College of Health Solutions, Arizona State University, Phoenix, AZ, United States.
College of Health Solutions, Arizona State University, Phoenix, AZ, United States.
J Nutr. 2023 Dec;153(12):3565-3575. doi: 10.1016/j.tjnut.2023.09.027. Epub 2023 Oct 14.
Sound evidence for effective community-based strategies is needed to curtail upward trends in childhood obesity in the United States (US).
The aim of the study was to assess the association between school and community food environments and the prevalence of obesity over time.
Data were collected from K-12 schools in 4 low-income New Jersey cities in the US. School-level obesity prevalence, calculated from nurse-measured heights and weights at 4 time points, was used as the outcome variable. Data on the school food environment (SFE) measured the healthfulness of school lunch and competitive food offerings annually. The community food environment (CFE), i.e., the number of different types of food outlets within 400 m of schools, was also captured annually. The count and presence of food outlets likely to be frequented by students were calculated. Exposure to composite environment profiles both within schools and in communities around schools was assessed using latent class analysis. Data from 106 schools were analyzed using multilevel linear regression.
The prevalence of obesity increased from 25% to 29% over the course of the study. Obesity rates were higher in schools that had nearby access to a greater number of limited-service restaurants and lower in schools with access to small grocery stores and upgraded convenience stores participating in initiatives to improve healthful offerings. Interaction analysis showed that schools that offered unhealthier, competitive foods experienced a faster increase in obesity rates over time. Examining composite food environment exposures, schools with unhealthy SFEs and high-density CFEs experienced a steeper time trend (β = 0.018, P < 0.001) in obesity prevalence compared to schools exposed to healthy SFE and low-density CFEs.
Food environments within and outside of schools are associated with differential obesity trajectories over time and can play an important role in curtailing the rising trends in childhood obesity.
需要有确凿的证据表明基于社区的有效策略可以遏制美国儿童肥胖率的上升趋势。
本研究旨在评估学校和社区食品环境与肥胖流行率随时间的变化关系。
数据来自美国新泽西州 4 个低收入城市的 K-12 学校。采用 4 个时间点护士测量的身高和体重计算学校肥胖率，作为因变量。学校食品环境（SFE）数据每年测量学校午餐和竞争性食品供应的健康程度。社区食品环境（CFE）数据每年捕获学校周围 400 米范围内不同类型食品店的数量。计算出学生可能光顾的食品店数量和存在情况。通过潜在类别分析评估学校内部和学校周围社区的复合环境特征。采用多层线性回归分析 106 所学校的数据。
研究期间肥胖患病率从 25%上升至 29%。附近有较多有限服务餐厅的学校肥胖率较高，而附近有小型杂货店和参与改善健康食品供应计划的便利店的学校肥胖率较低。交互分析显示，提供不健康的竞争性食品的学校肥胖率增长更快。检查复合食品环境暴露情况发现，与暴露于健康 SFE 和低密度 CFE 的学校相比，具有不健康 SFE 和高密 CFE 的学校肥胖患病率的时间趋势更为陡峭（β=0.018，P<0.001）。
学校内外的食品环境与肥胖流行率随时间的变化有关，对遏制儿童肥胖率的上升趋势具有重要作用。
