Patterson Richard, Ogilvie David, Hoenink Jody C, Burgoine Thomas, Sharp Stephen J, Hajna Samantha, Panter Jenna
MRC Epidemiology Unit, University of Cambridge, Box 285 Institute of Metabolic Science, CB2 0QQ, Cambridge, UK.
MRC Epidemiology Unit, University of Cambridge, Box 285 Institute of Metabolic Science, CB2 0QQ, Cambridge, UK.
Health Place. 2025 Jan;91:103405. doi: 10.1016/j.healthplace.2024.103405. Epub 2025 Jan 17.
Diet and physical activity are important determinants of energy balance, body weight and chronic health conditions. Peoples' health and behaviour are shaped by their environment. For example, the availability of unhealthy takeaway food in residential neighbourhoods and the ability to easily walk to a range of local destinations (high "walkability") influence diets and physical activity levels. Most existing evidence on the associations between residential neighbourhood and adiposity is cross-sectional and examines either walkability or takeaway availability, but not both in combination.We examined the cross-sectional and longitudinal associations of residential neighbourhood walkability and takeaway food availability with markers of adiposity separately and combined.
With data from the Fenland Study (Cambridgeshire, UK; n = 12,435), we used linear regression to estimate associations for walkability and takeaway availability separately and in mutually adjusted models, in addition to combining both into a measure of neighbourhood supportiveness for active living and healthy eating. Objective measures of BMI were examined cross-sectionally at baseline (2005-2015) and as change between baseline and follow-up (2014-2020). Additional outcomes (percentage body fat, waist circumference and hip circumference) were also examined both cross-sectionally and longitudinally.
Complete case analyses indicated that neighbourhoods with greater walkability and lower takeaway availability were associated with lower BMI (n = 10,607) and more favourable trends over time (n = 5508). For example, compared with the lowest exposure group (Q1), Q4 of walkability and takeaway food availability was associated with a difference in BMI of -0.69 kg/m (95% CI = -1.09 to -0.29) and 0.99 kg/m (95% CI = 0.58 to 1.39) respectively. These associations were more consistent when both neighbourhood measures were included in mutually adjusted models. The combined supportiveness measure was associated with lower BMI. High walkability and low takeaway availability were also associated with lower body fat percentage, waist circumference and hip circumference.
These findings are consistent with the residential environment having a role in shaping people's health and behaviour. Living in an area that supports walking and cycling and affords less access to unhealthy food may support people to maintain a healthy lifestyle. It was important to consider walkability and takeaway food availability together because to examine them separately risks unobserved confounding by the other. Future research could incorporate additional environmental measures, especially those likely to be correlated.
饮食和身体活动是能量平衡、体重及慢性健康状况的重要决定因素。人们的健康和行为受其环境影响。例如，居民区不健康外卖食品的可获得性以及轻松步行至一系列当地目的地的能力（高“步行便利性”）会影响饮食和身体活动水平。关于居民区与肥胖之间关联的现有证据大多是横断面研究，且仅考察了步行便利性或外卖食品的可获得性，而非两者结合。我们分别及综合研究了居民区步行便利性和外卖食品可获得性与肥胖指标之间的横断面和纵向关联。
利用来自芬兰研究（英国剑桥郡；n = 12435）的数据，我们使用线性回归分别估计步行便利性和外卖食品可获得性的关联，并在相互调整模型中进行估计，此外还将两者结合为一个衡量邻里对积极生活和健康饮食支持度的指标。在基线（2005 - 2015年）对体重指数（BMI）的客观测量进行横断面检查，并作为基线与随访（2014 - 2020年）之间的变化进行检查。还对其他结果（体脂百分比、腰围和臀围）进行了横断面和纵向检查。
完整病例分析表明，步行便利性较高且外卖食品可获得性较低的居民区与较低的BMI（n = 10607）及随时间更有利的趋势相关（n = 5508）。例如，与最低暴露组（Q1）相比，步行便利性和外卖食品可获得性的Q4分别与BMI差异为 -0.69 kg/m²（95%CI = -1.09至 -0.29）和0.99 kg/m²（95%CI = 0.58至1.39）相关。当在相互调整模型中纳入这两个邻里指标时，这些关联更为一致。综合支持度指标与较低的BMI相关。高步行便利性和低外卖食品可获得性也与较低的体脂百分比、腰围和臀围相关。
这些发现与居住环境在塑造人们健康和行为方面发挥作用相一致。生活在一个支持步行和骑自行车且获取不健康食品机会较少的地区可能有助于人们保持健康的生活方式。将步行便利性和外卖食品可获得性一起考虑很重要，因为分别考察它们可能会因另一个因素而存在未观察到的混杂因素。未来的研究可以纳入更多环境指标，尤其是那些可能相关的指标。
