Global positioning system-based food environment exposures, diet-related, and cardiometabolic health outcomes: a systematic review and research agenda.

BACKGROUND: Geographic access to food may affect dietary choices and health outcomes, but the strength and direction of associations may depend on the operationalization of exposure measures. We aimed to systematically review the literature on up-to-date evidence on the association between food environment exposures based on Global Positioning System (GPS) and diet-related and cardiometabolic health outcomes. METHODS: The databases PubMed, Embase.com, APA PsycInfo (via Ebsco), Cinahl (via Ebsco), the Web of Science Core Collection, Scopus, and the International Bibliography of the Social Sciences (via ProQuest) were searched from inception to October 31, 2022. We included studies that measured the activity space through GPS tracking data to identify exposure to food outlets and assessed associations with either diet-related or cardiometabolic health outcomes. Quality assessment was evaluated using the criteria from a modified version of the Newcastle-Ottawa Scale (NOS) for cross-sectional studies. We additionally used four items from a quality assessment tool to specifically assess the quality of GPS measurements. RESULTS: Of 2949 studies retrieved, 14 studies fulfilled our inclusion criteria. They were heterogeneous and represent inconsistent evidence. Yet, three studies found associations between food outlets and food purchases, for example, more exposure to junk food outlets was associated with higher odds of junk food purchases. Two studies found associations between greater exposure to fast food outlets and higher fast food consumption and out of three studies that investigated food environment in relation to metabolic outcomes, two studies found that higher exposure to an unhealthy food environment was associated with higher odds of being overweight. CONCLUSIONS: The current and limited evidence base does not provide strong evidence for consistent associations of GPS-based exposures of the food environment with diet-related and cardiometabolic health outcomes.

The interaction between the community food environment and cooking skills in association with diet-related outcomes in Dutch adults.

OBJECTIVE: We examined whether associations between the food environment, frequency of home cooking, diet quality and BMI were modified by the level of cooking skills. DESIGN: Cross-sectional study using linear and modified Poisson regression models adjusted for age, sex, energy intake, education, income, household size and urbanisation. The frequency of home cooking was categorised into <6 and 6-7 d. Diet quality was based on a validated Dutch healthy diet index (0-150 points). Count of restaurants and food stores were determined by their count in a 1000m buffer around home and work. Cooking skills (score 1-5) were assessed using a validated questionnaire and added as interaction term. SETTING: The Netherlands. PARTICIPANTS: 1461 adults aged 18-65 years. RESULTS: Count of restaurants and food stores were not associated with the frequency of home cooking. A 10-unit higher count of food stores was associated with a higher diet quality (ß: 0·58 (95 % CI (0·04, 1·12)), and a 10-unit higher count of restaurants was associated with a lower BMI kg/m2 (ß: -0·02 (95 % CI (-0·04, -0·004)). Better cooking skills were associated with a higher likelihood of cooking 6-7 d compared with <6 d (risk ratio: 1·24 (95 % CI (1·16, 1·31)) and a higher diet quality (ß: 4·45 (95 % CI (3·27, 5·63)) but not with BMI. We observed no interaction between the food environment and cooking skills (P-for-interaction > 0·1). CONCLUSIONS: Exposure to food stores was associated with a higher diet quality and exposure to restaurants with a lower BMI. Better cooking skills were associated with a higher frequency of home cooking and better diet quality but did not modify associations with the food environment. Future studies should explore different approaches to understand how individuals interact with their food environment.

Environmental risk factors of type 2 diabetes-an exposome approach.

