University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, 9700 RB Groningen, the Netherlands.
University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Hanzeplein 1, 9700 RB Groningen, the Netherlands.
Prev Med. 2022 Feb;155:106915. doi: 10.1016/j.ypmed.2021.106915. Epub 2021 Dec 16.
Unhealthy food environments may contribute to an elevated Body Mass Index (BMI), which is a chronic disease risk factor. We examined the association between residential fast-food outlet exposure, in terms of proximity and density, and BMI in the Dutch adult general population. Additionally, we investigated to what extent this association was modified by urbanisation level. In this cross-sectional study, we linked residential addresses of baseline adult Lifelines Cohort participants (n = 147,027) to fast-food outlet locations using geo-coding. We computed residential fast-food outlet proximity, and density within 500 m, 1, 3, and 5 km. We used stratified (urban versus rural areas) multilevel linear regression models, adjusting for age, sex, partner status, education, employment, neighbourhood deprivation, and address density. The mean BMI of participants was 26.1 (SD 4.3) kg/m. Participants had a mean (SD) age of 44.9 (13.0), 57.3% was female, and 67.0% lived in a rural area. Having two or more (urban areas) or five or more (rural areas) fast-food outlets within 1 km was associated with a higher BMI (B = 0.32, 95% confidence interval (CI): 0.03, 0.62; B = 0.23, 95% CI: 0.10, 0.36, respectively). Participants in urban and rural areas with a fast-food outlet within <250 m had a higher BMI (B = 0.30, 95% CI: 0.03, 0.57; B = 0.20, 95% CI: 0.09, 0.31, respectively). In rural areas, participants also had a higher BMI when having at least one fast-food outlet within 500 m (B = 0.10, 95% CI: 0.02, 0.18). In conclusion, fast-food outlet exposure within 1 km from the residential address was associated with BMI in urban and rural areas. Also, fast-food outlet exposure within 500 m was associated with BMI in rural areas, but not in urban areas. In the future, natural experiments should investigate changes in the fast-food environment over time.
不健康的食品环境可能导致身体质量指数（BMI）升高，而 BMI 是慢性病的一个风险因素。我们研究了荷兰成年人群中，居住地快餐销售点的暴露情况（临近程度和密度）与 BMI 之间的关系。此外，我们还研究了城市化水平对这种关联的影响程度。在这项横断面研究中，我们使用地理编码将基线成人生命线队列参与者（n=147027）的居住地址与快餐销售点的位置联系起来。我们计算了居住地址附近 500m、1km、3km 和 5km 范围内的快餐销售点临近程度和密度。我们使用分层（城市与农村地区）多水平线性回归模型，根据年龄、性别、伴侣状况、教育、就业、邻里贫困和地址密度进行调整。参与者的平均 BMI 为 26.1（SD=4.3）kg/m。参与者的平均年龄（SD）为 44.9（13.0）岁，57.3%为女性，67.0%居住在农村地区。在 1km 范围内有两个或更多（城市地区）或五个或更多（农村地区）快餐店与较高的 BMI 相关（B=0.32，95%置信区间（CI）：0.03，0.62；B=0.23，95%CI：0.10，0.36）。在城市和农村地区，距离快餐店小于 250m 处的参与者 BMI 更高（B=0.30，95%CI：0.03，0.57；B=0.20，95%CI：0.09，0.31）。在农村地区，当居住地址 500m 范围内至少有一个快餐店时，参与者的 BMI 也会升高（B=0.10，95%CI：0.02，0.18）。总之，居住地附近 1km 范围内的快餐销售点暴露与城市和农村地区的 BMI 相关。此外，居住地址 500m 范围内的快餐销售点暴露与农村地区的 BMI 相关，但与城市地区无关。未来，自然实验应研究随着时间的推移快餐环境的变化。
