生活在食物荒漠与心血管疾病风险之间的关联。
Association Between Living in Food Deserts and Cardiovascular Risk.
作者信息
Kelli Heval M, Hammadah Muhammad, Ahmed Hina, Ko Yi-An, Topel Matthew, Samman-Tahhan Ayman, Awad Mossab, Patel Keyur, Mohammed Kareem, Sperling Laurence S, Pemu Priscilla, Vaccarino Viola, Lewis Tene, Taylor Herman, Martin Greg, Gibbons Gary H, Quyyumi Arshed A
机构信息
From the Emory Clinical Cardiovascular Research Institute (H.M.K., M.H., H.A., M.T., A.S.-T., M.A., K.P., K.M., L.S.S., V.V., A.A.Q.), Rollins School of Public Health, Emory University School of Medicine (Y.-A.K., V.V., T.L.), and Predictive Health Institute (G.M.), Emory University, Atlanta, GA; Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA (P.P., H.T.); and National Heart, Lung, and Blood Institute, Bethesda, MD (G.H.G.).
出版信息
Circ Cardiovasc Qual Outcomes. 2017 Sep;10(9). doi: 10.1161/CIRCOUTCOMES.116.003532.
BACKGROUND
Food deserts (FD), neighborhoods defined as low-income areas with low access to healthy food, are a public health concern. We evaluated the impact of living in FD on cardiovascular risk factors and subclinical cardiovascular disease (CVD) with the hypothesis that people living in FD will have an unfavorable CVD risk profile. We further assessed whether the impact of FD on these measures is driven by area income, individual household income, or area access to healthy food.
METHODS AND RESULTS
We studied 1421 subjects residing in the Atlanta metropolitan area who participated in the META-Health study (Morehouse and Emory Team up to Eliminate Health Disparities; n=712) and the Predictive Health study (n=709). Participants' zip codes were entered into the United States Food Access Research Atlas for FD status. Demographic data, metabolic profiles, hs-CRP (high-sensitivity C-reactive protein) levels, oxidative stress markers (glutathione and cystine), and arterial stiffness were evaluated. Mean age was 49.4 years, 38.5% male and 36.6% black. Compared with those not living in FD, subjects living in FD (n=187, 13.2%) had a higher prevalence of hypertension and smoking, higher body mass index, fasting glucose, and 10-year risk for CVD. They also had higher hs-CRP (=0.014), higher central augmentation index (=0.015), and lower glutathione level (=0.003), indicative of increased oxidative stress. Area income and individual income, rather than food access, were associated with CVD risk measures. In a multivariate analysis that included food access, area income and individual income, both low-income area and low individual household income, were independent predictors of a higher 10-year risk for CVD. Only low individual income was an independent predictor of higher hs-CRP and augmentation index.
CONCLUSIONS
Although living in FD is associated with a higher burden of cardiovascular risk factors and preclinical indices of CVD, these associations are mainly driven by area income and individual income rather than access to healthy food.
背景
食物荒漠（FD）是指那些被定义为低收入地区且难以获取健康食品的社区，这是一个公共卫生问题。我们评估了生活在食物荒漠地区对心血管危险因素和亚临床心血管疾病（CVD）的影响，并假设生活在食物荒漠地区的人群会有不利的心血管疾病风险状况。我们进一步评估了食物荒漠地区对这些指标的影响是否由地区收入、个人家庭收入或地区获取健康食品的情况所驱动。
方法与结果
我们研究了居住在亚特兰大大都市区的1421名受试者，他们参与了META-Health研究（莫尔豪斯学院和埃默里大学携手消除健康差异；n = 712）和预测健康研究（n = 709）。将参与者的邮政编码输入美国食物获取研究地图集以确定其食物荒漠状况。评估了人口统计学数据、代谢谱、高敏C反应蛋白（hs-CRP）水平、氧化应激标志物（谷胱甘肽和胱氨酸）以及动脉僵硬度。平均年龄为49.4岁，男性占38.5%，黑人占36.6%。与不住在食物荒漠地区的人相比，生活在食物荒漠地区的受试者（n = 187，13.2%）高血压和吸烟的患病率更高，体重指数、空腹血糖以及10年心血管疾病风险更高。他们的hs-CRP也更高（= 0.014），中心增强指数更高（= 0.015），谷胱甘肽水平更低（= 0.003），表明氧化应激增加。与心血管疾病风险指标相关的是地区收入和个人收入，而非食物获取情况。在一项包括食物获取、地区收入和个人收入的多变量分析中，低收入地区和低个人家庭收入都是10年心血管疾病风险较高的独立预测因素。只有低个人收入是hs-CRP升高和增强指数升高的独立预测因素。
结论
尽管生活在食物荒漠地区与心血管危险因素负担加重以及心血管疾病的临床前指标相关，但这些关联主要由地区收入和个人收入驱动，而非获取健康食品的情况。
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