Type 2 diabetes is one of the major chronic diseases accounting for a substantial proportion of disease burden in Western countries. The majority of the burden of type 2 diabetes is attributed to environmental risks and modifiable risk factors such as lifestyle. The environment we live in, and changes to it, can thus contribute substantially to the prevention of type 2 diabetes at a population level. The 'exposome' represents the (measurable) totality of environmental, i.e. nongenetic, drivers of health and disease. The external exposome comprises aspects of the built environment, the social environment, the physico-chemical environment and the lifestyle/food environment. The internal exposome comprises measurements at the epigenetic, transcript, proteome, microbiome or metabolome level to study either the exposures directly, the imprints these exposures leave in the biological system, the potential of the body to combat environmental insults and/or the biology itself. In this review, we describe the evidence for environmental risk factors of type 2 diabetes, focusing on both the general external exposome and imprints of this on the internal exposome. Studies provided established associations of air pollution, residential noise and area-level socioeconomic deprivation with an increased risk of type 2 diabetes, while neighbourhood walkability and green space are consistently associated with a reduced risk of type 2 diabetes. There is little or inconsistent evidence on the contribution of the food environment, other aspects of the social environment and outdoor temperature. These environmental factors are thought to affect type 2 diabetes risk mainly through mechanisms incorporating lifestyle factors such as physical activity or diet, the microbiome, inflammation or chronic stress. To further assess causality of these associations, future studies should focus on investigating the longitudinal effects of our environment (and changes to it) in relation to type 2 diabetes risk and whether these associations are explained by these proposed mechanisms.

The longitudinal association between chronic stress and (visceral) obesity over seven years in the general population: The Hoorn Studies.

BACKGROUND: We aimed to study the mediating role of diet quality, physical activity, smoking, and alcohol intake in the association of stressful life events with visceral obesity over a seven-year period and assessed effect modification by sex and SES. METHODS: In total, 2416 participants with a mean age of 56.1 (±7.3) years, of which 51.4% were women, and 12.5% had a lower educational level from the Hoorn studies were followed for seven years. Stress was measured with a 'Serious Life Events' questionnaire, which was summed into a total score (range zero to ten events) and stratified to account for nonlinearity. Changes in visceral obesity were assessed by changes in BMI (kg/m2) and waist circumference (cm) in seven years. We used the product of coefficient approach to assess mediation of the following lifestyle factors: diet, physical activity, smoking, and alcohol intake. We analyzed associations between stressful life events and change in BMI and waist circumference with linear regression models. RESULTS: Within the low education group, we observed a significant association between ≥3 stressful life events and a change in BMI (0.60 kg/m2 (CI: 0.05, 1.14)) and waist circumference (2.23 cm (CI: 0.19, 4.48)), compared to experiencing no events. For both BMI and waist circumference, no significant associations were observed when experiencing 1 or 2 events. In the moderate to high education group, we observed only statistically significant associations for waist circumference when experiencing ≥3 stressful life events (0.86 cm (CI: 0.05, 1.41)) and not for the other event groups. Our mediation analyses showed that the proportion mediated by smoking was 13.2%, while the other lifestyle factors showed no mediating effect. CONCLUSIONS: Multiple stressful life events are associated with an increase in waist circumference and BMI in those with lower education. Smoking might play a mediating role in this association.

Diet quality and cardiometabolic health in childhood: the Generation R Study.

PURPOSE: Diet is an important determinant of cardiometabolic disease risk in adults. We aimed to study associations of diet quality with cardiometabolic health in school-age children. METHODS: This study was embedded in the Generation R Study a prospective population-based cohort in Rotterdam, the Netherlands and included 3991 children. Food intake was assessed with a Food-Frequency Questionnaire at age 8 years. A diet quality score (0-10) was calculated reflecting adherence to age-specific dietary guidelines. The following outcome variables were measured at age 10 years and used to create a continuous cardiometabolic risk factor score: body fat percentage, insulin, triglycerides, HDL cholesterol, and systolic and diastolic blood pressure. Outcomes were expressed in age- and sex-specific standard deviation scores (SDS). Multivariable linear regression models were used to assess associations between the diet quality score and the cardiometabolic risk factor score and with the individual cardiometabolic risk factors. RESULTS: In models adjusted for socioeconomic and lifestyle factors and BMI, a higher diet quality was associated with a lower cardiometabolic risk factor score [- 0.08 per point higher diet score, (95% CI - 0.15, - 0.001)]. This association was mainly driven by associations of higher diet quality with lower systolic [- 0.04 SD (95% CI - 0.06, - 0.01)] and diastolic blood pressure [- 0.05 SD, (95% CI - 0.07, - 0.02)]. No statistically significant associations were found for insulin, triglycerides, HDL cholesterol, or body fat percentage as individual factors. CONCLUSIONS: We found an association between higher diet quality and better cardiometabolic health in childhood, mainly driven by a lower blood pressure. Further research is needed to explore associations of diet quality in childhood with long-term cardiometabolic health.