Laraia Barbara A, Downing Janelle M, Zhang Y Tara, Dow William H, Kelly Maggi, Blanchard Samuel D, Adler Nancy, Schillinger Dean, Moffet Howard, Warton E Margaret, Karter Andrew J
Am J Epidemiol. 2017 May 1;185(9):743-750. doi: 10.1093/aje/kww167.
Associations between neighborhood food environment and adult body mass index (BMI; weight (kg)/height (m)2) derived using cross-sectional or longitudinal random-effects models may be biased due to unmeasured confounding and measurement and methodological limitations. In this study, we assessed the within-individual association between change in food environment from 2006 to 2011 and change in BMI among adults with type 2 diabetes using clinical data from the Kaiser Permanente Diabetes Registry collected from 2007 to 2011. Healthy food environment was measured using the kernel density of healthful food venues. Fixed-effects models with a 1-year-lagged BMI were estimated. Separate models were fitted for persons who moved and those who did not. Sensitivity analysis using different lag times and kernel density bandwidths were tested to establish the consistency of findings. On average, patients lost 1 pound (0.45 kg) for each standard-deviation improvement in their food environment. This relationship held for persons who remained in the same location throughout the 5-year study period but not among persons who moved. Proximity to food venues that promote nutritious foods alone may not translate into clinically meaningful diet-related health changes. Community-level policies for improving the food environment need multifaceted strategies to invoke clinically meaningful change in BMI among adult patients with diabetes.
使用横断面或纵向随机效应模型得出的邻里食物环境与成人体重指数（BMI；体重（千克）/身高（米）²）之间的关联可能会因未测量的混杂因素以及测量和方法学上的局限性而产生偏差。在本研究中，我们利用2007年至2011年从凯撒医疗永久糖尿病登记处收集的临床数据，评估了2006年至2011年食物环境变化与2型糖尿病成年患者BMI变化之间的个体内关联。健康食物环境通过健康食品场所的核密度来衡量。估计了具有1年滞后BMI的固定效应模型。针对搬家者和未搬家者分别建立模型。测试了使用不同滞后时间和核密度带宽的敏感性分析，以确定研究结果的一致性。平均而言，食物环境每改善一个标准差，患者体重减轻1磅（0.45千克）。这种关系在整个5年研究期间一直居住在同一地点的人群中成立，但在搬家人群中不成立。仅靠近推广营养食品的场所可能不会转化为具有临床意义的与饮食相关的健康变化。改善食物环境的社区层面政策需要多方面的策略，以促使成年糖尿病患者的BMI发生具有临床意义的变化。
