Department of Public Health, Californian State University, Los Angeles, CA, USA.
Department of Epidemiology, University of Alabama at Birmingham, AL, USA.
Am J Health Promot. 2020 Jul;34(6):652-658. doi: 10.1177/0890117120905240. Epub 2020 Feb 12.
This study aims to test the hypothesis that in addition to a direct effect of food environment on obesity, food environment is indirectly associated with obesity through consuming Mediterranean diet (MD).
Cross-sectional secondary data analysis.
Nationwide community-dwelling residency.
A total of 20 897 non-Hispanic black and white adults aged ≥45 years who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment during January 2003 and October 2007.
The Modified Retail Food Environment Index (mRFEI; 0-100) was used as food environment indicator. The MD score (0-9) was calculated to indicate the dietary pattern adherence. Body mass index (BMI; kg/m) was used to estimate obesity.
Path analysis was used to quantify the pathways between food environment, MD adherence, and obesity. Proper data transformation was made using Box-Cox power transformation to meet certain analysis assumptions.
The participants were from 49 states of the United States, with the majority (64.42%) residing in the South. Most of the participants were retired, female, white, married, having less than college graduate education, having annual household income ≤75 000, and having health insurance. The means of mRFEI was 10.92 (standard deviation [SD] = 10.19), MD score was 4.36 (SD = 1.70), and the BMI was 28.96 kg/m (SD = 5.90). Access to healthy food outlets (β = .04, < .0001) and MD adherence (β = .08, < .0001) had significant and inverse relationships with BMI, respectively. Mediterranean diet adherence mediated the relationship between food environment and obesity among a subpopulation who had an annual household income of <$75 000 (β = -.02, = .0391).
Population-tailored interventions/policies to modify food environment and promote MD consumption are needed in order to combat the obesity crisis in the United States.
本研究旨在检验以下假设，即除了食物环境对肥胖的直接影响外，食物环境还通过食用地中海饮食（Mediterranean diet，MD）与肥胖间接相关。
横断面二次数据分析。
全国社区居住场所。
共纳入 20897 名年龄≥45 岁的非西班牙裔黑人和白人成年人，他们参加了 Reasons for Geographic and Racial Differences in Stroke 研究，并于 2003 年 1 月至 2007 年 10 月完成基线评估。
使用改良零售食品环境指数（Modified Retail Food Environment Index，mRFEI；0-100）作为食物环境指标。计算地中海饮食评分（Mediterranean diet score，MD 评分；0-9）以表示饮食模式的依从性。体重指数（body mass index，BMI；kg/m）用于估计肥胖。
采用路径分析量化食物环境、MD 依从性与肥胖之间的关系。采用 Box-Cox 幂变换对数据进行适当转换，以满足某些分析假设。
参与者来自美国的 49 个州，其中大多数（64.42%）居住在南部。大多数参与者为退休人员、女性、白人、已婚、受教育程度低于大学毕业、家庭年收入≤75000 美元、有医疗保险。mRFEI 的平均值为 10.92（标准差 [standard deviation，SD] = 10.19），MD 评分为 4.36（SD = 1.70），BMI 为 28.96 kg/m（SD = 5.90）。获得健康食品店的机会（β =.04，<.0001）和 MD 依从性（β =.08，<.0001）与 BMI 呈显著负相关。在家庭年收入<75000 美元的人群中，MD 依从性部分介导了食物环境与肥胖之间的关系（β = -.02，<.0391）。
需要针对人群的干预/政策来改变食物环境并促进 MD 消费，以应对美国的肥胖危机。
