Pineda Elisa, Barbosa Cunha Diana, Taghavi Azar Sharabiani Mansour, Millett Christopher
Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, South Kensington Campus, London, United Kingdom.
Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom.
PLOS Glob Public Health. 2023 Feb 23;3(2):e0001069. doi: 10.1371/journal.pgph.0001069. eCollection 2023.
The retail food environment is a key modifiable driver of food choice and the risk of non-communicable diseases (NCDs). This study aimed to assess the relationship between the density of food retailers, body mass index (BMI), dietary patterns, and socioeconomic position in Mexico. Cross-sectional dietary data, BMI and socioeconomic characteristics of adult participants came from the nationally representative 2012 National Health and Nutrition Survey in Mexico. Geographical and food outlet data were obtained from official statistics. Densities of food outlets per census tract area (CTA) were calculated. Dietary patterns were determined using exploratory factor analysis and principal component analysis. The association of food environment variables, socioeconomic position, BMI, and dietary patterns was assessed using two-level multilevel linear regression models. Three dietary patterns were identified-the healthy, the unhealthy and the carbohydrates-and-drinks dietary pattern. Lower availability of fruit and vegetable stores was associated with an unhealthier dietary pattern whilst a higher restaurant density was associated with a carbohydrates-and-drinks pattern. A graded and inverse association was observed for fruit and vegetable store density and socioeconomic position (SEP)-lower-income populations had a reduced availability of fruit and vegetable stores, compared with higher-income populations. A higher density of convenience stores was associated with a higher BMI when adjusting for unhealthy dietary patterns. Upper-income households were more likely to consume healthy dietary patterns and middle-upper-income households were less likely to consume unhealthy dietary patterns when exposed to high densities of fruit and vegetable stores. When exposed to a high concentration of convenience stores, lower and upper-lower-income households were more likely to consume unhealthy dietary patterns. Food environment and sociodemographic conditions within neighbourhoods may affect dietary behaviours. Food environment interventions and policies which improve access to healthy foods and restrict access to unhealthy foods may facilitate healthier diets and contribute to the prevention of NCDs.
零售食品环境是食物选择和非传染性疾病（NCDs）风险的一个关键可改变驱动因素。本研究旨在评估墨西哥食品零售商密度、体重指数（BMI）、饮食模式和社会经济地位之间的关系。成年参与者的横断面饮食数据、BMI和社会经济特征来自具有全国代表性的2012年墨西哥全国健康与营养调查。地理和食品销售点数据来自官方统计。计算了每个普查区（CTA）的食品销售点密度。使用探索性因素分析和主成分分析确定饮食模式。使用二级多水平线性回归模型评估食品环境变量、社会经济地位、BMI和饮食模式之间的关联。确定了三种饮食模式——健康模式、不健康模式和碳水化合物与饮料饮食模式。果蔬店供应较少与不健康的饮食模式相关，而餐厅密度较高与碳水化合物与饮料模式相关。观察到果蔬店密度与社会经济地位（SEP）之间存在分级的反向关联——与高收入人群相比，低收入人群的果蔬店供应较少。在调整不健康饮食模式后，便利店密度较高与较高的BMI相关。当接触到高密度的果蔬店时，高收入家庭更有可能采用健康的饮食模式，中高收入家庭采用不健康饮食模式的可能性较小。当接触到高浓度的便利店时，低收入和中低收入家庭更有可能采用不健康的饮食模式。社区内的食品环境和社会人口状况可能会影响饮食行为。改善健康食品获取渠道并限制不健康食品获取渠道的食品环境干预措施和政策可能有助于促进更健康的饮食，并有助于预防非传染性疾病。
