Does Adherence to Mediterranean Diet Mediate the Association Between Food Environment and Obesity Among Non-Hispanic Black and White Older US Adults? A Path Analysis

Abstract

Purpose: This study aims to test the hypothesis that in addition to a direct effect of food environment on obesity, food environment is indirectly associated with obesity through consuming Mediterranean diet (MD). Design: Cross-sectional secondary data analysis. Setting: Nationwide community-dwelling residency. Sample: A total of 20 897 non-Hispanic black and white adults aged ≥45 years who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment during January 2003 and October 2007. Measures: The Modified Retail Food Environment Index (mRFEI; 0-100) was used as food environment indicator. The MD score (0-9) was calculated to indicate the dietary pattern adherence. Body mass index (BMI; kg/m2) was used to estimate obesity. Analysis: Path analysis was used to quantify the pathways between food environment, MD adherence, and obesity. Proper data transformation was made using Box–Cox power transformation to meet certain analysis assumptions. Results: The participants were from 49 states of the United States, with the majority (64.42%) residing in the South. Most of the participants were retired, female, white, married, having less than college graduate education, having annual household income ≤75 000, and having health insurance. The means of mRFEI was 10.92 (standard deviation [SD] = 10.19), MD score was 4.36 (SD = 1.70), and the BMI was 28.96 kg/m2 (SD = 5.90). Access to healthy food outlets (β = .04, P < .0001) and MD adherence (β = .08, P < .0001) had significant and inverse relationships with BMI, respectively. Mediterranean diet adherence mediated the relationship between food environment and obesity among a subpopulation who had an annual household income of <$75 000 (β = −.02, P = .0391). Conclusion: Population-tailored interventions/policies to modify food environment and promote MD consumption are needed in order to combat the obesity crisis in the United States.

Adherence to the Mediterranean Diet in a Portuguese Immigrant Community in the Central Valley of California

“…Even though MedDiet adherence has previously been assessed in populations living throughout the world [2], including elderly Portuguese [26] and the United States [27][28][29][30][31], few studies have examined MedDiet adherence in communities with immigrants from countries in which the MedDiet is a settled cultural heritage. The current study aimed to assess MedDiet adherence and its associated factors in a Portuguese immigrant community in the Central Valley of California, USA.…”

Food Environments and Hepatocellular Carcinoma Incidence

“…The usage of more granular data, such as census tracts, would increase exposure variability compared to county-level analyses of mRFEI scores [67]. Although the mRFEI score is an established measure for the food environment [23,48,68], there may be potential exposure misclassification, as there was no information on the specific food options provided at each food retailer. Furthermore, the binary grouping of establishments into healthy vs. unhealthy may not accurately represent the food environment.…”

There Is No Magic Pill to Prevent Frailty—You Still Have to Eat Your Vegetables

“…The Mediterranean diet encourages high consumption of plant-based foods, including fruits, vegetables, olive oil, whole grains, and nuts. Chen et al surveyed more than 20 000 people in 49 states in the US older than 45 years and found that less than half reported high adherence to the Mediterranean diet, and on average, people scored 4.36 of 9 on Mediterranean diet adherence. Having a lower household income was associated with lower adherence to the Mediterranean diet.…”