Disparities in access to healthy and unhealthy foods in central Massachusetts: implications for public health policy.

OBJECTIVES: To analyze geographic and income disparities in access to healthy foods in central Massachusetts. METHODS: We surveyed 106 (92% of all) food stores longitudinally in the study area between 2007 and 2010. We analyzed the geographic and temporal variations in community- and store-level healthy food availability indices (HFAI) and unhealthy food availability indices (UFAI) overall and by select store and community characteristics. RESULTS: Twenty-seven of 68 communities in the study area (39.7%) had no food store and 5 (8.3%) had one or few stores with very limited availability of healthy foods, affecting 23.7% of the county population. Lack of food stores was associated strongly with lower housing density and upper tertile of median household income. About 45% of the surveyed stores had inadequate availabilities of healthy food. Store-level HFAI and UFAI scores were highly correlated, and higher among larger stores affiliated with a chain (vs independent). Though healthy foods were usually most available in larger stores, unhealthy foods were widely available in all stores. CONCLUSIONS: Over half of central Massachusetts communities, mostly rural and small, had either no food store or few stores with limited availabilities of healthy foods. Immediate policy interventions on the food environment are necessary in these communities. Further, without examining what is actually sold in stores, analysis of disparities in access to healthy food relies on the number of food stores, which can lead to a distorted picture of accessibility and mislead community health policies.

Access to healthy food stores modifies effect of a dietary intervention.

BACKGROUND: Recent evidence suggests that opening a grocery store in a food desert does not translate to better diet quality among community residents. PURPOSE: This study evaluated the influence of proximity to a healthy food store on the effect of a dietary behavioral intervention on diet among obese adults randomized to either a high fiber or American Heart Association diet intervention. METHODS: Participants were recruited from Worcester County, Massachusetts, between June 2009 and January 2012. Dietary data were collected via 24-hour recalls at baseline and 3, 6, and 12 months post-intervention. Based on in-store inspection data, a store was considered as having adequate availability of healthy foods if it had at least one item available in each of 20 healthy food categories. Linear models evaluated maximum change in dietary outcomes in relation to road distance from residence to the nearest June healthy food store. The analysis was conducted in January to June 2014. RESULTS: On average, participants (N=204) were aged 52 years, BMI=34.9, and included 72% women and 89% non-Hispanic whites. Shorter distance to a healthy food store was associated with greater improvements in consumption of fiber (b=-1.07 g/day per mile, p<0.01) and fruits and vegetables (b=-0.19 servings/day per mile, p=0.03) with and without covariate adjustment. CONCLUSIONS: The effectiveness of dietary interventions is significantly influenced by the presence of a supportive community nutrition environment. Considering the nationwide efforts on promotion of healthy eating, the value of improving community access to healthy foods should not be underestimated. CLINICAL TRIAL REGISTRATION NUMBER: NCT00911885.

Racial/ethnic disparities in association between dietary quality and incident diabetes in postmenopausal women in the United States: the Women's Health Initiative 1993-2005.

OBJECTIVE: To examine the association of dietary quality and risk of incident diabetes overall and by race/ethnicity among postmenopausal women enrolled in the Women's Health Initiative (WHI). RESEARCH METHODS AND PROCEDURES: The WHI recruited 161,808 postmenopausal women between 1993 and 1998, and followed them until 2005. Incident diabetes was determined annually over an average of 7.6 years from enrollment. At baseline, all participants completed a Food Frequency Questionnaire (FFQ). Dietary quality was assessed by the Alternate Healthy Eating Index (AHEI), calculated from the baseline FFQ responses. RESULTS: There were 10,307 incident cases of self-reported treated diabetes over 1,172,761 person-years of follow-up. Most participants did not meet the AHEI dietary goals; that is, only 0.1% of women met or exceeded the recommended consumption of vegetables, and few (17.3%) met or exceeded the recommended level for total fiber. After adjusting for potential confounders, women in the highest quintile of the AHEI score were 24% less likely to develop diabetes relative to women in the lowest quintile of AHEI [hazard ratio (HR)=0.76 (95% CI: 0.70-0.82)]. This association was observed in Whites [HR=0.74 (95% CI: 0.68-0.82)] and Hispanics [HR=0.68 (95% CI: 0.46-0.99)], but not in Blacks [HR=0.85 (95% CI: 0.69-1.05)] or Asians [HR=0.88 (95% CI: 0.57-1.38)]. CONCLUSION: These findings support a protective role of healthful eating choices in reducing the risk of developing diabetes, after adjusting for other lifestyle factors, in White and Hispanic postmenopausal women. Future studies are needed to investigate the relationship between dietary quality and risk of diabetes among Blacks and Asians in relationship to other lifestyle factors.

Number of 24-hour diet recalls needed to estimate energy intake.

PURPOSE: Twenty-four-hour diet recall interviews (24HRs) are used to assess diet and to validate other diet assessment instruments. Therefore it is important to know how many 24HRs are required to describe an individual's intake. METHOD: Seventy-nine middle-aged white women completed seven 24HRs over a 14-day period, during which energy expenditure (EE) was determined by the doubly labeled water method (DLW). Mean daily intakes were compared to DLW-derived EE using paired t tests. Linear mixed models were used to evaluate the effect of call sequence and day of the week on 24HR-derived energy intake while adjusting for education, relative body weight, social desirability, and an interaction between call sequence and social desirability. RESULTS: Mean EE from DLW was 2115 kcal/day. Adjusted 24HR-derived energy intake was lowest at call 1 (1501 kcal/day); significantly higher energy intake was observed at calls 2 and 3 (2246 and 2315 kcal/day, respectively). Energy intake on Friday was significantly lower than on Sunday. Averaging energy intake from the first two calls better approximated true energy expenditure than did the first call, and averaging the first three calls further improved the estimate (p=0.02 for both comparisons). Additional calls did not improve estimation. CONCLUSIONS: Energy intake is underreported on the first 24HR. Three 24HRs appear optimal for estimating energy intake.