different strategies used produced similar results for the factors associated with BMI, but differed in the magnitude of the associations and goodness of fit. We recommend using the different approaches in combination, because they furnish complementary information on the problem studied. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3340-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | - Raquel Martins Lana
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Renata Cabrelli
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Aline Araújo Nobre
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Lúcia Rotenberg
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | |
Collapse
|
26
|
Dake FAA, Thompson AL, Ng SW, Agyei-Mensah S, Codjoe SNA. The Local Food Environment and Body Mass Index among the Urban Poor in Accra, Ghana. J Urban Health 2016; 93:438-55. [PMID: 27091736 PMCID: PMC4899328 DOI: 10.1007/s11524-016-0044-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Obesity in the sub-Saharan Africa region has been portrayed as a problem of affluence, partly because obesity has been found to be more common in urban areas and among the rich. Recent findings, however, reveal rising prevalence among the poor particularly the urban poor. A growing body of literature mostly in Western countries shows that obesity among the poor is partly the result of an obesogenic-built environment. Such studies are lacking in the African context. This study examines the characteristics of the local food environment in an urban poor setting in Accra, Ghana and further investigates the associated risk of obesity for residents. Data on the local food environment was collected using geographic positioning system (GPS) technology. The body mass indices (BMI) of females (15-49 years) and males (15-59 years) were calculated from measured weight and height. Data on the socio-demographic characteristics and lifestyle behaviors of respondents was also collected through a household survey. Spatial analysis tools were used to examine the characteristics of the local food environment while the influence of the food environment on BMI was examined using a two-level multilevel model. The measures of the food environment constituted the level 2 factors while individual socio-demographic characteristics and lifestyle behaviors constituted the level 1 factors. The local food environment in the study communities is suggestive of an obesogenic food environment characterized by an abundance of out-of-home cooked foods, convenience stores, and limited fruits and vegetables options. The results of the multilevel analysis reveal a 0.2 kg/m(2) increase in BMI for every additional convenience store and a 0.1 kg/m(2) reduction in BMI for every out-of-home cooked food place available in the study area after controlling for individual socio-demographic characteristics, lifestyle behaviors, and community characteristics. The findings of this study indicate that the local food environment in urban poor Accra is associated with increased risk of obesity through providing access to convenience stores. In order to reduce the risk of obesity in these urban poor communities, there is the need to regulate the availability of and access to convenience stores while also encouraging healthier offerings in convenience stores.
Collapse
Affiliation(s)
- Fidelia A A Dake
- Regional Institute for Population Studies, University of Ghana, P.O. Box LG 96, Legon, Accra, Ghana.
| | - Amanda L Thompson
- Department of Anthropology and Carolina Population Center, University of North Carolina at Chapel Hill, CB # 8120, 137 East Franklin St., Chapel Hill, NC, 27516, USA
| | - Shu Wen Ng
- Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill (UNC), CB # 8120, 137 East Franklin St., Chapel Hill, NC, 27516, USA
| | - Samuel Agyei-Mensah
- Department of Geography and Resource Development, University of Ghana, P.O. Box LG 59, Legon, Accra, Ghana
| | - Samuel N A Codjoe
- Regional Institute for Population Studies, University of Ghana, P.O. Box LG 96, Legon, Accra, Ghana
| |
Collapse
|
27
|
Bispo S, Correia MITD, Proietti FA, Xavier CC, Caiaffa WT. Nutritional status of urban adolescents: individual, household and neighborhood factors based on data from The BH Health Study. CAD SAUDE PUBLICA 2015; 31 Suppl 1:232-45. [DOI: 10.1590/0102-311x00100514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 04/13/2015] [Indexed: 11/22/2022] Open
Abstract
Abstract The increasing prevalence of overweight in young people suggests that adolescent nutritional status is influenced by environmental factors. Using hierarchical modelling, this study aimed to analyse the association between individual, household and neighborhood factors and adolescent nutritional status and well-being. The study used data from a population-based household survey conducted in Belo Horizonte, the capital of the State of Minas Gerais, Brazil, between 2008 and 2009. Data was obtained from an adult and adolescent in each household using a confidential questionnaire and anthropometric measurements. Adolescent nutritional status was evaluated using multinomial regression analysis considering distal and proximal influences. The prevalence of overweight and thinness among the sample of 1,030 adolescents was 21.9% and 4.6%, respectively. Although variables from all blocks remained in the final model, head of household education level, family habits and family nutritional status were shown to strongly influence adolescent nutritional status. New approaches to public health are needed which focus on raising awareness and promoting health education targeting teenagers and their social context.
Collapse
Affiliation(s)
| | | | | | - César Coelho Xavier
- Universidade Federal de Minas Gerais, Brasil; Faculdade de Saúde e Ecologia Humana, Brasil
| | | |
Collapse
|
28
|
The role of the local retail food environment in fruit, vegetable and sugar-sweetened beverage consumption in Brazil. Public Health Nutr 2015; 19:1093-102. [DOI: 10.1017/s1368980015001524] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo examine the relationship between the local retail food environment and consumption of fruits and vegetables (FV) and sugar-sweetened beverages (SSB) in São Paulo, Brazil, as well as the moderation effects of income in the studied relationships.DesignCross-sectional study design that drew upon neighbourhood- and individual-level data. For each participant, community (density and proximity) and community food environment (availability, variety, quality and price) measures of FV and SSB were assessed in retail food stores and specialized fresh produce markets within 1·6 km of their homes. Poisson generalized estimating equations (GEE) were used to model the associations of food consumption with food environment measures, adjusted by individual-level characteristics.SettingSão Paulo, Brazil.SubjectsAdults (n 1842) residing in the same census tracts (n 52) in São Paulo, Brazil as those where the neighbourhood-level measures were taken.ResultsFV availability in neighbourhoods was associated with regular FV consumption (≥5 times/week; prevalence ratio=1·41; 95 % CI 1·19, 1·67). Regular FV consumption prevalence was significantly lower among lower-income individuals living in neighbourhoods with fewer supermarkets and fresh produce markets (P-interaction <0·05). A greater variety of SSB was associated with a 15 % increase in regular SSB consumption (≥5 times/week) prevalence, after adjustment for confounding variables.ConclusionsOur findings suggest that the local retail food environment is associated with FV and SSB consumption in a Brazilian urban sample.
Collapse
|