Introduction There is growing interest in the role of food environments in suboptimal diet and overweight and obesity. This review assesses the evidence for the link between the retail food environment, diet quality and body mass index (BMI) in the Canadian population. Methods We conducted a systematic keyword search in two bibliometric databases. We tabulated proportions of conclusive associations for each outcome and exposure of interest. Absolute and relative measures of exposure to the food environment were compared and theoretical framing of the associations noted. We assessed two key methodological issues identified a priori—measurement of BMI, and validation of the underlying retail food environment data. Results Seventeen studies were included in the review. There was little evidence of a food environment–diet quality relationship and modest evidence of a food environment–BMI relationship. Relative measures of the food environment were more often associated with an outcome in the expected direction than absolute measures, but many results were inconclusive. Most studies adopted ecological theoretical frameworks but methodologies were similar regardless of stated theoretical approaches. Self-reported BMI was common and there was no “gold standard” database of food outlets nor a consensus on best ways to validate the data. Conclusion There was limited evidence of a relationship between the food environment and diet quality, but stronger evidence of a relationship between the food environment and BMI for Canadians. Studies with broad geographic scope that adopt innovative methods to measure diet and health outcomes and use relative measures of the food environment derived in geographic information systems are warranted. Consensus on a gold standard food environment database and approaches to its validation would also advance the field.
Introduction On s’intéresse de plus en plus au rôle de l’environnement alimentaire dans l’alimentation sous-optimale, le surpoids et l’obésité. Cette revue analyse les données probantes sur le lien entre l’environnement de la vente alimentaire au détail, la qualité de l’alimentation et l’indice de masse corporelle (IMC) au sein de la population canadienne. Méthodologie Nous avons réalisé une recherche systématique par mot-clé dans deux bases de données bibliométriques. Nous avons calculé les proportions d’associations concluantes pour chaque résultat et exposition d’intérêt. Nous avons comparé les mesures absolues et relatives de l’exposition à l’environnement alimentaire et consigné le cadre théorique des associations. Nous avons examiné deux enjeux méthodologiques importants relevés a priori : la mesure de l’IMC et la validation des données sous-jacentes sur l’environnement de la vente alimentaire au détail. Résultats Dix-sept études ont été incluses dans cette revue. Nous avons relevé peu de preuves d’un lien entre l’environnement alimentaire et la qualité de l’alimentation, mais quelques preuves d’un lien entre l’environnement alimentaire et l’IMC. Les mesures relatives de l’environnement alimentaire étaient plus souvent associées à un résultat attendu que les mesures absolues, mais de nombreux résultats n’étaient pas concluants. La plupart des études ont adopté des cadres théoriques globaux, les méthodologies demeurant néanmoins semblables quelles que soient les approches théoriques choisies. L’IMC autodéclaré était une mesure courante et nous n’avons repéré ni base de données « de référence » sur les points de vente d’aliments ni consensus sur les meilleures façons de valider les données. Conclusion Si peu de données probantes étayaient un lien entre l’environnement alimentaire et la qualité de l’alimentation, les preuves d’un lien entre l’environnement alimentaire et l’IMC dans la population canadienne se sont révélées plus solides. Il faudrait disposer d’études à grande portée géographique faisant appel à de nouvelles méthodes pour mesurer les résultats en matière d’alimentation et de santé et recourir à des mesures relatives de l’environnement alimentaire dérivées des systèmes d’information géographique. Il serait également utile d’établir un consensus sur ce qu’est une base de données de référence sur l’environnement alimentaire et sur la méthodologie associée à sa validation.
ObjectivesHypertension is a leading cause of cardiovascular disease and premature death. Neighbourhoods characterized by a high proportion of fast-food outlets may contribute to hypertension in residents; however, limited research has explored these associations. The objectives of this study were to assess associations between neighbourhood fast-food environments, measured and self-reported hypertension. ApproachWe used data from 10,700 adults who participated in six cycles of the Canadian Health Measures Survey (CHMS). Measured hypertension was defined as having an average systolic blood pressure (BP) of ≥140, a diastolic BP ≥90 mm Hg or being on BP lowering medication. Participants were also asked if they had been diagnosed with high BP or if they take BP lowering medication (i.e., self-reported hypertension). We characterized the fast-food environment of each participant’s neighbourhood using the Canadian Food Environment Dataset (Can-FED). We considered the proportion of fast-food outlets relative to fast-food outlets and full-service restaurants as a continuous variable. ResultsThe mean proportion of fast-food outlets was 23.3% (SD 26.8%). A one standard deviation (SD) increase in the proportion to fast-food outlets was associated with higher odds of measured hypertension in the full sample (OR=1.17, 95% CI 1.05 to 1.31) and in sex-specific models (women: OR=1.14, 95% CI 1.01 to 1.29; and men: OR=1.21, 95% CI 1.03 to 1.43). A one standard deviation (SD) increase in the proportion to fast-food outlets was associated with higher odds of self-reported hypertension in the full sample (OR=1.13, 95% CI 1.02 to 1.24); however, associations were inconclusive in sex-specific models (women: OR=1.11, 95% CI 0.99 to 1.26; and men: OR=1.14, 95% CI 0.99 to 1.33). ConclusionBy linking neighbourhood food environment measures that were created from an administrative data source (the Statistics Canada Business Register) to individual-level data from the CHMS, we were able to demonstrate that reducing the proportion of fast-food outlets in neighbourhoods may reduce rates of hypertension and support individually targeted interventions.
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