Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2000, New Orleans, LA, 70112, USA.
Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles (UCLA), 650 Charles E. Young Dr. South, Box 951772, Los Angeles, CA, 90095, USA.
BMC Public Health. 2020 May 13;20(1):678. doi: 10.1186/s12889-020-08779-2.
Food packages provided by the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) were revised in 2009 to better align them with the Dietary Guidelines for Americans. This study was conducted to evaluate whether the effect of the food package change on childhood obesity varied by the food environment in the neighborhoods where WIC-participating children live.
Administrative data from participating children in Los Angeles County, California (2003-2016) were merged with geocoded food vendor information by neighborhood of residence. Obesity risk at age 4 was compared between children receiving old (2003-2009) and new (2010-2016) WIC food packages using sex-stratified Poisson regression models, with interaction terms between WIC package and neighborhood density (number per square mile) of healthy and unhealthy food outlets.
The new food package was associated with a significant decrease in obesity risk. Among boys, the new food package was associated with 8 to 18% lower obesity risk at all healthy and unhealthy food outlet densities, and the association was not modified by neighborhood food outlet density. Among girls, the association of the new food package with obesity risk was protective in neighborhoods with high healthy and low unhealthy food outlet densities, and adverse in neighborhoods with high unhealthy and low healthy food outlet densities. The effect of the new food package among girls was modified by unhealthy food outlet density, with significantly smaller (p-value = 0.004) decreases in obesity risk observed in neighborhoods with higher unhealthy food outlet density.
The impact of the food package change was modified by the neighborhood food environment among girls only. Future policy changes should incorporate consideration of ways to mitigate potentially inequitable geographic distribution of the health benefits of policy changes.
特别补充营养计划（WIC）为妇女、婴儿和儿童提供的食品包于 2009 年进行了修订，以使其与《美国人饮食指南》更好地保持一致。本研究旨在评估食品包装变化对儿童肥胖的影响是否因 WIC 参与儿童居住的社区的食品环境而异。
加利福尼亚州洛杉矶县参与儿童的行政数据（2003-2016 年）与按居住社区进行地理编码的食品供应商信息合并。使用按性别分层的泊松回归模型，比较接受旧（2003-2009 年）和新（2010-2016 年）WIC 食品包的儿童在 4 岁时的肥胖风险，模型中包含 WIC 套餐和健康及不健康食品销售点密度（每平方英里数量）之间的交互项。
新食品套餐与肥胖风险显著降低相关。在男孩中，在所有健康和不健康食品销售点密度下，新食品套餐与肥胖风险降低 8-18%相关，且这种关联不受社区食品销售点密度的影响。在女孩中，在健康食品销售点密度高且不健康食品销售点密度低的社区中，新食品套餐与肥胖风险之间的关联具有保护作用，而在不健康食品销售点密度高且健康食品销售点密度低的社区中，这种关联则具有不良影响。新食品套餐对女孩肥胖风险的影响受到不健康食品销售点密度的修饰，在不健康食品销售点密度较高的社区中，肥胖风险降低的幅度显著较小（p 值=0.004）。
仅在女孩中，食品包装变化的影响受到社区食品环境的修饰。未来的政策变化应考虑采取措施，减轻政策变化的健康效益在地理上的不平等分配。
